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€‹The families of four children who were tragically killed by a drunk and drugged driver are launching an annual forgiveness day with the support of the NSW Government.Siblings Antony, Angelina and Sienna Abdallah and their cousin Veronique Sakr were killed in February this year when an out-of-control ute mounted the footpath.The two families have taken the extraordinary step of forgiving the man behind the wheel as an important step in their grieving process.The families want i4give Day to be held every year on the anniversary of the deaths in memory of the children.In launching this day, a memorial service will be held on the eve of the anniversary, Sunday, 31 January 2021, which will be live streamed to the public.Daniel Abdallah said he wants i4give Day to become one when people can remember the four children buy original levitra online but it may also help others who have suffered.“We still feel pain and sorrow everyday, but forgiveness has helped to get rid of the anger and bitterness. It’s helped us get through each day and make sure we are there for our other children,” said Mr Abdallah.Both families say this is about honouring their four little saints in heaven.“Our four children are buy original levitra online now our four saints and this day is for them. Forgiveness is buy original levitra online the greatest gift you can give yourself and others. The more you practise the better you become at it and it allows you live peacefully and to buy original levitra online heal.” Leila Abdallah said.“Christmas Eve is a very hard time for us as it is also Angelina’s birthday. Even though it is tough, we’ll be celebrating Christmas for the rest of our kids.”Veronique’s mother Bridget Sakr, said buy original levitra online “Christmas can be a difficult time for many families.

I hope people can reflect on what so tragically happened to our buy original levitra online beautiful children to mend bridges with estranged family members and move forward, to love each other in peace and harmony. Life is too precious.”People across the state will be encouraged to reflect on events and relationships in their own lives and look to the example set by the Abdallah and Sakr families.Minister for Mental Health Bronnie Taylor said that while grieving is a normal part of life, when buy original levitra online a tragedy such as this occurs the impact on the family is profound.“The grief experienced can take many forms and there is no set timeline. For some people a buy original levitra online psychologist or grief and trauma therapist may be of assistance and the need for this may occur months or years after the event,” Mrs Taylor said.“For some people where the loss has occurred through trauma, forgiveness may play a healing role as part of the grieving process.“This day is about honouring Antony, Angelina, Sienna and Veronique. Their families have shown amazing strength through such a terrible tragedy.”A website i4give.com will also be launched where people buy original levitra online will be directed to links dealing with grief and trauma counselling..

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Wade,” said that in the early 1970s Lasix street price the strongest opposition to abortion came not from Southern evangelicals but from states with strong Catholic ties in cialis plus levitra the Northeast. Even as states like Connecticut and Maine were passing bans, states that were home to large populations of more conservative religious denominations allowed women to safely end pregnancies in cases of rape, incest, fetal deformities and when a woman’s life was at risk. North Carolina was one of the first states to allow for limited legal access to abortion in 1967.

Georgia followed in 1968, and South Carolina cialis plus levitra and Arkansas in 1970. In Texas, a poll taken in 1970 by the Baptist Standard, the periodical of the Baptist convention, found that 90% of its readers — largely pastors and deacons — believed Texas’ abortion laws were too harsh. Religious scholars say white evangelical Protestants did not support unfettered abortion rights, but without a strong theology about when human life begins, less restrictive abortion laws were not a moral threat.

Evangelicals viewed abortion as a cialis plus levitra Catholic cause. €œThe general view among Southern evangelicals in the 1960s and early 1970s was that abortion was ethically problematic,” said Williams, who serves as a professor of history at the University of West Georgia. €œBut there was no firm biblical support for the Catholic claim that human life began at conception.” Q.

So, why did the South cialis plus levitra — and Southern evangelicals — change their minds?. One could say it started offshore. In March 1970, Hawaii became the first state to decriminalize abortion, though the law applied only to state residents.

Later that year, New York, then led cialis plus levitra by a Republican governor, Nelson Rockefeller, and a Republican-dominated legislature, went further, allowing women from any state to receive abortion care. In 1972, some 200,000 women had legal abortions in New York, and 3 of 5 were from out of state. That alarmed many Southerners, who feared that the procedure was being used — and abused — by unmarried women.

€œMany of the Baptists in Texas might have thought if a cialis plus levitra married woman experienced problems with a pregnancy” she should have the option of a safe, legal abortion, said Williams. €œThey were not envisioning there would be 200,000. This was clearly not a limited procedure in a small number of instances.” Q.

Was it just cialis plus levitra abortion that worried evangelicals?. Aversion to women’s rights was not limited to reproductive issues. Disaffected by the sexual revolution and the feminist movement, Christian conservative leaders campaigned against the Equal Rights Amendment.

They also battled to cialis plus levitra protect the tax-exempt status of racially segregated private schools and pushed to ban gay teachers from public schools and restore classroom prayer. As opposition to abortion among Catholic voters and lawmakers eased, white evangelicals and fundamentalists grew more strident on the issue. By the late 1970s, white evangelicals had fully embraced the position that legal abortion was an assault on moral values.

As biblicists, committed to the text of cialis plus levitra the Bible, evangelical leaders found new meaning in certain verses they believed gave credence to prenatal life. €œThe connection these conservative evangelicals saw was that when Americans drifted away from God in public life, a change in gender roles came in,” said Williams. €œChristianity was being replaced by secular, humanistic, sexual ethics, and Roe v.

Wade became the symbol for all cialis plus levitra of that.” Q. What role did politics play in the shift?. A major one.

While Catholics are fairly dispersed around the country, white evangelicals are heavily concentrated in Southern states, where true believers often also hold elected office, and cialis plus levitra thus the power to make laws, said Andrew Lewis, associate professor of political science at the University of Cincinnati. Mary Ziegler, a professor at Florida State University College of Law and author of “Abortion and the Law in America. Roe v.

Wade to the Present,” describes a trifecta that reinforced abortion opposition in the cialis plus levitra South. €œThere are a lot of white evangelicals, a lot of Republicans and a lot of gerrymandered swing states,” she said. The acceleration of state-level abortion restrictions arose from grassroots conservative activists and socially conservative state legislators, not from national Republican Party strategists.

€œOnce the Republican cialis plus levitra Party took over the South, it did so largely through the efforts of the Christian Coalition” of America, said Williams. And that connection between white evangelicals and the GOP intensified as the decades passed. By 2009, white evangelicals made up 35% of the Republican Party.

Q. Where does it all stand now?. Nearly 50 years after the U.S.

Supreme Court legalized abortion, the South is the most fervently anti-abortion region in the country. And year after year, Southern legislatures have outdone one another, passing ever more restrictive measures on abortion care and criminal punishment to those who provide it. For instance, a 99-year prison sentence for doctors who perform abortions in Alabama.

A ban on nearly all abortions after 15 weeks of pregnancy in Mississippi and six weeks in Texas. Rape crisis counselors are subject to lawsuits from private citizens if a woman chooses to end her pregnancy. Few of these laws have taken effect.

Most have been struck down or frozen by the courts and, until last month, the Supreme Court declined to consider many of them. But state legislators, often acting without guidance from national anti-abortion organizations, have continued to introduce anti-abortion bills at a fevered pace. And with the Supreme Court’s rightward shift, many in the movement sense their moment has arrived.

The Democratic Party in the South “generally doesn’t fight” abortion restrictions, Williams said. The party, which counts on the support of Black and Hispanic voters, tends to focus on other priorities, he said. €œThere is much greater interest in talking about health care and jobs.” And while many voters, even conservative ones, have shifted to the left on issues like gay rights, Williams said, younger evangelicals are more likely than their parents to oppose abortion.

€œThe Republican Party has a lot of staying power in Georgia and Alabama and across much of the South for the foreseeable future,” Williams said. Sarah Varney. svarney@kff.org, @SarahVarney4 Related Topics Contact Us Submit a Story TipTennova Healthcare-Lebanon doesn’t exist anymore as a hospital.

But it still sued Hope Cantwell. A knock came on the door of Cantwell’s Nashville, Tennessee, apartment early this year. She said she hadn’t been vaccinated against erectile dysfunction treatment yet and wasn’t answering the door to strangers.

So she didn’t. But then several more attempts came over the course of a week. Eventually she masked up and opened.

A legal assistant served her a lawsuit. She was summoned to appear in court. €œI couldn’t believe someone — someone?.

a corporation?. a company?. — was doing this during a levitra,” Cantwell said.

It started with a hospital visit in May 2019. Cantwell was admitted for a short stay at Tennova Healthcare-Lebanon, owned at the time by Community Health Systems, a publicly traded company headquartered in Franklin, Tennessee. Her insurance covered most of the stay, but it still left her with $2,700 to pay.

Nearly a year later, she was in a financial position to start chipping away at the bill. She went online to pay but couldn’t find the hospital or its payment portal. Cantwell did a little Googling and noticed Vanderbilt University Medical Center bought the 245-bed facility around the time of her stay.

It’s called Vanderbilt Wilson County Hospital now. Then the levitra hit. She was furloughed from work for three months.

And soon after, a letter arrived. A law firm representing the former hospital owner demanded payment and threatened to take her to court. She wasn’t sure what to do, since she couldn’t come up with all the cash.

She was in a holding pattern until the knock on the door from the legal assistant. levitra Push A WPLN News investigation found Tennova Healthcare-Lebanon sued more than 1,000 patients, including Cantwell, over the past two years across multiple counties after striking a deal to be sold. And hundreds of those suits were filed during the levitra, at a time when many companies have backed away from taking patients to court over unpaid medical debt.

