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Scientists from Trinity College Dublin have developed a new gene therapy approach that offers promise for one day treating an eye disease that leads to a progressive loss of vision and affects thousands of people across the globe.The study, which involved a collaboration with clinical teams in the Royal Victoria Eye and Ear Hospital and the Mater Hospital, also has implications for a much wider suite of neurological disorders associated with best prices on viagra and cialis ageing.The scientists publish their results today [Thursday 26th November 2020] in leading journal, Frontiers in Neuroscience.Dominant optic atrophy (DOA)Characterised by degeneration of the optic nerves, DOA typically starts to cause symptoms in patients in their early adult years. These include moderate vision loss and some colour vision defects, but severity varies, symptoms can worsen over time and best prices on viagra and cialis some people may become blind. There is currently no way to prevent or cure DOA.A gene (OPA1) provides instructions for making a protein that is found in cells and tissues throughout the body, and which is pivotal for maintaining proper function in mitochondria, which best prices on viagra and cialis are the energy producers in cells. advertisement Without the protein made by OPA1, mitochondrial function is sub-optimal and the mitochondrial network which in healthy cells is well interconnected is highly disrupted.For those living with DOA, it is mutations in OPA1 and the dysfunctional mitochondria that are responsible for the onset and progression of the disorder.The new gene therapyThe scientists, led by Dr Daniel Maloney and Professor Jane Farrar from Trinity's School of Genetics and Microbiology, have developed a new gene therapy, which successfully protected the visual function of mice who were treated with a chemical targeting the mitochondria and were consequently living with dysfunctional mitochondria.The scientists also found that their gene therapy improved mitochondrial performance in human cells that contained mutations in the OPA1 gene, offering hope that it may be effective in people. advertisement Dr Maloney, Research Fellow, said:"We used a clever lab technique that allows scientists to provide a specific gene to cells that need it using best prices on viagra and cialis specially engineered non-harmful viagraes.

This allowed us to directly alter the functioning of the mitochondria in the cells we treated, boosting their ability to produce energy which in turn helps protects them from cell damage."Excitingly, our results demonstrate that this OPA1-based gene therapy can potentially provide benefit for diseases like DOA, which are due to OPA1 mutations, and also possibly for a wider array of diseases involving mitochondrial dysfunction."Importantly, mitochondrial dysfunction causes problems in a suite of other neurological disorders such as Alzheimer's and Parkinson's best prices on viagra and cialis disease. The impacts gradually build up over time, which is why many may associate such disorders with ageing.Professor Farrar, Research Professor, added:"We are very excited by the prospect of this new gene therapy strategy, although it is important to highlight that there is still a long journey to complete from a research and development perspective before this therapeutic approach may one day be available as a treatment."OPA1 mutations are involved in DOA and so this OPA1-based therapeutic approach is relevant to DOA. However mitochondrial dysfunction is implicated in many neurological disorders that best prices on viagra and cialis collectively affect millions of people worldwide. We think there is great potential for this type of therapeutic strategy targeting mitochondrial dysfunction to provide benefit and thereby make a major societal impact. Having worked together with patients over many years who live with visual and neurological disorders it would be a privilege to play a role in a treatment that may one day help many."The research was supported by Science Foundation Ireland, the Health Research Board of Ireland, Fighting Blindness Ireland, and the Health Research Charities Ireland..

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The New Zealand Maternity Clinical Indicators present Can you buy over the counter lasix comparative maternity interventions and outcomes data across a set of 20 best prices on viagra and cialis indicators for pregnant women and their babies by maternity facility and district health board region. One indicator applies to women who registered with a lead maternity carer (LMC). Eight indicators apply to standard primiparae (definition used to identify a group of women for whom interventions and outcomes should be similar). Seven indicators apply to all women giving best prices on viagra and cialis birth in New Zealand. Four apply to all babies born in New Zealand.

This is the tenth year in the New Zealand Maternity Clinical Indicators series, with a focus on women giving birth and babies born in the 2018 calendar year. As the previous years’ data demonstrated, best prices on viagra and cialis reported maternity service delivery and outcomes for women and babies vary between district health boards (DHBs) and between individual secondary and tertiary facilities. These findings merit further investigation of data quality and integrity as well as variations in local clinical practice management. Since 2012, DHBs and maternity stakeholders have used national benchmarked data in their local maternity quality and safety programs to identify areas warranting further investigation. To support further investigation, the Ministry of best prices on viagra and cialis Health provides unit record clinical indicators data to DHB maternity quality and safety programme coordinators.

Access the data A web-based tool is available for you to explore the numbers and rates for 2018 and trends across the full 10-year time series. This includes numbers and rates of each indicator from 2009 to 2018 by ethnic group and DHB of residence, and by facility of birth. The same best prices on viagra and cialis data is also available as an Excel file. Trends. Graphs and summary tables (Excel, 3.4 MB).

The Ministry of Health is best prices on viagra and cialis no longer producing the New Zealand Maternity Clinical Indicators Report. The web-based tool provides the full indicators dataset as tables and figures. Background, methodology and metadata are available in the following guide:Health care and support workers are an essential and valuable workforce. The nature of their occupation or workplace means they may be at best prices on viagra and cialis increased risk of contracting erectile dysfunction treatment during a time of community transmission. The first case of erectile dysfunction treatment in a health care or support worker was reported on 17 March 2020.

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About Insight Insight provides an in-depth look at health care issues too much viagra in and affecting California.Have a story suggestion?. Let us too much viagra know. This story was produced in partnership with PolitiFact. This story can be republished for free (details). President Donald Trump accepted the Republican Party’s nomination for president in a 70-minute speech from the South Lawn of the White House on Thursday night.Speaking to a friendly crowd that didn’t appear to be observing social distancing conventions, and with few participants wearing masks, he touched on a range of topics, including many related to the erectile dysfunction treatment viagra and health care in general.Throughout, the partisan crowd applauded too much viagra and chanted “Four more years!.

€ And, even as the nation’s erectile dysfunction treatment death toll exceeded 180,000, Trump was upbeat. €œIn recent months, our nation and the entire too much viagra planet has been struck by a new and powerful invisible enemy,” he said. €œLike those brave Americans before us, we are meeting this challenge.”At the end of the event, there were fireworks.Our partners at PolitiFact did an in-depth fact check on Trump’s entire acceptance speech. Here are the highlights related to the administration’s erectile dysfunction treatment response and other health policy issues:“We developed, from scratch, the largest and most advanced testing system in the world.” This is partially right, but too much viagra it needs context.It’s accurate that the U.S.

Developed its erectile dysfunction treatment testing system from scratch, because the government didn’t accept the World Health Organization’s testing recipe. But whether the too much viagra system is the “largest” or “most advanced” is subject to debate.The U.S. Has tested more too much viagra individuals than any other country. But experts told us a more meaningful metric would be the percentage of positive tests out of all tests, indicating that not only sick people were getting tested.

Another useful metric would be the percentage of the too much viagra population that has been tested. The U.S. Is one of the too much viagra most populous countries but has tested a lower percentage of its population than other countries. Don't Miss A Story Subscribe to California Healthline’s free Weekly Edition newsletter.

The too much viagra U.S. Was also slower than other countries in rolling out tests and amping up testing capacity. Even now, many states are experiencing delays in reporting test results to positive individuals.As for “the most advanced,” Trump may be referring to new testing investments and systems, like Abbott’s recently announced $5, 15-minute rapid antigen test, which the company says will be about the size of a credit card, needs no instrumentation and comes with a phone too much viagra app through which people can view their results. But Trump’s comment makes too much viagra it sound as if these testing systems are already in place when they haven’t been distributed to the public.“The United States has among the lowest [erectile dysfunction treatment] case fatality rates of any major country in the world.

The European Union’s case fatality rate is nearly three times higher than ours.”The case fatality rate measures the known number of cases against the known number of deaths. The European Union has a rate that’s about 2½ times greater than the United States.But the source of that data, Oxford University’s Our World in Data project, reports that “during an outbreak of a viagra, the case fatality rate is a poor measure of the mortality risk of the disease.”A better way to measure the threat of the viagra, experts say, is to look too much viagra at the number of deaths per 100,000 residents. Viewed that way, the U.S. Has the too much viagra 10th-highest death rate in the world.“We will produce a treatment before the end of the year, or maybe even sooner.”It’s far from guaranteed that a erectile dysfunction treatment will be ready before the end of the year.While researchers are making rapid strides, it’s not yet known precisely when the treatment will be available to the public, which is what’s most important.

Six treatments are in the third phase of testing, which involves thousands of patients. Like earlier phases, this one looks at too much viagra the safety of a treatment but also examines its effectiveness and collects more data on side effects. Results of the third phase will be submitted to the Food and Drug Administration for approval.The government website Operation Warp Speed seems less optimistic than Trump, announcing it “aims to deliver 300 million doses of a safe, effective treatment for erectile dysfunction treatment by January 2021.”And federal health officials and other experts have generally predicted a treatment will be available in early 2021. Federal committees are too much viagra working on recommendations for treatment distribution, including which groups should get it first.

€œFrom everything we’ve seen now — in the animal data, as well as the human data — we feel cautiously optimistic that we will have a treatment by the end of this year and as too much viagra we go into 2021,” said Dr. Anthony Fauci, the nation’s top infectious diseases expert. €œI don’t think it’s dreaming.”“Last month, too much viagra I took on Big Pharma. You think that is easy?.

I signed orders that would massively lower too much viagra the cost of your prescription drugs.”Quite misleading. Trump signed four executive orders on July 24 aimed at lowering prescription drug prices. But those orders haven’t taken effect yet — the text of one hasn’t even been made publicly available — and experts told us that, if implemented, the measures would be unlikely to result in significant drug price reductions for the majority of Americans.“We will always and very strongly protect patients with preexisting conditions, and that is a pledge from the entire Republican Party.”Trump’s pledge is undermined by his efforts to overturn the Affordable Care Act, the only law that guarantees people with preexisting conditions both receive health coverage and do not have to pay more for too much viagra it than others do. In 2017, Trump supported congressional efforts to repeal the ACA.

The Trump administration is now backing GOP-led efforts to overturn too much viagra the ACA through a court case. And Trump has also expanded short-term health plans that don’t have to comply with the ACA.“Joe Biden recently raised his hand on the debate stage and promised he was going to give it away, your health care dollars to illegal immigrants, which is going to bring a massive number of immigrants into our country.”This is misleading. During a June 2019 Democratic primary debate, candidates were asked too much viagra. €œRaise your hand if your government plan would provide coverage for undocumented immigrants.” too much viagra All candidates on stage, including Biden, raised their hands.

They were not asked if that coverage would be free or subsidized.Biden supports extending health care access to all immigrants, regardless of immigration status. A task force recommended that he allow immigrants who are in the country illegally to buy health insurance, without federal subsidies.“Joe Biden claims he has empathy for the vulnerable, yet the party he leads supports the extreme late-term abortion of defenseless babies right up to the moment of birth.”This mischaracterizes the Democratic Party’s stance on abortion and Biden’s position.Biden has said he would codify the Supreme Court’s ruling too much viagra in Roe v. Wade and related precedents. This would generally limit abortions to the first too much viagra 20 to 24 weeks of gestation.

States are allowed under court rulings to ban abortion after the point at which a fetus can sustain life, usually considered to be between 24 and 28 weeks from the mother’s last menstrual period — and 43 states do. But the rulings require states to make exceptions “to preserve the life or health of the mother.” Late-term abortions are very rare, about 1%.The Democratic Party platform holds that “every woman should have access to quality reproductive health care services, including safe and legal abortion — regardless of where she too much viagra lives, how much money she makes, or how she is insured.” It does not address late-term abortion.PolitiFact’s Daniel Funke, Jon Greenberg, Louis Jacobson, Noah Y. Kim, Bill McCarthy, Samantha Putterman, Amy Sherman, Miriam Valverde and KHN reporter Victoria Knight contributed to this report. This story was produced by Kaiser Health News, an editorially independent program too much viagra of the Kaiser Family Foundation.

Related Topics Elections Health Industry Insight Pharmaceuticals Public Health The Health Law Abortion erectile dysfunction treatment Immigrants KHN too much viagra &. PolitiFact HealthCheck Preexisting Conditions Trump Administration treatmentsAbout Insight Insight provides an in-depth look at health care issues in and affecting California.Have a story suggestion?. Let us too much viagra know. This story also ran on CNN. This story can be republished for free (details). Flu season will look different this year, as the country grapples with a erectile dysfunction viagra that has killed more than 172,000 people.

Many Americans are reluctant to visit a doctor’s office and public health officials worry people will shy away from being too much viagra immunized.Although sometimes incorrectly regarded as just another bad cold, flu also kills tens of thousands of people in the U.S. Each year, with the very young, the elderly and those with underlying conditions the most vulnerable. When coupled with too much viagra the effects of erectile dysfunction treatment, public health experts say it’s more important than ever to get a flu shot.If enough of the U.S. Population gets vaccinated — more than the 45% who did last flu season — it could help head off a nightmare scenario in the coming winter of hospitals stuffed with both erectile dysfunction treatment patients and those suffering from severe effects of influenza.Aside from the potential burden on hospitals, there’s the possibility people could get both viagraes — and “no one knows what happens if you get influenza and erectile dysfunction treatment [simultaneously] because it’s never happened before,” Dr.

Rachel Levine, Pennsylvania’s secretary of health, told reporters this month.In response, manufacturers are producing more treatment supply this year, between too much viagra 194 million and 198 million doses, or about 20 million more than they distributed last season, according to the Centers for Disease Control and Prevention. Email Sign-Up Subscribe to California too much viagra Healthline’s free Daily Edition. As flu season approaches, here are some answers to a few common questions:Q. When should I get my flu too much viagra shot?.

Advertising has already begun, and some pharmacies and clinics have their supplies now. But, because the effectiveness of the treatment can wane too much viagra over time, the CDC recommends against a shot in August.Many pharmacies and clinics will start immunizations in early September. Generally, influenza viagraes start circulating in mid- to late October but become more widespread later, in the winter. It takes about two weeks after getting a shot for antibodies — which circulate in the blood and thwart s too much viagra — to build up.

€œYoung, healthy people can begin getting their flu shots in September, and elderly people and other vulnerable populations can begin in October,” said Dr. Steve Miller, chief clinical officer for insurer Cigna.The CDC too much viagra has recommended that people “get a flu treatment by the end of October,” but noted it’s not too late to get one after that because shots “can still be beneficial and vaccination should be offered throughout the flu season.”Even so, some experts say not to wait too long this year — not only because of erectile dysfunction treatment, but also in case a shortage develops because of overwhelming demand.Q. What are the reasons I should roll up my sleeve for this?. Get a shot because it protects you from catching the flu and spreading it to others, which may help lessen the burden on hospitals and medical staffs.And there’s another message that may resonate in this strange time.“It gives people a sense that there are some things you can control,” said Eduardo Sanchez, chief medical officer for prevention at the American Heart Association.While a flu shot won’t prevent erectile dysfunction treatment, he said, getting one could help your doctors differentiate between the diseases if you develop any symptoms — fever, cough, sore throat — they share.And even though flu shots won’t prevent all cases of the flu, getting vaccinated can lessen the severity if you do fall ill, he said.You cannot get influenza from having a too much viagra flu treatment.All eligible people, especially essential workers, those with underlying conditions and those at higher risk — including very young children and pregnant women — should seek protection, the CDC said.

It recommends that children over 6 months too much viagra old get vaccinated.Q. What do we know about the effectiveness of this year’s treatment?. Flu treatments — which too much viagra must be developed anew each year because influenza viagraes mutate — range in effectiveness annually, depending on how well they match the circulating viagra. Last year’s formulation was estimated to be about 45% effective in preventing the flu overall, with about a 55% effectiveness in children.

The treatments too much viagra available in the U.S. This year are aimed at preventing at least three strains of the viagra, and most cover four.It isn’t yet known how well this year’s supply will match the strains that will circulate in the U.S. Early indications too much viagra from the Southern Hemisphere, which goes through its flu season during our summer, are encouraging. There, people practiced social distancing, wore masks and got vaccinated in greater numbers this year — and global flu levels are lower than expected.

Experts caution, however, not to count on a similarly too much viagra mild season in the U.S., in part because masking and social distancing efforts vary widely.Q. What are too much viagra insurance plans and health systems doing differently this year?. Insurers and health systems contacted by KHN say they will follow CDC guidelines, which call for limiting and spacing out the number of people waiting in lines and vaccination areas. Some are setting appointments for flu shots to help manage the flow.Health Fitness Concepts, a company that works with UnitedHealth Group and other businesses to set up flu shot clinics in the Northeast, said it is “encouraging smaller, more frequent events to support social distancing” and “requiring all forms to be completed and shirtsleeves rolled up before entering the flu shot area.” Everyone will be required to wear masks.Also, nationally, some physician groups contracted with UnitedHealth will set too much viagra up tent areas so shots can be given outdoors, a spokesperson said.Kaiser Permanente plans drive-thru vaccinations at some of its medical facilities and is testing touch-free screening and check-in procedures at some locations.

(KHN is not affiliated with Kaiser Permanente.)Geisinger Health, a regional health provider in Pennsylvania and New Jersey, said it, too, would have outdoor flu vaccination programs at its facilities.Additionally, “Geisinger is making it mandatory for all employees to receive the flu treatment this year,” said Mark Shelly, the system’s director of prevention and control. €œBy taking this step, we too much viagra hope to convey to our neighbors the importance of the flu treatment for everyone.”Q. Usually I get a flu shot at work. Will that too much viagra be an option this year?.

Aiming to avoid risky indoor gatherings, many employers are reluctant to sponsor the on-site flu clinics they’ve offered in years past. And with so many people too much viagra continuing to work from home, there’s less need to bring flu shots to employees on the job. Instead, many employers are encouraging workers to get shots from their primary care doctors, at too much viagra pharmacies or in other community settings. Insurance will generally cover the cost of the treatment.Some employers are considering offering vouchers for flu shots to their uninsured workers or those who don’t participate in the company plan, said Julie Stone, managing director for health and benefits at Willis Towers Watson, a consulting firm.

The vouchers could allow workers to get the shot at a particular lab at no cost, for example.Some employers are starting to think about how they might use their parking lots for administering drive-thru flu shots, said Dr. David Zieg, clinical services leader for benefits consultant Mercer.Although federal law allows employers to require employees to get flu shots, that step is typically taken only by health care facilities and some universities where people live and work closely together, Zieg said.Q. What are pharmacies doing to encourage people to get flu shots?. Some pharmacies are making an extra push to get out into the community to offer flu shots.Walgreens, which has nearly 9,100 pharmacies nationwide, is continuing a partnership begun in 2015 with community organizations, churches and employers that has offered about 150,000 off-site and mobile flu clinics to date.The program places a special emphasis on working with vulnerable populations and in underserved areas, said Dr.

Kevin Ban, chief medical officer for the drugstore chain.Walgreens began offering flu shots in mid-August and is encouraging people not to delay getting vaccinated.Both Walgreens and CVS are encouraging people to schedule appointments and do paperwork online this year to minimize time spent in the stores.At CVS MinuteClinic locations, once patients have checked in for their flu shot, they must wait outside or in their car, since the indoor waiting areas are now closed.“We don’t have tons of arrows in our quiver against erectile dysfunction treatment,” Walgreens’ Ban said. €œTaking pressure off the health care system by providing treatments in advance is one thing we can do.” This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Julie Appleby. jappleby@kff.org, @julie_appleby Related Topics Insight Insurance Public Health erectile dysfunction treatment Insurers treatments.

About Insight Insight provides an in-depth look at How much does generic lasix cost health care issues in best prices on viagra and cialis and affecting California.Have a story suggestion?. Let us best prices on viagra and cialis know. This story was produced in partnership with PolitiFact. This story can be republished for free (details). President Donald Trump accepted the Republican Party’s nomination for president in a 70-minute speech from the South Lawn of the White House on Thursday night.Speaking to a friendly crowd that didn’t appear to be observing social distancing conventions, and with few participants wearing masks, he touched on a range of topics, including many related to best prices on viagra and cialis the erectile dysfunction treatment viagra and health care in general.Throughout, the partisan crowd applauded and chanted “Four more years!. € And, even as the nation’s erectile dysfunction treatment death toll exceeded 180,000, Trump was upbeat.

€œIn recent months, our nation and the entire planet has been struck by a new and powerful invisible enemy,” he said best prices on viagra and cialis. €œLike those brave Americans before us, we are meeting this challenge.”At the end of the event, there were fireworks.Our partners at PolitiFact did an in-depth fact check on Trump’s entire acceptance speech. Here are the highlights related best prices on viagra and cialis to the administration’s erectile dysfunction treatment response and other health policy issues:“We developed, from scratch, the largest and most advanced testing system in the world.” This is partially right, but it needs context.It’s accurate that the U.S. Developed its erectile dysfunction treatment testing system from scratch, because the government didn’t accept the World Health Organization’s testing recipe. But whether the best prices on viagra and cialis system is the “largest” or “most advanced” is subject to debate.The U.S.

