Federal Register / Vol. 65, No. 24 / Friday, February 4, 2000 / Notices 5647

Form Number of

respondents

Responses

per

respondent

Hours per

response

Total hour

burden

Hospital Facility Data Abstract ......................................................................... 150 1 1 150

Send comments to Susan G. Queen,

Ph.D., HRSA Reports Clearance Officer,

Room 14–33, Parklawn Building, 5600

Fishers Lane, Rockville, MD 20857.

Written comments should be received

within 60 days of this notice.

Dated: January 28, 2000.

Jane Harrison,

Director, Division of Policy Review and

Coordination.

[FR Doc. 00–2433 Filed 2–3–00; 8:45 am]

BILLING CODE 4160–15–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Resources and Services

Administration

Availability of Funds for Grants for the

Community Access Program

AGENCY: Health Resources and Services

Administration, HHS.

ACTION: Notice of availability of funds.

SUMMARY: The Health Resources and

Services Administration (HRSA)

announces the availability of $25

million to assist communities and their

safety net providers in developing

integrated health care delivery systems

that serve the uninsured and

underinsured with greater efficiency

and improved quality of care. The $25

million in available funding has been

appropriated under the FY 2000 HHS

Appropriations Act.

In FY 2000, HRSA will provide

funding for approximately 20

communities to further their

development of integrated delivery

systems for the uninsured and

underinsured. Grants will vary in size,

based on the scope of the project and

the size of the service area.

During the first year of funding for

this program, HRSA will support

infrastructure development in

communities that have already begun to

reorganize and integrate their health

care delivery systems. FY 2000 funding

is not intended to support those

communities that have not yet begun

the planning and development of

necessary organizational structure.

Up to 100 communities may

ultimately be funded as part of this

national program targeted by the

Administration to spend $1 billion over

five years. FY 2000 funded communities

may be eligible for available FY 2001

funding (assuming continued

appropriations) to support further

infrastructure development and filling

service gaps. In addition, using the

experiences of the FY 2000 funded

communities as potential models for

adaptation, FY 2001 funding is

anticipated for support of new

communities for planning and system

development. Thus, communities that

have not yet begun the planning and

development of necessary

organizational structure should have an

opportunity to apply in FY 2001.

Over the years that the program is

funded, funds are anticipated to be

available to fill service gaps within

coordinated systems of care.

This program shares some of the same

goals of the W.K. Kellogg Foundation’s

Community Voices Program and the

Robert Wood Johnson Foundation’s

Communities in Charge Program. Thus,

CAP will take into account the

experiences of these foundations as well

as other programs that promote the

integration of services to the uninsured

and underinsured.

DATES: The timeline for application

submission, review, and award are as

follows:

February 10, 2000: Application kits

and additional guidance will be

available through the HRSA Grants

Application Center (GAC).

March 7–16, 2000: There will be a

series of six pre-application workshops

conducted across the country: Boston,

MA—March 7, 2000; Atlanta, GA—

March 8, 2000; Chicago, IL—March 9,

2000; Dallas, TX—March 14, 2000; Los

Angeles, CA—March 15, 2000; Seattle,

WA March 16, 2000.

June 1, 2000: Applications due.

July 3–17, 2000: Applications

reviewed.

August 2000: Site visits to selected

applicants.

September 2000: Grant awards

announced.

ADDRESSES: To receive a complete

application kit (i.e., application

instructions, necessary forms, and

application review criteria), contact the

HRSA GAC at: HRSA GAC, 1815 N. Fort

Meyer Drive, Suite 300, Arlington, VA

22209, Phone: 1–877-HRSA–123, Fax:

1–877-HRSA–345, E-Mail:

hrsagac@hrsa.gov

FOR FURTHER INFORMATION CONTACT: For

further information, contact the

Community Access Program Office:

Community Access Program Office,

Health Resources and Services

Administration, Parklawn Building,

Suite 9A–30, 5600 Fishers Lane,

Rockville, MD 20857, Phone: (301) 443–

0536, Fax: (301) 443–0248.