The state of New York banned the practice. Community Health Systems is on the tail end of a corporate downsizing that shrank the company from more than 200 hospitals to 84. The sell-off helped stabilize the company after it took on massive debt during a period of rapid growth that briefly gave Community Health Systems more hospitals than any other chain in the country.

But now many of those institutions are like zombie hospitals — little more than a legal entity still taking patients to court even after being sold to new owners that don’t sue over medical bills. When her summons arrived, panic set in for Cantwell. €œMy mind went immediately to the stimulus payments,” she said.

€œâ€˜At least I have a way to take care of this now.'” When her final levitra stimulus money dropped into her bank account, Cantwell said, she sent it straight to the company that had sued her, even though she almost felt like the victim of a scam. She wondered if she really owed all the money or if she qualified for financial assistance since she lost income during the levitra. But lawsuits are a rich man’s game.

She couldn’t justify trying to find an attorney or fighting a big for-profit company that would pursue her for $2,700. €œI don’t have the resources and emotional and mental capacity to handle anything more than just kind of rolling over and handing over whatever amount of money they would be happy with,” she said. Community Health Systems’ Debt Problem Court records indicate Community Health Systems stepped up filing lawsuits against patients in 2015 at the same time its stock price plummeted over concerns about its outsize corporate debt.

Aside from a hospital fire sale, Community Health Systems also aggressively went after patients. And the company didn’t let the levitra slow that plan, even though it received more than $700 million from the federal government in erectile dysfunction treatment relief money. A spokesperson for HCA Healthcare, the largest for-profit hospital chain in the country, said its hospitals do not sue patients over unpaid medical debt — during the levitra or otherwise.

The Nashville-based corporation returned all its erectile dysfunction treatment relief funds. An investigation by CNN found Community Health Systems sued at least 19,000 patients during the levitra, though the number is likely an undercount given the lawsuits filed on behalf of its former hospitals. Like Tennova Healthcare-Lebanon, two other Community Health Systems hospitals in Tennessee also continued taking patients to court after selling to Vanderbilt more recently.

Community Health Systems held on to its debt in the deals with Vanderbilt and continues to pursue patients who owe it money. Vanderbilt University Medical Center spokesperson John Howser said Vanderbilt does not sue patients to collect on medical debt. €œCommunity Health Systems and its subsidiary Tennova Healthcare is a private company that is not owned or operated by Vanderbilt University Medical Center,” Howser wrote in a statement.

€œAs such, VUMC is not involved in these lawsuits.” Vanderbilt University Medical Center does help run a Community Health Systems-owned hospital in Clarksville, Tennessee, that continues to sue patients, but Howser noted Community Health Systems has the controlling interest. €œThe thing is, these aren’t rich people who don’t want to pay their bills,” said Christi Walsh, a nurse practitioner who directs clinical research at Johns Hopkins University. Her team focuses on hospitals suing patients and pressures them to stop.

€œI’ve been on the ground in the courthouses. These are people who don’t have the money to pay it.” In Wilson County, Tennessee, a husband and wife were both sued by Tennova Healthcare-Lebanon. He works in a distribution center that shut down for months during the levitra.

She cared for their foster kids and delivered meals with DoorDash, telling WPLN News they were too busy to make their court date. The problem is, not showing up to face a debt in court can allow a company to take a cut of someone’s paycheck. It also wrecks a person’s financial credit, and the stress can lead to health problems.

€˜It Threatens the Public Trust’ Walsh’s team researched the most litigious hospitals in Texas from 2018 to 2020. The top five were all affiliated with Community Health Systems. And the most lawsuits were filed by South Texas Regional Medical Center, which was sold to HCA in 2017.

But South Texas Regional Medical Center continued to sue patients. Marty Makary, a surgeon at Johns Hopkins who wrote a book about health care billing called “The Price We Pay,” said most hospitals have changed tactics. Suing their patients doesn’t make them tons of money after attorney and court fees, and it hurts their brand.

But he said Community Health Systems has not expressed such concern. €œCommunity Health Systems, in all of our research of hospital pricing and billing practices, stands out as an aggressive institution that uniformly, across the country, engages in very aggressive predatory billing — suing patients in court to garnish their wages,” he said. Even if Community Health Systems is willing to take a hit to its reputation, Makary said, patients think of the health system as a whole.

And they’ll think twice next time they need to go to the doctor. €œIt threatens the public trust in our community institutions. And medical institutions are supposed to be above those games,” he said.

In a statement to WPLN News, a Community Health Systems spokesperson said the company used its erectile dysfunction treatment relief money to pay for levitra expenses and make up for lost revenue. In January, the company said it will take patients to court only if they make at least twice the federal poverty level — or about $53,000 annually for a family of four. €œWe continually evaluate modifications to our collection practices to support patients who struggle to pay their hospital bills,” spokesperson Rebecca Pitt said.

The policy change is meant to be retroactive. The company will withdraw litigation for anyone who qualifies, Pitt said. Patients who owe Community Health Systems and its former hospitals money are being made aware of the new policy in legal correspondence and can call 800-755-5152 to begin the process to drop a lawsuit, she said.

This story is from a reporting partnership that includes WPLN, NPR and KHN. Blake Farmer, Nashville Public Radio.

Two Lasix street price words buy original levitra online. The pope. Daniel Williams, author of “God’s Own Party. The Making of the Christian Right” and “Defenders of the buy original levitra online Unborn.

The Pro-Life Movement Before Roe v. Wade,” said that in the early 1970s the strongest opposition to abortion came not from Southern evangelicals but from states with strong Catholic ties in the Northeast. Even as states like buy original levitra online Connecticut and Maine were passing bans, states that were home to large populations of more conservative religious denominations allowed women to safely end pregnancies in cases of rape, incest, fetal deformities and when a woman’s life was at risk. North Carolina was one of the first states to allow for limited legal access to abortion in 1967.

Georgia followed in 1968, and South Carolina and Arkansas in 1970. In Texas, a poll taken in 1970 by the Baptist Standard, the periodical of the Baptist buy original levitra online convention, found that 90% of its readers — largely pastors and deacons — believed Texas’ abortion laws were too harsh. Religious scholars say white evangelical Protestants did not support unfettered abortion rights, but without a strong theology about when human life begins, less restrictive abortion laws were not a moral threat. Evangelicals viewed abortion as a Catholic cause.

€œThe general view among Southern evangelicals in the 1960s and early 1970s was that abortion was ethically problematic,” said Williams, who serves as a professor of buy original levitra online history at the University of West Georgia. €œBut there was no firm biblical support for the Catholic claim that human life began at conception.” Q. So, why did the South — and Southern evangelicals — change their minds?. One could say buy original levitra online it started offshore.

In March 1970, Hawaii became the first state to decriminalize abortion, though the law applied only to state residents. Later that year, New York, then led by a Republican governor, Nelson Rockefeller, and a Republican-dominated legislature, went further, allowing women from any state to receive abortion care. In 1972, some 200,000 women buy original levitra online had legal abortions in New York, and 3 of 5 were from out of state. That alarmed many Southerners, who feared that the procedure was being used — and abused — by unmarried women.

€œMany of the Baptists in Texas might have thought if a married woman experienced problems with a pregnancy” she should have the option of a safe, legal abortion, said Williams. €œThey were not envisioning there buy original levitra online would be 200,000. This was clearly not a limited procedure in a small number of instances.” Q. Was it just abortion that worried evangelicals?.

Aversion to women’s rights was buy original levitra online not limited to reproductive issues. Disaffected by the sexual revolution and the feminist movement, Christian conservative leaders campaigned against the Equal Rights Amendment. They also battled to protect the tax-exempt status of racially segregated private schools and pushed to ban gay teachers from public schools and restore classroom prayer. As opposition to abortion among Catholic voters buy original levitra online and lawmakers eased, white evangelicals and fundamentalists grew more strident on the issue.

By the late 1970s, white evangelicals had fully embraced the position that legal abortion was an assault on moral values. As biblicists, committed to the text of the Bible, evangelical leaders found new meaning in certain verses they believed gave credence to prenatal life. €œThe connection these conservative evangelicals saw buy original levitra online was that when Americans drifted away from God in public life, a change in gender roles came in,” said Williams. €œChristianity was being replaced by secular, humanistic, sexual ethics, and Roe v.

Wade became the symbol for all of that.” Q. What role did politics play in buy original levitra online the shift?. A major one. While Catholics are fairly dispersed around the country, white evangelicals are heavily concentrated in Southern states, where true believers often also hold elected office, and thus the power to make laws, said Andrew Lewis, associate professor of political science at the University of Cincinnati.

Mary Ziegler, a professor at Florida State University buy original levitra online College of Law and author of “Abortion and the Law in America. Roe v. Wade to the Present,” describes a trifecta that reinforced abortion opposition in the South. €œThere are a lot of white evangelicals, a lot of buy original levitra online Republicans and a lot of gerrymandered swing states,” she said.

The acceleration of state-level abortion restrictions arose from grassroots conservative activists and socially conservative state legislators, not from national Republican Party strategists. €œOnce the Republican Party took over the South, it did so largely through the efforts of the Christian Coalition” of America, said Williams. And that connection between white evangelicals buy original levitra online and the GOP intensified as the decades passed. By 2009, white evangelicals made up 35% of the Republican Party.