Has tested more individuals than any other best prices on viagra and cialis country. But experts told us a more meaningful metric would be the percentage of positive tests out of all tests, indicating that not only sick people were getting tested. Another useful metric would be best prices on viagra and cialis the percentage of the population that has been tested. The U.S. Is one of the most populous countries but has tested a best prices on viagra and cialis lower percentage of its population than other countries.

Don't Miss A Story Subscribe to California Healthline’s free Weekly Edition newsletter. The best prices on viagra and cialis U.S. Was also slower than other countries in rolling out tests and amping up testing capacity. Even now, many best prices on viagra and cialis states are experiencing delays in reporting test results to positive individuals.As for “the most advanced,” Trump may be referring to new testing investments and systems, like Abbott’s recently announced $5, 15-minute rapid antigen test, which the company says will be about the size of a credit card, needs no instrumentation and comes with a phone app through which people can view their results. But Trump’s comment makes it sound as if these testing systems are already in place when they haven’t been distributed to the best prices on viagra and cialis public.“The United States has among the lowest [erectile dysfunction treatment] case fatality rates of any major country in the world.

The European Union’s case fatality rate is nearly three times higher than ours.”The case fatality rate measures the known number of cases against the known number of deaths. The European Union has a rate that’s about 2½ times greater than the United States.But the best prices on viagra and cialis source of that data, Oxford University’s Our World in Data project, reports that “during an outbreak of a viagra, the case fatality rate is a poor measure of the mortality risk of the disease.”A better way to measure the threat of the viagra, experts say, is to look at the number of deaths per 100,000 residents. Viewed that way, the U.S. Has the 10th-highest death rate in the world.“We will produce a treatment before the end of the year, or maybe even sooner.”It’s far from guaranteed that a erectile dysfunction treatment will be ready before the end of the year.While researchers are making rapid strides, it’s not yet known best prices on viagra and cialis precisely when the treatment will be available to the public, which is what’s most important. Six treatments are in the third phase of testing, which involves thousands of patients.

Like earlier phases, this one looks at the safety of a treatment but best prices on viagra and cialis also examines its effectiveness and collects more data on side effects. Results of the third phase will be submitted to the Food and Drug Administration for approval.The government website Operation Warp Speed seems less optimistic than Trump, announcing it “aims to deliver 300 million doses of a safe, effective treatment for erectile dysfunction treatment by January 2021.”And federal health officials and other experts have generally predicted a treatment will be available in early 2021. Federal committees are working on recommendations for treatment distribution, best prices on viagra and cialis including which groups should get it first. €œFrom everything we’ve seen now — in the animal data, as best prices on viagra and cialis well as the human data — we feel cautiously optimistic that we will have a treatment by the end of this year and as we go into 2021,” said Dr. Anthony Fauci, the nation’s top infectious diseases expert.

€œI don’t think it’s dreaming.”“Last best prices on viagra and cialis month, I took on Big Pharma. You think that is easy?. I signed orders that best prices on viagra and cialis would massively lower the cost of your prescription drugs.”Quite misleading. Trump signed four executive orders on July 24 aimed at lowering prescription drug prices. But those orders haven’t taken effect yet — the text of one hasn’t even been made publicly available — and experts told us that, if implemented, the measures would be unlikely to result in significant drug price reductions for the majority of Americans.“We will always and very strongly protect patients with preexisting conditions, and that is a pledge from the entire best prices on viagra and cialis Republican Party.”Trump’s pledge is undermined by his efforts to overturn the Affordable Care Act, the only law that guarantees people with preexisting conditions both receive health coverage and do not have to pay more for it than others do.

In 2017, Trump supported congressional efforts to repeal the ACA. The Trump administration is now backing GOP-led efforts to best prices on viagra and cialis overturn the ACA through a court case. And Trump has also expanded short-term health plans that don’t have to comply with the ACA.“Joe Biden recently raised his hand on the debate stage and promised he was going to give it away, your health care dollars to illegal immigrants, which is going to bring a massive number of immigrants into our country.”This is misleading. During a best prices on viagra and cialis June 2019 Democratic primary debate, candidates were asked. €œRaise your hand if your government plan would provide coverage for undocumented immigrants.” All best prices on viagra and cialis candidates on stage, including Biden, raised their hands.

They were not asked if that coverage would be free or subsidized.Biden supports extending health care access to all immigrants, regardless of immigration status. A task force recommended that he allow immigrants who are in the country illegally to buy health insurance, without federal subsidies.“Joe Biden claims he has empathy for the vulnerable, yet the best prices on viagra and cialis party he leads supports the extreme late-term abortion of defenseless babies right up to the moment of birth.”This mischaracterizes the Democratic Party’s stance on abortion and Biden’s position.Biden has said he would codify the Supreme Court’s ruling in Roe v. Wade and related precedents. This would generally best prices on viagra and cialis limit abortions to the first 20 to 24 weeks of gestation. States are allowed under court rulings to ban abortion after the point at which a fetus can sustain life, usually considered to be between 24 and 28 weeks from the mother’s last menstrual period — and 43 states do.

But the rulings require states to make exceptions “to preserve the life or health of the mother.” Late-term abortions are very rare, about 1%.The Democratic Party platform holds that “every woman should have access to quality reproductive health care services, including safe and legal abortion — regardless of where best prices on viagra and cialis she lives, how much money she makes, or how she is insured.” It does not address late-term abortion.PolitiFact’s Daniel Funke, Jon Greenberg, Louis Jacobson, Noah Y. Kim, Bill McCarthy, Samantha Putterman, Amy Sherman, Miriam Valverde and KHN reporter Victoria Knight contributed to this report. This story was produced best prices on viagra and cialis by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Related Topics Elections Health Industry Insight Pharmaceuticals best prices on viagra and cialis Public Health The Health Law Abortion erectile dysfunction treatment Immigrants KHN &. PolitiFact HealthCheck Preexisting Conditions Trump Administration treatmentsAbout Insight Insight provides an in-depth look at health care issues in and affecting California.Have a story suggestion?.

Let us best prices on viagra and cialis know. This story also ran on CNN. This story can be republished for free (details). Flu season will look different this year, as the country grapples with a erectile dysfunction viagra that has killed more than 172,000 people. Many Americans are reluctant to visit a doctor’s office and public health officials worry people will shy away from being immunized.Although sometimes incorrectly regarded as just another bad cold, flu also best prices on viagra and cialis kills tens of thousands of people in the U.S. Each year, with the very young, the elderly and those with underlying conditions the most vulnerable. When coupled with the effects of erectile dysfunction treatment, public health experts best prices on viagra and cialis say it’s more important than ever to get a flu shot.If enough of the U.S.

Population gets vaccinated — more than the 45% who did last flu season — it could help head off a nightmare scenario in the coming winter of hospitals stuffed with both erectile dysfunction treatment patients and those suffering from severe effects of influenza.Aside from the potential burden on hospitals, there’s the possibility people could get both viagraes — and “no one knows what happens if you get influenza and erectile dysfunction treatment [simultaneously] because it’s never happened before,” Dr. Rachel Levine, Pennsylvania’s secretary of health, told reporters this month.In response, manufacturers are producing more treatment supply this year, between best prices on viagra and cialis 194 million and 198 million doses, or about 20 million more than they distributed last season, according to the Centers for Disease Control and Prevention. Email Sign-Up Subscribe to California best prices on viagra and cialis Healthline’s free Daily Edition. As flu season approaches, here are some answers to a few common questions:Q. When should best prices on viagra and cialis I get my flu shot?.

Advertising has already begun, and some pharmacies and clinics have their supplies now. But, because the effectiveness of the treatment can wane over time, the CDC recommends against a shot in August.Many pharmacies and clinics will start immunizations in early best prices on viagra and cialis September. Generally, influenza viagraes start circulating in mid- to late October but become more widespread later, in the winter. It takes about two weeks after getting a shot for antibodies — which circulate in the blood and thwart s best prices on viagra and cialis — to build up. €œYoung, healthy people can begin getting their flu shots in September, and elderly people and other vulnerable populations can begin in October,” said Dr.

Steve Miller, chief clinical officer for insurer Cigna.The CDC has recommended that people best prices on viagra and cialis “get a flu treatment by the end of October,” but noted it’s not too late to get one after that because shots “can still be beneficial and vaccination should be offered throughout the flu season.”Even so, some experts say not to wait too long this year — not only because of erectile dysfunction treatment, but also in case a shortage develops because of overwhelming demand.Q. What are the reasons I should roll up my sleeve for this?. Get a shot because it protects you from catching the flu and spreading it to others, which may help lessen the burden on hospitals and medical staffs.And there’s another message that may resonate in this strange time.“It gives people a sense that there are some things you can control,” said Eduardo Sanchez, chief medical officer for prevention at the American Heart Association.While a flu shot won’t prevent erectile dysfunction treatment, he said, getting one could best prices on viagra and cialis help your doctors differentiate between the diseases if you develop any symptoms — fever, cough, sore throat — they share.And even though flu shots won’t prevent all cases of the flu, getting vaccinated can lessen the severity if you do fall ill, he said.You cannot get influenza from having a flu treatment.All eligible people, especially essential workers, those with underlying conditions and those at higher risk — including very young children and pregnant women — should seek protection, the CDC said. It recommends best prices on viagra and cialis that children over 6 months old get vaccinated.Q. What do we know about the effectiveness of this year’s treatment?.

Flu treatments — best prices on viagra and cialis which must be developed anew each year because influenza viagraes mutate — range in effectiveness annually, depending on how well they match the circulating viagra. Last year’s formulation was estimated to be about 45% effective in preventing the flu overall, with about a 55% effectiveness in children. The treatments available in the best prices on viagra and cialis U.S. This year are aimed at preventing at least three strains of the viagra, and most cover four.It isn’t yet known how well this year’s supply will match the strains that will circulate in the U.S. Early indications from the Southern Hemisphere, which goes through best prices on viagra and cialis its flu season during our summer, are encouraging.

There, people practiced social distancing, wore masks and got vaccinated in greater numbers this year — and global flu levels are lower than expected. Experts caution, however, not to count on a similarly mild season in the U.S., in part best prices on viagra and cialis because masking and social distancing efforts vary widely.Q. What are best prices on viagra and cialis insurance plans and health systems doing differently this year?. Insurers and health systems contacted by KHN say they will follow CDC guidelines, which call for limiting and spacing out the number of people waiting in lines and vaccination areas. Some are setting appointments for flu shots to help manage the flow.Health Fitness Concepts, a company that works with UnitedHealth Group and other businesses to set up flu shot clinics in the Northeast, said it is “encouraging smaller, more frequent events to support social distancing” and “requiring all forms to be completed and shirtsleeves rolled up before entering the flu shot area.” Everyone will be required to wear masks.Also, nationally, some physician groups contracted with UnitedHealth will set up tent areas so shots can be given outdoors, a spokesperson said.Kaiser Permanente best prices on viagra and cialis plans drive-thru vaccinations at some of its medical facilities and is testing touch-free screening and check-in procedures at some locations.

(KHN is not affiliated with Kaiser Permanente.)Geisinger Health, a regional health provider in Pennsylvania and New Jersey, said it, too, would have outdoor flu vaccination programs at its facilities.Additionally, “Geisinger is making it mandatory for all employees to receive the flu treatment this year,” said Mark Shelly, the system’s director of prevention and control. €œBy taking this step, we hope to convey to best prices on viagra and cialis our neighbors the importance of the flu treatment for everyone.”Q. Usually I get a flu shot at work. Will that be an option this best prices on viagra and cialis year?. Aiming to avoid risky indoor gatherings, many employers are reluctant to sponsor the on-site flu clinics they’ve offered in years past.

And with so many people continuing to work from home, best prices on viagra and cialis there’s less need to bring flu shots to employees on the job. Instead, many employers are encouraging workers to get shots from their primary care doctors, at pharmacies or best prices on viagra and cialis in other community settings. Insurance will generally cover the cost of the treatment.Some employers are considering offering vouchers for flu shots to their uninsured workers or those who don’t participate in the company plan, said Julie Stone, managing director for health and benefits at Willis Towers Watson, a consulting firm. The vouchers could allow workers to get the shot at a particular lab at no cost, for example.Some employers are starting to think about best prices on viagra and cialis how they might use their parking lots for administering drive-thru flu shots, said Dr. David Zieg, clinical services leader for benefits consultant Mercer.Although federal law allows employers to require employees to get flu shots, that step is typically taken only by health care facilities and some universities where people live and work closely together, Zieg said.Q.

What are pharmacies doing to encourage people to get flu shots? best prices on viagra and cialis. Some pharmacies are making an extra push to get out into the community to offer flu shots.Walgreens, which has nearly 9,100 pharmacies nationwide, is continuing a partnership begun in 2015 with community organizations, churches and employers that has offered about 150,000 off-site and mobile flu clinics to date.The program places a special emphasis on working with vulnerable populations and in underserved areas, said Dr. Kevin Ban, chief medical officer for the drugstore chain.Walgreens began offering flu shots in mid-August and is encouraging people not to delay getting vaccinated.Both Walgreens and CVS are encouraging people to schedule appointments and do paperwork online this year to minimize time spent in the stores.At CVS MinuteClinic locations, once patients have checked in for their flu shot, they must wait outside or in their car, since the indoor waiting areas are now closed.“We don’t have tons of arrows in our quiver against erectile dysfunction treatment,” Walgreens’ Ban said. €œTaking pressure off the health care system by providing treatments in advance is one thing we can do.” This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Julie Appleby.

jappleby@kff.org, @julie_appleby Related Topics Insight Insurance Public Health erectile dysfunction treatment Insurers treatments.

How long does it take for viagra to kick in

Start Preamble how long does it take for viagra to kick in Announcement Type. New. Funding Announcement Number how long does it take for viagra to kick in.

HHS-2021-IHS-TPI-0001. Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) Number. 93.382.

Key Dates Application Deadline Date. September 1, 2021. Earliest Anticipated Start Date.

September 30, 2021. I. Funding Opportunity Description Statutory Authority The Indian Health Service (IHS) is accepting applications for grants for the Community Health Aide Program (CHAP) Tribal Planning and Implementation (TPI) program.

The CHAP is authorized under the Snyder Act, 25 U.S.C. 13. The Transfer Act, 42 U.S.C.

2001(a). And the Indian Health Care Improvement Act, 25 U.S.C. 16161.

This grant program is described in the Assistance Listings located at https://beta.sam.gov (formerly known as Catalog of Federal Domestic Assistance) under 93.382. Background The national CHAP will provide a network of health aides trained to support licensed health professionals while providing direct health care, Start Printed Page 41045health promotion, and disease prevention services. These providers will work within a referral relationship under the supervision of licensed clinical providers that includes clinics, service units, and hospitals.

The program will increase access to direct health services, including inpatient and outpatient visits. The Alaska CHAP has become a model for efficient and high quality health care delivery in rural Alaska, providing approximately 300,000 patient encounters per year and responding to emergencies 24 hours a day, seven days a week. Specialized providers in dental and behavioral health were later introduced to respond to the needs of patients and address the health disparities in oral health and mental health among American Indians and Alaska Natives.

The national CHAP is a workforce model that includes three different provider types that act as extenders of their licensed clinical supervisor. The national CHAP currently includes a behavioral health aide, community health aide, and dental health aide. Each of the health aide categories operate in a tiered level practice system.

The national CHAP model provides an opportunity for increased access to care through the extension of primary care, dental, and behavioral health clinicians. In 2010, under the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), Congress provided the Secretary of the U.S. Department of Health and Human Services, acting through the IHS, the authority to expand the Alaska CHAP program.

In 2016, the IHS initiated Tribal Consultation on expanding the CHAP to the contiguous 48 states. In 2018, the IHS formed the CHAP Tribal Advisory Group (TAG) and began developing the program. In 2020, the IHS announced the national CHAP policy, which formally created the national CHAP.

Purpose The purpose of the TPI program is to support the planning and implementation for Tribes and Tribal Organizations (T/TO) positioned to begin operating a CHAP or support a growing CHAP in the contiguous 48 states. The grant program is designed to support the regional flexibility required for T/TO to implement a CHAP unique to the needs of their individual communities across the country through the identification of feasibility factors. The focus of the program is to.

1. Develop clinical supervisor support for primary care, behavioral health, and dental health clinicians providing both direct and indirect supervision of prospective health aides. 2.

Identify area and community-specific health care needs of patients that can be addressed by the health aides. 3. Identify and develop a technology infrastructure plan for the mobility and success of health aides in anticipation of providing services.

4. Develop a training plan to include partners across the T/TO's geographic region to enhance the training opportunities available to prospective health aides to include continuing education and clinical practice. 5.

Identify best practices for integrating a CHAP workforce into an existing Tribal health system. 6. Address social determinants of health that impact the recruitment and retention of prospective health aides.

And 7. Identify the total cost of full implementation of a CHAP within an existing Tribal health system. II.

Award Information Funding Instrument—Grant Estimated Funds Available The total funding identified for fiscal year (FY) 2021 is approximately $1,500,000. Individual award amounts are anticipated to be between $450,000 and $500,000. The funding available for competing awards issued under this announcement is subject to the availability of appropriations and budgetary priorities of the Agency.

The IHS is under no obligation to make awards that are selected for funding under this announcement. Anticipated Number of Awards Approximately three awards will be issued under this program announcement. The IHS intends to award no more than one grant per IHS area.

Period of Performance The period of performance is two years. III. Eligibility Information 1.

Eligibility To be eligible for this new FY 2021 funding opportunity, an applicant must be one of the following, as defined under 25 U.S.C. 1603. A federally recognized Indian Tribe as defined by 25 U.S.C.

1603(14). The term “Indian Tribe” means any Indian Tribe, band, nation, or other organized group or community, including any Alaska Native village or group, or regional or village corporation, as defined in or established pursuant to the Alaska Native Claims Settlement Act (85 Stat. 688) [43 U.S.C.

1601 et seq.], which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians. A Tribal organization as defined by 25 U.S.C. 1603(26).

The term “Tribal organization” has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304). €œTribal organization” means the recognized governing body of any Indian Tribe.

Any legally established organization of Indians which is controlled, sanctioned, or chartered by such governing body or which is democratically elected by the adult members of the Indian community to be served by such organization and which includes the maximum participation of Indians in all phases of its activities. Provided that, in any case where a contract is let or grant made to an organization to perform services benefiting more than one Indian Tribe, the approval of each such Indian Tribe shall be a prerequisite to the letting or making of such contract or grant. Applicant shall submit letters of support and/or Tribal Resolutions from the Tribes to be served.

An applicant may not apply to both this opportunity, TPI, and the CHAP Tribal Assessment and Planning (TAP) opportunity (number HHS-2021-IHS-TAP-0001). An organization currently carrying out a CHAP in the United States, in accordance with 25 U.S.C. 1616l through an Indian Self-Determination and Education Assistance Act (ISDEAA) agreement, is eligible to apply, but may not utilize the funds to carry out a CHAP.

The Program Office will notify any applicants deemed ineligible. Note. Please refer to Section IV.2 (Application and Submission Information/Subsection 2, Content and Form of Application Submission) for additional proof of applicant status documents required, such as Tribal Resolutions, proof of nonprofit status, etc.

2. Cost Sharing or Matching The IHS does not require matching funds or cost sharing for grants or cooperative agreements. 3.

Other Requirements Applications with budget requests that exceed the highest dollar amount outlined under Section II Award Information, Estimated Funds Available, or exceed the Period of Performance outlined under Section II Award Information, Period of Performance, will Start Printed Page 41046be considered not responsive and will not be reviewed. The Division of Grants Management (DGM) will notify the applicant. Additional Required Documentation Tribal Resolution The DGM must receive an official, signed Tribal Resolution prior to issuing a Notice of Award (NoA) to any applicant selected for funding.

An Indian Tribe or Tribal organization that is proposing a project affecting another Indian Tribe must include resolutions from all affected Tribes to be served. However, if an official, signed Tribal Resolution cannot be submitted with the application prior to the application deadline date, a draft Tribal Resolution must be submitted with the application by the deadline date in order for the application to be considered complete and eligible for review. The draft Tribal Resolution is not in lieu of the required signed resolution but is acceptable until a signed resolution is received.

If an application without a signed Tribal Resolution is selected for funding, the applicant will be contacted by the Grants Management Specialist (GMS) listed in this funding announcement and given 90 days to submit an official, signed Tribal Resolution to the GMS. If the signed Tribal Resolution is not received within 90 days, the award will be forfeited. Tribes organized with a governing structure other than a Tribal council may submit an equivalent document commensurate with their governing organization.

Proof of Nonprofit Status Organizations claiming nonprofit status must submit a current copy of the 501(c)(3) Certificate with the application. IV. Application and Submission Information 1.