SUPPLEMENTARY INFORMATION: In 1998,

44.5 million people in the United States

did not have health insurance. Of these,

24.6 million were employed—18.7

million worked full time and 5.9 million

worked part time.

The uninsured and underinsured

often have complex medical needs,

remain outside organized systems of

care, and have insufficient resources to

obtain care. They may defer care or not

receive needed services, and they are

about half as likely to receive a routine

check-up as insured adults. The

uninsured and underinsured also rely

heavily on expensive emergency rooms,

and because they lack a routine source

of care, they often do not receive needed

follow-up services.

Many of the uninsured and

underinsured rely on the nation’s

institutions, systems, and individual

health professionals that provide a

significant volume of health care

services without regard for ability to

pay. In many communities, these

providers are struggling to care for the

increasing numbers of uninsured and

underinsured individuals. They face

many challenges such as an uneven

distribution of the burden of

uncompensated care, the fragmentation

of services for the uninsured,

insufficient numbers of certain types of

providers, reduced Medicaid revenues,

and a growing need for mental health

and substance abuse services.

While integration among these

providers is critical to serve the

uninsured and underinsured with

greater efficiency and to improve quality

of care, many of these providers are so

pressured by basic caregiving tasks, that

they need assistance to coordinate their

efforts with other providers and to

develop integrated community-based

systems of care.

The Community Access Program

Program Purpose

The purpose of this program is to

assist communities and consortia of

5648 Federal Register / Vol. 65, No. 24 / Friday, February 4, 2000 / Notices

health care providers to develop the

infrastructure necessary to fully develop

or strengthen integrated health systems

of care that coordinate health services

for the uninsured and underinsured.

Program Goal

The coordination of services through

the CAP grant will allow the uninsured

and underinsured to receive efficient

and higher quality care and gain entry

into a comprehensive system of care.

The system will be characterized by

effective collaboration, information

sharing, and clinical and financial

coordination among all levels of care in

the community network. The system

will be committed to continuous

performance improvement,

implementation of best practices, staff

development, and real-time feedback of

outcomes of care. Care management

(e.g., case, disease) will be applied

across the continuum for those with

chronic illnesses, high-risk individuals,

and high utilizers. The system will also

strive to provide universal access to the

target population, and to improve the

health status of the community

population.

This vision requires a re-thinking of

the relationships, priorities, and desired

outcomes for local or regional care

delivery. It means adopting the

philosophy that care for the ill and

injured occurs within the context of a

comprehensive system design of

population health improvement.

The community being served should

be actively involved in the system

design. Broad understanding, two-way

learning between providers and

community, and participation in

priority setting and governance by the

community are essential components of

this vision. This will reduce out

migration for services in rural areas and

assure sustainability of the system.

Program Description

In implementing a system of

coordinated care for the uninsured and

underinsured in a community, we are

seeking to fund a variety of program

models in communities that have an

established track record for building

partnerships and that have completed

the basic planning necessary to

implement a system. The successful

applicant will design a program that

builds upon its current capacities and

strengths; brings the major players in

the political and health delivery systems

to the table; uses the federal funds

available to plan a transition to an

expanded and innovative approach that

will ultimately be competitive within its

own market; and, in any event, will

sustain the delivery of services and

funding after these federal grants no

longer exist. The successful applicant

will work with its county board, city

council, state legislature, and state

health programs to assure the

coordination and efficient use of all

available resources to achieve program

goals.

There is no one successful model that

we are trying to replicate. Rather, there

are several models that already exist and

that each community may draw from in

creating a program to address its own

needs.

