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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

Division of Grants Management

Billing Code: 4165-16

Department of Health and Human Services
Indian Health Service
Office of Clinical and Preventive Services
Chronic Care Collaborative
Announcement Type: Cooperative Agreement
Funding Opportunity Number: HHS-2007-IHS-HPDP1-0001
Catalog of Federal Domestic Assistance Number: 93.443

Key Dates: Application Deadline Date: February 1, 2007
Review Date: February 8, 2007
Earliest Anticipated Start Date: February 16, 2007

I. Funding Opportunity Description
The Indian Health Service (IHS) announces a sole source cooperative agreement for the Institute for Healthcare Improvement (IHI) for HHS-2007-IHS-HPDP1-0001. This program is authorized under the authority of the Snyder Act and Section 301 of the Public Health Service Act as amended. This program is described at 93.443 in the Catalog of Federal Domestic Assistance (CFDA).


Approximately $800,000 per year for three years will be available to support a cooperative agreement to improve prevention and management of chronic conditions for the American Indian/Alaska Native (AI/AN) population by strengthening the care team, designing care that is patient-centered, and developing care processes that apply across multiple chronic care conditions instead of care based on managing individual diseases. This effort will assist the IHS to put in place innovations in care delivery and a system of testing and implementing changes to shift care in this new direction. It will also require the building of a more robust improvement infrastructure and developing strategies for engaging stakeholders at multiple levels to continuously advance the quality of care given to patients. The capabilities of IHS' cutting-edge information systems will be instrumental in these transformations.

This cooperative agreement will support the implementation of the IHS Director's initiative on chronic care management as well as the closely related initiatives in health promotion and disease prevention and behavioral health. In addition to the overall goal of decreasing years of potential life lost, the project effort will also focus on improving the quality of care and other appropriate performance measures. In addition, efforts will focus on:
1. Testing adaptations and innovations in chronic conditions in the Indian health system;
2. Developing a strategy for spreading the lessons learned to Indian health sites;
3. Creating a more robust improvement infrastructure; and
4. Nurturing the image of the IHS as an innovator in health care.


Most other improvement agencies and organizations focus on specific steps and methodologies while IHI takes a much more comprehensive and strategic approach to improvement. Over the past 15 years they have become the recognized world leader in system change in healthcare. They have moved beyond the specifics of software into process development using a variety of techniques to make the best use of technologies and existing organizational capabilities. Their methodologies include improvement advisors who act as peer to peer coaches for organizations implementing change. This personal approach and the IHI's considerable expertise are critical to expand existing Indian Country efforts, where personal connection and effective relationships are often the difference between project success and failure.

II. Award Information:
TYPE OF AWARD: Cooperative Agreement.
ESTIMATED FUNDS AVAILABLE: The award is for three years. For year one $600,000 is available and for years two and three $800,000 is available for each year for a continuation award. Award under this announcement is subject to availability of funds.
ANTICIPATED NUMBER OF AWARDS: One single source award will be made under the Program.
PROJECT PERIOD: February 16, 2007 - February 15, 2010.
AWARD AMOUNT: $600,000 in year 1; $800,000 in years 2 and 3 and continuation awards are subject to the availability of funds.

PROGRAMMATIC INVOLVEMENT: The IHS will work closely with IHI on innovating and testing new designs of care delivery systems, leveraging results for thousands of patients, and creating a system-wide emphasis on improvement. The IHS and IHI's senior leaders and faculty will work closely with the senior leadership team of the Indian health care system to design an improvement strategy to meet the agreed upon aims. Leadership is the critical driver for change and IHS will work with the Indian Tribal Organizations and Urban leadership to build a culture and structure to support improved levels of performance in the delivery of health care. The IHI and the IHS will work collaboratively to build new models of care and care processes, with the intent of disseminating such learning and