Obtaining Application Materials The application package and detailed instructions for this announcement are hosted on https://www.Grants.gov. Please direct questions regarding the application process to Mr. Paul Gettys at (301) 443-2114 or (301) 443-5204.

2. Content and Form Application Submission Mandatory documents for all applicants include. Abstract (one page) summarizing the project.

Application forms. 1. SF-424, Application for Federal Assistance.

2. SF-424A, Budget Information—Non-Construction Programs. 3.

SF-424B, Assurances—Non-Construction Programs. Project Narrative (not to exceed 15 pages). See Section IV.2.A Project Narrative for instructions.

1. Background information on the organization. 2.

Proposed scope of work, objectives, and activities that provide a description of what the applicant plans to accomplish. Budget Justification and Narrative (not to exceed 5 pages). See Section IV.2.B Budget Narrative for instructions.

One-page Timeframe Chart. Tribal Resolution(s). Letters of Support from organization's Board of Directors (if applicable).

501(c)(3) Certificate. Biographical sketches for all Key Personnel. Contractor/Consultant resumes or qualifications and scope of work.

Disclosure of Lobbying Activities (SF-LLL), if applicant conducts reportable lobbying. Certification Regarding Lobbying (GG-Lobbying Form). Copy of current Negotiated Indirect Cost rate (IDC) agreement (required in order to receive IDC).

Organizational Chart (optional). Documentation of current Office of Management and Budget (OMB) Financial Audit (if applicable). Acceptable forms of documentation include.

1. Email confirmation from Federal Audit Clearinghouse (FAC) that audits were submitted. Or 2.

Face sheets from audit reports. Applicants can find these on the FAC website at https://harvester.census.gov/​facdissem/​Main.aspx. Public Policy Requirements All Federal public policies apply to IHS grants and cooperative agreements.

Pursuant to 45 CFR 80.3(d), an individual shall not be deemed subjected to discrimination by reason of their exclusion from benefits limited by Federal law to individuals eligible for benefits and services from the IHS. See https://www.hhs.gov/​grants/​grants/​grants-policies-regulations/​index.html. Requirements for Project and Budget Narratives A.

Project Narrative This narrative should be a separate document that is no more than 15 pages and must. (1) Have consecutively numbered pages. (2) use black font 12 points or larger.

(3) be single-spaced. And (4) be formatted to fit standard letter paper (81/2 x 11 inches). Be sure to succinctly answer all questions listed under the evaluation criteria (refer to Section V.1, Evaluation Criteria) and place all responses and required information in the correct section noted below or they will not be considered or scored.

If the narrative exceeds the page limit, the application will be considered not responsive and will not be reviewed. The 15-page limit for the narrative does not include the work plan, standard forms, Tribal Resolutions, budget, budget justifications, narratives, and/or other items. There are three parts to the narrative.

Part 1—Program Information. Part 2—Program Plan. And Part 3—Program Evaluation.

See below for additional details about what must be included in the narrative. The page limits below are for each narrative and budget submitted. Part 1.

Program Information (Limit—4 pages) Section 1. Community Profile Describe the demographics of the community including, but not limited to, geography, languages, age, and socioeconomic status. The community profile should include data specific to the community that would benefit from the implementation of CHAP.

Section 2. Health &. Infrastructure Needs Describe the community's current health disparities related to primary, behavioral, and oral health care.

The needs section should provide facts and evidence related to infrastructure barriers (e.g., recruitment, retention, and access to facilities). Section 3. Organizational Capacity Describe the T/TO's current health program activities, how long it has been operating, and what programs or services are currently being provided.

Describe in full the organization's infrastructure and its ability to assess the feasibility of implementing a CHAP and identifying significant barriers that could prohibit the implementation. Part 2. Program Plan (Limit—6 pages) Section 1.

Program Plan Describe in full the direction the T/TO plans to take in the CHAP TPI. The program plan should identify the plan to address Tribal infrastructure needs specific to. Clinical supervisor support and clinical operations.

Enhanced scope of work to address community and region specific needs. Training infrastructure (including continuing education).Start Printed Page 41047 Technology infrastructure. System integration.

Support to prospective health aides that address social determinants of health. Section 2. Program Activities Describe in full how the applicant will develop a robust clinical support system for the clinical supervision of providers.

The activities should also include how the applicant will correlate the community health needs to additional requirements to be included into the scope of work of health aides, a detailed plan of how to adjust the clinical operations to incorporate a CHAP, and the training plan to include continuing education for prospective health aides. Describe the resources the applicant will provide for health aides once the CHAP is operating, including technology investments to aide in mobility of providers and auxiliary supports to address critical social determinants of health. The program plan activities should also include how the applicant plans to calculate the full implementation.

Section 3. Staffing Plan Describe key staff tasked with carrying out the program activities in Section 2. Applicants are highly encouraged to partner with other key stakeholders within the T/TO's region for a robust understanding of the needs and implications of implementing a CHAP into their respective communities.

Section 4. Timeline Describe a timeline not to exceed two years for the completion of the program plan, activities, and evaluation plan. Provide a timeline chart depicting a realistic timeline that details all major activities, milestones, and applicable staffing plans.

The timeline should include the projected progress report due at the midpoint of the project period. The timeline chart should not exceed one page. Part 3.

Program Evaluation (Limit—5 pages) Section 1. Evaluation Plan Please identify and describe significant program activities and achievements associated with the delivery of quality health services. Provide a plan to provide a comparison of the actual accomplishments to the goals established for the project period, or if applicable, provide justification for the lack of progress.

The evaluation plan should address major categories related to (See Sample Logic Model in Related Documents in Grants.gov). Clinical supervision support. Enhanced scope of practice.

Training infrastructure (including continuing education). Technology needs. Integration best practices.

Auxiliary supports for prospective health aides working within the system. Calculating total implementation cost. B.

Budget Narrative (Limit—5 pages) Provide a budget narrative that explains the amounts requested for each line item of the budget from the SF-424A (Budget Information for Non-Construction Programs). The budget narrative should specifically describe how each item will support the achievement of proposed objectives. Be very careful about showing how each item in the “Other” category is justified.

For subsequent budget years (see Multi-Year Project Requirements in Section V.1. Application Review Information, Evaluation Criteria), the narrative should highlight the changes from year 1 or clearly indicate that there are no substantive budget changes during the period of performance. Do NOT use the budget narrative to expand the project narrative.

3. Submission Dates and Times Applications must be submitted through Grants.gov by 11:59 p.m. Eastern Time on the Application Deadline Date.

Any application received after the application deadline will not be accepted for review. Grants.gov will notify the applicant via email if the application is rejected. If technical challenges arise and assistance is required with the application process, contact Grants.gov Customer Support (see contact information at https://www.Grants.gov).

If problems persist, contact Mr. Paul Gettys (Paul.Gettys@ihs.gov), Acting Director, DGM, by telephone at (301) 443-2114 or (301) 443-5204. Please be sure to contact Mr.

Gettys at least ten days prior to the application deadline. Please do not contact the DGM until you have received a Grants.gov tracking number. In the event you are not able to obtain a tracking number, call the DGM as soon as possible.

The IHS will not acknowledge receipt of applications. 4. Intergovernmental Review Executive Order 12372 requiring intergovernmental review is not applicable to this program.

5. Funding Restrictions Pre-award costs are allowable up to 90 days before the start date of the award provided the costs are otherwise allowable if awarded. Pre-award costs are incurred at the risk of the applicant.

The available funds are inclusive of direct and indirect costs. Only one grant may be awarded per applicant. 6.

Electronic Submission Requirements All applications must be submitted via Grants.gov. Please use the https://www.Grants.gov website to submit an application. Find the application by selecting the “Search Grants” link on the homepage.

Follow the instructions for submitting an application under the Package tab. No other method of application submission is acceptable. If the applicant cannot submit an application through Grants.gov, a waiver must be requested.

Prior approval must be requested and obtained from Mr. Paul Gettys, Acting Director, DGM. A written waiver request must be sent to GrantsPolicy@ihs.gov with a copy to Paul.Gettys@ihs.gov.

The waiver request must be documented in writing (emails are acceptable) before submitting an application by some other method, and include clear justification for the need to deviate from the required application submission process. Once the waiver request has been approved, the applicant will receive a confirmation of approval email containing submission instructions. A copy of the written approval must be included with the application that is submitted to the DGM.

Applications that are submitted without a copy of the signed waiver from the Acting Director of the DGM will not be reviewed. The Grants Management Officer of the DGM will notify the applicant via email of this decision. Applications submitted under waiver must be received by the DGM no later than 5:00 p.m., Eastern Time, on the Application Deadline Date.

Late applications will not be accepted for processing. Applicants that do not register for both the System for Award Management (SAM) and Grants.gov and/or fail to request timely assistance with technical issues will not be considered for a waiver to submit an application via alternative method. Please be aware of the following.

Please search for the application package in https://www.Grants.gov by entering the Assistance Listing (CFDA) number or the Funding Opportunity Number. Both numbers are located in the header of this announcement. If you experience technical challenges while submitting your application, please contact Grants.gov Customer Support (see contact information at https://www.Grants.gov).Start Printed Page 41048 Upon contacting Grants.gov, obtain a tracking number as proof of contact.

The tracking number is helpful if there are technical issues that cannot be resolved and a waiver from the agency must be obtained. Applicants are strongly encouraged not to wait until the deadline date to begin the application process through Grants.gov as the registration process for SAM and Grants.gov could take up to 20 working days. Please follow the instructions on Grants.gov to include additional documentation that may be requested by this funding announcement.

Applicants must comply with any page limits described in this funding announcement. After submitting the application, the applicant will receive an automatic acknowledgment from Grants.gov that contains a Grants.gov tracking number. The IHS will not notify the applicant that the application has been received.

Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) Applicants and grantee organizations are required to obtain a DUNS number and maintain an active registration in the SAM database. The DUNS number is a unique 9-digit identification number provided by D&B that uniquely identifies each entity. The DUNS number is site specific.

Therefore, each distinct performance site may be assigned a DUNS number. Obtaining a DUNS number is easy, and there is no charge. To obtain a DUNS number, please access the request service through https://fedgov.dnb.com/​webform or call (866) 705-5711.

The Federal Funding Accountability and Transparency Act of 2006, as amended (“Transparency Act”), requires all HHS recipients to report information on sub-awards. Accordingly, all IHS grantees must notify potential first-tier sub-recipients that no entity may receive a first-tier sub-award unless the entity has provided its DUNS number to the prime grantee organization. This requirement ensures the use of a universal identifier to enhance the quality of information available to the public pursuant to the Transparency Act.

System for Award Management (SAM) Organizations that are not registered with SAM must have a DUNS number first, then access the SAM online registration through the SAM home page at https://sam.gov (U.S. Organizations will also need to provide an Employer Identification Number from the Internal Revenue Service that may take an additional 2-5 weeks to become active). Please see SAM.gov for details on the registration process and timeline.

Registration with the SAM is free of charge but can take several weeks to process. Applicants may register online at https://sam.gov. Additional information on implementing the Transparency Act, including the specific requirements for DUNS and SAM, are available on the DGM Grants Management, Policy Topics web page.

Https://www.ihs.gov/​dgm/​policytopics/​. V. Application Review Information Possible points assigned to each section are noted in parentheses.

The 15-page project narrative should include only the first year of activities. Information for multi-year projects should be included as a separate document. See “Multi-year Project Requirements” at the end of this section for more information.

The narrative section should be written in a manner that is clear to outside reviewers unfamiliar with prior related activities of the applicant. It should be well organized, succinct, and contain all information necessary for reviewers to fully understand the project. Points will be assigned to each evaluation criteria adding up to a total of 100 possible points.

Points are assigned as follows. 1. Evaluation Criteria A.

Introduction and Need for Assistance (10 points) Identify the proposed project and plans to fully implement a CHAP within their community. The needs should clearly identify the existing health system and how the CHAP will be integrated to meet the health needs of the community in the fields of behavioral, oral, and primary health care. B.

Project Objective(s), Work Plan, and Approach (30 points) The work plan should be comprised of two key parts. Program Information and Program Plan. Provide information related to three key sections.

Community profile. Health and infrastructure. And organizational capacity.

The Program Information part should demonstrate a robust community profile that highlights the existing health system, demographic data of community members and user population, and a detailed description of the T/TO carrying out the proposed activity. An acceptable Program Plan expecting to receive full points should include details of the applicants plan to address the program objective. The Program Plan should address, at a minimum, key activities related to clinical supervisor support, scope of work, technology infrastructure, training infrastructure, integration best practices, and auxiliary support to health aides that address social determinants.

C. Program Evaluation (30 points) The program evaluation should be comprised of two key sections. Evaluation plan and outcome report.

The evaluation plan should address major categories related to. Clinical supervisor support. Enhanced scope of work.

Technology infrastructure. Training infrastructure. Integration best practices.

Auxiliary support. And full implementation costs (See Sample Logic Model in Related Documents in Grants.gov). The evaluation plan should identify how the T/TO plans to fully integrate CHAP.

The evaluation should include total implementation costs based on the implementation plan and program plan identified, including any significant implementation barriers. List measurable and attainable goals with explicit timelines that detail expectation of findings. The Outcome Report should describe, in full, the findings of the program plan, evaluation, and determination on stage of readiness for implementation.

The outcome report should organize the findings into at least five of the seven categories. 1. Clinical Supervisor Support.

Technology Infrastructure. 4. Training Infrastructure.

Applicants are encouraged to identify additional categories above the seven aforementioned and may choose to develop subcategories that best fit the program plan. D. Organizational Capabilities, Key Personnel, and Qualifications (10 points) Provide a detailed biographical sketch of each member of key personnel assigned to carry out the objectives of the program plan.

The sketches should detail the qualifications and expertise of identified staff. E. Categorical Budget and Budget Justification (20 points) Provide a detailed budget of each expenditure directly related to the identified program activities.

Multi-Year Project Requirements Applications must include a brief project narrative and budget (one Start Printed Page 41049additional page per year) addressing the developmental plans for each additional year of the project. This attachment will not count as part of the project narrative or the budget narrative. Additional documents can be uploaded as Other Attachments in Grants.gov Work plan, logic model, and/or timeline for proposed objectives.

Position descriptions for key staff. Resumes of key staff that reflect current duties. Consultant or contractor proposed scope of work and letter of commitment (if applicable).

Current Indirect Cost Rate Agreement. Organizational chart. Map of area identifying project location(s).

Additional documents to support narrative (i.e., data tables, key news articles, etc.). 2. Review and Selection Each application will be prescreened for eligibility and completeness, as outlined in the funding announcement.

Applications that meet the eligibility criteria shall be reviewed for merit by the Objective Review Committee (ORC) based on evaluation criteria. Incomplete applications and applications that are not responsive to the administrative thresholds (budget limit, project period limit) will not be referred to the ORC and will not be funded. The applicant will be notified of this determination.

Applicants must address all program requirements and provide all required documentation. 3. Notifications of Disposition All applicants will receive an Executive Summary Statement from the IHS Office of Clinical and Preventive Services within 30 days of the conclusion of the ORC outlining the strengths and weaknesses of their application.

The summary statement will be sent to the Authorizing Official identified on the face page (SF-424) of the application. A. Award Notices for Funded Applications The NoA is the authorizing document for which funds are dispersed to the approved entities and reflects the amount of Federal funds awarded, the purpose of the grant, the terms and conditions of the award, the effective date of the award, and the budget/project period.

Each entity approved for funding must have a user account in GrantSolutions in order to retrieve the NoA. Please see the Agency Contacts list in Section VII for the systems contact information. B.

Approved But Unfunded Applications Approved applications not funded due to lack of available funds will be held for one year. If funding becomes available during the course of the year, the application may be reconsidered. Note.

Any correspondence other than the official NoA executed by an IHS grants management official announcing to the project director that an award has been made to their organization is not an authorization to implement their program on behalf of the IHS. VI. Award Administration Information 1.

Administrative Requirements Awards issued under this announcement are subject to, and are administered in accordance with, the following regulations and policies. A. The Criteria as Outlined in This Program Announcement B.

Administrative Regulations for Grants C. Grants Policy D. Cost Principles Uniform Administrative Requirements for HHS Awards, “Cost Principles,” at 45 CFR part 75, subpart E.

E. Audit Requirements Uniform Administrative Requirements for HHS Awards, “Audit Requirements,” at 45 CFR part 75, subpart F. F.

As of August 13, 2020, 2 CFR 200 has been updated to include a prohibition on certain telecommunications and video surveillance services or equipment. This prohibition is described in 2 CFR 200.216. This will also be described in the terms and conditions of every IHS grant and cooperative agreement awarded on or after August 13, 2020.

2. Indirect Costs This section applies to all recipients that request reimbursement of indirect costs (IDC) in their application budget. In accordance with HHS Grants Policy Statement, Part II-27, IHS requires applicants to obtain a current IDC rate agreement and submit it to the DGM prior to the DGM issuing an award.

The rate agreement must be prepared in accordance with the applicable cost principles and guidance as provided by the cognizant agency or office. A current rate covers the applicable grant activities under the current award's budget period. If the current rate agreement is not on file with the DGM at the time of award, the IDC portion of the budget will be restricted.

The restrictions remain in place until the current rate agreement is provided to the DGM. Per 45 CFR 75.414(f) Indirect (F&A) costs, “any non-Federal entity [i.e., applicant] that has never received a negotiated indirect cost rate,. .

. May elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC) which may be used indefinitely. As described in Section 75.403, costs must be consistently charged as either indirect or direct costs, but may not be double charged or inconsistently charged as both.

If chosen, this methodology once elected must be used consistently for all Federal awards until such time as the non-Federal entity chooses to negotiate for a rate, which the non-Federal entity may apply to do at any time.” Electing to charge a de minimis rate of 10 percent only applies to applicants that have never received an approved negotiated indirect cost rate from HHS or another cognizant federal agency. Applicants awaiting approval of their indirect cost proposal may request the 10 percent de minimis rate. When the applicant chooses this method, costs included in the indirect cost pool must not be charged as direct costs to the grant.

Available funds are inclusive of direct and appropriate indirect costs. Approved indirect funds are awarded as part of the award amount, and no additional funds will be provided. Generally, IDC rates for IHS grantees are negotiated with the Division of Cost Allocation (DCA) at https://rates.psc.gov/​ or the Department of the Interior (Interior Business Center) at Start Printed Page 41050 https://ibc.doi.gov/​ICS/​tribal.

For questions regarding the indirect cost policy, please call the Grants Management Specialist listed under “Agency Contacts” or the main DGM office at (301) 443-5204. 3. Reporting Requirements The grantee must submit required reports consistent with the applicable deadlines.

Failure to submit required reports within the time allowed may result in suspension or termination of an active grant, withholding of additional awards for the project, or other enforcement actions such as withholding of payments or converting to the reimbursement method of payment. Continued failure to submit required reports may result in the imposition of special award provisions and/or the non-funding or non-award of other eligible projects or activities. This requirement applies whether the delinquency is attributable to the failure of the awardee organization or the individual responsible for preparation of the reports.

Per DGM policy, all reports must be submitted electronically by attaching them as a “Grant Note” in GrantSolutions. Personnel responsible for submitting reports will be required to obtain a login and password for GrantSolutions. Please see the Agency Contacts list in Section VII for the systems contact information.

The reporting requirements for this program are noted below. A. Progress Reports Program progress reports are required semi-annually.

The progress reports are due within 30 days after the budget period ends (specific dates will be listed in the NoA Terms and Conditions). These reports must include a brief comparison of actual accomplishments to the goals established for the period, a summary of progress to date or, if applicable, provide sound justification for the lack of progress, and other pertinent information as required. A final report must be submitted within 90 days of expiration of the period of performance.

B. Financial Reports Federal Cash Transaction Reports are due 30 days after the close of every calendar quarter to the Payment Management Services at https://pms.psc.gov. Failure to submit timely reports may result in adverse award actions blocking access to funds.

Federal Financial Reports are due 30 days after the end of each budget period, and a final report is due 90 days after the end of the Period of Performance. Grantees are responsible and accountable for accurate information being reported on all required reports. The Progress Reports, the Federal Cash Transaction Report, and the Federal Financial Report.

C. Data Collection and Reporting At the conclusion of the program period, the outcome report should detail how the T/TO plans to completely integrate CHAP into their Tribal health system and list major barriers that could potentially impact full integration. The Outcome Report should describe, in full, the findings of the program plan and evaluation, and plans for implementation.

The outcome report should organize the findings of the key categories. 1. Clinical Supervisor Support.

Technology Infrastructure. 4. Training Plan.

Auxiliary Support to Address Social Determinants. Based on the findings and measurable outcomes of the categories, the applicant should explicitly identify the implementation plan and projected cost associated with full implementation. D.