In surveying innovative community

approaches to the provision of safety net

services, we have come across

communities that have:

• combined the development of

managed care networks for the indigent

funded through local tax increases and

the redirection of funds towards the care

network and away from the support of

tertiary care at public hospitals;

• Redistributed caseload to private

providers because of the forced closure

of public hospitals;

• Coordinated the provision of care

through public hospitals, public health

departments, and community health

centers;

• Linked hospital and clinic services

through state of the art data systems and

are able to create seamless transitions

between Medicaid, uninsured, and

insured status for low income

populations;

• Linked behavioral and acute care

service provision; and

• Created networks to allocate

uncompensated ambulatory care loads

among physicians.

We are looking for applicants with

clear goals, an operational plan for

meeting those goals, a history of

commitment to serving indigent

populations, and enough of a track

record to indicate a fair chance at being

successful. Innovative proposals for

sustaining the service delivery

component of projects could include

state redirection of DSH funds or

general assistance funds, creative use of

local or state taxing authorities, use of

tobacco settlement funds, and creative

partnerships with the provider and

business communities. Applications

will be judged from the perspective of

whether the financing proposed is

realistic—given state and community

resources—and appropriate to the

project proposed.

Funded Projects Will Contain Several

Common Elements

Community Need: Communities

funded through this program will have

high or increasing rates of uninsured

and underinsured and will have

identified specific organizational needs

within existing delivery systems. A

‘‘community’’ for the purpose of this

program may be based on geography or

a population group (e.g., the homeless)

as defined by the people in the

community.

Collaboration Among Safety Net

Providers: The proposed system should

build upon current investments in

communities for serving these

populations and include the safety net

providers who have traditionally

provided services without regard to the

ability to pay. The coalition should be

built upon formal arrangements among

the partners that define the extent of the

commitment and involvement in policy

development and decision-making from

each partner.

Comprehensive Services: The

proposed system will include all

partners necessary to assure access to a

full range of services, including mental

health and substance abuse treatment. It

is anticipated that the health services

(prevention, primary, and specialty)

provided by Federally-supported

programs that are present in the

community will be part of this coalition

of providers.

Coordination with Public Insurance

Programs: The proposed system will

demonstrate coordination with state

(e.g., memorandum of agreements)

programs to ensure that eligible

beneficiaries are enrolled in public

insurance programs (e.g., S–CHIP,

Medicaid).

Community Involvement: There is

strong community support for these

efforts that provide a broad foundation

of assistance to the provider community

undertaking this project. Management

and governance structures are in place

that assure accountability to funders

and define the community role in

setting policy. The community

involvement in the development,

implementation, and governance of the

project will be evident. This should

include the leadership within the

appropriate legislative and executive

bodies, providers identified above,

health plans and payers, and

community leaders.

Sustainability: A plan for long-term

sustainability is designed and has

community consensus. There is

evidence that the program is capable of

leveraging other sources of funds and

integrating current funding sources in a

way to assure long-term sustainability of

the project.

Eligible Applicants

To encourage the development of

various types of system integration

models, this program seeks a variety of

Federal Register / Vol. 65, No. 24 / Friday, February 4, 2000 / Notices 5649

applicants representing all types of

communities. Applicants who receive

funding may be large health care

systems or small organizations.

Applications are encouraged from large

urban areas, small rural communities,

and tribal organizations.

Applications may be submitted by

public, private, and non-profit entities

that demonstrate a commitment to and

experience with providing a continuum

of care to uninsured individuals. Each

applicant must represent a communitywide coalition that is committed to the

project and includes safety net

providers (where they exist) who have

traditionally provided care to the

community’s uninsured and

underinsured regardless of ability to

pay. The community-wide coalition

must consist of partners from all levels

of care (i.e., primary, secondary,

tertiary) and partners who represent a

range of services (e.g., mental health and

substance abuse treatment, maternal and

child health care, oral health, HIV/

AIDS).