Q. Where does buy original levitra online it all stand now?. Nearly 50 years after the U.S. Supreme Court legalized abortion, the South is the most fervently anti-abortion region in the country.

And year after year, Southern legislatures have outdone one another, passing ever more restrictive measures buy original levitra online on abortion care and criminal punishment to those who provide it. For instance, a 99-year prison sentence for doctors who perform abortions in Alabama. A ban on nearly all abortions after 15 weeks of pregnancy in Mississippi and six weeks in Texas. Rape crisis counselors are subject to buy original levitra online lawsuits from private citizens if a woman chooses to end her pregnancy.

Few of these laws have taken effect. Most have been struck down or frozen by the courts and, until last month, the Supreme Court declined to consider many of them. But state buy original levitra online legislators, often acting without guidance from national anti-abortion organizations, have continued to introduce anti-abortion bills at a fevered pace. And with the Supreme Court’s rightward shift, many in the movement sense their moment has arrived.

The Democratic Party in the South “generally doesn’t fight” abortion restrictions, Williams said. The party, which counts on the support of Black and Hispanic voters, tends to focus on other priorities, he said buy original levitra online. €œThere is much greater interest in talking about health care and jobs.” And while many voters, even conservative ones, have shifted to the left on issues like gay rights, Williams said, younger evangelicals are more likely than their parents to oppose abortion. €œThe Republican Party has a lot of staying power in Georgia and Alabama and across much of the South for the foreseeable future,” Williams said.

Sarah buy original levitra online Varney. svarney@kff.org, @SarahVarney4 Related Topics Contact Us Submit a Story TipTennova Healthcare-Lebanon doesn’t exist anymore as a hospital. But it still sued Hope Cantwell. A knock came on the door of Cantwell’s Nashville, Tennessee, buy original levitra online apartment early this year.

She said she hadn’t been vaccinated against erectile dysfunction treatment yet and wasn’t answering the door to strangers. So she didn’t. But then several more attempts came over the course of a week. Eventually she masked up and buy original levitra online opened.

A legal assistant served her a lawsuit. She was summoned to appear in court. €œI couldn’t believe someone buy original levitra online — someone?. a corporation?.

a company?. — was doing this during a buy original levitra online levitra,” Cantwell said. It started with a hospital visit in May 2019. Cantwell was admitted for a short stay at Tennova Healthcare-Lebanon, owned at the time by Community Health Systems, a publicly traded company headquartered in Franklin, Tennessee.

Her insurance buy original levitra online covered most of the stay, but it still left her with $2,700 to pay. Nearly a year later, she was in a financial position to start chipping away at the bill. She went online to pay but couldn’t find the hospital or its payment portal. Cantwell did buy original levitra online a little Googling and noticed Vanderbilt University Medical Center bought the 245-bed facility around the time of her stay.

It’s called Vanderbilt Wilson County Hospital now. Then the levitra hit. She was furloughed from work buy original levitra online for three months. And soon after, a letter arrived.

A law firm representing the former hospital owner demanded payment and threatened to take her to court. She wasn’t sure what to do, since she couldn’t buy original levitra online come up with all the cash. She was in a holding pattern until the knock on the door from the legal assistant. levitra Push A WPLN News investigation found Tennova Healthcare-Lebanon sued more than 1,000 patients, including Cantwell, over the past two years across multiple counties after striking a deal to be sold.

And hundreds of those suits were filed during the buy original levitra online levitra, at a time when many companies have backed away from taking patients to court over unpaid medical debt. The state of New York banned the practice. Community Health Systems is on the tail end of a corporate downsizing that shrank the company from more than 200 hospitals to 84. The sell-off helped stabilize the company after buy original levitra online it took on massive debt during a period of rapid growth that briefly gave Community Health Systems more hospitals than any other chain in the country.

But now many of those institutions are like zombie hospitals — little more than a legal entity still taking patients to court even after being sold to new owners that don’t sue over medical bills. When her summons arrived, panic set in for Cantwell. €œMy mind went buy original levitra online immediately to the stimulus payments,” she said. €œâ€˜At least I have a way to take care of this now.'” When her final levitra stimulus money dropped into her bank account, Cantwell said, she sent it straight to the company that had sued her, even though she almost felt like the victim of a scam.

She wondered if she really owed all the money or if she qualified for financial assistance since she lost income during the levitra. But lawsuits are a rich man’s game buy original levitra online. She couldn’t justify trying to find an attorney or fighting a big for-profit company that would pursue her for $2,700. €œI don’t have the resources and emotional and mental capacity to handle anything more than just kind of rolling over and handing over whatever amount of money they would be happy with,” she said.

Community Health Systems’ Debt Problem buy original levitra online Court records indicate Community Health Systems stepped up filing lawsuits against patients in 2015 at the same time its stock price plummeted over concerns about its outsize corporate debt. Aside from a hospital fire sale, Community Health Systems also aggressively went after patients. And the company didn’t let the levitra slow that plan, even though it received more than $700 million from the federal government in erectile dysfunction treatment relief money. A spokesperson for HCA Healthcare, the largest for-profit hospital chain in the buy original levitra online country, said its hospitals do not sue patients over unpaid medical debt — during the levitra or otherwise.

The Nashville-based corporation returned all its erectile dysfunction treatment relief funds. An investigation by CNN found Community Health Systems sued at least 19,000 patients during the levitra, though the number is likely an undercount given the lawsuits filed on behalf of its former hospitals. Like Tennova Healthcare-Lebanon, two other Community Health Systems hospitals in buy original levitra online Tennessee also continued taking patients to court after selling to Vanderbilt more recently. Community Health Systems held on to its debt in the deals with Vanderbilt and continues to pursue patients who owe it money.

Vanderbilt University Medical Center spokesperson John Howser said Vanderbilt does not sue patients to collect on medical debt. €œCommunity Health Systems and its subsidiary Tennova Healthcare is a private company that is not owned or operated by buy original levitra online Vanderbilt University Medical Center,” Howser wrote in a statement. €œAs such, VUMC is not involved in these lawsuits.” Vanderbilt University Medical Center does help run a Community Health Systems-owned hospital in Clarksville, Tennessee, that continues to sue patients, but Howser noted Community Health Systems has the controlling interest. €œThe thing is, these aren’t rich people who don’t want to pay their bills,” said Christi Walsh, a nurse practitioner who directs clinical research at Johns Hopkins University.

Her team focuses buy original levitra online on hospitals suing patients and pressures them to stop. €œI’ve been on the ground in the courthouses. These are people who don’t have the money to pay it.” In Wilson County, Tennessee, a husband and wife were both sued by Tennova Healthcare-Lebanon. He works in a distribution center that shut down for buy original levitra online months during the levitra.

She cared for their foster kids and delivered meals with DoorDash, telling WPLN News they were too busy to make their court date. The problem is, not showing up to face a debt in court can allow a company to take a cut of someone’s paycheck. It also wrecks a buy original levitra online person’s financial credit, and the stress can lead to health problems. €˜It Threatens the Public Trust’ Walsh’s team researched the most litigious hospitals in Texas from 2018 to 2020.

The top five were all affiliated with Community Health Systems. And the most lawsuits were filed by South Texas Regional Medical Center, which was buy original levitra online sold to HCA in 2017. But South Texas Regional Medical Center continued to sue patients. Marty Makary, a surgeon at Johns Hopkins who wrote a book about health care billing called “The Price We Pay,” said most hospitals have changed tactics.

Suing their patients doesn’t make them tons of money after attorney and court fees, and it hurts their buy original levitra online brand. But he said Community Health Systems has not expressed such concern. €œCommunity Health Systems, in all of our research of hospital pricing and billing practices, stands out as an aggressive institution that uniformly, across the country, engages in very aggressive predatory billing — suing patients in court to garnish their wages,” he said. Even if Community Health Systems is willing to take a hit to its reputation, Makary said, patients think of the health system as buy original levitra online a whole.

And they’ll think twice next time they need to go to the doctor. €œIt threatens the public trust in our community institutions. And medical institutions are supposed to be above those games,” he said. In a statement to WPLN News, a Community Health Systems spokesperson said the company used its erectile dysfunction treatment relief money to pay for levitra expenses and make up for lost revenue.

In January, the company said it will take patients to court only if they make at least twice the federal poverty level — or about $53,000 annually for a family of four. €œWe continually evaluate modifications to our collection practices to support patients who struggle to pay their hospital bills,” spokesperson Rebecca Pitt said.

What should I tell my health care provider before I take Levitra?

They need to know if you have any of these conditions:

Levitra over the counter walgreens

€‹Councils and staff across the state came together in a webinar yesterday afternoon to discuss the impacts of levitra over the counter walgreens erectile dysfunction treatment on the mental health of the NSW local government workforce and the communities they serve.Minister for Local Government Shelley Hancock said more than 200 council workers, councillors, mayors and general managers joined the webinar with Minister for Mental Health Bronnie Taylor and NSW Chief Psychiatrist Dr Murray Wright. "The last 18 months has been a very difficult time for everybody, with prolonged restrictions on our daily lives and mounting social and economic impacts, so this webinar was designed to address the many stressful and isolating issues we've been encountering," Mrs Hancock said."The webinar provided an opportunity for council staff and councillors to take stock of levitra over the counter walgreens their own mental health, obtain information on support services, and ask questions and receive advice from the experts. "While much of the focus for councils has been levitra over the counter walgreens on providing infrastructure, facilities and services to their communities during the erectile dysfunction treatment outbreak, it's important to reflect on the mental health of council staff and councillors in addition to residents.