Federal Sub-Award Reporting System (FSRS) This award may be subject to the Transparency Act sub-award and executive compensation reporting requirements of 2 CFR part 170. The Transparency Act requires the OMB to establish a single searchable database, accessible to the public, with information on financial assistance awards made by Federal agencies. The Transparency Act also includes a requirement for recipients of Federal grants to report information about first-tier sub-awards and executive compensation under Federal assistance awards.

IHS has implemented a Term of Award into all IHS Standard Terms and Conditions, NoAs, and funding announcements regarding the FSRS reporting requirement. This IHS Term of Award is applicable to all IHS grant and cooperative agreements issued on or after October 1, 2010, with a $25,000 sub-award obligation threshold met for any specific reporting period. For the full IHS award term implementing this requirement and additional award applicability information, visit the DGM Grants Management website at https://www.ihs.gov/​dgm/​policytopics/​.

E. Compliance With Executive Order 13166 Implementation of Services Accessibility Provisions for All Grant Application Packages and Funding Opportunity Announcements Recipients of Federal financial assistance (FFA) from HHS must administer their programs in compliance with Federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age, and, in some circumstances, religion, conscience, and sex. This includes ensuring programs are accessible to persons with limited English proficiency.

The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. Please see https://www.hhs.gov/​civil-rights/​for-providers/​provider-obligations/​index.html and http://www.hhs.gov/​ocr/​civilrights/​understanding/​section1557/​index.html. Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under Federal civil rights laws at https://www.hhs.gov/​ocr/​about-us/​contact-us/​index.html or call 1-800-368-1019 or TDD 1-800-537-7697.

F. Federal Awardee Performance and Integrity Information System (FAPIIS) The IHS is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS) at https://www.fapiis.gov before making any award in excess of the simplified acquisition threshold (currently $250,000) over the period of performance. An applicant may review and comment on any information about itself that a Federal awarding agency previously entered.

The IHS will consider any comments by the applicant, in addition to other information in FAPIIS, in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 45 CFR 75.205. As required by 45 CFR part 75, appendix XII, of the Uniform Guidance, non-Federal entities (NFEs) are required to disclose in FAPIIS any information about criminal, civil, and administrative proceedings, and/or affirm that there is no new information to provide. This applies to NFEs that receive Federal awards (currently active grants, cooperative agreements, and procurement contracts) greater than $10,000,000 for any period of time during the period of performance of an award/project.

Mandatory Disclosure Requirements As required by 2 CFR part 200 of the Uniform Guidance and the HHS implementing regulations at 45 CFR part 75, the IHS must require an NFE or an applicant for a Federal award to disclose, in a timely manner, in writing to the IHS or pass-through entity all violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award. Submission is required for all applicants and recipients, in writing, to the IHS and to the HHS Office of Inspector General, all information related to violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award. 45 CFR 75.113.

Disclosures must be sent in writing to. U.S. Department of Health and Human Services, Indian Health Service, Division of Grants Management, ATTN.

Paul Gettys, Acting Director, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, (Include “Mandatory Grant Disclosures” in subject line), Office. (301) 443-5204, Fax.

(301) 594-0899, Email. Paul.Gettys@ihs.gov. And U.S.

Department of Health and Human Services, Office of Inspector General, ATTN. Mandatory Grant Disclosures, Intake Coordinator, 330 Independence Avenue SW, Cohen Building, Room 5527, Washington, DC 20201, URL. Https://oig.hhs.gov/​fraud/​report-fraud/​, (Include “Mandatory Grant Disclosures” in subject line), Fax.

(202) 205-0604 (Include “Mandatory Grant Disclosures” in subject line) or, Email. MandatoryGranteeDisclosures@oig.hhs.gov. Failure to make required disclosures can result in any of the remedies described in 45 CFR 75.371 Remedies for noncompliance, including suspension or debarment (see 2 CFR parts 180 &.

Questions on the programmatic issues may be directed to. Minette C. Galindo, Public Health Advisor, Indian Health Service, Office of Clinical and Preventive Services, 5600 Fishers Lane, Mail Stop.

08N34A, Rockville, MD 20857, Phone. (301) 443-4644, Fax. (301) 594-6213, Email.

IHSCHAP@ihs.gov. 2. Questions on grants management and fiscal matters may be directed to.

Donald Gooding, Grants Management Specialist, Indian Health Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, Phone. (301) 443-2298, Email.

Donald.Gooding@ihs.gov. 3. Questions on systems matters may be directed to.

Paul Gettys, Acting Director, Indian Health Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, Phone. (301) 443-2114.

Or the DGM main line (301) 443-5204, email. Paul.Gettys@ihs.gov. VIII.

Other Information The Public Health Service strongly encourages all grant, cooperative agreement, and contract recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of the facility) in which regular or routine education, library, day care, health care, or early childhood development services are provided to children. This is consistent with the HHS mission to protect and advance the physical and mental health of the American people.

Start Signature Elizabeth A. Fowler, Acting Director, Indian Health Service. End Signature End Preamble [FR Doc.

2021-16283 Filed 7-29-21. 8:45 am]BILLING CODE 4165-16-PStart Preamble Announcement Type. New.

Funding Announcement Number. HHS-2021-IHS-TAP-0001. Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) Number.

93.382. Key Dates Application Deadline Date. September 6, 2021.

Earliest Anticipated Start Date. September 30, 2021. I.

Funding Opportunity Description Statutory Authority The Indian Health Service (IHS) is accepting applications for grants for the Community Health Aide Program (CHAP) Tribal Assessment and Planning (TAP) program. The CHAP is authorized under the Snyder Act, 25 U.S.C. 13.

The Transfer Act, 42 U.S.C. 2001(a). And the Indian Health Care Improvement Act, 25 U.S.C.

1616l. This grant program is described in the Assistance Listings located at https://sam.gov/​content/​home (formerly known as Catalog of Federal Domestic Assistance) under 93.382. Background The national CHAP will provide a network of health aides trained to support licensed health professionals while providing direct health care, health promotion, and disease prevention services.

These providers will work within a referral relationship under the supervision of licensed clinical providers that include clinics, service units, and hospitals. The CHAP aides will increase access to direct health services, including inpatient and outpatient visits.Start Printed Page 41052 The Alaska CHAP has become a model for efficient and high quality health care delivery in rural Alaska, providing approximately 300,000 patient encounters per year and responding to emergencies 24 hours a day, seven days a week. Specialized providers in dental and behavioral health were later introduced to respond to the needs of patients and address the health disparities in oral health and mental health among American Indian and Alaska Natives.

The national CHAP is a workforce model that includes three different provider types that act as extenders of their licensed clinical supervisor. The national CHAP currently includes a behavioral health aide, community health aide, and dental health aide. Each of the health aide categories operate in a tiered level practice system.

The national CHAP model provides an opportunity for increased access to care through the extension of primary care, dental, and behavioral health clinicians. In 2010, under the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), Congress provided the Secretary of the U.S. Department of Health and Human Services, acting through the IHS, the authority to expand the CHAP nationally.

In 2016, the IHS initiated Tribal Consultation on expanding the CHAP to the contiguous 48 states. In 2018, the IHS formed the CHAP Tribal Advisory Group (TAG) and began developing the program. In 2020, the IHS announced the national CHAP policy, which formally created the national CHAP.

Purpose The purpose of the TAP program is to support the assessment and planning of Tribes and Tribal Organizations (T/TO) in determining the feasibility of implementing CHAP in their respective communities. The program is designed to support the regional flexibility required for T/TO to design a program unique to the needs of their individual communities across the country through the identification of feasibility factors. The focus of the program is to.

1. Assess whether the T/TO can integrate CHAP into the Tribal health system, including the health care workforce. 2.

Identify systemic barriers that prohibit the complete integration of CHAP into an existing health care system. The barriers should be related to. Clinical infrastructure.

Workforce barriers. Certification of providers. Training of providers.

Inclusion of culture in the services provided by a CHAP provider. 3. Plan partnerships across the T/TO geographic region to address the barriers, including reimbursement, training, education, clinical infrastructure, implementation cost, and determination of system integration.

II. Award Information Funding Instrument—Grant Estimated Funds Available The total funding identified for fiscal year (FY) 2021 is approximately $2,340,000. Individual award amounts for the first budget year are anticipated to be between $250,000 and $260,000.

The funding available for competing and subsequent continuation awards issued under this announcement is subject to the availability of appropriations and budgetary priorities of the Agency. The IHS is under no obligation to make awards that are selected for funding under this announcement. Anticipated Number of Awards Approximately nine awards will be issued under this program announcement.

The IHS intends to award no more than one grant per IHS area. Period of Performance The period of performance is two years. III.

Eligibility Information 1. Eligibility To be eligible for this new FY 2021 funding opportunity, an applicant must be one of the following, as defined under 25 U.S.C. 1603.

A federally recognized Indian Tribe as defined by 25 U.S.C. 1603(14). The term “Indian Tribe” means any Indian Tribe, band, nation, or other organized group or community, including any Alaska Native village or group, or regional or village corporation, as defined in or established pursuant to the Alaska Native Claims Settlement Act (85 Stat.

688) [43 U.S.C. 1601 et seq.], which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians. A Tribal organization as defined by 25 U.S.C.

1603(26). The term “Tribal organization” has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).

€œTribal organization” means the recognized governing body of any Indian Tribe. Any legally established organization of Indians which is controlled, sanctioned, or chartered by such governing body or which is democratically elected by the adult members of the Indian community to be served by such organization and which includes the maximum participation of Indians in all phases of its activities. Provided that, in any case where a contract is let or grant made to an organization to perform services benefiting more than one Indian Tribe, the approval of each such Indian Tribe shall be a prerequisite to the letting or making of such contract or grant.

Applicant shall submit letters of support and/or Tribal Resolutions from the Tribes to be served. An applicant may not apply to both this opportunity, TAP, and the CHAP Tribal Planning and Implementation (TPI) opportunity (number HHS-2021-IHS-TPI-0001). An organization currently carrying out a CHAP in the United States, in accordance with 25 U.S.C.

1616l through an Indian Self-Determination and Education Assistance Act (ISDEAA) agreement, is also not eligible to apply. The Program office will notify any applicants deemed ineligible. Note.

Please refer to Section IV.2 (Application and Submission Information/Subsection 2, Content and Form of Application Submission) for additional proof of applicant status documents required, such as Tribal Resolutions, proof of nonprofit status, etc. 2. Cost Sharing or Matching The IHS does not require matching funds or cost sharing for grants or cooperative agreements.

3. Other Requirements Applications with budget requests that exceed the highest dollar amount outlined under Section II Award Information, Estimated Funds Available, or exceed the Period of Performance outlined under Section II Award Information, Period of Performance, will be considered not responsive and will not be reviewed. The Division of Grants Management (DGM) will notify the applicant.

Additional Required Documentation Tribal Resolution The DGM must receive an official, signed Tribal Resolution prior to issuing a Notice of Award (NoA) to any applicant selected for funding. An Indian Tribe or Tribal organization that is proposing a project affecting another Indian Tribe must include resolutions from all affected Tribes to be served. However, if an official, signed Tribal Resolution cannot be submitted with the application prior to the application Start Printed Page 41053deadline date, a draft Tribal Resolution must be submitted with the application by the deadline date in order for the application to be considered complete and eligible for review.

The draft Tribal Resolution is not in lieu of the required signed resolution but is acceptable until a signed resolution is received. If an application without a signed Tribal Resolution is selected for funding, the applicant will be contacted by the Grants Management Specialist (GMS) listed in this funding announcement and given 90 days to submit an official, signed Tribal Resolution to the GMS. If the signed Tribal Resolution is not received within 90 days, the award will be forfeited.

Tribes organized with a governing structure other than a Tribal council may submit an equivalent document commensurate with their governing organization. Proof of Nonprofit Status Organizations claiming nonprofit status must submit a current copy of the 501(c)(3) Certificate with the application. IV.

Application and Submission Information 1. Obtaining Application Materials The application package and detailed instructions for this announcement are hosted on https://www.Grants.gov. Please direct questions regarding the application process to Mr.

Paul Gettys at (301) 443-2114 or (301) 443-5204. 2. Content and Form Application Submission Mandatory documents for all applicants include.

Abstract (one page) summarizing the project. Application forms. 1.

SF-424, Application for Federal Assistance. 2. SF-424A, Budget Information—Non-Construction Programs.

3. SF-424B, Assurances—Non-Construction Programs. Project Narrative (not to exceed 15 pages).

See Section IV.2.A Project Narrative for instructions. 1. Background information on the organization.

2. Proposed scope of work, objectives, and activities that provide a description of what the applicant plans to accomplish. Budget Justification and Narrative (not to exceed 5 pages).

See Section IV.2.B Budget Narrative for instructions. One-page Timeframe Chart. Tribal Resolution(s).

Letters of Support from organization's Board of Directors (if applicable). 501(c)(3) Certificate. Biographical sketches for all Key Personnel.

Contractor/Consultant resumes or qualifications and scope of work. Disclosure of Lobbying Activities (SF-LLL), if applicant conducts reportable lobbying. Certification Regarding Lobbying (GG-Lobbying Form).

Copy of current Negotiated Indirect Cost rate (IDC) agreement (required in order to receive IDC). Organizational Chart (optional). Documentation of current Office of Management and Budget (OMB) Financial Audit (if applicable).

Acceptable forms of documentation include. 1. Email confirmation from Federal Audit Clearinghouse (FAC) that audits were submitted.

Or 2. Face sheets from audit reports. Applicants can find these on the FAC website at https://harvester.census.gov/​facdissem/​Main.aspx.

Public Policy Requirements All Federal public policies apply to IHS grants and cooperative agreements. Pursuant to 45 CFR 80.3(d), an individual shall not be deemed subjected to discrimination by reason of their exclusion from benefits limited by Federal law to individuals eligible for benefits and services from the IHS. See https://www.hhs.gov/​grants/​grants/​grants-policies-regulations/​index.html.

Requirements for Project and Budget Narratives A. Project Narrative This narrative should be a separate document that is no more than 15 pages and must. (1) Have consecutively numbered pages.

(2) use black font 12 points or larger. (3) be single-spaced. And (4) be formatted to fit standard letter paper (81/2 x 11 inches).

Be sure to succinctly answer all questions listed under the evaluation criteria (refer to Section V.1, Evaluation Criteria) and place all responses and required information in the correct section noted below or they will not be considered or scored. If the narrative exceeds the page limit, the application will be considered not responsive and not be reviewed. The 15-page limit for the narrative does not include the work plan, standard forms, Tribal Resolutions, budget, budget justifications, narratives, and/or other items.

There are three parts to the narrative. Part 1—Program Information. Part 2—Program Plan.

And Part 3—Program Evaluation and Outcome Report. See below for additional details about what must be included in the narrative. The page limits below are for each narrative and budget submitted.

Part 1. Program Information (Limit—4 Pages) Section 1. Community Profile Describe the demographics of the community including, but not limited to, geography, languages, age, and socioeconomic status.

The community profile should include data specific to the community that would benefit from the implementation of CHAP. Section 2. Health &.

Infrastructure Needs Describe the community's current health disparities related to primary, behavioral, and oral health care. Section 3. Organizational Capacity Describe the T/TO's current health program activities, how long it has been operating, and what programs or services are currently being provided.

Describe in full the organization's infrastructure and its ability to assess the barriers that could impact the integration of CHAP and identify significant barriers that could prohibit the implementation. Part 2. Program Plan (Limit—6 Pages) Section 1.

Program Plan Describe in full the direction the T/TO plans to take in the CHAP TAP. The program plan should first clearly identify the problems within the community related to behavioral, primary, and oral health. The program plan should then include the plan to assess the problem(s).

This should include a timeline for the assessment. The program plan should identify a timeline to determine whether CHAP can address the barriers identified. Section 2.

Program Activities Describe in full the activities to identify problems creating barriers within the community related to behavioral, primary, and oral health. These activities should be categorized (at a minimum) within key factors related to clinical infrastructure, workforce barriers, training infrastructure, and cultural inclusion. Describe in full how the applicant plans to assess the problems identified.

Finally, describe in detail the activities and associated timeline to determine whether CHAP is feasible and activities to quantify the cost associated with CHAP. The program activities should detail which partners will aid in Start Printed Page 41054identifying and assessing barriers related to clinical infrastructure, workforce barriers, training infrastructure, and cultural inclusion. Section 3.

Staffing Plan Describe key staff tasked with carrying out the program activities in Section 2. Applicants should account for potential stakeholder partnerships following the assessment of barriers in the staffing plan. Section 4.

Timeline Describe a timeline not to exceed two years for the completion of the program plan, activities, and evaluation plan. Provide a timeline chart depicting a realistic timeline that details all major activities, milestones, and applicable staffing plans. The timeline should include the projected progress report due at the midpoint of the project period.

The timeline chart should not exceed one page. Part 3. Program Evaluation &.

Outcome Report (Limit—5 Pages) Section 1. Evaluation Plan The evaluation plan should identify and describe significant program activities and achievements associated with the assessment and planning of whether CHAP can address identified barriers within the existing Tribal health system. Provide a comparison of the actual accomplishments to the goals established for the project period, or if applicable, provide justification for the lack of progress.

The evaluation plan should organize all identified problems that lead to barriers into major categories related to clinical infrastructure, workforce barriers, training infrastructure, and cultural inclusion specific to the scope of practice of prospective CHAP providers. The evaluation plan should detail how these barriers can be quantified. The evaluation plan should detail how the applicant will measure the assessment of whether CHAP can address the issues identified including number of partnerships for each major category of barriers, other factors that may impact feasibility, and sustainability.

Finally, the evaluation plan should detail how the applicant plans to calculate the total cost associated with integrating CHAP as part of the planning process. Section 2. Outcome Report At the conclusion of the program period, using the findings from the evaluation, the T/TO should determine the feasibility of implementing a CHAP within their own community.

The Outcome Report should describe in full the findings of the program plan, evaluation, and determination on stage of readiness for implementation. The outcome report should organize the findings into at least five categories. 1.

Clinical Infrastructure. 2. Workforce Barriers.

Based on the findings and measurable outcomes of the categories, the applicant should explicitly identify whether CHAP is feasible for implementation into their respective community. Applicants should develop an organized report that highlights the categories succinctly and includes data (quantitative or qualitative) from the evaluation plan. The outcome report should explicitly detail the cost associated with integrating CHAP if it is found that CHAP can address the barriers identified in the assessment phase.

B. Budget Narrative (Limit—5 Pages) Provide a budget narrative that explains the amounts requested for each line item of the budget from the SF-424A (Budget Information for Non-Construction Programs). The budget narrative should specifically describe how each item will support the achievement of proposed objectives.

Be very careful about showing how each item in the “Other” category is justified. For subsequent budget years (see Multi-Year Project Requirements in Section V.1. Application Review Information, Evaluation Criteria), the narrative should highlight the changes from year 1 or clearly indicate that there are no substantive budget changes during the period of performance.

Do NOT use the budget narrative to expand the project narrative. 3. Submission Dates and Times Applications must be submitted through Grants.gov by 11:59 p.m.

Eastern Time on the Application Deadline Date. Any application received after the application deadline will not be accepted for review. Grants.gov will notify the applicant via email if the application is rejected.

If technical challenges arise and assistance is required with the application process, contact Grants.gov Customer Support (see contact information at https://www.Grants.gov). If problems persist, contact Mr. Paul Gettys (Paul.Gettys@ihs.gov), Acting Director, DGM, by telephone at (301) 443-2114 or (301) 443-5204.

Please be sure to contact Mr. Gettys at least ten days prior to the application deadline. Please do not contact the DGM until you have received a Grants.gov tracking number.

In the event you are not able to obtain a tracking number, call the DGM as soon as possible. The IHS will not acknowledge receipt of applications. 4.

Intergovernmental Review Executive Order 12372 requiring intergovernmental review is not applicable to this program. 5. Funding Restrictions Pre-award costs are allowable up to 90 days before the start date of the award provided the costs are otherwise allowable if awarded.

Pre-award costs are incurred at the risk of the applicant. The available funds are inclusive of direct and indirect costs. Only one grant may be awarded per applicant.

6. Electronic Submission Requirements All applications must be submitted via Grants.gov. Please use the https://www.Grants.gov website to submit an application.

Find the application by selecting the “Search Grants” link on the homepage. Follow the instructions for submitting an application under the Package tab. No other method of application submission is acceptable.

If the applicant cannot submit an application through Grants.gov, a waiver must be requested. Prior approval must be requested and obtained from Mr. Paul Gettys, Acting Director, DGM.

A written waiver request must be sent to GrantsPolicy@ihs.gov with a copy to Paul.Gettys@ihs.gov. The waiver request must. (1) Be documented in writing (emails are acceptable) before submitting an application by some other method, and (2) include clear justification for the need to deviate from the required application submission process.