  • best practices
  • throughout the health care system. The IHS will have the opportunity to showcase the results of this work by publishing them on shared websites as well as in jointly authored publications.
    It is expected that IHI will:
    1. Develop a small team to work closely with the IHS staff assigned to the Chronic Care Management Initiative. The team will meet at least bi-weekly to determine priority activities and timelines for work completion.
    2. Conduct weekly conference calls and periodic virtual and face-to-face meetings to enhance communication between the IHI and IHS teams. IHI team will participate in site visit activities in order to gain a greater understanding of the approaches, challenges, and successes relating to the Indian health system of care delivery (access, efficiencies developed, and the care team). These visits will enhance communication and engage leadership in the collaborative.

    3. Involve the IHS core team as well as the pilot sites in decisions about the impact of the collaborative.

    In close collaboration, the IHS will:
    1. Identify a core group of staff to work closely with the IHI team. The team will meet at least bi-weekly to determine priority activities and timelines for work completion.
    2. Participate in all conference calls; virtual and face-to-face meetings to assure communication. IHI will coordinate site visit activities in order to provide a greater understanding of the approaches, challenges, and successes relating to the system of care delivery (access, efficiencies developed, and the care team). These visits will enhance communication and engage leadership in the collaborative.
    3. Engage I/T/U pilot sites, subject matter experts, Senior I/T/U leadership in decisions about the development, implementation and spread of the collaborative.

    III. Eligibility Information
    1. Single Source Entity (Non-profit organization) - Institute for Healthcare Improvement.

    IHI must provide proof of non-profit status with the application.


    2. Cost Sharing or Matching - This program does not require matching funds or cost sharing.

    IV. Application and Submission Information

    1. Applicant package may be found in Grants.gov (www.grants.gov ) or at: http://www.ihs.gov/NonMedicalPrograms/gogp/gogp_funding.asp web sites.
    Information regarding the electronic application process may be directed to Michelle G. Bulls, at (301) 443-6290.

    The entire application package is available at: http://www.grants.gov. Detailed application instructions for this announcement are downloadable from Grants.gov.

    2. Content and Form of Application Submission:
    · Be single spaced.
    · Be typewritten.
    · Have consecutively numbered pages.
    · Use black type not smaller than 12 characters per one inch.
    · Contain a narrative that does not exceed 15 typed pages that includes the other submission requirements below. The 15 page narrative does not include the work plan, standard forms, table of contents, budget, budget justifications, narratives, and/or other appendix items.

    Public Policy Requirements: All Federal-wide public policies apply to IHS grants with the exception of Lobbying and Discrimination.

    3. Submission Dates and Times:
    The application from IHI must be submitted electronically through Grants.gov by 12:00 midnight Eastern Standard Time (EST). If technical challenges arise and IHI is unable to successfully complete the electronic application process, IHI must contact Michelle G. Bulls, Grants Policy Staff fifteen days prior to the application deadline and advise of the difficulties that IHI is experiencing. IHI must obtain prior approval, in writing (emails are acceptable), from Ms. Bulls allowing the paper submission. If submission of a paper application is requested and approved, the original and two copies may be sent to the appropriate grants contact that is listed in Section IV.1 above. Application not submitted through Grants.gov, without an approved waiver, may be returned to IHI without review or consideration.

    A late application will be returned to IHI without review or consideration.

    4. Intergovernmental Review: Executive Order 12372 requiring intergovernmental review is not applicable to this program.


    5. Funding Restrictions:
    A. Pre-award costs are allowable pending prior approval from the awarding agency. However, in accordance with 45 CFR Part 74, all pre-award costs are incurred at the recipient's risk. The awarding office is under no obligation to reimburse such costs if for any reason IHI does not receive an award or if the award to the recipient is less than anticipated.
    B. The available funds are inclusive of direct and appropriate indirect costs.
    C. Only one cooperative agreement will be awarded to IHI.
    D. IHS will acknowledge receipt of the application.