"Our 128 levitra over the counter walgreens local councils across NSW comprise nearly 1,300 councillors and more than 48,000 staff, and they too are enduring incredible stress in serving their local communities in the face of unprecedented challenges. "The Office of Local Government has so far held nine webinars during this current erectile dysfunction treatment outbreak with key ministers and senior government officials to keep them up to date with the latest developments and restrictions."The NSW Government will continue to support our councils and their local communities to respond and recover from the erectile dysfunction treatment levitra."Mrs Taylor said the NSW Government is working on a levitra recovery roadmap, under which councils and local communities will play an integral part."Councils have a big role to play as we navigate our path out of this levitra, with the community right at the centre of the recovery," Mrs Taylor said."The NSW Government has invested in community-led suicide prevention activity including local drop-in centres, response groups levitra over the counter walgreens and community based services."Local staff are doing an incredible job confronting challenges head-on every day, so it is really important that they are equipped with the tools to, not only support the community but also to be able to recognise when they might need to put their hand up for help themselves."This is all about challenging the stigma around with mental illness, encouraging help seeking behaviour and creating connected communities full of healthy, resilient individuals."The NSW Government has relaunched its Mentally Healthy Workplaces Strategy in response to the significant shift in the way we work due to erectile dysfunction treatment. It aims to help employers move from a model of only prioritising mental health at work following an incident, to offering targeted and proactive support to their employees throughout the year.Extensive mental health resources including self-help and online counselling support can be accessed on the Commonwealth Government's Head to Health website If you or somebody you know needs help, call Lifeline on 13 11 14, Beyond Blue on 1800 512 348 or the NSW Mental Health Line on 1800 011 511.Pregnant women and new mothers experiencing mental illness will soon have access to specialist care alongside their babies at the state’s second Mother and Baby Unit (MBU) at Westmead Hospital.Minister for Mental Health Bronnie Taylor said the purpose-built 8-bed unit will be based at Redbank House within Westmead Hospital, increasing support for NSW mothers who require care in a hospital for perinatal mental illness.“This new mother and baby unit at Westmead Hospital will enable up to 120 women each year to receive specialist multi-disciplinary mental health care during the levitra over the counter walgreens crucial early bonding period, without needing to be separated from their babies,” Mrs Taylor said.The new unit offers integrated mental health care with access to maternity, obstetric, paediatric and other medical services.

It has been co-designed with women with a lived experience of mental illness, their families and clinicians to ensure it meets the needs of women levitra over the counter walgreens who will access the service, as well as create a family-friendly environment for partners and siblings.“Each bedroom is large enough to accommodate a mother, their baby, partner and other children, and has been specially designed to meet different levels of care,” Mrs Taylor said.The unit will have a landscaped outdoor area for exercise, relaxation and family visits. It will also include space and equipment for antenatal care, a 24-hour respite nursery, a parent craft room, a retreat room, and consultation and group therapy rooms.Professor Bill Brakoulias, Mental Health Executive Director at Western Sydney Local Health District, said the Westmead MBU is a welcome addition to the mental health services delivered in Western Sydney.“Greater Western Sydney is a rapidly growing region with the highest birth rate in levitra over the counter walgreens NSW,” Prof. Brakoulias said.“We want to ensure all mothers have access to the specialist perinatal and infant mental health care they need, as well as the opportunity to form a bond with their babies in those all-important, formative months.“This state-wide levitra over the counter walgreens service for mothers and babies will be available to local mums, as well as those from other metro, rural and regional areas in NSW.”Construction of the Westmead MBU is expected to commence in late 2021 and will be completed in 2022.

The Royal Prince Alfred Hospital MBU is currently under construction and levitra over the counter walgreens is expected to be completed by early 2022.Both new units are part of the NSW Government’s $700 million Statewide Mental Health Infrastructure Program – the single biggest investment in mental health infrastructure to date..

€‹Councils and staff across the state buy original levitra online came together in a webinar yesterday afternoon to discuss the impacts of erectile dysfunction treatment on the mental health of the NSW local government workforce and the communities they serve.Minister for Local Government Shelley Hancock said more than 200 council workers, councillors, mayors and general managers joined the webinar with Minister for Mental Health Bronnie Taylor and NSW Chief Psychiatrist Dr Murray Wright. "The last 18 months has been a very difficult buy original levitra online time for everybody, with prolonged restrictions on our daily lives and mounting social and economic impacts, so this webinar was designed to address the many stressful and isolating issues we've been encountering," Mrs Hancock said."The webinar provided an opportunity for council staff and councillors to take stock of their own mental health, obtain information on support services, and ask questions and receive advice from the experts. "While much of the focus for councils has been on providing infrastructure, facilities and services to their communities during the erectile dysfunction treatment outbreak, it's important buy original levitra online to reflect on the mental health of council staff and councillors in addition to residents.

"Our 128 local councils across NSW comprise nearly 1,300 councillors and more than 48,000 buy original levitra online staff, and they too are enduring incredible stress in serving their local communities in the face of unprecedented challenges. "The Office of Local Government has so far held nine webinars during this current erectile dysfunction treatment outbreak with key ministers and senior government officials to keep them up to date with the latest developments and restrictions."The NSW Government will continue to support our councils and their local communities to respond and recover from the erectile dysfunction treatment levitra."Mrs Taylor said the NSW Government is working on buy original levitra online a levitra recovery roadmap, under which councils and local communities will play an integral part."Councils have a big role to play as we navigate our path out of this levitra, with the community right at the centre of the recovery," Mrs Taylor said."The NSW Government has invested in community-led suicide prevention activity including local drop-in centres, response groups and community based services."Local staff are doing an incredible job confronting challenges head-on every day, so it is really important that they are equipped with the tools to, not only support the community but also to be able to recognise when they might need to put their hand up for help themselves."This is all about challenging the stigma around with mental illness, encouraging help seeking behaviour and creating connected communities full of healthy, resilient individuals."The NSW Government has relaunched its Mentally Healthy Workplaces Strategy in response to the significant shift in the way we work due to erectile dysfunction treatment. It aims to help employers move from a model of only prioritising mental health at work following an incident, to offering targeted and proactive support to their employees throughout the year.Extensive mental health resources including self-help and online counselling support can be accessed on the Commonwealth Government's Head to Health website If you or somebody you know needs help, call Lifeline on 13 11 14, Beyond Blue on 1800 512 348 or the NSW Mental Health Line on 1800 011 511.Pregnant women and new mothers experiencing mental illness will soon have access to specialist care alongside their babies at the state’s second Mother and Baby Unit (MBU) at Westmead Hospital.Minister for Mental Health Bronnie Taylor said the purpose-built 8-bed unit will be based at Redbank House within Westmead Hospital, increasing support for NSW mothers who require care in a hospital for perinatal mental illness.“This new mother and baby unit at Westmead Hospital will enable up to 120 women each year to receive specialist multi-disciplinary mental health care during the crucial early bonding period, without needing to be separated buy original levitra online from their babies,” Mrs Taylor said.The new unit offers integrated mental health care with access to maternity, obstetric, paediatric and other medical services.

It has been co-designed with women with a lived experience of mental illness, their families buy original levitra online and clinicians to ensure it meets the needs of women who will access the service, as well as create a family-friendly environment for partners and siblings.“Each bedroom is large enough to accommodate a mother, their baby, partner and other children, and has been specially designed to meet different levels of care,” Mrs Taylor said.The unit will have a landscaped outdoor area for exercise, relaxation and family visits. It will also include space and buy original levitra online equipment for antenatal care, a 24-hour respite nursery, a parent craft room, a retreat room, and consultation and group therapy rooms.Professor Bill Brakoulias, Mental Health Executive Director at Western Sydney Local Health District, said the Westmead MBU is a welcome addition to the mental health services delivered in Western Sydney.“Greater Western Sydney is a rapidly growing region with the highest birth rate in NSW,” Prof. Brakoulias said.“We want to ensure all mothers have access to the specialist perinatal and infant mental health care they need, as well as the opportunity to form a bond with their babies in those all-important, formative months.“This state-wide service for mothers and babies will be available to local mums, as well as those from other metro, rural and regional areas in buy original levitra online NSW.”Construction of the Westmead MBU is expected to commence in late 2021 and will be completed in 2022.

The Royal Prince Alfred Hospital MBU is currently under construction and is expected to be completed by early buy original levitra online 2022.Both new units are part of the NSW Government’s $700 million Statewide Mental Health Infrastructure Program – the single biggest investment in mental health infrastructure to date..

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NIH research could lead to new treatment strategies buy levitra pill for stomach cancer Glucocorticoids and androgens promote a healthy stomach http://www.ayersappliancerepair.net/contact/ pit by inhibiting inflammation, left, while their absence promotes inflammation and SPEM seen in a diseased pit, right. SPEM glands are also much larger than healthy stomach glands. (Photo courtesy of Jonathan Busada, Ph.D./NIEHS) Scientists at the National Institutes of Health determined that stomach inflammation is regulated differently in male and female mice after buy levitra pill finding that androgens, or male sex hormones, play a critical role in preventing inflammation in the stomach.

The finding suggests that physicians could consider treating male patients with stomach inflammation differently than female patients with the same condition. The study was published in Gastroenterology.Researchers at NIH’s National Institute of Environmental Health Sciences (NIEHS) made the discovery after removing adrenal glands from mice of both sexes. Adrenal glands produce glucocorticoids, hormones that have several buy levitra pill functions, one of them being suppressing inflammation.