Once the waiver request has been approved, the applicant will receive a confirmation of approval email containing submission instructions. A copy of the written approval must be included with the application that is submitted to the DGM. Applications that are submitted without a copy of the signed waiver from the Acting Director of the DGM will not be reviewed.

The Grants Management Officer of the DGM will notify the applicant via email of this decision. Applications submitted under waiver must be received by the DGM no later than 5:00 p.m., Eastern Time, on the Application Deadline Date. Late applications will not be accepted for processing.

Applicants that do not register for both the System for Award Management (SAM) and Grants.gov and/or fail to request timely assistance with technical issues will not be Start Printed Page 41055considered for a waiver to submit an application via alternative method. Please be aware of the following. Please search for the application package in https://www.Grants.gov by entering the Assistance Listing (CFDA) number or the Funding Opportunity Number.

Both numbers are located in the header of this announcement. If you experience technical challenges while submitting your application, please contact Grants.gov Customer Support (see contact information at https://www.Grants.gov). Upon contacting Grants.gov, obtain a tracking number as proof of contact.

The tracking number is helpful if there are technical issues that cannot be resolved and a waiver from the agency must be obtained. Applicants are strongly encouraged not to wait until the deadline date to begin the application process through Grants.gov as the registration process for SAM and Grants.gov could take up to 20 working days. Please follow the instructions on Grants.gov to include additional documentation that may be requested by this funding announcement.

Applicants must comply with any page limits described in this funding announcement. After submitting the application, the applicant will receive an automatic acknowledgment from Grants.gov that contains a Grants.gov tracking number. The IHS will not notify the applicant that the application has been received.

Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) Applicants and grantee organizations are required to obtain a DUNS number and maintain an active registration in the SAM database. The DUNS number is a unique 9-digit identification number provided by D&B that uniquely identifies each entity. The DUNS number is site specific.

Therefore, each distinct performance site may be assigned a DUNS number. Obtaining a DUNS number is easy, and there is no charge. To obtain a DUNS number, please access the request service through https://fedgov.dnb.com/​webform or call (866) 705-5711.

The Federal Funding Accountability and Transparency Act of 2006, as amended (“Transparency Act”), requires all HHS recipients to report information on sub-awards. Accordingly, all IHS grantees must notify potential first-tier sub-recipients that no entity may receive a first-tier sub-award unless the entity has provided its DUNS number to the prime grantee organization. This requirement ensures the use of a universal identifier to enhance the quality of information available to the public pursuant to the Transparency Act.

System for Award Management (SAM) Organizations that are not registered with SAM must have a DUNS number first, then access the SAM online registration through the SAM home page at https://sam.gov (U.S. Organizations will also need to provide an Employer Identification Number from the Internal Revenue Service that may take an additional 2-5 weeks to become active). Please see SAM.gov for details on the registration process and timeline.

Registration with the SAM is free of charge but can take several weeks to process. Applicants may register online at https://sam.gov. Additional information on implementing the Transparency Act, including the specific requirements for DUNS and SAM, are available on the DGM Grants Management, Policy Topics web page.

Https://www.ihs.gov/​dgm/​policytopics/​. V. Application Review Information Possible points assigned to each section are noted in parentheses.

The 15-page project narrative should include only the first year of activities. Information for multi-year projects should be included as a separate document. See “Multi-year Project Requirements” at the end of this section for more information.

The narrative section should be written in a manner that is clear to outside reviewers unfamiliar with prior related activities of the applicant. It should be well organized, succinct, and contain all information necessary for reviewers to fully understand the project. Attachments requested in the criteria do not count toward the 15-page limit for the project narrative.

Points will be assigned to each evaluation criteria adding up to a total of 100 possible points. Points are assigned as follows. 1.

Evaluation Criteria A. Introduction and Need for Assistance (10 Points) Identify the proposed project and plans to identify the feasibility of implementing a CHAP within their community. The needs should clearly identify the existing health system and how the CHAP may be a viable workforce model for the community needs.

B. Project Objective(s), Work Plan, and Approach (30 Points) The work plan should be comprised of two key parts. Program Information and Program Plan.

Acceptable Program Information should provide information related to three (3) key sections. Community profile. Health and infrastructure.

And organizational capacity. The Program Information part should demonstrate a robust community profile that highlights the existing health system, demographic data of community members and user population, and a detailed description of the T/TO carrying out the proposed activity. An acceptable Program Plan should include details of the applicant's plan to address the program objective.

The Program Plan should address, at a minimum, key activities related to clinical infrastructure, workforce barriers, and training infrastructure. C. Program Evaluation (30 Points) The program evaluation should address how the applicant intends to measure major categories related to clinical infrastructure.

Workforce barriers. Training infrastructure. Cultural inclusion (See Sample Logic Model in Related Documents in Grants.gov) specific to the scope of practice of prospective CHAP providers.

And implementation costs. The evaluation plan should identify. how the applicant plans to determine the feasibility of CHAP integration into the Tribal system.

Measurement of significant systematic barriers. Implementation cost associated with CHAP. And planning for the scope of work.

The applicant may choose to develop a readiness assessment to measure the feasibility. List measurable and attainable goals with explicit timelines that detail expectation of findings. D.

Organizational Capabilities, Key Personnel, and Qualifications (10 Points) Provide a detailed biographical sketch of each member of key personnel assigned to carry out the objectives of the program plan. The sketches should detail the qualifications and expertise of identified staff. E.

Categorical Budget and Budget Justification (20 Points) Provide a detailed budget of each expenditure directly related to the identified program activities. Multi-Year Project Requirements Applications must include a brief project narrative and budget (one additional page per year) addressing the developmental plans for each additional year of the project. This attachment will Start Printed Page 41056not count as part of the project narrative or the budget narrative.

Additional documents can be uploaded as Other Attachments in Grants.gov. Work plan, logic model, and/or timeline for proposed objectives. Position descriptions for key staff.

Resumes of key staff that reflect current duties. Consultant or contractor proposed scope of work and letter of commitment (if applicable). Current Indirect Cost Rate Agreement.

Organizational chart. Map of area identifying project location(s). Additional documents to support narrative (i.e., data tables, key news articles, etc.).

2. Review and Selection Each application will be prescreened for eligibility and completeness, as outlined in the funding announcement. Applications that meet the eligibility criteria shall be reviewed for merit by the Objective Review Committee (ORC) based on evaluation criteria.

Incomplete applications and applications that are not responsive to the administrative thresholds (budget limit, project period limit) will not be referred to the ORC and will not be funded. The applicant will be notified of this determination. Applicants must address all program requirements and provide all required documentation.

3. Notifications of Disposition All applicants will receive an Executive Summary Statement from the IHS Office of Clinical and Preventive Services within 30 days of the conclusion of the ORC outlining the strengths and weaknesses of their application. The summary statement will be sent to the Authorizing Official identified on the face page (SF-424) of the application.

A. Award Notices for Funded Applications The NoA is the authorizing document for which funds are dispersed to the approved entities and reflects the amount of Federal funds awarded, the purpose of the grant, the terms and conditions of the award, the effective date of the award, and the budget/project period. Each entity approved for funding must have a user account in GrantSolutions in order to retrieve the NoA.

Please see the Agency Contacts list in Section VII for the systems contact information. B. Approved but Unfunded Applications Approved applications not funded due to lack of available funds will be held for one year.

If funding becomes available during the course of the year, the application may be reconsidered. Note. Any correspondence other than the official NoA executed by an IHS grants management official announcing to the project director that an award has been made to their organization is not an authorization to implement their program on behalf of the IHS.

VI. Award Administration Information 1. Administrative Requirements Awards issued under this announcement are subject to, and are administered in accordance with, the following regulations and policies.

A. The Criteria as Outlined in This Program Announcement B. Administrative Regulations for Grants C.

Grants Policy D. Cost Principles Uniform Administrative Requirements for HHS Awards, “Cost Principles,” at 45 CFR part 75, subpart E. E.

Audit Requirements Uniform Administrative Requirements for HHS Awards, “Audit Requirements,” at 45 CFR part 75, subpart F. F. As of August 13, 2020, 2 CFR 200 was updated to include a prohibition on certain telecommunications and video surveillance services or equipment.

This prohibition is described in 2 CFR 200.216. This will also be described in the terms and conditions of every IHS grant and cooperative agreement awarded on or after August 13, 2020. 2.

Indirect Costs This section applies to all recipients that request reimbursement of indirect costs (IDC) in their application budget. In accordance with HHS Grants Policy Statement, Part II-27, IHS requires applicants to obtain a current IDC rate agreement and submit it to the DGM prior to the DGM issuing an award. The rate agreement must be prepared in accordance with the applicable cost principles and guidance as provided by the cognizant agency or office.

A current rate covers the applicable grant activities under the current award's budget period. If the current rate agreement is not on file with the DGM at the time of award, the IDC portion of the budget will be restricted. The restrictions remain in place until the current rate agreement is provided to the DGM.

Per 45 CFR 75.414(f) Indirect (F&A) costs, “any non-Federal entity [i.e., applicant] that has never received a negotiated indirect cost rate,. . .

May elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC) which may be used indefinitely. As described in Section 75.403, costs must be consistently charged as either indirect or direct costs, but may not be double charged or inconsistently charged as both. If chosen, this methodology once elected must be used consistently for all Federal awards until such time as the non-Federal entity chooses to negotiate for a rate, which the non-Federal entity may apply to do at any time.” Electing to charge a de minimis rate of 10 percent only applies to applicants that have never received an approved negotiated indirect cost rate from HHS or another cognizant federal agency.

Applicants awaiting approval of their indirect cost proposal may request the 10 percent de minimis rate. When the applicant chooses this method, costs included in the indirect cost pool must not be charged as direct costs to the grant. Available funds are inclusive of direct and appropriate indirect costs.

Approved indirect funds are awarded as part of the award amount, and no additional funds will be provided. Generally, IDC rates for IHS grantees are negotiated with the Division of Cost Allocation (DCA) at https://rates.psc.gov/​ or the Department of the Interior (Interior Business Center) at https://ibc.doi.gov/​ICS/​tribal. For Start Printed Page 41057questions regarding the indirect cost policy, please call the Grants Management Specialist listed under “Agency Contacts” or the main DGM office at (301) 443-5204.

3. Reporting Requirements The grantee must submit required reports consistent with the applicable deadlines. Failure to submit required reports within the time allowed may result in suspension or termination of an active grant, withholding of additional awards for the project, or other enforcement actions such as withholding of payments or converting to the reimbursement method of payment.

Continued failure to submit required reports may result in the imposition of special award provisions and/or the non-funding or non-award of other eligible projects or activities. This requirement applies whether the delinquency is attributable to the failure of the awardee organization or the individual responsible for preparation of the reports. Per DGM policy, all reports must be submitted electronically by attaching them as a “Grant Note” in GrantSolutions.

Personnel responsible for submitting reports will be required to obtain a login and password for GrantSolutions. Please see the Agency Contacts list in Section VII for the systems contact information. The reporting requirements for this program are noted below.

A. Progress Reports Program progress reports are required semi-annually. The progress reports are due within 30 days after the budget period ends (specific dates will be listed in the NoA Terms and Conditions).

These reports must include a brief comparison of actual accomplishments to the goals established for the period, a summary of progress to date or, if applicable, provide sound justification for the lack of progress, and other pertinent information as required. A final report must be submitted within 90 days of expiration of the period of performance. B.

Financial Reports Federal Cash Transaction Reports are due 30 days after the close of every calendar quarter to the Payment Management Services at https://pms.psc.gov. Failure to submit timely reports may result in adverse award actions blocking access to funds. Federal Financial Reports are due 30 days after the end of each budget period, and a final report is due 90 days after the end of the Period of Performance.

Grantees are responsible and accountable for accurate information being reported on all required reports. The Progress Reports and Federal Financial Report. C.

Data Collection and Reporting To satisfy the reporting requirements, the applicant is expected to develop an outcome report. The outcome report should explicitly state whether CHAP implementation and integration into the existing health care system is viable or not. The Outcome Report should describe, in full, the findings of the program plan, evaluation, and determination on stage of readiness for implementation.

The outcome report should organize the findings into at least five categories. 1. Clinical Infrastructure.

Training Infrastructure. 4. Cultural Inclusion.

5. Implementation Cost. Applicants are encouraged to identify additional categories above the five aforementioned and may choose to develop subcategories that best fit the program plan.

D. Federal Sub-Award Reporting System (FSRS) This award may be subject to the Transparency Act sub-award and executive compensation reporting requirements of 2 CFR part 170. The Transparency Act requires the OMB to establish a single searchable database, accessible to the public, with information on financial assistance awards made by Federal agencies.

The Transparency Act also includes a requirement for recipients of Federal grants to report information about first-tier sub-awards and executive compensation under Federal assistance awards. IHS has implemented a Term of Award into all IHS Standard Terms and Conditions, NoAs, and funding announcements regarding the FSRS reporting requirement. This IHS Term of Award is applicable to all IHS grant and cooperative agreements issued on or after October 1, 2010, with a $25,000 sub-award obligation threshold met for any specific reporting period.

For the full IHS award term implementing this requirement and additional award applicability information, visit the DGM Grants Management website at https://www.ihs.gov/​dgm/​policytopics/​. E. Compliance With Executive Order 13166 Implementation of Services Accessibility Provisions for All Grant Application Packages and Funding Opportunity Announcements Recipients of Federal financial assistance (FFA) from HHS must administer their programs in compliance with Federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age, and, in some circumstances, religion, conscience, and sex.

This includes ensuring programs are accessible to persons with limited English proficiency. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. Please see https://www.hhs.gov/​civil-rights/​for-providers/​provider-obligations/​index.html and http://www.hhs.gov/​ocr/​civilrights/​understanding/​section1557/​index.html.

Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under Federal civil rights laws at https://www.hhs.gov/​ocr/​about-us/​contact-us/​index.html or call 1-800-368-1019 or TDD 1-800-537-7697. F. Federal Awardee Performance and Integrity Information System (FAPIIS) The IHS is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS), at https://www.fapiis.gov, before making any award in excess of the simplified acquisition threshold (currently $250,000) over the period of performance.

An applicant may review and comment on any information about itself that a Federal awarding agency previously entered. IHS will consider any comments by the applicant, in addition to other information in FAPIIS, in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 45 CFR 75.205. As required by 45 CFR part 75, appendix XII, of the Uniform Guidance, non-Federal entities (NFEs) are required to disclose in FAPIIS any information about criminal, civil, and administrative proceedings, and/or affirm that there is no new information to provide.

This applies to NFEs that receive Federal awards (currently active grants, cooperative agreements, and procurement contracts) greater than $10,000,000 for any period of time during the period of performance of an award/project. Mandatory Disclosure Requirements As required by 2 CFR part 200 of the Uniform Guidance and the HHS implementing regulations at 45 CFR part 75, the IHS must require an NFE or an applicant for a Federal award to disclose, in a timely manner, in writing to the IHS or pass-through entity all violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award. Submission is required for all applicants and recipients, in writing, to the IHS and to the HHS Office of Inspector General of all information related to violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award.

45 CFR 75.113. Disclosures must be sent in writing to. U.S.

Department of Health and Human Services, Indian Health Service, Division of Grants Management, ATTN. Paul Gettys, Acting Director, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857 (Include “Mandatory Grant Disclosures” in subject line), Office.

(301) 443-5204, Fax. (301) 594-0899, Email. Paul.Gettys@ihs.gov.

And U.S. Department of Health and Human Services, Office of Inspector General, ATTN. Mandatory Grant Disclosures, Intake Coordinator, 330 Independence Avenue SW, Cohen Building, Room 5527, Washington, DC 20201, URL.

Https://oig.hhs.gov/​fraud/​report-fraud/​ (Include “Mandatory Grant Disclosures” in subject line), Fax. (202) 205-0604 (Include “Mandatory Grant Disclosures” in subject line) or Email. MandatoryGranteeDisclosures@oig.hhs.gov.

Failure to make required disclosures can result in any of the remedies described in 45 CFR 75.371 Remedies for noncompliance, including suspension or debarment (see 2 CFR parts 180 &. 376). VII.

Agency Contacts 1. Questions on the programmatic issues may be directed to. Minette C.

Galindo, Public Health Advisor, Indian Health Service, Office of Clinical and Preventive Services, 5600 Fishers Lane, Mail Stop. 08N34A, Rockville, MD 20857, Phone. (301) 443-4644, Email.

IHSCHAP@ihs.gov. 2. Questions on grants management and fiscal matters may be directed to.

Donald Gooding, Grants Management Specialist, Indian Health Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, Phone. (301) 443-2298, Email.

Donald.Gooding@ihs.gov. 3. Questions on systems matters may be directed to.

Paul Gettys, Acting Director, Indian Health Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, Phone. (301) 443-2114.

Or the DGM main line (301) 443-5204, Email. Paul.Gettys@ihs.gov. VIII.

Other Information The Public Health Service strongly encourages all grant, cooperative agreement and contract recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of the facility) in which regular or routine education, library, day care, health care, or early childhood development services are provided to children. This is consistent with the HHS mission to protect and advance the physical and mental health of the American people.

Start Signature Elizabeth A. Fowler, Acting Director, Indian Health Service. End Signature End Preamble [FR Doc.

2021-16280 Filed 7-29-21. 8:45 am]BILLING CODE 4165-16-P.

Start Preamble best prices on viagra and cialis Buy kamagra without a prescription Announcement Type. New. Funding Announcement Number best prices on viagra and cialis. HHS-2021-IHS-TPI-0001.

Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) Number. 93.382. Key Dates Application Deadline Date. September 1, 2021.

Earliest Anticipated Start Date. September 30, 2021. I. Funding Opportunity Description Statutory Authority The Indian Health Service (IHS) is accepting applications for grants for the Community Health Aide Program (CHAP) Tribal Planning and Implementation (TPI) program.

The CHAP is authorized under the Snyder Act, 25 U.S.C. 13. The Transfer Act, 42 U.S.C. 2001(a).

And the Indian Health Care Improvement Act, 25 U.S.C. 16161. This grant program is described in the Assistance Listings located at https://beta.sam.gov (formerly known as Catalog of Federal Domestic Assistance) under 93.382. Background The national CHAP will provide a network of health aides trained to support licensed health professionals while providing direct health care, Start Printed Page 41045health promotion, and disease prevention services.

These providers will work within a referral relationship under the supervision of licensed clinical providers that includes clinics, service units, and hospitals. The program will increase access to direct health services, including inpatient and outpatient visits. The Alaska CHAP has become a model for efficient and high quality health care delivery in rural Alaska, providing approximately 300,000 patient encounters per year and responding to emergencies 24 hours a day, seven days a week. Specialized providers in dental and behavioral health were later introduced to respond to the needs of patients and address the health disparities in oral health and mental health among American Indians and Alaska Natives.

The national CHAP is a workforce model that includes three different provider types that act as extenders of their licensed clinical supervisor. The national CHAP currently includes a behavioral health aide, community health aide, and dental health aide. Each of the health aide categories operate in a tiered level practice system. The national CHAP model provides an opportunity for increased access to care through the extension of primary care, dental, and behavioral health clinicians.

In 2010, under the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), Congress provided the Secretary of the U.S. Department of Health and Human Services, acting through the IHS, the authority to expand the Alaska CHAP program. In 2016, the IHS initiated Tribal Consultation on expanding the CHAP to the contiguous 48 states. In 2018, the IHS formed the CHAP Tribal Advisory Group (TAG) and began developing the program.

In 2020, the IHS announced the national CHAP policy, which formally created the national CHAP. Purpose The purpose of the TPI program is to support the planning and implementation for Tribes and Tribal Organizations (T/TO) positioned to begin operating a CHAP or support a growing CHAP in the contiguous 48 states. The grant program is designed to support the regional flexibility required for T/TO to implement a CHAP unique to the needs of their individual communities across the country through the identification of feasibility factors. The focus of the program is to.

1. Develop clinical supervisor support for primary care, behavioral health, and dental health clinicians providing both direct and indirect supervision of prospective health aides. 2. Identify area and community-specific health care needs of patients that can be addressed by the health aides.

3. Identify and develop a technology infrastructure plan for the mobility and success of health aides in anticipation of providing services. 4. Develop a training plan to include partners across the T/TO's geographic region to enhance the training opportunities available to prospective health aides to include continuing education and clinical practice.

5. Identify best practices for integrating a CHAP workforce into an existing Tribal health system. 6. Address social determinants of health that impact the recruitment and retention of prospective health aides.

And 7. Identify the total cost of full implementation of a CHAP within an existing Tribal health system. II. Award Information Funding Instrument—Grant Estimated Funds Available The total funding identified for fiscal year (FY) 2021 is approximately $1,500,000.

Individual award amounts are anticipated to be between $450,000 and $500,000. The funding available for competing awards issued under this announcement is subject to the availability of appropriations and budgetary priorities of the Agency. The IHS is under no obligation to make awards that are selected for funding under this announcement. Anticipated Number of Awards Approximately three awards will be issued under this program announcement.

