Federal Register / Vol. 66, No. 27 / Thursday, February 8, 2001 / Notices 9589

recommendations for the proposed

information collections must be mailed

within 30 days of this notice directly to

the OMB desk officer: OMB Human

Resources and Housing Branch,

Attention: Wendy Taylor, New

Executive Office Building, Room 10235,

Washington, DC 20503.

Dated: January 23, 2001.

John P. Burke III,

HCFA Reports Clearance Officer, HCFA Office

of Information Services, Information

Technology Investment Management Group,

Division of HCFA Enterprise Standards.

[FR Doc. 01–3231 Filed 2–7–01; 8:45 am]

BILLING CODE 4120–03–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 up to $40

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. This

funding is part of the $125 million

appropriated for the Community Access

Program (CAP) under the FY 2001 HHS

Appropriations Act, of which $8.4

million is allocated for special projects

and Agency-wide programmatic

investments. For those applications that

were approved, but not funded in FY

2000, approximately $56 million will be

made available pending the results of

their validation site visits. The

remaining $20 million will be made

available later in the fiscal year in the

form of grants to new communities or in

the form of supplemental/expansion

awards to FY 2000 grantees.

In FY 2000, DHHS provided about

$23 million in funding for 23

communities for infrastructure

development. In FY 2001, HRSA will

provide grants to about 50 more

communities which were approved but

not funded in the FY 2000 application

cycle. FY 2001 funding will also be used

to support up to 40 additional

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, and will be

for one year.

Through this program, HRSA will

support infrastructure development in

communities that have already begun to

reorganize and integrate their health

care delivery systems. Funding

described in this notice is not intended

to support those communities that have

not yet begun the planning and

development of necessary

organizational structure.

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. These

foundations have also funded

communities to develop integrated

health care delivery systems for the

uninsured, and CAP intends to build on

the learning from their experiences.

DATES: The timeline for application

submission, review, and award is as

follows:

January 26, 2001: Application kits and

additional guidance will be available

through the HRSA Grants Application

Center (GAC).

February 12–16, 2001: There will be

a series of six pre-application

workshops conducted across the

country:

Nashville, TN—February 12, 2001

New Orleans, LA—February 12, 2001

Minneapolis, MN—February 14, 2001

Denver, CO—February 14, 2001

Philadelphia, PA—February 16, 2001

San Francisco, CA—February 16, 2001

May 7, 2001: Applications due to

HRSA Grants Application Center.

June 11–22, 2001: Applications

reviewed.

July/August 2001: Site visits to

selected applicants.

September 2001: Grant awards

announced.

ADDRESSES: To receive a complete

application kit (i.e., application

instructions, necessary forms, and

application review criteria), contact the

HRSA Grants Application Center at:

HRSA GAC, 1815 N. Fort Myer 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 11–25, 5600 Fishers Lane,

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

0536, Fax: (301) 443–0248.

SUPPLEMENTARY INFORMATION: In 1999,

42.6 million people in the United States

did not have health insurance. Of these,

24.2 million were employed—19

million worked full time and 5.2 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

due to the market forces of Medicaid

managed care, 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, 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 health care providers to

develop the infrastructure necessary to

fully develop or strengthen integrated

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

9590 Federal Register / Vol. 66, No. 27 / Thursday, February 8, 2001 / Notices

improvement, implementation of best

practices, staff development, and realtime 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, mutual

learning between providers and

community, and participation in

priority setting and governance by the

community are essential components of

this vision. This will assure

sustainability of the system.

Program Description

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 coordinated system of

care. The successful applicant will

design a project 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 will sustain the delivery of services

and funding after these federal grants

expire. 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 many models that already exist and

that each community may draw from in

creating a project to address its own

needs.

In surveying innovative community

approaches to the provision of safety net

services, we have come across

communities that have:

• 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

which allow transitions between

Medicaid, uninsured, and insured status

for low income populations;

• 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;

• Created networks to allocate

uncompensated ambulatory care loads

among physicians and redistribute

caseloads to private providers; and

• Linked behavioral and acute care

services.

We are looking for applicants with

clear goals, an operational plan for

meeting those goals, a history of

commitment to serving indigent

populations, and a track record which

indicates likely success. Innovative

proposals for sustaining the service

delivery component of projects could

include 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. It is our intent

to fund those applicants that either

serve a target population that is distinct

from the target population of other

applicants or current CAP grantees, or

propose distinct strategies that are

coordinated and complimentary to those

applicants or CAP grantees that have

overlapping target populations.

Funded projects will address several

common elements:

Community Need: Funded

communities 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: Funded communities will

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: Funded

communities 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: Funded communities will

demonstrate coordination (e.g.,

memoranda of agreements) with state

programs to ensure that eligible

beneficiaries are enrolled in public

insurance programs (e.g., SCHIP,

Medicaid).

Community Involvement: Funded

communities will have strong

community support for these efforts,

which provide a broad foundation of

assistance to the provider community

undertaking this project. Management

and governance structures should be 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 should be evident. This should

include the leadership within the

appropriate legislative and executive

bodies, providers identified above,

health plans and payers, community

leaders and consumers.

Sustainability: Funded communities

will have a plan for long-term

sustainability. There should be 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

different models, this program seeks a

variety of applicants representing all

types of communities. Applicants which

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 and private 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

Federal Register / Vol. 66, No. 27 / Thursday, February 8, 2001 / Notices 9591

must consist of partners from all levels

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

tertiary) and partners which represent a

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

substance abuse treatment, maternal and

child health, oral health, HIV/AIDS

care).

Examples of eligible applicants which

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 school-based

health centers; rural health clinics;

free health clinics; teaching hospitals

and academic institutions)

• Local government agencies (e.g., local

public health departments with

service delivery components)

• Tribal governments

• Managed care plans or other payers

(e.g., HMOs)

• Agencies of State government, multistate health systems, or other 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.

Current CAP grantees are not eligible

to apply for this funding.

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 plan and

reasonableness of the budget

• 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 through coordinated

systmes of care. Each community

should design a project that best

addresses the needs of the uninsured

and underinsured, and the providers in

their community.

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.

Applicants will be expected to budget

for travel to two grantee meetings and to

meet interim and final reporting

requirements as directed by the

Community Access Program.

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 a total of 15

percent of grant funds may be used for

the following:

• Alteration or renovation of facilities

• Development of additional primary

care sites

• 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 care 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, 2001.

Claude Earl Fox,

Administrator.

[FR Doc. 01–3251 Filed 2–7–01; 8:45 am]

BILLING CODE 4160–15–U

DEPARTMENT OF THE INTERIOR

Fish and Wildlife Service

Notice of Receipt of Applications for

Permit

Endangered Species

The following applicants have

applied for a permit to conduct certain

activities with endangered species. This

notice is provided pursuant to Section

10(c) of the Endangered Species Act of

1973, as amended (16 U.S.C. 1531, et

seq.). Written data or comments should

be submitted to the Director, U.S. Fish

and Wildlife Service, Division of

Management Authority, 4401 North

Fairfax Drive, Room 700, Arlington,

Virginia 22203 and must be received by

the Director within 30 days of the date

of this publication.

PRT–038203

Applicant: E. Benjamin Nelson,

Omaha, NE.

The applicant requests a permit to

import the sport-hunted trophy of one

male bontebok (Damaliscus pygargus

dorcas) culled from a captive herd

maintained under the management

program of the Republic of South Africa,

for the purpose of enhancement of the

survival of the species.

PRT–038338

Applicant: Neil A. Chamberlain,

Linwood, MI.

The applicant requests a permit to

import the sport-hunted trophy of one