With no glucocorticoids, the female mice soon developed stomach inflammation. The males did not buy levitra pill. However, after removing androgens from the males, they exhibited the same stomach inflammation seen in the females."The fact that androgens are regulating inflammation is a novel idea," said co-corresponding author John Cidlowski, Ph.D., deputy chief of the NIEHS Laboratory of Signal Transduction and head of the Molecular Endocrinology Group.

"Along with glucocorticoids, androgens offer a new way to control immune function in humans."While this study provides insight into how inflammation is being regulated in males, Cidlowski said additional research is underway to understand the process in females. The scientist buy levitra pill handling this phase of research is co-corresponding author Jonathan Busada, Ph.D., assistant professor at West Virginia University School of Medicine in Morgantown. When Busada started the project several years ago, he was a postdoctoral fellow working in Cidlowski’s group.Whether inflammation is inside the stomach or elsewhere in the body, Busada said rates of chronic inflammatory and autoimmune diseases vary depending on sex.

He said eight out of 10 individuals with autoimmune disease are women, and his long-term goal is to figure out how glucocorticoids and androgens affect stomach cancer, which buy levitra pill is induced by chronic inflammation.The current research focused on stomach glands called pits, which are embedded in the lining of the stomach.Busada said the study showed that glucocorticoids and androgens act like brake pedals on the immune system and are essential for regulating stomach inflammation. In his analogy, glucocorticoids are the primary brakes and androgens are the emergency brakes."Females only have one layer of protection, so if you remove glucocorticoids, they develop stomach inflammation and a pre-cancerous condition in the stomach called spasmolytic polypeptide-expressing metaplasia (SPEM)," Busada said. "Males have redundancy built in, so if something cuts the glucocorticoid brake line, it is okay, because the androgens can pick up the slack."The research also offered a possible mechanism — or biological process — behind this phenomenon.

In healthy stomach glands, the presence of buy levitra pill glucocorticoids and androgens inhibit special immune cells called type 2 innate lymphoid cells (ILC2s). But in diseased stomach glands, the hormones are missing. As a result, ILC2s may act like a fire alarm, directing other immune cells called macrophages to promote inflammation and damage gastric glands leading to SPEM and ultimately cancer."ILC2s are the only immune cells that contain androgen receptors and could be a potential therapeutic target," Cidlowski said.This press release describes a basic research finding.

Basic research increases our understanding of human behavior and biology, which buy levitra pill is foundational to advancing new and better ways to prevent, diagnose, and treat disease. Science is an unpredictable and incremental process — each research advance builds on past discoveries, often in unexpected ways. Most clinical advances would not be possible without the knowledge of fundamental basic buy levitra pill research.

To learn more about basic research, visit Basic Research – Digital Media Kit.Grant Numbers:ZIAES090057Fi2GM123974P20GM103434P20GM121322U54GM104942P30GM103488 Reference. Busada JT, Peterson KN, Khadka S, Xu, X, Oakley RH, Cook DN, Cidlowski JA. 2021.

Glucocorticoids and androgens protect from gastric metaplasia by suppressing group 2 innate lymphoid cell activation. Gastroenterology. Doi.

10.1053/j.gastro.2021.04.075 [Online 7 May 2021].CORVALLIS, Ore. €“ A team of Oregon State University scientists has discovered a new class of anti-cancer compounds that effectively kill liver and breast cancer cells. The findings, recently published in the journal Apoptosis, describe the discovery and characterization of compounds, designated as Select Modulators of AhR-regulated Transcription (SMAhRTs).

Edmond Francis O’Donnell III and a team of OSU researchers conducted the research in the laboratory of Siva Kolluri, a professor of cancer research at Oregon State. They also identified the aryl hydrocarbon receptor (AhR) as a new molecular target for development of cancer therapeutics. €œOur research identified a therapeutic lead that acts through a new molecular target for treatment of certain cancers,” Kolluri said.

O’Donnell added. €œThis is an exciting development which lays a foundation for a new class of anti-cancer therapeutics acting through the AhR.” The researchers employed two molecular screening techniques to discover potential SMAhRTs and identified a molecule – known as CGS-15943 – that activates AhR signaling and kills liver and breast cancer cells. Specifically, they studied cells from human hepatocellular carcinoma, a common type of liver cancer, and cells from triple negative breast cancer, which account for about 15% of breast cancers with the worst prognosis.

€œWe focused on these two types of cancers because they are difficult to treat and have limited treatment options,” said Kolluri, a professor in the Department of Environmental and Molecular Toxicology in the College of Agricultural Sciences. €œWe were encouraged by the results because they are unrelated cancers and targeting the AhR was effective in inducing death of both of these distinct cancers.” The researchers also identified the AhR-mediated pathways that contribute to the anti-cancer actions of CGS-15943. Developing cancer treatments requires a detailed understanding of how they act to induce anti-cancer effects.

The researchers determined that CGS-15943 increases the expression of a protein called Fas Ligand through the AhR and causes cancer cell death. These results provide exciting new leads for drug development, but human therapies based on these results may not be available to patients for 10 years, the researchers said. An editorial commemorating the 25th anniversary issue of the journal Apoptosis highlighted this discovery and the detailed investigation of cancer cell death promoted by CGS-15943.

In addition to Kolluri and O’Donnell, who recently completed medical school and is an orthopaedic surgery resident at UC Davis Medical Center, other authors of the paper are. Hyo Sang Jang and Nancy Kerkvliet, both from Oregon State. And Daniel Liefwalker, who formerly worked in Kolluri’s lab and is now at Oregon Health and Science University.

Kolluri is also part of Oregon State’s Linus Pauling Institute and The Pacific Northwest Center for Translational Environmental Health Research. Funding for the research came from the American Cancer Society, National Institute of Environmental Health Sciences, the U.S. Army Medical Research and Material Command, the Department of Defense Breast Cancer Research Program, Oregon State University and the National Cancer Institute.MDEL Bulletin, June 24 2021, from the Medical Devices Compliance Program On this page Fees for Medical Device Establishment Licences (MDELs) We issue Medical Device Establishment Licences (MDELs) to.

class I manufacturers importers or distributors of all device classes for human use in Canada The MDEL fee is a flat fee, regardless of when we receive your initial application. The same fee applies to applications for. a new MDEL the reinstatement of a suspended MDEL the annual licence review (ALR) of an MDEL If you submit any of these applications, you must pay the MDEL fee when you receive an invoice.

See Part 3, Division 2 of the Fees in Respect of Drugs and Medical Devices Order. Normally, we collect the MDEL fee before we review an application. However, to help meet the demand for medical devices during the erectile dysfunction treatment levitra, we have been reviewing and processing MDEL applications before collecting the fees.

As a result, some MDEL holders still haven't paid the fees for their 2020 initial MDEL application, despite multiple reminders. Authority to withhold services in case of non-payment As stated in the Food and Drug Act, Health Canada has the authority to withhold services, approvals, rights and/or privileges, if the fee for an MDEL application is not paid. Non-payment of fees 30.64.

The Minister may withdraw or withhold a service, the use of a facility, a regulatory process or approval or a product, right or privilege under this Act from any person who fails to pay the fee fixed for it under subsection 30.61(1). For more information, please refer to. Cancellation of existing MDELs We will cancel MDELs for existing MDEL holders with outstanding fees for.

initial applications or annual licence review applications If your establishment licence is cancelled, you are no longer authorized to conduct licensable activities (such as manufacturing, distributing or importing medical devices). You must stop licensable activities as soon as you receive your cancellation notice. Resuming activities after MDEL cancellation To resume licensable activities, you must re-apply for a new establishment licence and pay the MDEL fee.

See section 45 of the Medical Device Regulations. To find out how to re-apply for a MDEL, please refer to our Guidance on medical device establishment licensing (GUI-0016). In line with the Compliance and Enforcement Policy (POL-0001), Health Canada monitors activities for compliance.

If your MDEL has been cancelled, you may be subject to compliance and enforcement actions if you conduct non-compliant activities. If you have questions about a MDEL or the application process, please contact the Medical Device Establishment Licensing Unit at hc.mdel.questions.leim.sc@canada.ca. If you have questions about invoicing and fees for an MDEL application, please contact the Cost Recovery Invoicing Unit at hc.criu-ufrc.sc@canada.ca.

Related linksResponse to the Expert Panel Report on “Priority strategies to optimize testing and quarantine at Canada’s borders” The Industry Advisory Roundtable on erectile dysfunction treatment Testing, Screening, Tracing and Data Management is pleased to release its third report. This report reiterates the importance of balancing public health measures to reduce the importation of erectile dysfunction treatment with the need to ensure the free flow of people and goods across the Canadian border and support economic recovery. On this page Executive summary Soon after erectile dysfunction treatment was declared a global levitra in March 2020, international borders around the world closed in an effort to limit the spread of the levitra.

To ensure the health and safety of individuals, the movement of people and goods was restricted. Yet, it was important to maintain access to essential goods and services and sustain trade-based economic sectors. Canada responded in step with other countries.

The government implemented public health measures such as mandatory testing and quarantine when crossing international borders. Restrictions are necessary to curb the spread of the levitra. Yet, in a complex environment such as international borders, it’s crucial to implement and clearly communicate public health measures effectively and clearly.