The IHS intends to award no more than one grant per IHS area. Period of Performance The period of performance is two years. III. Eligibility Information 1.

Eligibility To be eligible for this new FY 2021 funding opportunity, an applicant must be one of the following, as defined under 25 U.S.C. 1603. A federally recognized Indian Tribe as defined by 25 U.S.C. 1603(14).

The term “Indian Tribe” means any Indian Tribe, band, nation, or other organized group or community, including any Alaska Native village or group, or regional or village corporation, as defined in or established pursuant to the Alaska Native Claims Settlement Act (85 Stat. 688) [43 U.S.C. 1601 et seq.], which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians. A Tribal organization as defined by 25 U.S.C.

1603(26). The term “Tribal organization” has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304). €œTribal organization” means the recognized governing body of any Indian Tribe.

Any legally established organization of Indians which is controlled, sanctioned, or chartered by such governing body or which is democratically elected by the adult members of the Indian community to be served by such organization and which includes the maximum participation of Indians in all phases of its activities. Provided that, in any case where a contract is let or grant made to an organization to perform services benefiting more than one Indian Tribe, the approval of each such Indian Tribe shall be a prerequisite to the letting or making of such contract or grant. Applicant shall submit letters of support and/or Tribal Resolutions from the Tribes to be served. An applicant may not apply to both this opportunity, TPI, and the CHAP Tribal Assessment and Planning (TAP) opportunity (number HHS-2021-IHS-TAP-0001).

An organization currently carrying out a CHAP in the United States, in accordance with 25 U.S.C. 1616l through an Indian Self-Determination and Education Assistance Act (ISDEAA) agreement, is eligible to apply, but may not utilize the funds to carry out a CHAP. The Program Office will notify any applicants deemed ineligible. Note.

Please refer to Section IV.2 (Application and Submission Information/Subsection 2, Content and Form of Application Submission) for additional proof of applicant status documents required, such as Tribal Resolutions, proof of nonprofit status, etc. 2. Cost Sharing or Matching The IHS does not require matching funds or cost sharing for grants or cooperative agreements. 3.

Other Requirements Applications with budget requests that exceed the highest dollar amount outlined under Section II Award Information, Estimated Funds Available, or exceed the Period of Performance outlined under Section II Award Information, Period of Performance, will Start Printed Page 41046be considered not responsive and will not be reviewed. The Division of Grants Management (DGM) will notify the applicant. Additional Required Documentation Tribal Resolution The DGM must receive an official, signed Tribal Resolution prior to issuing a Notice of Award (NoA) to any applicant selected for funding. An Indian Tribe or Tribal organization that is proposing a project affecting another Indian Tribe must include resolutions from all affected Tribes to be served.

However, if an official, signed Tribal Resolution cannot be submitted with the application prior to the application deadline date, a draft Tribal Resolution must be submitted with the application by the deadline date in order for the application to be considered complete and eligible for review. The draft Tribal Resolution is not in lieu of the required signed resolution but is acceptable until a signed resolution is received. If an application without a signed Tribal Resolution is selected for funding, the applicant will be contacted by the Grants Management Specialist (GMS) listed in this funding announcement and given 90 days to submit an official, signed Tribal Resolution to the GMS. If the signed Tribal Resolution is not received within 90 days, the award will be forfeited.

Tribes organized with a governing structure other than a Tribal council may submit an equivalent document commensurate with their governing organization. Proof of Nonprofit Status Organizations claiming nonprofit status must submit a current copy of the 501(c)(3) Certificate with the application. IV. Application and Submission Information 1.

Obtaining Application Materials The application package and detailed instructions for this announcement are hosted on https://www.Grants.gov. Please direct questions regarding the application process to Mr. Paul Gettys at (301) 443-2114 or (301) 443-5204. 2.

Content and Form Application Submission Mandatory documents for all applicants include. Abstract (one page) summarizing the project. Application forms. 1.

SF-424, Application for Federal Assistance. 2. SF-424A, Budget Information—Non-Construction Programs. 3.

SF-424B, Assurances—Non-Construction Programs. Project Narrative (not to exceed 15 pages). See Section IV.2.A Project Narrative for instructions. 1.

Background information on the organization. 2. Proposed scope of work, objectives, and activities that provide a description of what the applicant plans to accomplish. Budget Justification and Narrative (not to exceed 5 pages).

See Section IV.2.B Budget Narrative for instructions. One-page Timeframe Chart. Tribal Resolution(s). Letters of Support from organization's Board of Directors (if applicable).

501(c)(3) Certificate. Biographical sketches for all Key Personnel. Contractor/Consultant resumes or qualifications and scope of work. Disclosure of Lobbying Activities (SF-LLL), if applicant conducts reportable lobbying.

Certification Regarding Lobbying (GG-Lobbying Form). Copy of current Negotiated Indirect Cost rate (IDC) agreement (required in order to receive IDC). Organizational Chart (optional). Documentation of current Office of Management and Budget (OMB) Financial Audit (if applicable).

Acceptable forms of documentation include. 1. Email confirmation from Federal Audit Clearinghouse (FAC) that audits were submitted. Or 2.

Face sheets from audit reports. Applicants can find these on the FAC website at https://harvester.census.gov/​facdissem/​Main.aspx. Public Policy Requirements All Federal public policies apply to IHS grants and cooperative agreements. Pursuant to 45 CFR 80.3(d), an individual shall not be deemed subjected to discrimination by reason of their exclusion from benefits limited by Federal law to individuals eligible for benefits and services from the IHS.

See https://www.hhs.gov/​grants/​grants/​grants-policies-regulations/​index.html. Requirements for Project and Budget Narratives A. Project Narrative This narrative should be a separate document that is no more than 15 pages and must. (1) Have consecutively numbered pages.

(2) use black font 12 points or larger. (3) be single-spaced. And (4) be formatted to fit standard letter paper (81/2 x 11 inches). Be sure to succinctly answer all questions listed under the evaluation criteria (refer to Section V.1, Evaluation Criteria) and place all responses and required information in the correct section noted below or they will not be considered or scored.

If the narrative exceeds the page limit, the application will be considered not responsive and will not be reviewed. The 15-page limit for the narrative does not include the work plan, standard forms, Tribal Resolutions, budget, budget justifications, narratives, and/or other items. There are three parts to the narrative. Part 1—Program Information.

Part 2—Program Plan. And Part 3—Program Evaluation. See below for additional details about what must be included in the narrative. The page limits below are for each narrative and budget submitted.

Part 1. Program Information (Limit—4 pages) Section 1. Community Profile Describe the demographics of the community including, but not limited to, geography, languages, age, and socioeconomic status. The community profile should include data specific to the community that would benefit from the implementation of CHAP.

Section 2. Health &. Infrastructure Needs Describe the community's current health disparities related to primary, behavioral, and oral health care. The needs section should provide facts and evidence related to infrastructure barriers (e.g., recruitment, retention, and access to facilities).

Section 3. Organizational Capacity Describe the T/TO's current health program activities, how long it has been operating, and what programs or services are currently being provided. Describe in full the organization's infrastructure and its ability to assess the feasibility of implementing a CHAP and identifying significant barriers that could prohibit the implementation. Part 2.

Program Plan (Limit—6 pages) Section 1. Program Plan Describe in full the direction the T/TO plans to take in the CHAP TPI. The program plan should identify the plan to address Tribal infrastructure needs specific to. Clinical supervisor support and clinical operations.

Enhanced scope of work to address community and region specific needs. Training infrastructure (including continuing education).Start Printed Page 41047 Technology infrastructure. System integration. Support to prospective health aides that address social determinants of health.

Section 2. Program Activities Describe in full how the applicant will develop a robust clinical support system for the clinical supervision of providers. The activities should also include how the applicant will correlate the community health needs to additional requirements to be included into the scope of work of health aides, a detailed plan of how to adjust the clinical operations to incorporate a CHAP, and the training plan to include continuing education for prospective health aides. Describe the resources the applicant will provide for health aides once the CHAP is operating, including technology investments to aide in mobility of providers and auxiliary supports to address critical social determinants of health.

The program plan activities should also include how the applicant plans to calculate the full implementation. Section 3. Staffing Plan Describe key staff tasked with carrying out the program activities in Section 2. Applicants are highly encouraged to partner with other key stakeholders within the T/TO's region for a robust understanding of the needs and implications of implementing a CHAP into their respective communities.

Section 4. Timeline Describe a timeline not to exceed two years for the completion of the program plan, activities, and evaluation plan. Provide a timeline chart depicting a realistic timeline that details all major activities, milestones, and applicable staffing plans. The timeline should include the projected progress report due at the midpoint of the project period.

The timeline chart should not exceed one page. Part 3. Program Evaluation (Limit—5 pages) Section 1. Evaluation Plan Please identify and describe significant program activities and achievements associated with the delivery of quality health services.

Provide a plan to provide a comparison of the actual accomplishments to the goals established for the project period, or if applicable, provide justification for the lack of progress. The evaluation plan should address major categories related to (See Sample Logic Model in Related Documents in Grants.gov). Clinical supervision support. Enhanced scope of practice.

Training infrastructure (including continuing education). Technology needs. Integration best practices. Auxiliary supports for prospective health aides working within the system.

Calculating total implementation cost. B. Budget Narrative (Limit—5 pages) Provide a budget narrative that explains the amounts requested for each line item of the budget from the SF-424A (Budget Information for Non-Construction Programs). The budget narrative should specifically describe how each item will support the achievement of proposed objectives.

Be very careful about showing how each item in the “Other” category is justified. For subsequent budget years (see Multi-Year Project Requirements in Section V.1. Application Review Information, Evaluation Criteria), the narrative should highlight the changes from year 1 or clearly indicate that there are no substantive budget changes during the period of performance. Do NOT use the budget narrative to expand the project narrative.

3. Submission Dates and Times Applications must be submitted through Grants.gov by 11:59 p.m. Eastern Time on the Application Deadline Date. Any application received after the application deadline will not be accepted for review.

Grants.gov will notify the applicant via email if the application is rejected. If technical challenges arise and assistance is required with the application process, contact Grants.gov Customer Support (see contact information at https://www.Grants.gov). If problems persist, contact Mr. Paul Gettys (Paul.Gettys@ihs.gov), Acting Director, DGM, by telephone at (301) 443-2114 or (301) 443-5204.

Please be sure to contact Mr. Gettys at least ten days prior to the application deadline. Please do not contact the DGM until you have received a Grants.gov tracking number. In the event you are not able to obtain a tracking number, call the DGM as soon as possible.

The IHS will not acknowledge receipt of applications. 4. Intergovernmental Review Executive Order 12372 requiring intergovernmental review is not applicable to this program. 5.

Funding Restrictions Pre-award costs are allowable up to 90 days before the start date of the award provided the costs are otherwise allowable if awarded. Pre-award costs are incurred at the risk of the applicant. The available funds are inclusive of direct and indirect costs. Only one grant may be awarded per applicant.

6. Electronic Submission Requirements All applications must be submitted via Grants.gov. Please use the https://www.Grants.gov website to submit an application. Find the application by selecting the “Search Grants” link on the homepage.

Follow the instructions for submitting an application under the Package tab. No other method of application submission is acceptable. If the applicant cannot submit an application through Grants.gov, a waiver must be requested. Prior approval must be requested and obtained from Mr.

Paul Gettys, Acting Director, DGM. A written waiver request must be sent to GrantsPolicy@ihs.gov with a copy to Paul.Gettys@ihs.gov. The waiver request must be documented in writing (emails are acceptable) before submitting an application by some other method, and include clear justification for the need to deviate from the required application submission process. Once the waiver request has been approved, the applicant will receive a confirmation of approval email containing submission instructions.

A copy of the written approval must be included with the application that is submitted to the DGM. Applications that are submitted without a copy of the signed waiver from the Acting Director of the DGM will not be reviewed. The Grants Management Officer of the DGM will notify the applicant via email of this decision. Applications submitted under waiver must be received by the DGM no later than 5:00 p.m., Eastern Time, on the Application Deadline Date.

Late applications will not be accepted for processing. Applicants that do not register for both the System for Award Management (SAM) and Grants.gov and/or fail to request timely assistance with technical issues will not be considered for a waiver to submit an application via alternative method. Please be aware of the following. Please search for the application package in https://www.Grants.gov by entering the Assistance Listing (CFDA) number or the Funding Opportunity Number.

Both numbers are located in the header of this announcement. If you experience technical challenges while submitting your application, please contact Grants.gov Customer Support (see contact information at https://www.Grants.gov).Start Printed Page 41048 Upon contacting Grants.gov, obtain a tracking number as proof of contact. The tracking number is helpful if there are technical issues that cannot be resolved and a waiver from the agency must be obtained. Applicants are strongly encouraged not to wait until the deadline date to begin the application process through Grants.gov as the registration process for SAM and Grants.gov could take up to 20 working days.

Please follow the instructions on Grants.gov to include additional documentation that may be requested by this funding announcement. Applicants must comply with any page limits described in this funding announcement. After submitting the application, the applicant will receive an automatic acknowledgment from Grants.gov that contains a Grants.gov tracking number. The IHS will not notify the applicant that the application has been received.

Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) Applicants and grantee organizations are required to obtain a DUNS number and maintain an active registration in the SAM database. The DUNS number is a unique 9-digit identification number provided by D&B that uniquely identifies each entity. The DUNS number is site specific. Therefore, each distinct performance site may be assigned a DUNS number.

Obtaining a DUNS number is easy, and there is no charge. To obtain a DUNS number, please access the request service through https://fedgov.dnb.com/​webform or call (866) 705-5711. The Federal Funding Accountability and Transparency Act of 2006, as amended (“Transparency Act”), requires all HHS recipients to report information on sub-awards. Accordingly, all IHS grantees must notify potential first-tier sub-recipients that no entity may receive a first-tier sub-award unless the entity has provided its DUNS number to the prime grantee organization.

This requirement ensures the use of a universal identifier to enhance the quality of information available to the public pursuant to the Transparency Act. System for Award Management (SAM) Organizations that are not registered with SAM must have a DUNS number first, then access the SAM online registration through the SAM home page at https://sam.gov (U.S. Organizations will also need to provide an Employer Identification Number from the Internal Revenue Service that may take an additional 2-5 weeks to become active). Please see SAM.gov for details on the registration process and timeline.

Registration with the SAM is free of charge but can take several weeks to process. Applicants may register online at https://sam.gov. Additional information on implementing the Transparency Act, including the specific requirements for DUNS and SAM, are available on the DGM Grants Management, Policy Topics web page. Https://www.ihs.gov/​dgm/​policytopics/​.

V. Application Review Information Possible points assigned to each section are noted in parentheses. The 15-page project narrative should include only the first year of activities. Information for multi-year projects should be included as a separate document.

See “Multi-year Project Requirements” at the end of this section for more information. The narrative section should be written in a manner that is clear to outside reviewers unfamiliar with prior related activities of the applicant. It should be well organized, succinct, and contain all information necessary for reviewers to fully understand the project. Points will be assigned to each evaluation criteria adding up to a total of 100 possible points.

Points are assigned as follows. 1. Evaluation Criteria A. Introduction and Need for Assistance (10 points) Identify the proposed project and plans to fully implement a CHAP within their community.

The needs should clearly identify the existing health system and how the CHAP will be integrated to meet the health needs of the community in the fields of behavioral, oral, and primary health care. B. Project Objective(s), Work Plan, and Approach (30 points) The work plan should be comprised of two key parts. Program Information and Program Plan.

Provide information related to three key sections. Community profile. Health and infrastructure. And organizational capacity.

The Program Information part should demonstrate a robust community profile that highlights the existing health system, demographic data of community members and user population, and a detailed description of the T/TO carrying out the proposed activity. An acceptable Program Plan expecting to receive full points should include details of the applicants plan to address the program objective. The Program Plan should address, at a minimum, key activities related to clinical supervisor support, scope of work, technology infrastructure, training infrastructure, integration best practices, and auxiliary support to health aides that address social determinants. C.

Program Evaluation (30 points) The program evaluation should be comprised of two key sections. Evaluation plan and outcome report. The evaluation plan should address major categories related to. Clinical supervisor support.

Enhanced scope of work. Technology infrastructure. Training infrastructure. Integration best practices.

Auxiliary support. And full implementation costs (See Sample Logic Model in Related Documents in Grants.gov). The evaluation plan should identify how the T/TO plans to fully integrate CHAP. The evaluation should include total implementation costs based on the implementation plan and program plan identified, including any significant implementation barriers.

List measurable and attainable goals with explicit timelines that detail expectation of findings. The Outcome Report should describe, in full, the findings of the program plan, evaluation, and determination on stage of readiness for implementation. The outcome report should organize the findings into at least five of the seven categories. 1.

Clinical Supervisor Support. 2. Scope of Work. 3.

Technology Infrastructure. 4. Training Infrastructure. 5.

Integration Planning. 6. Auxiliary Support. 7.

Implementation Cost. Applicants are encouraged to identify additional categories above the seven aforementioned and may choose to develop subcategories that best fit the program plan. D. Organizational Capabilities, Key Personnel, and Qualifications (10 points) Provide a detailed biographical sketch of each member of key personnel assigned to carry out the objectives of the program plan.

The sketches should detail the qualifications and expertise of identified staff. E. Categorical Budget and Budget Justification (20 points) Provide a detailed budget of each expenditure directly related to the identified program activities. Multi-Year Project Requirements Applications must include a brief project narrative and budget (one Start Printed Page 41049additional page per year) addressing the developmental plans for each additional year of the project.

This attachment will not count as part of the project narrative or the budget narrative. Additional documents can be uploaded as Other Attachments in Grants.gov Work plan, logic model, and/or timeline for proposed objectives. Position descriptions for key staff. Resumes of key staff that reflect current duties.

Consultant or contractor proposed scope of work and letter of commitment (if applicable). Current Indirect Cost Rate Agreement. Organizational chart. Map of area identifying project location(s).

Additional documents to support narrative (i.e., data tables, key news articles, etc.). 2. Review and Selection Each application will be prescreened for eligibility and completeness, as outlined in the funding announcement. Applications that meet the eligibility criteria shall be reviewed for merit by the Objective Review Committee (ORC) based on evaluation criteria.

Incomplete applications and applications that are not responsive to the administrative thresholds (budget limit, project period limit) will not be referred to the ORC and will not be funded. The applicant will be notified of this determination. Applicants must address all program requirements and provide all required documentation. 3.

Notifications of Disposition All applicants will receive an Executive Summary Statement from the IHS Office of Clinical and Preventive Services within 30 days of the conclusion of the ORC outlining the strengths and weaknesses of their application. The summary statement will be sent to the Authorizing Official identified on the face page (SF-424) of the application. A. Award Notices for Funded Applications The NoA is the authorizing document for which funds are dispersed to the approved entities and reflects the amount of Federal funds awarded, the purpose of the grant, the terms and conditions of the award, the effective date of the award, and the budget/project period.

Each entity approved for funding must have a user account in GrantSolutions in order to retrieve the NoA. Please see the Agency Contacts list in Section VII for the systems contact information. B. Approved But Unfunded Applications Approved applications not funded due to lack of available funds will be held for one year.

If funding becomes available during the course of the year, the application may be reconsidered. Note. Any correspondence other than the official NoA executed by an IHS grants management official announcing to the project director that an award has been made to their organization is not an authorization to implement their program on behalf of the IHS. VI.

Award Administration Information 1. Administrative Requirements Awards issued under this announcement are subject to, and are administered in accordance with, the following regulations and policies. A. The Criteria as Outlined in This Program Announcement B.

Administrative Regulations for Grants C. Grants Policy D. Cost Principles Uniform Administrative Requirements for HHS Awards, “Cost Principles,” at 45 CFR part 75, subpart E. E.

Audit Requirements Uniform Administrative Requirements for HHS Awards, “Audit Requirements,” at 45 CFR part 75, subpart F. F. As of August 13, 2020, 2 CFR 200 has been updated to include a prohibition on certain telecommunications and video surveillance services or equipment. This prohibition is described in 2 CFR 200.216.

This will also be described in the terms and conditions of every IHS grant and cooperative agreement awarded on or after August 13, 2020. 2. Indirect Costs This section applies to all recipients that request reimbursement of indirect costs (IDC) in their application budget. In accordance with HHS Grants Policy Statement, Part II-27, IHS requires applicants to obtain a current IDC rate agreement and submit it to the DGM prior to the DGM issuing an award.

The rate agreement must be prepared in accordance with the applicable cost principles and guidance as provided by the cognizant agency or office. A current rate covers the applicable grant activities under the current award's budget period. If the current rate agreement is not on file with the DGM at the time of award, the IDC portion of the budget will be restricted. The restrictions remain in place until the current rate agreement is provided to the DGM.