    6. Other Submission Requirements.
    ELECTRONIC SUBMISSION - IHI must submit through Grants.gov. However, should any technical challenges arise regarding the submission, please contact Grants.gov Customer Support at 1-800-518-4726 or support@grants.gov. The Contact Center hours of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. EST. If you require additional assistance please call (301) 443-6290 and identify the need for assistance regarding your Grants.gov application. Your call will be transferred to the appropriate grants staff member. IHI must seek assistance at least fifteen days prior to the application deadline. If IHI doesn't adhere to the timelines for Central Contractor Registry (CCR), Grants.gov registration and request timely assistance with technical issues, paper application submission may not be granted.


    To submit an application electronically, please use the http://www.Grants.gov web site. Download a copy of the application package on the Grants.gov website, complete it offline and then upload and submit the application via the Grants.gov site. You may not e-mail an electronic copy of a grant application to IHS.

    Please be reminded of the following:
    · Under the new IHS application submission requirements, paper applications are not the preferred method. However, if IHI has technical problems submitting the application on-line, please directly contact Grants.gov Customer Support at: http://www.grants.gov/CustomerSupport.
    · Upon contacting Grants.gov, obtain a Grants.gov tracking number as proof of contact. The tracking number is helpful if there are technical issues that cannot be resolved and a waiver request from Grants Policy must be obtained. If IHI is still unable to successfully submit the application on-line, please contact Michelle G. Bulls, Grants Policy Staff at (301) 443-6290 at least fifteen days prior to the application deadline to advise her of the difficulties you have experienced.

    · If it is determined that a formal waiver is necessary, IHI must submit a request, in writing (emails are acceptable), to Michelle.Bulls@ihs.gov providing a justification for the need to deviate from the standard electronic submission process. Upon receipt of approval, a hard-copy application package must be downloaded from Grants.gov, and sent directly to the Division of Grants Operations, 801 Thompson Avenue, TMP 360, Rockville, MD 20852 by February 1, 2007.
    · Upon entering the Grants.gov web site, there is information available that outlines the requirements to IHI regarding electronic submission of application and hours of operation. We strongly encourage that IHI does not wait until the deadline date to begin the application process as the registration process for CCR and Grants.gov could take up to fifteen working days.
    · To use Grants.gov, IHI must have a DUNS Number and register in the CCR. IHI should allow a minimum of ten working days to complete CCR registration. See below on how to apply.
    · IHI must submit all documents electronically, including all information typically included on the SF-424 and all necessary assurances and certifications.
    · Please use the optional attachment feature in Grants.gov to attach additional documentation that may be requested by IHS.
    · IHI must comply with any page limitation requirements described in the program announcement.
    · After you electronically submit your application, you will receive an automatic acknowledgment from Grants.gov that contains a Grants.gov tracking number. The Division of Grants Operations (DGO) will retrieve your application from Grants.gov. The DGO will notify IHI that the application has been received.

    · You may access the electronic application for this program on http://www.Grants.gov.
    · You may search for the downloadable application package using either the CFDA number or the Funding Opportunity Number. Both numbers are identified in the heading of this announcement.
    · To receive an application package, IHI must provide the Funding Opportunity Number: HHS-2007-IHS-HPDP1-0001.

    E-mail applications will not be accepted under this announcement.

    DUNS NUMBER
    Applicants are required to have a Dun and Bradstreet (DUNS) number to apply for a grant or cooperative agreement from the Federal Government. The DUNS number is a nine-digit identification number, which uniquely identifies business entities. Obtaining a DUNS number is easy and there is no charge. To obtain a DUNS number, access <http://www.dunandbradstreet.com> or call 1-866-705-5711. Interested parties may wish to obtain their DUNS number by phone to expedite the process.


    Applications submitted electronically must also be registered with the CCR. A DUNS number is required before CCR registration can be completed. Many organizations may already have a DUNS number. Please use the number listed above to investigate whether or not your organization has a DUNS number. Registration with the CCR is free of charge.