Border measures such as testing regimes and other public health measures must be based on the most recent science-based public health evidence. Such measures must also leverage advances in testing options, consider vaccination rates and balance the needs of industries operating across borders. Furthermore, plans must be cheap levitra canada easy to implement consistently across several entry modes.

They should also be communicated broadly and include a roadmap for easing or increasing border restrictions based on objective criteria and benchmarks. As we enter the second year of the levitra, the Roundtable is offering insights and recommendations to adjust current border measures. We have based our recommendations on evidence collected from international scans and observations from industries that move goods and people across borders.

The Roundtable recognizes the effort required to implement plans for easing border restrictions, given rapidly evolving public health circumstances and emerging variants of concern. Prompt action is needed to design and implement a border measures plan that reduces the risk of the levitra spreading while proactively moving towards economic recovery. Current border environment In March 2020, the ability of people to move across the Canadian border was restricted.

Since then, several measures were taken to reduce the importation of erectile dysfunction treatment and limit the spread of the levitra. As circumstances changed over the following weeks and months, border measures became more restrictive. In early 2021, more stringent public health measures were introduced for non-essential travellers at air and land borders.

This was done to reduce the importation rate of erectile dysfunction treatment and its variants of concern. Measures included the following. mandatory pre-departure erectile dysfunction treatment molecular test contact/quarantine plan using the ArriveCAN application on-arrival and post-arrival testing for travellers arriving by air, mandatory 3-day quarantine in government-authorized hotels followed by quarantine or isolation at an approved location such as the traveller’s home The Government of Canada and the aviation industry also worked together on a plan to suspend Canadian air carrier flights to and from Mexico and Caribbean countries from January 31 to April 30, 2021.

Then on February 3, 2021, all incoming international commercial passenger flights to Canada were restricted to the 4 largest airports. Montreal, Toronto, Calgary and Vancouver. In order to prevent importation of variants of concern, the Government of Canada took additional measures that included suspension of flights from certain countries.

Canada suspended all commercial and passenger flights from the United Kingdom between December 20, 2020 and January 6, 2021. Additionally, on April 22, 2021, all commercial and private passenger flights from India and Pakistan were suspended in response to a high number of cases detected among individuals travelling on flights originating from the two countries. These measures are in place until at least June 21, 2021.

Internal data from the Public Health Agency of Canada indicates the following positivity rates for the seven days up to and including May 27, 2021, for air and land travel combined. the 7-day average positivity rate for testing on arrival was 0.2% the 7-day average positivity rate for second tests was 0.3% As well, all positive tests undergo genomic sequencing to identify variants of concern. Cross-border travel volumes decreased significantly from December 2019 to December 2020.

Statistics Canada data show that the. number of travellers to Canada was down 93% total number of international travellers to and from Canada declined from 96.8 million in 2019 to 25.9 million in 2020 Air travel has experienced the most dramatic shifts, as travellers arriving by air are mostly non-exempt from border measures. In comparison, travellers exempt from border measures make up the vast majority of land border traffic.

Essential travel continued largely unimpeded, as governments recognized the importance of preserving vital supply chains to ensure that food, fuel and life-saving medicines continue to reach people. A shifting landscape As of May 28, 2021, variants of concern account for an estimated 70% of reported cases in recent weeks. Any border measures must account for this new reality.

At the same time, individuals and organizations within and outside of Canada are increasingly looking for. a concrete roadmap to the economic reopening of the country clear guidelines for restarting cross-border travel Plans and guidelines should clearly spell out the public health criteria for adjusting border measures. They should also outline when and how restrictions should be eased in the short and longer term.

Guidelines must take into consideration the risk of importing new variants of concern in the move towards a safe restart of the trade and tourism industries that operate internationally. As scientists learn more about how the levitra spreads, as travellers are tested regularly and as vaccination efforts increase, it will be easier to manage the risk of importing erectile dysfunction treatment and its variants. Nevertheless, while the international border is open, there’s always the risk of importation.

For a safe reopening, we need a risk framework that takes into account public health measures and socio-economic factors. To bring the risk to an acceptable level, detection and surveillance options should be part of any robust border testing strategy. Evidence concerning restrictive border measures, including lengthy quarantines, shows that the effectiveness of these measures declines over time.

Non-compliance increases when measures are too tough and/or not communicated well. This can counter efforts to reduce the spread of the levitra and break the chains of transmission. As more and more people in Canada and abroad are vaccinated, it will be necessary to update Canada’s strategy to allow the movement of vaccinated travellers, based on emerging scientific evidence and while respecting public health measures.

Complex border measures may present significant implementation challenges, which can lead to disparities in how the various rules, regulations and guidelines are applied at ports of entry. This may have a negative impact on people crossing the Canadian border and those industries engaged in cross-border and transnational business. Small and medium companies may be especially impacted.

Although essential workers have largely been exempt from border measures, the Roundtable is aware of the challenges they face when rules are applied inconsistently. For example, several Canadian companies have reported incidences where some engineers, technicians and other specialists have faced challenges crossing the Canada-US border and meeting their contractual obligations to provide skilled services. Some business executives and professional services providers with cross-border responsibilities are constrained in their ability to manage their operations effectively.

As well, disruptions to the cross-border travel of these workers could expose businesses to legal recourse from clients for failure to meet commitments. Many countries, including Canada, are aggressively rolling out vaccination regimes and partially permitting the movement of people (with restrictions). Canada is now the top country in the G7, G20 and OECD for vaccination rates of first doses.

As the campaign shifts to second doses, Canada must continue to reach vulnerable populations to ensure treatment equity and broad-based coverage to facilitate re-opening the economy and growth. Canada’s biggest trading partner also shares its largest border. Efforts should be made to align public health and economic recovery goals between Canada and the United States.

Prioritizing the Canada-US border would be consistent with the commitments made by both countries in the Roadmap for a Renewed U.S.-Canada Partnership. This roadmap recommends a coordinated and science-based approach to ease border restrictions in the future. Countries around the world are also exploring cooperative arrangements with other countries and looking at piloting innovative technology and information-sharing platforms designed to facilitate safe travel, such as treatment certification.

Implementing significant changes requires wide support and cooperation, as highlighted in the Industry Strategy Council’s Restart, recover, and reimagine prosperity for all Canadians report. The report proposes a three-phase action plan – restart, recover, and reimagine – focused on investment and growth, and embodies values and principles of action and shared responsibility to mobilize all sectors to propel Canada forward. The phases are anchored in five recommendations to safely restore confidence and commerce, stabilize the hardest-hit sectors, reignite growth by doubling down on a future-oriented investment plan, develop an ambitious industrial strategy, and establish renewed public-private sector partnerships and investments anchored in a sound and rigorous fiscal framework.

At the same time, we must recognize we live in times of uncertainty and contend with a rapidly shifting landscape. Plans should be flexible in order to balance public health concerns with the desire to ease restrictions. We must work with public health experts to establish and clearly communicate criteria and benchmarks to help travellers and businesses understand how and when border restrictions will be eased or increased in the coming months.

Provinces and territories have outlined their reopening plans, with an important strength being the use of benchmarks to move between several steps of restrictions. Communicating a clear path with well-defined criteria will provide a much-needed level of predictability for reopening to industry and travellers alike. Recommendations The Industry Roundtable recommends an approach to border measures that include both short- and longer-term recommendations.

Short-term recommendations Provide clear definitions of cross-border essential travellers and apply these in a consistent manner at all ports of entry. Recognize that companies are well positioned to identify essential travellers within their organization, enabling them to leverage existing domestic testing regimes for employees to demonstrate that public health requirements are met. Accepting employer-issued proof of testing would shift the onus away from the border and alleviate traveller flow pressures.

Explicitly state the conditions for testing travellers and the criteria for shortening or removing quarantine measures. Connect the pace of vaccination rollout with public health measures and the gradual lifting of travel restrictions, and include clear procedures for vaccinated, partially vaccinated and unvaccinated travellers. This may need to adjust as new variants of concern emerge.

Enable industry to take an active role in meeting vaccination targets in Canada by supporting priority vaccination of cross-border essential workers. Aggressive vaccination targets for these workers would help companies contribute to the safe reopening of the economy in a timely manner. Apply measures consistently at air and land borders, whenever possible.

Provide clear, straightforward messaging for every person and company involved in the cross-border movement of people and goods. Clear communication leads to effective, consistent implementation of any border measure and subsequent updates. Longer-term recommendations Take into account evolving scientific evidence and adopt emerging findings.

For example, evidence suggests that rapid antigen testing can be effective as a screening tool and adds another layer of defence when used as part of surveillance testing. Ensure that processes, information systems and infrastructure needed to implement modified border measures are in place and can manage increased travel volumes effectively. Re-position Canada as a competitive participant in the tourism and global trade sectors through enabling border measures that facilitate the movement of people and goods across international borders.

In collaboration with the private sector, the government should develop an enhanced framework to better prepare for and respond to future levitras..

NIH research could lead to buy original levitra online new treatment strategies for stomach cancer Glucocorticoids and androgens promote a healthy stomach pit by inhibiting inflammation, left, while their absence promotes inflammation and SPEM seen in a diseased pit, right. SPEM glands are also much larger than healthy stomach glands. (Photo courtesy of Jonathan Busada, Ph.D./NIEHS) Scientists at the National Institutes of Health determined that stomach inflammation is regulated differently in male and female mice after finding that androgens, or male sex hormones, play a critical role buy original levitra online in preventing inflammation in the stomach.