Per 45 CFR 75.414(f) Indirect (F&A) costs, “any non-Federal entity [i.e., applicant] that has never received a negotiated indirect cost rate,. . . May elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC) which may be used indefinitely.

As described in Section 75.403, costs must be consistently charged as either indirect or direct costs, but may not be double charged or inconsistently charged as both. If chosen, this methodology once elected must be used consistently for all Federal awards until such time as the non-Federal entity chooses to negotiate for a rate, which the non-Federal entity may apply to do at any time.” Electing to charge a de minimis rate of 10 percent only applies to applicants that have never received an approved negotiated indirect cost rate from HHS or another cognizant federal agency. Applicants awaiting approval of their indirect cost proposal may request the 10 percent de minimis rate. When the applicant chooses this method, costs included in the indirect cost pool must not be charged as direct costs to the grant.

Available funds are inclusive of direct and appropriate indirect costs. Approved indirect funds are awarded as part of the award amount, and no additional funds will be provided. Generally, IDC rates for IHS grantees are negotiated with the Division of Cost Allocation (DCA) at https://rates.psc.gov/​ or the Department of the Interior (Interior Business Center) at Start Printed Page 41050 https://ibc.doi.gov/​ICS/​tribal. For questions regarding the indirect cost policy, please call the Grants Management Specialist listed under “Agency Contacts” or the main DGM office at (301) 443-5204.

3. Reporting Requirements The grantee must submit required reports consistent with the applicable deadlines. Failure to submit required reports within the time allowed may result in suspension or termination of an active grant, withholding of additional awards for the project, or other enforcement actions such as withholding of payments or converting to the reimbursement method of payment. Continued failure to submit required reports may result in the imposition of special award provisions and/or the non-funding or non-award of other eligible projects or activities.

This requirement applies whether the delinquency is attributable to the failure of the awardee organization or the individual responsible for preparation of the reports. Per DGM policy, all reports must be submitted electronically by attaching them as a “Grant Note” in GrantSolutions. Personnel responsible for submitting reports will be required to obtain a login and password for GrantSolutions. Please see the Agency Contacts list in Section VII for the systems contact information.

The reporting requirements for this program are noted below. A. Progress Reports Program progress reports are required semi-annually. The progress reports are due within 30 days after the budget period ends (specific dates will be listed in the NoA Terms and Conditions).

These reports must include a brief comparison of actual accomplishments to the goals established for the period, a summary of progress to date or, if applicable, provide sound justification for the lack of progress, and other pertinent information as required. A final report must be submitted within 90 days of expiration of the period of performance. B. Financial Reports Federal Cash Transaction Reports are due 30 days after the close of every calendar quarter to the Payment Management Services at https://pms.psc.gov.

Failure to submit timely reports may result in adverse award actions blocking access to funds. Federal Financial Reports are due 30 days after the end of each budget period, and a final report is due 90 days after the end of the Period of Performance. Grantees are responsible and accountable for accurate information being reported on all required reports. The Progress Reports, the Federal Cash Transaction Report, and the Federal Financial Report.

C. Data Collection and Reporting At the conclusion of the program period, the outcome report should detail how the T/TO plans to completely integrate CHAP into their Tribal health system and list major barriers that could potentially impact full integration. The Outcome Report should describe, in full, the findings of the program plan and evaluation, and plans for implementation. The outcome report should organize the findings of the key categories.

1. Clinical Supervisor Support. 2. Scope of Practice.

3. Technology Infrastructure. 4. Training Plan.

5. System Integration. 6. Auxiliary Support to Address Social Determinants.

Based on the findings and measurable outcomes of the categories, the applicant should explicitly identify the implementation plan and projected cost associated with full implementation. D. Federal Sub-Award Reporting System (FSRS) This award may be subject to the Transparency Act sub-award and executive compensation reporting requirements of 2 CFR part 170. The Transparency Act requires the OMB to establish a single searchable database, accessible to the public, with information on financial assistance awards made by Federal agencies.

The Transparency Act also includes a requirement for recipients of Federal grants to report information about first-tier sub-awards and executive compensation under Federal assistance awards. IHS has implemented a Term of Award into all IHS Standard Terms and Conditions, NoAs, and funding announcements regarding the FSRS reporting requirement. This IHS Term of Award is applicable to all IHS grant and cooperative agreements issued on or after October 1, 2010, with a $25,000 sub-award obligation threshold met for any specific reporting period. For the full IHS award term implementing this requirement and additional award applicability information, visit the DGM Grants Management website at https://www.ihs.gov/​dgm/​policytopics/​.

E. Compliance With Executive Order 13166 Implementation of Services Accessibility Provisions for All Grant Application Packages and Funding Opportunity Announcements Recipients of Federal financial assistance (FFA) from HHS must administer their programs in compliance with Federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age, and, in some circumstances, religion, conscience, and sex. This includes ensuring programs are accessible to persons with limited English proficiency. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS.

Please see https://www.hhs.gov/​civil-rights/​for-providers/​provider-obligations/​index.html and http://www.hhs.gov/​ocr/​civilrights/​understanding/​section1557/​index.html. Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under Federal civil rights laws at https://www.hhs.gov/​ocr/​about-us/​contact-us/​index.html or call 1-800-368-1019 or TDD 1-800-537-7697. F. Federal Awardee Performance and Integrity Information System (FAPIIS) The IHS is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS) at https://www.fapiis.gov before making any award in excess of the simplified acquisition threshold (currently $250,000) over the period of performance.

An applicant may review and comment on any information about itself that a Federal awarding agency previously entered. The IHS will consider any comments by the applicant, in addition to other information in FAPIIS, in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 45 CFR 75.205. As required by 45 CFR part 75, appendix XII, of the Uniform Guidance, non-Federal entities (NFEs) are required to disclose in FAPIIS any information about criminal, civil, and administrative proceedings, and/or affirm that there is no new information to provide. This applies to NFEs that receive Federal awards (currently active grants, cooperative agreements, and procurement contracts) greater than $10,000,000 for any period of time during the period of performance of an award/project.

Mandatory Disclosure Requirements As required by 2 CFR part 200 of the Uniform Guidance and the HHS implementing regulations at 45 CFR part 75, the IHS must require an NFE or an applicant for a Federal award to disclose, in a timely manner, in writing to the IHS or pass-through entity all violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award. Submission is required for all applicants and recipients, in writing, to the IHS and to the HHS Office of Inspector General, all information related to violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award. 45 CFR 75.113. Disclosures must be sent in writing to.

U.S. Department of Health and Human Services, Indian Health Service, Division of Grants Management, ATTN. Paul Gettys, Acting Director, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, (Include “Mandatory Grant Disclosures” in subject line), Office.

(301) 443-5204, Fax. (301) 594-0899, Email. Paul.Gettys@ihs.gov. And U.S.

Department of Health and Human Services, Office of Inspector General, ATTN. Mandatory Grant Disclosures, Intake Coordinator, 330 Independence Avenue SW, Cohen Building, Room 5527, Washington, DC 20201, URL. Https://oig.hhs.gov/​fraud/​report-fraud/​, (Include “Mandatory Grant Disclosures” in subject line), Fax. (202) 205-0604 (Include “Mandatory Grant Disclosures” in subject line) or, Email.

MandatoryGranteeDisclosures@oig.hhs.gov. Failure to make required disclosures can result in any of the remedies described in 45 CFR 75.371 Remedies for noncompliance, including suspension or debarment (see 2 CFR parts 180 &. 376). VII.

Agency Contacts 1. Questions on the programmatic issues may be directed to. Minette C. Galindo, Public Health Advisor, Indian Health Service, Office of Clinical and Preventive Services, 5600 Fishers Lane, Mail Stop.

08N34A, Rockville, MD 20857, Phone. (301) 443-4644, Fax. (301) 594-6213, Email. IHSCHAP@ihs.gov.

2. Questions on grants management and fiscal matters may be directed to. Donald Gooding, Grants Management Specialist, Indian Health Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, Phone.

(301) 443-2298, Email. Donald.Gooding@ihs.gov. 3. Questions on systems matters may be directed to.

Paul Gettys, Acting Director, Indian Health Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, Phone. (301) 443-2114. Or the DGM main line (301) 443-5204, email.

Paul.Gettys@ihs.gov. VIII. Other Information The Public Health Service strongly encourages all grant, cooperative agreement, and contract recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of the facility) in which regular or routine education, library, day care, health care, or early childhood development services are provided to children.

This is consistent with the HHS mission to protect and advance the physical and mental health of the American people. Start Signature Elizabeth A. Fowler, Acting Director, Indian Health Service. End Signature End Preamble [FR Doc.

2021-16283 Filed 7-29-21. 8:45 am]BILLING CODE 4165-16-PStart Preamble Announcement Type. New. Funding Announcement Number.

HHS-2021-IHS-TAP-0001. Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) Number. 93.382. Key Dates Application Deadline Date.

September 6, 2021. Earliest Anticipated Start Date. September 30, 2021. I.

Funding Opportunity Description Statutory Authority The Indian Health Service (IHS) is accepting applications for grants for the Community Health Aide Program (CHAP) Tribal Assessment and Planning (TAP) program. The CHAP is authorized under the Snyder Act, 25 U.S.C. 13. The Transfer Act, 42 U.S.C.

2001(a). And the Indian Health Care Improvement Act, 25 U.S.C. 1616l. This grant program is described in the Assistance Listings located at https://sam.gov/​content/​home (formerly known as Catalog of Federal Domestic Assistance) under 93.382.

Background The national CHAP will provide a network of health aides trained to support licensed health professionals while providing direct health care, health promotion, and disease prevention services. These providers will work within a referral relationship under the supervision of licensed clinical providers that include clinics, service units, and hospitals. The CHAP aides will increase access to direct health services, including inpatient and outpatient visits.Start Printed Page 41052 The Alaska CHAP has become a model for efficient and high quality health care delivery in rural Alaska, providing approximately 300,000 patient encounters per year and responding to emergencies 24 hours a day, seven days a week. Specialized providers in dental and behavioral health were later introduced to respond to the needs of patients and address the health disparities in oral health and mental health among American Indian and Alaska Natives.

The national CHAP is a workforce model that includes three different provider types that act as extenders of their licensed clinical supervisor. The national CHAP currently includes a behavioral health aide, community health aide, and dental health aide. Each of the health aide categories operate in a tiered level practice system. The national CHAP model provides an opportunity for increased access to care through the extension of primary care, dental, and behavioral health clinicians.

In 2010, under the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), Congress provided the Secretary of the U.S. Department of Health and Human Services, acting through the IHS, the authority to expand the CHAP nationally. In 2016, the IHS initiated Tribal Consultation on expanding the CHAP to the contiguous 48 states. In 2018, the IHS formed the CHAP Tribal Advisory Group (TAG) and began developing the program.

In 2020, the IHS announced the national CHAP policy, which formally created the national CHAP. Purpose The purpose of the TAP program is to support the assessment and planning of Tribes and Tribal Organizations (T/TO) in determining the feasibility of implementing CHAP in their respective communities. The program is designed to support the regional flexibility required for T/TO to design a program unique to the needs of their individual communities across the country through the identification of feasibility factors. The focus of the program is to.

1. Assess whether the T/TO can integrate CHAP into the Tribal health system, including the health care workforce. 2. Identify systemic barriers that prohibit the complete integration of CHAP into an existing health care system.

The barriers should be related to. Clinical infrastructure. Workforce barriers. Certification of providers.

Training of providers. Inclusion of culture in the services provided by a CHAP provider. 3. Plan partnerships across the T/TO geographic region to address the barriers, including reimbursement, training, education, clinical infrastructure, implementation cost, and determination of system integration.

II. Award Information Funding Instrument—Grant Estimated Funds Available The total funding identified for fiscal year (FY) 2021 is approximately $2,340,000. Individual award amounts for the first budget year are anticipated to be between $250,000 and $260,000. The funding available for competing and subsequent continuation awards issued under this announcement is subject to the availability of appropriations and budgetary priorities of the Agency.

The IHS is under no obligation to make awards that are selected for funding under this announcement. Anticipated Number of Awards Approximately nine awards will be issued under this program announcement. The IHS intends to award no more than one grant per IHS area. Period of Performance The period of performance is two years.

III. Eligibility Information 1. Eligibility To be eligible for this new FY 2021 funding opportunity, an applicant must be one of the following, as defined under 25 U.S.C. 1603.

A federally recognized Indian Tribe as defined by 25 U.S.C. 1603(14). The term “Indian Tribe” means any Indian Tribe, band, nation, or other organized group or community, including any Alaska Native village or group, or regional or village corporation, as defined in or established pursuant to the Alaska Native Claims Settlement Act (85 Stat. 688) [43 U.S.C.

1601 et seq.], which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians. A Tribal organization as defined by 25 U.S.C. 1603(26). The term “Tribal organization” has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C.

5304). €œTribal organization” means the recognized governing body of any Indian Tribe. Any legally established organization of Indians which is controlled, sanctioned, or chartered by such governing body or which is democratically elected by the adult members of the Indian community to be served by such organization and which includes the maximum participation of Indians in all phases of its activities. Provided that, in any case where a contract is let or grant made to an organization to perform services benefiting more than one Indian Tribe, the approval of each such Indian Tribe shall be a prerequisite to the letting or making of such contract or grant.

Applicant shall submit letters of support and/or Tribal Resolutions from the Tribes to be served. An applicant may not apply to both this opportunity, TAP, and the CHAP Tribal Planning and Implementation (TPI) opportunity (number HHS-2021-IHS-TPI-0001). An organization currently carrying out a CHAP in the United States, in accordance with 25 U.S.C. 1616l through an Indian Self-Determination and Education Assistance Act (ISDEAA) agreement, is also not eligible to apply.

The Program office will notify any applicants deemed ineligible. Note. Please refer to Section IV.2 (Application and Submission Information/Subsection 2, Content and Form of Application Submission) for additional proof of applicant status documents required, such as Tribal Resolutions, proof of nonprofit status, etc. 2.

Cost Sharing or Matching The IHS does not require matching funds or cost sharing for grants or cooperative agreements. 3. Other Requirements Applications with budget requests that exceed the highest dollar amount outlined under Section II Award Information, Estimated Funds Available, or exceed the Period of Performance outlined under Section II Award Information, Period of Performance, will be considered not responsive and will not be reviewed. The Division of Grants Management (DGM) will notify the applicant.

Additional Required Documentation Tribal Resolution The DGM must receive an official, signed Tribal Resolution prior to issuing a Notice of Award (NoA) to any applicant selected for funding. An Indian Tribe or Tribal organization that is proposing a project affecting another Indian Tribe must include resolutions from all affected Tribes to be served. However, if an official, signed Tribal Resolution cannot be submitted with the application prior to the application Start Printed Page 41053deadline date, a draft Tribal Resolution must be submitted with the application by the deadline date in order for the application to be considered complete and eligible for review. The draft Tribal Resolution is not in lieu of the required signed resolution but is acceptable until a signed resolution is received.

If an application without a signed Tribal Resolution is selected for funding, the applicant will be contacted by the Grants Management Specialist (GMS) listed in this funding announcement and given 90 days to submit an official, signed Tribal Resolution to the GMS. If the signed Tribal Resolution is not received within 90 days, the award will be forfeited. Tribes organized with a governing structure other than a Tribal council may submit an equivalent document commensurate with their governing organization. Proof of Nonprofit Status Organizations claiming nonprofit status must submit a current copy of the 501(c)(3) Certificate with the application.

IV. Application and Submission Information 1. Obtaining Application Materials The application package and detailed instructions for this announcement are hosted on https://www.Grants.gov. Please direct questions regarding the application process to Mr.

Paul Gettys at (301) 443-2114 or (301) 443-5204. 2. Content and Form Application Submission Mandatory documents for all applicants include. Abstract (one page) summarizing the project.

Application forms. 1. SF-424, Application for Federal Assistance. 2.

SF-424A, Budget Information—Non-Construction Programs. 3. SF-424B, Assurances—Non-Construction Programs. Project Narrative (not to exceed 15 pages).

See Section IV.2.A Project Narrative for instructions. 1. Background information on the organization. 2.

Proposed scope of work, objectives, and activities that provide a description of what the applicant plans to accomplish. Budget Justification and Narrative (not to exceed 5 pages). See Section IV.2.B Budget Narrative for instructions. One-page Timeframe Chart.

Tribal Resolution(s). Letters of Support from organization's Board of Directors (if applicable). 501(c)(3) Certificate. Biographical sketches for all Key Personnel.

Contractor/Consultant resumes or qualifications and scope of work. Disclosure of Lobbying Activities (SF-LLL), if applicant conducts reportable lobbying. Certification Regarding Lobbying (GG-Lobbying Form). Copy of current Negotiated Indirect Cost rate (IDC) agreement (required in order to receive IDC).

Organizational Chart (optional). Documentation of current Office of Management and Budget (OMB) Financial Audit (if applicable). Acceptable forms of documentation include. 1.

Email confirmation from Federal Audit Clearinghouse (FAC) that audits were submitted. Or 2. Face sheets from audit reports. Applicants can find these on the FAC website at https://harvester.census.gov/​facdissem/​Main.aspx.

Public Policy Requirements All Federal public policies apply to IHS grants and cooperative agreements. Pursuant to 45 CFR 80.3(d), an individual shall not be deemed subjected to discrimination by reason of their exclusion from benefits limited by Federal law to individuals eligible for benefits and services from the IHS. See https://www.hhs.gov/​grants/​grants/​grants-policies-regulations/​index.html. Requirements for Project and Budget Narratives A.

Project Narrative This narrative should be a separate document that is no more than 15 pages and must. (1) Have consecutively numbered pages. (2) use black font 12 points or larger. (3) be single-spaced.

And (4) be formatted to fit standard letter paper (81/2 x 11 inches). Be sure to succinctly answer all questions listed under the evaluation criteria (refer to Section V.1, Evaluation Criteria) and place all responses and required information in the correct section noted below or they will not be considered or scored. If the narrative exceeds the page limit, the application will be considered not responsive and not be reviewed. The 15-page limit for the narrative does not include the work plan, standard forms, Tribal Resolutions, budget, budget justifications, narratives, and/or other items.

There are three parts to the narrative. Part 1—Program Information. Part 2—Program Plan. And Part 3—Program Evaluation and Outcome Report.

See below for additional details about what must be included in the narrative. The page limits below are for each narrative and budget submitted. Part 1. Program Information (Limit—4 Pages) Section 1.

Community Profile Describe the demographics of the community including, but not limited to, geography, languages, age, and socioeconomic status. The community profile should include data specific to the community that would benefit from the implementation of CHAP. Section 2. Health &.

Infrastructure Needs Describe the community's current health disparities related to primary, behavioral, and oral health care. Section 3. Organizational Capacity Describe the T/TO's current health program activities, how long it has been operating, and what programs or services are currently being provided. Describe in full the organization's infrastructure and its ability to assess the barriers that could impact the integration of CHAP and identify significant barriers that could prohibit the implementation.

Part 2. Program Plan (Limit—6 Pages) Section 1. Program Plan Describe in full the direction the T/TO plans to take in the CHAP TAP. The program plan should first clearly identify the problems within the community related to behavioral, primary, and oral health.

The program plan should then include the plan to assess the problem(s). This should include a timeline for the assessment. The program plan should identify a timeline to determine whether CHAP can address the barriers identified. Section 2.

Program Activities Describe in full the activities to identify problems creating barriers within the community related to behavioral, primary, and oral health. These activities should be categorized (at a minimum) within key factors related to clinical infrastructure, workforce barriers, training infrastructure, and cultural inclusion. Describe in full how the applicant plans to assess the problems identified. Finally, describe in detail the activities and associated timeline to determine whether CHAP is feasible and activities to quantify the cost associated with CHAP.

The program activities should detail which partners will aid in Start Printed Page 41054identifying and assessing barriers related to clinical infrastructure, workforce barriers, training infrastructure, and cultural inclusion. Section 3. Staffing Plan Describe key staff tasked with carrying out the program activities in Section 2. Applicants should account for potential stakeholder partnerships following the assessment of barriers in the staffing plan.

Section 4. Timeline Describe a timeline not to exceed two years for the completion of the program plan, activities, and evaluation plan. Provide a timeline chart depicting a realistic timeline that details all major activities, milestones, and applicable staffing plans. The timeline should include the projected progress report due at the midpoint of the project period.

The timeline chart should not exceed one page. Part 3. Program Evaluation &. Outcome Report (Limit—5 Pages) Section 1.

Evaluation Plan The evaluation plan should identify and describe significant program activities and achievements associated with the assessment and planning of whether CHAP can address identified barriers within the existing Tribal health system. Provide a comparison of the actual accomplishments to the goals established for the project period, or if applicable, provide justification for the lack of progress. The evaluation plan should organize all identified problems that lead to barriers into major categories related to clinical infrastructure, workforce barriers, training infrastructure, and cultural inclusion specific to the scope of practice of prospective CHAP providers. The evaluation plan should detail how these barriers can be quantified.