    Applicants may register by calling 1-888-227-2423. Please review and complete the CCR Registration Worksheet located on http://www.grants.gov/CCR Register.

    More detailed information regarding these registration processes can be found at http://www.grants.gov.

    V. Application Review Information
    1. CriteriaThe instructions for preparing the application narrative also constitute the evaluation criteria for reviewing and scoring the application. Weights assigned to each section are noted in parentheses. The narrative should include the first year of activities; information for multi-year projects should be included as an appendix (see E.

  • Categorical Budget and Budget Justification
  • at the end of this section for more information). The narrative should be written in a manner that is clear to outside reviewers unfamiliar with prior related activities of IHI. It should be well organized, succinct, and contain all information necessary for reviewers to understand the project fully.


    A. UNDERSTANDING OF THE NEED AND NECESSARY CAPACITY (30 points)
    This section should include an understanding of the morbidity and mortality of chronic diseases and systems of care for the AI/AN population. IHI should have a thorough understanding and experience with evidence-based models for improving the care of chronic conditions and achieving improved outcomes in clinical prevention. IHI should also demonstrate an understanding of how these models can be customized for facilities and communities within the Indian health care system. IHI must demonstrate an understanding of improvement processes and how these processes can be implemented in IHS, Tribal, and urban Indian Health programs to improve outcomes of care. Care needs to be designed that is patient-centered with an active care team to apply change processes across multiple chronic conditions. Applicant should demonstrate knowledge in: (1) Data management sources and information technology available in the Indian Health system and the way these resources can be used to improve care through organized improvement processes;
    (2) Demographics and health status of the population;
    (3) Geographic and social factors including availability of care givers;
    (4) Funding streams and available resources and partners that can support this process; and
    (5) Organizational infrastructure of the Indian health system.

    IHI should demonstrate that they have the organizational experience and capacity to address the needs identified in this section.

    B. WORK PLAN (40 points) This section should demonstrate the soundness and effectiveness of IHI's proposal. The annual work plan should reflect deliverables and milestones. The work plan should be designed to: (1) Describe how IHI will use the Chronic Care Model and the Model for Improvement to support up to 14 pilot sites throughout the Indian health system.
    (2) Describe how IHI will enhance the improvement capacity within the Indian health system.
    (3) Describe and design a spread strategy plan to rapidly spread learning from the pilot sites to all desired sites in the Indian health system.
    (4) Describe how IHI will engage and strengthen the capacity for improved leadership within the Indian health system.

    C. PROJECT EVALUATION (10 points)This section should show how progress on this project will be assessed and how the success of the project will be judged. (1) Specifically list and describe the outcomes by which this project will be evaluated.

    (2) Identify the individual(s) responsible for the evaluation and their qualifications.
    (3) Each proposed project objective and task of the work plan should be evaluated and the evaluation activities should appear in the work plan.

    D. ORGANIZATIONAL CAPABILITIES AND QUALIFICATIONS (10 points)This section outlines the broader capacity of the organization to complete the project outlined in the work plan. It includes the identification of personnel responsible for completing tasks and the chain of responsibility for successful completion of the project outline in the work plan. (1) Describe the organization structure of the organization.
    (2) Describe the ability of the organization to manage the proposed project. Include information regarding similarly sized projects in scope and financial assistance as well as other grants and projects successfully completed.
    (3) Describe what equipment (i.e., phone, web sites, etc.) and facility space (i.e., office space) will be available for use during the proposed project. Include information about any equipment not currently available that will be purchased throughout the agreement.
    (4) List key personnel who will work on the project. a. Identify existing personnel and new program staff to be hired.

    b. In the appendix, include position descriptions and resumes for all key personnel. Position descriptions should clearly describe each position and duties indicating desired qualifications experience, requirements related to the proposed project and how they will be supervised. Resumes must indicate that the proposed staff member is qualified to carry out the proposed project activities and who will determine if the work of a contractor is acceptable.
    c. Note who will be writing the progress reports.
    d. If a position is to be filled, indicate that information on the proposed position description.
    e. If the project requires additional personnel beyond those covered by the cooperative agreement funds, (i.e., IT support, volunteers, interviewers, etc.), note these and address how these positions will be filled and, if funds are required, the source of these funds.
    f. If personnel are to be only partially funded by this cooperative agreement, indicate the percentage of time to be allocated to this project and identify the resources used to fund the remainder of the individual's salary.