The finding suggests that physicians could consider treating male patients with stomach inflammation differently than female patients with the same condition. The study was published in Gastroenterology.Researchers at NIH’s National Institute of Environmental Health Sciences (NIEHS) made the discovery after removing adrenal glands from mice of both sexes. Adrenal glands produce glucocorticoids, hormones that have several functions, one of them buy original levitra online being suppressing inflammation.

With no glucocorticoids, the female mice soon developed stomach inflammation. The males did not buy original levitra online. However, after removing androgens from the males, they exhibited the same stomach inflammation seen in the females."The fact that androgens are regulating inflammation is a novel idea," said co-corresponding author John Cidlowski, Ph.D., deputy chief of the NIEHS Laboratory of Signal Transduction and head of the Molecular Endocrinology Group.

"Along with glucocorticoids, androgens offer a new way to control immune function in humans."While this study provides insight into how inflammation is being regulated in males, Cidlowski said additional research is underway to understand the process in females. The scientist handling this phase of research is co-corresponding author Jonathan Busada, Ph.D., assistant professor at West Virginia University School of Medicine buy original levitra online in Morgantown. When Busada started the project several years ago, he was a postdoctoral fellow working in Cidlowski’s group.Whether inflammation is inside the stomach or elsewhere in the body, Busada said rates of chronic inflammatory and autoimmune diseases vary depending on sex.

He said eight out of 10 individuals with autoimmune disease are women, and his long-term goal is to figure out how glucocorticoids and androgens affect stomach cancer, which is induced by chronic inflammation.The current research focused on stomach glands called pits, which are embedded in the lining of the stomach.Busada said the study showed that glucocorticoids and buy original levitra online androgens act like brake pedals on the immune system and are essential for regulating stomach inflammation. In his analogy, glucocorticoids are the primary brakes and androgens are the emergency brakes."Females only have one layer of protection, so if you remove glucocorticoids, they develop stomach inflammation and a pre-cancerous condition in the stomach called spasmolytic polypeptide-expressing metaplasia (SPEM)," Busada said. "Males have redundancy built in, so if something cuts the glucocorticoid brake line, it is okay, because the androgens can pick up the slack."The research also offered a possible mechanism — or biological process — behind this phenomenon.

In healthy stomach glands, the presence of glucocorticoids buy original levitra online and androgens inhibit special immune cells called type 2 innate lymphoid cells (ILC2s). But in diseased stomach glands, the hormones are missing. As a result, ILC2s may act like a fire alarm, directing other immune cells called macrophages to promote inflammation and damage gastric glands leading to SPEM and ultimately cancer."ILC2s are the only immune cells that contain androgen receptors and could be a potential therapeutic target," Cidlowski said.This press release describes a basic research finding.

Basic research increases our understanding of human behavior and biology, which buy original levitra online is foundational to advancing new and better ways to prevent, diagnose, and treat disease. Science is an unpredictable and incremental process — each research advance builds on past discoveries, often in unexpected ways. Most clinical buy original levitra online advances would not be possible without the knowledge of fundamental basic research.

To learn more about basic research, visit Basic Research – Digital Media Kit.Grant Numbers:ZIAES090057Fi2GM123974P20GM103434P20GM121322U54GM104942P30GM103488 Reference. Busada JT, Peterson KN, Khadka S, Xu, X, Oakley RH, Cook DN, Cidlowski JA. 2021.

Glucocorticoids and androgens protect from gastric metaplasia by suppressing group 2 innate lymphoid cell activation. Gastroenterology. Doi.

10.1053/j.gastro.2021.04.075 [Online 7 May 2021].CORVALLIS, Ore. €“ A team of Oregon State University scientists has discovered a new class of anti-cancer compounds that effectively kill liver and breast cancer cells. The findings, recently published in the journal Apoptosis, describe the discovery and characterization of compounds, designated as Select Modulators of AhR-regulated Transcription (SMAhRTs).

Edmond Francis O’Donnell III and a team of OSU researchers conducted the research in the laboratory of Siva Kolluri, a professor of cancer research at Oregon State. They also identified the aryl hydrocarbon receptor (AhR) as a new molecular target for development of cancer therapeutics. €œOur research identified a therapeutic lead that acts through a new molecular target for treatment of certain cancers,” Kolluri said.

O’Donnell added. €œThis is an exciting development which lays a foundation for a new class of anti-cancer therapeutics acting through the AhR.” The researchers employed two molecular screening techniques to discover potential SMAhRTs and identified a molecule – known as CGS-15943 – that activates AhR signaling and kills liver and breast cancer cells. Specifically, they studied cells from human hepatocellular carcinoma, a common type of liver cancer, and cells from triple negative breast cancer, which account for about 15% of breast cancers with the worst prognosis.

€œWe focused on these two types of cancers because they are difficult to treat and have limited treatment options,” said Kolluri, a professor in the Department of Environmental and Molecular Toxicology in the College of Agricultural Sciences. €œWe were encouraged by the results because they are unrelated cancers and targeting the AhR was effective in inducing death of both of these distinct cancers.” The researchers also identified the AhR-mediated pathways that contribute to the anti-cancer actions of CGS-15943. Developing cancer treatments requires a detailed understanding of how they act to induce anti-cancer effects.

The researchers determined that CGS-15943 increases the expression of a protein called Fas Ligand through the AhR and causes cancer cell death. These results provide exciting new leads for drug development, but human therapies based on these results may not be available to patients for 10 years, the researchers said. An editorial commemorating the 25th anniversary issue of the journal Apoptosis highlighted this discovery and the detailed investigation of cancer cell death promoted by CGS-15943.

In addition to Kolluri and O’Donnell, who recently completed medical school and is an orthopaedic surgery resident at UC Davis Medical Center, other authors of the paper are. Hyo Sang Jang and Nancy Kerkvliet, both from Oregon State. And Daniel Liefwalker, who formerly worked in Kolluri’s lab and is now at Oregon Health and Science University.

Kolluri is also part of Oregon State’s Linus Pauling Institute and The Pacific Northwest Center for Translational Environmental Health Research. Funding for the research came from the American Cancer Society, National Institute of Environmental Health Sciences, the U.S. Army Medical Research and Material Command, the Department of Defense Breast Cancer Research Program, Oregon State University and the National Cancer Institute.MDEL Bulletin, June 24 2021, from the Medical Devices Compliance Program On this page Fees for Medical Device Establishment Licences (MDELs) We issue Medical Device Establishment Licences (MDELs) to.

class I manufacturers importers or distributors of all device classes for human use in Canada The MDEL fee is a flat fee, regardless of when we receive your initial application. The same fee applies to applications for. a new MDEL the reinstatement of a suspended MDEL the annual licence review (ALR) of an MDEL If you submit any of these applications, you must pay the MDEL fee when you receive an invoice.

See Part 3, Division 2 of the Fees in Respect of Drugs and Medical Devices Order. Normally, we collect the MDEL fee before we review an application. However, to help meet the demand for medical devices during the erectile dysfunction treatment levitra, we have been reviewing and processing MDEL applications before collecting the fees.

As a result, some MDEL holders still haven't paid the fees for their 2020 initial MDEL application, despite multiple reminders. Authority to withhold services in case of non-payment As stated in the Food and Drug Act, Health Canada has the authority to withhold services, approvals, rights and/or privileges, if the fee for an MDEL application is not paid. Non-payment of fees 30.64.

The Minister may withdraw or withhold a service, the use of a facility, a regulatory process or approval or a product, right or privilege under this Act from any person who fails to pay the fee fixed for it under subsection 30.61(1). For more information, please refer to. Cancellation of existing MDELs We will cancel MDELs for existing MDEL holders with outstanding fees for.

initial applications or annual licence review applications If your establishment licence is cancelled, you are no longer authorized to conduct licensable activities (such as manufacturing, distributing or importing medical devices). You must stop licensable activities as soon as you receive your cancellation notice. Resuming activities after MDEL cancellation To resume licensable activities, you must re-apply for a new establishment licence and pay the MDEL fee.

See section 45 of the Medical Device Regulations. To find out how to re-apply for a MDEL, please refer to our Guidance on medical device establishment licensing (GUI-0016). In line with the Compliance and Enforcement Policy (POL-0001), Health Canada monitors activities for compliance.

If your MDEL has been cancelled, you may be subject to compliance and enforcement actions if you conduct non-compliant activities. If you have questions about a MDEL or the application process, please contact the Medical Device Establishment Licensing Unit at hc.mdel.questions.leim.sc@canada.ca. If you have questions about invoicing and fees for an MDEL application, please contact the Cost Recovery Invoicing Unit at hc.criu-ufrc.sc@canada.ca.

Related linksResponse to the Expert Panel Report on “Priority strategies to optimize testing and quarantine at Canada’s borders” The Industry Advisory Roundtable on erectile dysfunction treatment Testing, Screening, Tracing and Data Management is pleased to release its third report. This report reiterates the importance of balancing public health measures to reduce the importation of erectile dysfunction treatment with the need to ensure the free flow of people and goods across the Canadian border and support economic recovery. On this page Executive summary Soon after erectile dysfunction treatment was declared a global levitra in March 2020, international borders around the world closed in an effort to limit the spread of the levitra.

To ensure the health and safety of individuals, the movement of people and goods was restricted. Yet, it was important to maintain access to essential goods and services and sustain trade-based economic sectors. Canada responded in step with other countries.