Examples of eligible applicants who

may apply on behalf of the communitywide coalition include but are not

limited to:

• A consortium or network of

providers (e.g., public and charitable

hospitals; community, migrant,

homeless, public housing, and schoolbased health centers; rural health

clinics; free health clinics; teaching

hospitals and health professions

education schools)

• Local government agencies (e.g.,

local public health departments with

service delivery components)

• Tribal governments

• Managed care plans or other payers

(e.g., HMOs, insurance companies)

Agencies of State governments, multistate health systems, or special interest

groups may submit applications on

behalf of multiple communities if they

demonstrate the ability to coordinate

community health care delivery systems

and bring resources to the community.

Competing applications for the same

patient population will not be

considered for funding; therefore,

applicants from the same community

are required to collaborate.

Funding Criteria

• Review criteria that will be used to

evaluate applications include:

• Evidence of progress towards

integration prior to application for

funding

• Evidence that the target population

has a high or increasing rate of

uninsurance

• Evidence of established

partnerships among a broad-based

community consortium

• Appropriateness and quality of

clinical services to be provided

• Commitments from local

government agencies, public and private

health care providers, community

leaders

• Demonstration of existing and

sustainable public and private funding

sources

• Accountable management and

budget plan

• Commitment to self evaluation and

participation in a national evaluation

Program Expectations

Funding through this initiative may

be used to support a variety of projects

that would improve access to all levels

of care for the uninsured and

underinsured. While each community

should design a program that best

addresses the needs of the uninsured

and underinsured, and the providers in

their community, funding is intended to

encourage safety net providers to

develop coordinated care systems for

the community’s uninsured and

underinsured.

Examples of activities that could be

supported with this funding include:

• Offering a comprehensive delivery

system for the uninsured and

underinsured through a network of

safety net providers. [Single registration,

eligibility systems]

• Integrating preventive, mental

health, substance abuse, HIV/AIDS, and

maternal and child health services

within the system. [Block grant funded

services, other DHHS programs, state

and local programs]

• Developing a shared information

system among the community’s safety

net providers. [Tracking, case

management, medical records, financial

records]

• Developing and incorporating

shared clinical protocols, quality

improvement systems, utilization

management systems, and error

prevention systems.

• Sharing core management

functions. [Finance, purchasing,

appointment systems]

• Coordinating and strengthening

priority services to specific targeted

patient groups.

• Developing affordable

pharmaceutical services.

Use of Grant Funds

Funding provided through this

program may NOT be used to substitute

for or duplicate funds currently

supporting similar activities. Grant

funds may support costs such as:

• Project staff salaries

• Consultant support

• Management information systems

(e.g., hardware and software)

• Project-related travel

• Other direct expenses necessary for

the integration of administrative,

clinical, information system, or

financial functions

• Program evaluation activities

With appropriate justification on why

funds are needed to support the

following costs, up to 15 percent of

grant funds may be used for:

• Alteration or renovation of facilities

• Primary care site development

• Service expansions or direct patient

care

Grant funds may NOT be used for:

• Construction

• Reserve requirements for state

insurance licensure

Expected Results

The integration and coordination of

services among a community’s safety

net providers are expected to result in:

• A system of care that provides

coordinated coverage to the target

population.

• Increased access to primary care

resulting in a reduction in hospital

admissions for ambulatory sensitive

conditions among the uninsured and

underinsured.

• Elimination of unnecessary,

duplicate functions in service delivery

and administrative functions, resulting

in savings to reinvest in the system.

• Increased numbers of low-income

uninsured people with access to a full

range of health services.

Dated: January 31, 2000.

Claude Earl Fox,

Administrator.

[FR Doc. 00–2567 Filed 2–3–00; 8:45 am]

BILLING CODE 4160–15–U

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Resources and Services

Administration

Advisory Council; Notice of Meeting;

Correction

In Federal Register Document 00–

1032 appearing on page 2634 in the

issue for Tuesday, January 18, 2000, the

February 10–11, 2000, meeting dates of

the ‘‘National Advisory Council on

Migrant Health’’ are incorrect. The

meeting will be held on February 11–12,

2000; 9:00 a.m.–5:00 p.m.

All other information is correct as it

appears.