    E. CATEGORICAL BUDGET AND BUDGET JUSTIFICATION (10 points)This section should provide a clear estimate of the project program costs and justification for expenses for the entire cooperative agreement period. The budget and budget justification should be consistent with the tasks identified in the work plan. (1) Categorical budget (Form SF 424A, Budget Information Non-Construction Programs) completing each of the budget periods requested.
    (2) Narrative justification for all costs, explaining why each line item is necessary or relevant to the proposed project. Include sufficient details to facilitate the determination of cost allowability.
    (3) Indication of any special start-up costs.
    (4) Budget justification should include a brief program narrative for the second and third years.
    (5) If indirect costs are claimed, indicate and apply the current negotiated rate to the budget. Include a copy of the rate agreement in the appendix.

    2. Review and Selection Process
    In addition to the above criteria/requirements, the application will be considered according to the following: A. The submission deadline: February 1, 2007. The application submitted in advance of or by the deadline and verified by the postmark will undergo a preliminary review to determine that: (1) The applicant is eligible in accordance with this cooperative agreement announcement.

    (2) The application is not a duplication of a previously funded project.
    (3) The application narrative, forms, and materials submitted meet the requirements of the announcement allowing the review panel to undertake an in-depth evaluation; otherwise, it may be returned.

    B. The Objective Review date is February 8, 2007. The application requirements that are complete, responsive, and conform to this program announcement will be reviewed for merit by the Ad Hoc Objective Review Committee (ORC) appointed by the IHS to review and make recommendations on this application. Prior to ORC review, the application will be screened to determine that programs proposed are those which the IHS has the authority to provide, either directly or through funding agreement, and that those programs are designed for the benefit of IHS beneficiaries. If IHI does not meet these requirements, the application will not be reviewed. The ORC review will be conducted in accordance with the IHS Objective Review Guidelines. The application will be evaluated and rated on the basis of the evaluation criteria listed in section V. 1. The criteria are used to evaluate the quality of a proposed project and determine the likelihood of success.

    3. Anticipated Announcement and Award Dates


    Anticipated announcement date is December 18, 2006 with Award Date of February 16, 2007.

    VI. Award Administration Information
    1. Award Notices
    The Notice of Award (NoA) will be initiated by the DGO and will be mailed via postal mail to IHI. The NoA will be signed by the Grants Management Officer and this is the authorizing document for which funds are dispersed. The NoA is the legal binding document, will serve as the official notification of the cooperative agreement award and will reflect the amount of Federal funds awarded for the purpose of the cooperative agreement, the terms and conditions of the award, the effective date of the award, and the budget/project period. The NoA is the legal binding document.

    2. Administrative Requirements
    Grants are administered in accordance with the following documents:
    · This Program Announcement.
    · 45 CFR Part 74,

  • Uniform Administrative Requirements for Awards to Institutions of Higher Education, Hospitals, Other Non-Profit Organizations, and Commercial Organizations.

  • · Grants Policy Guidance: HHS Grants Policy Statement, October 2006.
    ·
  • Non-profit Organizations
  • (Title 2 Part 230).