The government implemented public health measures such as mandatory testing and quarantine when crossing international borders. Restrictions are necessary to curb the spread of the levitra. Yet, in a complex environment such as international borders, it’s crucial to implement and clearly communicate public health measures effectively and clearly.

Border measures such as testing regimes and other public health measures must be based on the most recent science-based public health evidence. Such measures must also leverage advances in testing options, consider vaccination rates and balance the needs of industries operating across borders. Furthermore, plans must be easy to implement consistently across several entry modes.

They should also be communicated broadly and include a roadmap for easing or increasing border restrictions based on objective criteria and benchmarks. As we enter the second year of the levitra, the Roundtable is offering insights and recommendations to adjust current border measures. We have based our recommendations on evidence collected from international scans and observations from industries that move goods and people across borders.

The Roundtable recognizes the effort required to implement plans for easing border restrictions, given rapidly evolving public health circumstances and emerging variants of concern. Prompt action is needed to design and implement a border measures plan that reduces the risk of the levitra spreading while proactively moving towards economic recovery. Current border environment In March 2020, the ability of people to move across the Canadian border was restricted.

Since then, several measures were taken to reduce the importation of erectile dysfunction treatment and limit the spread of the levitra. As circumstances changed over the following weeks and months, border measures became more restrictive. In early 2021, more stringent public health measures were introduced for non-essential travellers at air and land borders.

This was done to reduce the importation rate of erectile dysfunction treatment and its variants of concern. Measures included the following. mandatory pre-departure erectile dysfunction treatment molecular test contact/quarantine plan using the ArriveCAN application on-arrival and post-arrival testing for travellers arriving by air, mandatory 3-day quarantine in government-authorized hotels followed by quarantine or isolation at an approved location such as the traveller’s home The Government of Canada and the aviation industry also worked together on a plan to suspend Canadian air carrier flights to and from Mexico and Caribbean countries from January 31 to April 30, 2021.

Then on February 3, 2021, all incoming international commercial passenger flights to Canada were restricted to the 4 largest airports. Montreal, Toronto, Calgary and Vancouver. In order to prevent importation of variants of concern, the Government of Canada took additional measures that included suspension of flights from certain countries.

Canada suspended all commercial and passenger flights from the United Kingdom between December 20, 2020 and January 6, 2021. Additionally, on April 22, 2021, all commercial and private passenger flights from India and Pakistan were suspended in response to a high number of cases detected among individuals travelling on flights originating from the two countries. These measures are in place until at least June 21, 2021.

Internal data from the Public Health Agency of Canada indicates the following positivity rates for the seven days up to and including May 27, 2021, for air and land travel combined. the 7-day average positivity rate for testing on arrival was 0.2% the 7-day average positivity rate for second tests was 0.3% As well, all positive tests undergo genomic sequencing to identify variants of concern. Cross-border travel volumes decreased significantly from December 2019 to December 2020.

Statistics Canada data show that the. number of travellers to Canada was down 93% total number of international travellers to and from Canada declined from 96.8 million in 2019 to 25.9 million in 2020 Air travel has experienced the most dramatic shifts, as travellers arriving by air are mostly non-exempt from border measures. In comparison, travellers exempt from border measures make up the vast majority of land border traffic.

Essential travel continued largely unimpeded, as governments recognized the importance of preserving vital supply chains to ensure that food, fuel and life-saving medicines continue to reach people. A shifting landscape As of May 28, 2021, variants of concern account for an estimated 70% of reported cases in recent weeks. Any border measures must account for this new reality.

At the same time, individuals and organizations within and outside of Canada are increasingly looking for. a concrete roadmap to the economic reopening of the country clear guidelines for restarting cross-border travel Plans and guidelines should clearly spell out the public health criteria for adjusting border measures. They should also outline when and how restrictions should be eased in the short and longer term.

Guidelines must take into consideration the risk of importing new variants of concern in the move towards a safe restart of the trade and tourism industries that operate internationally. As scientists learn more about how the levitra spreads, as travellers are tested regularly and as vaccination efforts increase, it will be easier to manage the risk of importing erectile dysfunction treatment and its variants. Nevertheless, while the international border is open, there’s always the risk of importation.

For a safe reopening, we need a risk framework that takes into account public health measures and socio-economic factors. To bring the risk to an acceptable level, detection and surveillance options should be part of any robust border testing strategy. Evidence concerning restrictive border measures, including lengthy quarantines, shows that the effectiveness of these measures declines over time.

Non-compliance increases when measures are too tough and/or not communicated well. This can counter efforts to reduce the spread of the levitra and break the chains of transmission. As more and more people in Canada and abroad are vaccinated, it will be necessary to update Canada’s strategy to allow the movement of vaccinated travellers, based on emerging scientific evidence and while respecting public health measures.

Complex border measures may present significant implementation challenges, which can lead to disparities in how the various rules, regulations and guidelines are applied at ports of entry. This may have a negative impact on people crossing the Canadian border and those industries engaged in cross-border and transnational business. Small and medium companies may be especially impacted.

Although essential workers have largely been exempt from border measures, the Roundtable is aware of the challenges they face when rules are applied inconsistently. For example, several Canadian companies have reported incidences where some engineers, technicians and other specialists have faced challenges crossing the Canada-US border and meeting their contractual obligations to provide skilled services. Some business executives and professional services providers with cross-border responsibilities are constrained in their ability to manage their operations effectively.

As well, disruptions to the cross-border travel of these workers could expose businesses to legal recourse from clients for failure to meet commitments. Many countries, including Canada, are aggressively rolling out vaccination regimes and partially permitting the movement of people (with restrictions). Canada is now the top country in the G7, G20 and OECD for vaccination rates of first doses.

As the campaign shifts to second doses, Canada must continue to reach vulnerable populations to ensure treatment equity and broad-based coverage to facilitate re-opening the economy and growth. Canada’s biggest trading partner also shares its largest border. Efforts should be made to align public health and economic recovery goals between Canada and the United States.

Prioritizing the Canada-US border would be consistent with the commitments made by both countries in the Roadmap for a Renewed U.S.-Canada Partnership. This roadmap recommends a coordinated and science-based approach to ease border restrictions in the future. Countries around the world are also exploring cooperative arrangements with other countries and looking at piloting innovative technology and information-sharing platforms designed to facilitate safe travel, such as treatment certification.

Implementing significant changes requires wide support and cooperation, as highlighted in the Industry Strategy Council’s Restart, recover, and reimagine prosperity for all Canadians report. The report proposes a three-phase action plan – restart, recover, and reimagine – focused on investment and growth, and embodies values and principles of action and shared responsibility to mobilize all sectors to propel Canada forward. The phases are anchored in five recommendations to safely restore confidence and commerce, stabilize the hardest-hit sectors, reignite growth by doubling down on a future-oriented investment plan, develop an ambitious industrial strategy, and establish renewed public-private sector partnerships and investments anchored in a sound and rigorous fiscal framework.

At the same time, we must recognize we live in times of uncertainty and contend with a rapidly shifting landscape. Plans should be flexible in order to balance public health concerns with the desire to ease restrictions. We must work with public health experts to establish and clearly communicate criteria and benchmarks to help travellers and businesses understand how and when border restrictions will be eased or increased in the coming months.

Provinces and territories have outlined their reopening plans, with an important strength being the use of benchmarks to move between several steps of restrictions. Communicating a clear path with well-defined criteria will provide a much-needed level of predictability for reopening to industry and travellers alike. Recommendations The Industry Roundtable recommends an approach to border measures that include both short- and longer-term recommendations.

Short-term recommendations Provide clear definitions of cross-border essential travellers and apply these in a consistent manner at all ports of entry. Recognize that companies are well positioned to identify essential travellers within their organization, enabling them to leverage existing domestic testing regimes for employees to demonstrate that public health requirements are met. Accepting employer-issued proof of testing would shift the onus away from the border and alleviate traveller flow pressures.

Explicitly state the conditions for testing travellers and the criteria for shortening or removing quarantine measures. Connect the pace of vaccination rollout with public health measures and the gradual lifting of travel restrictions, and include clear procedures for vaccinated, partially vaccinated and unvaccinated travellers. This may need to adjust as new variants of concern emerge.

Enable industry to take an active role in meeting vaccination targets in Canada by supporting priority vaccination of cross-border essential workers. Aggressive vaccination targets for these workers would help companies contribute to the safe reopening of the economy in a timely manner. Apply measures consistently at air and land borders, whenever possible.

Provide clear, straightforward messaging for every person and company involved in the cross-border movement of people and goods. Clear communication leads to effective, consistent implementation of any border measure and subsequent updates. Longer-term recommendations Take into account evolving scientific evidence and adopt emerging findings.

For example, evidence suggests that rapid antigen testing can be effective as a screening tool and adds another layer of defence when used as part of surveillance testing. Ensure that processes, information systems and infrastructure needed to implement modified border measures are in place and can manage increased travel volumes effectively. Re-position Canada as a competitive participant in the tourism and global trade sectors through enabling border measures that facilitate the movement of people and goods across international borders.

In collaboration with the private sector, the government should develop an enhanced framework to better prepare for and respond to future levitras..

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Start Preamble how important is the expiration date on levitra Announcement Type. New. Funding how important is the expiration date on levitra Announcement Number.

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 Announcement Type buy original levitra online. New. Funding Announcement buy original levitra online Number. 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.