The evaluation plan should detail how the applicant will measure the assessment of whether CHAP can address the issues identified including number of partnerships for each major category of barriers, other factors that may impact feasibility, and sustainability. Finally, the evaluation plan should detail how the applicant plans to calculate the total cost associated with integrating CHAP as part of the planning process. Section 2. Outcome Report At the conclusion of the program period, using the findings from the evaluation, the T/TO should determine the feasibility of implementing a CHAP within their own community.

The Outcome Report should describe in full the findings of the program plan, evaluation, and determination on stage of readiness for implementation. The outcome report should organize the findings into at least five categories. 1. Clinical Infrastructure.

2. Workforce Barriers. 3. Training Infrastructure.

4. Cultural Inclusion. 5. Implementation Cost.

Based on the findings and measurable outcomes of the categories, the applicant should explicitly identify whether CHAP is feasible for implementation into their respective community. Applicants should develop an organized report that highlights the categories succinctly and includes data (quantitative or qualitative) from the evaluation plan. The outcome report should explicitly detail the cost associated with integrating CHAP if it is found that CHAP can address the barriers identified in the assessment phase. B.

Budget Narrative (Limit—5 Pages) Provide a budget narrative that explains the amounts requested for each line item of the budget from the SF-424A (Budget Information for Non-Construction Programs). The budget narrative should specifically describe how each item will support the achievement of proposed objectives. Be very careful about showing how each item in the “Other” category is justified. For subsequent budget years (see Multi-Year Project Requirements in Section V.1.

Application Review Information, Evaluation Criteria), the narrative should highlight the changes from year 1 or clearly indicate that there are no substantive budget changes during the period of performance. Do NOT use the budget narrative to expand the project narrative. 3. Submission Dates and Times Applications must be submitted through Grants.gov by 11:59 p.m.

Eastern Time on the Application Deadline Date. Any application received after the application deadline will not be accepted for review. Grants.gov will notify the applicant via email if the application is rejected. If technical challenges arise and assistance is required with the application process, contact Grants.gov Customer Support (see contact information at https://www.Grants.gov).

If problems persist, contact Mr. Paul Gettys (Paul.Gettys@ihs.gov), Acting Director, DGM, by telephone at (301) 443-2114 or (301) 443-5204. Please be sure to contact Mr. Gettys at least ten days prior to the application deadline.

Please do not contact the DGM until you have received a Grants.gov tracking number. In the event you are not able to obtain a tracking number, call the DGM as soon as possible. The IHS will not acknowledge receipt of applications. 4.

Intergovernmental Review Executive Order 12372 requiring intergovernmental review is not applicable to this program. 5. Funding Restrictions Pre-award costs are allowable up to 90 days before the start date of the award provided the costs are otherwise allowable if awarded. Pre-award costs are incurred at the risk of the applicant.

The available funds are inclusive of direct and indirect costs. Only one grant may be awarded per applicant. 6. Electronic Submission Requirements All applications must be submitted via Grants.gov.

Please use the https://www.Grants.gov website to submit an application. Find the application by selecting the “Search Grants” link on the homepage. Follow the instructions for submitting an application under the Package tab. No other method of application submission is acceptable.

If the applicant cannot submit an application through Grants.gov, a waiver must be requested. Prior approval must be requested and obtained from Mr. Paul Gettys, Acting Director, DGM. A written waiver request must be sent to GrantsPolicy@ihs.gov with a copy to Paul.Gettys@ihs.gov.

The waiver request must. (1) Be documented in writing (emails are acceptable) before submitting an application by some other method, and (2) include clear justification for the need to deviate from the required application submission process. Once the waiver request has been approved, the applicant will receive a confirmation of approval email containing submission instructions. A copy of the written approval must be included with the application that is submitted to the DGM.

Applications that are submitted without a copy of the signed waiver from the Acting Director of the DGM will not be reviewed. The Grants Management Officer of the DGM will notify the applicant via email of this decision. Applications submitted under waiver must be received by the DGM no later than 5:00 p.m., Eastern Time, on the Application Deadline Date. Late applications will not be accepted for processing.

Applicants that do not register for both the System for Award Management (SAM) and Grants.gov and/or fail to request timely assistance with technical issues will not be Start Printed Page 41055considered for a waiver to submit an application via alternative method. Please be aware of the following. Please search for the application package in https://www.Grants.gov by entering the Assistance Listing (CFDA) number or the Funding Opportunity Number. Both numbers are located in the header of this announcement.

If you experience technical challenges while submitting your application, please contact Grants.gov Customer Support (see contact information at https://www.Grants.gov). Upon contacting Grants.gov, obtain a tracking number as proof of contact. The tracking number is helpful if there are technical issues that cannot be resolved and a waiver from the agency must be obtained. Applicants are strongly encouraged not to wait until the deadline date to begin the application process through Grants.gov as the registration process for SAM and Grants.gov could take up to 20 working days.

Please follow the instructions on Grants.gov to include additional documentation that may be requested by this funding announcement. Applicants must comply with any page limits described in this funding announcement. After submitting the application, the applicant will receive an automatic acknowledgment from Grants.gov that contains a Grants.gov tracking number. The IHS will not notify the applicant that the application has been received.

Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) Applicants and grantee organizations are required to obtain a DUNS number and maintain an active registration in the SAM database. The DUNS number is a unique 9-digit identification number provided by D&B that uniquely identifies each entity. The DUNS number is site specific. Therefore, each distinct performance site may be assigned a DUNS number.

Obtaining a DUNS number is easy, and there is no charge. To obtain a DUNS number, please access the request service through https://fedgov.dnb.com/​webform or call (866) 705-5711. The Federal Funding Accountability and Transparency Act of 2006, as amended (“Transparency Act”), requires all HHS recipients to report information on sub-awards. Accordingly, all IHS grantees must notify potential first-tier sub-recipients that no entity may receive a first-tier sub-award unless the entity has provided its DUNS number to the prime grantee organization.

This requirement ensures the use of a universal identifier to enhance the quality of information available to the public pursuant to the Transparency Act. System for Award Management (SAM) Organizations that are not registered with SAM must have a DUNS number first, then access the SAM online registration through the SAM home page at https://sam.gov (U.S. Organizations will also need to provide an Employer Identification Number from the Internal Revenue Service that may take an additional 2-5 weeks to become active). Please see SAM.gov for details on the registration process and timeline.

Registration with the SAM is free of charge but can take several weeks to process. Applicants may register online at https://sam.gov. Additional information on implementing the Transparency Act, including the specific requirements for DUNS and SAM, are available on the DGM Grants Management, Policy Topics web page. Https://www.ihs.gov/​dgm/​policytopics/​.

V. Application Review Information Possible points assigned to each section are noted in parentheses. The 15-page project narrative should include only the first year of activities. Information for multi-year projects should be included as a separate document.

See “Multi-year Project Requirements” at the end of this section for more information. The narrative section should be written in a manner that is clear to outside reviewers unfamiliar with prior related activities of the applicant. It should be well organized, succinct, and contain all information necessary for reviewers to fully understand the project. Attachments requested in the criteria do not count toward the 15-page limit for the project narrative.

Points will be assigned to each evaluation criteria adding up to a total of 100 possible points. Points are assigned as follows. 1. Evaluation Criteria A.

Introduction and Need for Assistance (10 Points) Identify the proposed project and plans to identify the feasibility of implementing a CHAP within their community. The needs should clearly identify the existing health system and how the CHAP may be a viable workforce model for the community needs. B. Project Objective(s), Work Plan, and Approach (30 Points) The work plan should be comprised of two key parts.

Program Information and Program Plan. Acceptable Program Information should provide information related to three (3) key sections. Community profile. Health and infrastructure.

And organizational capacity. The Program Information part should demonstrate a robust community profile that highlights the existing health system, demographic data of community members and user population, and a detailed description of the T/TO carrying out the proposed activity. An acceptable Program Plan should include details of the applicant's plan to address the program objective. The Program Plan should address, at a minimum, key activities related to clinical infrastructure, workforce barriers, and training infrastructure.

C. Program Evaluation (30 Points) The program evaluation should address how the applicant intends to measure major categories related to clinical infrastructure. Workforce barriers. Training infrastructure.

Cultural inclusion (See Sample Logic Model in Related Documents in Grants.gov) specific to the scope of practice of prospective CHAP providers. And implementation costs. The evaluation plan should identify. how the applicant plans to determine the feasibility of CHAP integration into the Tribal system.

Measurement of significant systematic barriers. Implementation cost associated with CHAP. And planning for the scope of work. The applicant may choose to develop a readiness assessment to measure the feasibility.

List measurable and attainable goals with explicit timelines that detail expectation of findings. D. Organizational Capabilities, Key Personnel, and Qualifications (10 Points) Provide a detailed biographical sketch of each member of key personnel assigned to carry out the objectives of the program plan. The sketches should detail the qualifications and expertise of identified staff.

E. Categorical Budget and Budget Justification (20 Points) Provide a detailed budget of each expenditure directly related to the identified program activities. Multi-Year Project Requirements Applications must include a brief project narrative and budget (one additional page per year) addressing the developmental plans for each additional year of the project. This attachment will Start Printed Page 41056not count as part of the project narrative or the budget narrative.

Additional documents can be uploaded as Other Attachments in Grants.gov. Work plan, logic model, and/or timeline for proposed objectives. Position descriptions for key staff. Resumes of key staff that reflect current duties.

Consultant or contractor proposed scope of work and letter of commitment (if applicable). Current Indirect Cost Rate Agreement. Organizational chart. Map of area identifying project location(s).

Additional documents to support narrative (i.e., data tables, key news articles, etc.). 2. Review and Selection Each application will be prescreened for eligibility and completeness, as outlined in the funding announcement. Applications that meet the eligibility criteria shall be reviewed for merit by the Objective Review Committee (ORC) based on evaluation criteria.

Incomplete applications and applications that are not responsive to the administrative thresholds (budget limit, project period limit) will not be referred to the ORC and will not be funded. The applicant will be notified of this determination. Applicants must address all program requirements and provide all required documentation. 3.

Notifications of Disposition All applicants will receive an Executive Summary Statement from the IHS Office of Clinical and Preventive Services within 30 days of the conclusion of the ORC outlining the strengths and weaknesses of their application. The summary statement will be sent to the Authorizing Official identified on the face page (SF-424) of the application. A. Award Notices for Funded Applications The NoA is the authorizing document for which funds are dispersed to the approved entities and reflects the amount of Federal funds awarded, the purpose of the grant, the terms and conditions of the award, the effective date of the award, and the budget/project period.

Each entity approved for funding must have a user account in GrantSolutions in order to retrieve the NoA. Please see the Agency Contacts list in Section VII for the systems contact information. B. Approved but Unfunded Applications Approved applications not funded due to lack of available funds will be held for one year.

If funding becomes available during the course of the year, the application may be reconsidered. Note. Any correspondence other than the official NoA executed by an IHS grants management official announcing to the project director that an award has been made to their organization is not an authorization to implement their program on behalf of the IHS. VI.

Award Administration Information 1. Administrative Requirements Awards issued under this announcement are subject to, and are administered in accordance with, the following regulations and policies. A. The Criteria as Outlined in This Program Announcement B.

Administrative Regulations for Grants C. Grants Policy D. Cost Principles Uniform Administrative Requirements for HHS Awards, “Cost Principles,” at 45 CFR part 75, subpart E. E.

Audit Requirements Uniform Administrative Requirements for HHS Awards, “Audit Requirements,” at 45 CFR part 75, subpart F. F. As of August 13, 2020, 2 CFR 200 was updated to include a prohibition on certain telecommunications and video surveillance services or equipment. This prohibition is described in 2 CFR 200.216.

This will also be described in the terms and conditions of every IHS grant and cooperative agreement awarded on or after August 13, 2020. 2. Indirect Costs This section applies to all recipients that request reimbursement of indirect costs (IDC) in their application budget. In accordance with HHS Grants Policy Statement, Part II-27, IHS requires applicants to obtain a current IDC rate agreement and submit it to the DGM prior to the DGM issuing an award.

The rate agreement must be prepared in accordance with the applicable cost principles and guidance as provided by the cognizant agency or office. A current rate covers the applicable grant activities under the current award's budget period. If the current rate agreement is not on file with the DGM at the time of award, the IDC portion of the budget will be restricted. The restrictions remain in place until the current rate agreement is provided to the DGM.

Per 45 CFR 75.414(f) Indirect (F&A) costs, “any non-Federal entity [i.e., applicant] that has never received a negotiated indirect cost rate,. . . May elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC) which may be used indefinitely.

As described in Section 75.403, costs must be consistently charged as either indirect or direct costs, but may not be double charged or inconsistently charged as both. If chosen, this methodology once elected must be used consistently for all Federal awards until such time as the non-Federal entity chooses to negotiate for a rate, which the non-Federal entity may apply to do at any time.” Electing to charge a de minimis rate of 10 percent only applies to applicants that have never received an approved negotiated indirect cost rate from HHS or another cognizant federal agency. Applicants awaiting approval of their indirect cost proposal may request the 10 percent de minimis rate. When the applicant chooses this method, costs included in the indirect cost pool must not be charged as direct costs to the grant.

Available funds are inclusive of direct and appropriate indirect costs. Approved indirect funds are awarded as part of the award amount, and no additional funds will be provided. Generally, IDC rates for IHS grantees are negotiated with the Division of Cost Allocation (DCA) at https://rates.psc.gov/​ or the Department of the Interior (Interior Business Center) at https://ibc.doi.gov/​ICS/​tribal. For Start Printed Page 41057questions regarding the indirect cost policy, please call the Grants Management Specialist listed under “Agency Contacts” or the main DGM office at (301) 443-5204.

3. Reporting Requirements The grantee must submit required reports consistent with the applicable deadlines. Failure to submit required reports within the time allowed may result in suspension or termination of an active grant, withholding of additional awards for the project, or other enforcement actions such as withholding of payments or converting to the reimbursement method of payment. Continued failure to submit required reports may result in the imposition of special award provisions and/or the non-funding or non-award of other eligible projects or activities.

This requirement applies whether the delinquency is attributable to the failure of the awardee organization or the individual responsible for preparation of the reports. Per DGM policy, all reports must be submitted electronically by attaching them as a “Grant Note” in GrantSolutions. Personnel responsible for submitting reports will be required to obtain a login and password for GrantSolutions. Please see the Agency Contacts list in Section VII for the systems contact information.

The reporting requirements for this program are noted below. A. Progress Reports Program progress reports are required semi-annually. The progress reports are due within 30 days after the budget period ends (specific dates will be listed in the NoA Terms and Conditions).

These reports must include a brief comparison of actual accomplishments to the goals established for the period, a summary of progress to date or, if applicable, provide sound justification for the lack of progress, and other pertinent information as required. A final report must be submitted within 90 days of expiration of the period of performance. B. Financial Reports Federal Cash Transaction Reports are due 30 days after the close of every calendar quarter to the Payment Management Services at https://pms.psc.gov.

Failure to submit timely reports may result in adverse award actions blocking access to funds. Federal Financial Reports are due 30 days after the end of each budget period, and a final report is due 90 days after the end of the Period of Performance. Grantees are responsible and accountable for accurate information being reported on all required reports. The Progress Reports and Federal Financial Report.

C. Data Collection and Reporting To satisfy the reporting requirements, the applicant is expected to develop an outcome report. The outcome report should explicitly state whether CHAP implementation and integration into the existing health care system is viable or not. The Outcome Report should describe, in full, the findings of the program plan, evaluation, and determination on stage of readiness for implementation.

The outcome report should organize the findings into at least five categories. 1. Clinical Infrastructure. 2.

Workforce Barriers. 3. Training Infrastructure. 4.

Cultural Inclusion. 5. Implementation Cost. Applicants are encouraged to identify additional categories above the five aforementioned and may choose to develop subcategories that best fit the program plan.

D. Federal Sub-Award Reporting System (FSRS) This award may be subject to the Transparency Act sub-award and executive compensation reporting requirements of 2 CFR part 170. The Transparency Act requires the OMB to establish a single searchable database, accessible to the public, with information on financial assistance awards made by Federal agencies. The Transparency Act also includes a requirement for recipients of Federal grants to report information about first-tier sub-awards and executive compensation under Federal assistance awards.

IHS has implemented a Term of Award into all IHS Standard Terms and Conditions, NoAs, and funding announcements regarding the FSRS reporting requirement. This IHS Term of Award is applicable to all IHS grant and cooperative agreements issued on or after October 1, 2010, with a $25,000 sub-award obligation threshold met for any specific reporting period. For the full IHS award term implementing this requirement and additional award applicability information, visit the DGM Grants Management website at https://www.ihs.gov/​dgm/​policytopics/​. E.

Compliance With Executive Order 13166 Implementation of Services Accessibility Provisions for All Grant Application Packages and Funding Opportunity Announcements Recipients of Federal financial assistance (FFA) from HHS must administer their programs in compliance with Federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age, and, in some circumstances, religion, conscience, and sex. This includes ensuring programs are accessible to persons with limited English proficiency. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. Please see https://www.hhs.gov/​civil-rights/​for-providers/​provider-obligations/​index.html and http://www.hhs.gov/​ocr/​civilrights/​understanding/​section1557/​index.html.

Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under Federal civil rights laws at https://www.hhs.gov/​ocr/​about-us/​contact-us/​index.html or call 1-800-368-1019 or TDD 1-800-537-7697. F. Federal Awardee Performance and Integrity Information System (FAPIIS) The IHS is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS), at https://www.fapiis.gov, before making any award in excess of the simplified acquisition threshold (currently $250,000) over the period of performance. An applicant may review and comment on any information about itself that a Federal awarding agency previously entered.

IHS will consider any comments by the applicant, in addition to other information in FAPIIS, in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 45 CFR 75.205. As required by 45 CFR part 75, appendix XII, of the Uniform Guidance, non-Federal entities (NFEs) are required to disclose in FAPIIS any information about criminal, civil, and administrative proceedings, and/or affirm that there is no new information to provide. This applies to NFEs that receive Federal awards (currently active grants, cooperative agreements, and procurement contracts) greater than $10,000,000 for any period of time during the period of performance of an award/project. Mandatory Disclosure Requirements As required by 2 CFR part 200 of the Uniform Guidance and the HHS implementing regulations at 45 CFR part 75, the IHS must require an NFE or an applicant for a Federal award to disclose, in a timely manner, in writing to the IHS or pass-through entity all violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award.

Submission is required for all applicants and recipients, in writing, to the IHS and to the HHS Office of Inspector General of all information related to violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award. 45 CFR 75.113. Disclosures must be sent in writing to. U.S.

Department of Health and Human Services, Indian Health Service, Division of Grants Management, ATTN. Paul Gettys, Acting Director, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857 (Include “Mandatory Grant Disclosures” in subject line), Office. (301) 443-5204, Fax.

(301) 594-0899, Email. Paul.Gettys@ihs.gov. And U.S. Department of Health and Human Services, Office of Inspector General, ATTN.

Mandatory Grant Disclosures, Intake Coordinator, 330 Independence Avenue SW, Cohen Building, Room 5527, Washington, DC 20201, URL. Https://oig.hhs.gov/​fraud/​report-fraud/​ (Include “Mandatory Grant Disclosures” in subject line), Fax. (202) 205-0604 (Include “Mandatory Grant Disclosures” in subject line) or Email. MandatoryGranteeDisclosures@oig.hhs.gov.

Failure to make required disclosures can result in any of the remedies described in 45 CFR 75.371 Remedies for noncompliance, including suspension or debarment (see 2 CFR parts 180 &. 376). VII. Agency Contacts 1.

Questions on the programmatic issues may be directed to. Minette C. Galindo, Public Health Advisor, Indian Health Service, Office of Clinical and Preventive Services, 5600 Fishers Lane, Mail Stop. 08N34A, Rockville, MD 20857, Phone.

(301) 443-4644, Email. IHSCHAP@ihs.gov. 2. Questions on grants management and fiscal matters may be directed to.

Donald Gooding, Grants Management Specialist, Indian Health Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, Phone. (301) 443-2298, Email. Donald.Gooding@ihs.gov.

3. Questions on systems matters may be directed to. Paul Gettys, Acting Director, Indian Health Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, Phone.

(301) 443-2114. Or the DGM main line (301) 443-5204, Email. Paul.Gettys@ihs.gov. VIII.

Other Information The Public Health Service strongly encourages all grant, cooperative agreement and contract recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of the facility) in which regular or routine education, library, day care, health care, or early childhood development services are provided to children. This is consistent with the HHS mission to protect and advance the physical and mental health of the American people. Start Signature Elizabeth A.

Fowler, Acting Director, Indian Health Service. End Signature End Preamble [FR Doc. 2021-16280 Filed 7-29-21. 8:45 am]BILLING CODE 4165-16-P.