    · Audit Requirements: OMB Circular A-133,
  • Audits of States, Local Governments, and Non-profit Organizations.
  • 3. Indirect Costs
    This section applies to indirect cost in accordance with HHS Grants Policy Statement, Part II-27, IHS requires applicants to have a current indirect cost rate agreement in place prior to 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 means the rate covering the applicable activities and the award budget period. If the current rate is not on file with the awarding office, the award shall include funds for reimbursement of indirect costs. However, the indirect cost portion will remain restricted until the current rate is provided to DGO.

    If IHI has questions regarding the indirect cost policy, please contact the DGO at (301) 443-5204.

    4. Reporting

    A. Progress Report. Program progress reports are required semi annually. These reports will include a brief comparison of actual accomplishments to the goals established for the period, reasons for slippage (if applicable), and other pertinent information as required. A final report must be submitted within 90 days of expiration of the budget/project period.
    B. Financial Status Report. Semi-annual financial status reports must be submitted within 30 days of the end of the half year. Final financial status reports are due within 90 days of expiration of the budget period. Standard Form 269 (long form) will be used for financial reporting.
    C. Reports. IHI is responsible and accountable for accurate reporting of the Progress Reports and Financial Status Reports which are generally due semi-annually. Financial Status Reports (SF-269) are due 90 days after each budget period and the final SF-269 must be verified on how the value was derived. IHI must submit reports in a reasonable period of time.

    Failure to submit required reports within the time allowed may result in suspension or termination of an active agreement, 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 one or both of the following: (1) the imposition of special award provisions; and (2) the non-funding or non-award of other eligible projects or activities. This applies whether the delinquency is attributable to the failure of the organization or the individual responsible for preparation of the reports.
    5. Telecommunication for the hearing impaired is available at: TTY 301-443-6394.

    VII. Agency Contacts

    For program-related information:
    Candace M. Jones, MPH
    National Programs in Albuquerque
    5300 Homestead Road, N.E.
    Albuquerque, New Mexico 87110
    (505) 248-4961 or candace.jones@ihs.gov

    For general information regarding this announcement:
    Ms. Orie Platero
    IHS Headquarters, Office of Clinical and Preventive Services
    801 Thompson Avenue, Room 326
    Rockville, MD 20852
    (301) 443-2522 or orie.platero@ihs.gov

    For specific grant-related and business management information:
    Denise Clark
    Senior Grants Management Specialist
    801 Thompson Avenue, TMP 360
    Rockville, MD 20852
    301-443-5204 or denise.clark@ihs.gov

    VIII. Other Information

    The IHS is focusing efforts on three health initiatives that linked together, have the potential to achieve positive improvements in the health of American Indian and Alaska Native (AI/AN) people. These three initiatives are Health Promotion/Disease Prevention, Management of Chronic Disease, and Behavioral Health. Further information is available at the Health Initiatives web site: http://www.ihs.gov/nonMedicalPrograms/DirInitiatives/index.cfm.

    This cooperative agreement supports the Department of Health and Human Services' objective in FY 2006 to transform the health care system as well as the FY 2007 objective to emphasize prevention and healthy living as well as to accelerate personalized health care. This effort is also part of the IHS Director's FY 2007 Performance Contract.

    Date: ___________________________ _____________________________
    Charles W. Grim, D.D.S., M.H.S.A.
    Assistant Surgeon General
    Director, Indian Health Service


    The IHS is focusing efforts on three health initiatives that linked together, have the potential to achieve positive improvements in the health of American Indian and Alaska Native (AI/AN) people. These three initiatives are Health Promotion/Disease Prevention, Management of Chronic Disease, and Behavioral Health. Further information is available at the Health Initiatives web site: http://www.ihs.gov/nonMedicalPrograms/DirInitiatives/index.cfm.

    This cooperative agreement supports the Department of Health and Human Services' objective in FY 2006 to transform the health care system as well as the FY 2007 objective to emphasize prevention and healthy living as well as to accelerate personalized health care. This effort is also part of the IHS Director's FY 2007 Performance Contract.

    Date: ___________________ _____________________________
    Robert G. McSwain
    Deputy Director, Indian Health Service

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