Full Text HS-94-006 AHCPR RURAL CENTERS NIH GUIDE, Volume 23, Number 7, February 18, 1994 RFA: HS-94-006 P.T. Keywords: Agency for Health Care Policy and Research Letter of Intent Receipt Date: April 15, 1994 Application Receipt Date: May 17, 1994 PURPOSE The Agency for Health Care Policy and Research (AHCPR) announces the availability of cooperative agreements to develop and manage AHCPR Rural Centers (Centers) to plan and carry out demonstrations of rural managed care systems in HHS Regions which do not currently have an AHCPR Rural Center: Regions I, III, VI, VII, and IX. This solicitation is part of AHCPR's Rural Health Initiative. (AHCPR now supports by contracts Rural Centers in Regions II, IV, V, VIII, and X). The Centers are encouraged to form consortia that include appropriate State health agencies and academic health science centers. Center staff should include appropriate multidisciplinary scientific and administrative experts. This Request for Applications (RFA) responds to a Fiscal Year (FY) 1994 directive from the Senate Appropriations Committee for AHCPR to make grants or cooperative agreements to rural States or health science centers to assist in the development and demonstration of managed care networks. The Committee is particularly concerned that changes in health care systems nationally that incorporate innovations in the organization, financing, and delivery of health care services will not be as accessible to rural populations as those in urban areas where market forces already effect changes. The Centers, with substantial input from staff and consultants at AHCPR, will conduct demonstrations of innovations in the delivery of health care services in rural areas of the Center's respective State or region. Priority will be given to demonstrations of organized networks of health services delivered to underserved populations such as populations living in a designated health professional shortage area, those living in isolated areas and/or impoverished areas, and uninsured and/or unemployed rural people. AHCPR will arrange for the conduct of independent evaluations of these demonstrations. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2000," a PHS-led national activity for setting priority areas. This Request for Applications (RFA), AHCPR Rural Centers, addresses several of those objectives. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001-00474-0 or Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238). ELIGIBILITY REQUIREMENTS Applications may be submitted by: (1) domestic, non-profit organizations, public or private, including universities, clinics, units of State and local governments, non-profit firms, and non-profit foundations; or (2) consortia of organizations, if the application is submitted by a domestic, non-profit, public or private organization. For AHCPR Rural Centers demonstration projects, only non-profit organizations in HHS Regions I, III, VI, VII, and IX are eligible to apply. See discussion under "Objectives and Scope." Applications from minority and women investigators are encouraged. MECHANISM OF SUPPORT The administrative and funding instrument to be used for this program will be the cooperative agreement (U54), an assistance mechanism (rather than an acquisition mechanism), in which substantial AHCPR scientific and programmatic involvement with the awardee(s) is anticipated during the performance of the activity. These awards permit core funding in which the recipient organization may be reimbursed for administrative and staff support for: the planning, initiation, and monitoring of the demonstration(s); technical assistance in the implementation of statewide managed care plans; and dissemination mechanisms such as Center-sponsored newsletters. Any other support for these activities is available to grant-eligible institutions from AHCPR and other PHS agencies through their continuing programs of extramural investigator initiated research and not through this RFA. Demonstrations may be supported in their initial stages with core funds, although it is expected that most of the demonstrations will be sponsored with funds obtained from sources other than the core award. As noted below, review criteria include reference to the proposed Center's plans to attract and retain other funding sources in support of its demonstration(s). Details of the responsibilities, relationships, and governance of the projects to be funded under this cooperative agreement are listed under SPECIAL REQUIREMENTS. The total project period for applications submitted in response to this RFA may not exceed five years. The anticipated award date is September 1, 1994. Award of continuation funding beyond the initial budget period will depend upon availability of funds, satisfactory progress, and annual progress reviews according to customary AHCPR administrative procedures. This RFA is a one-time solicitation. FUNDS AVAILABLE The AHCPR expects to award a total of $10 million over five years under this RFA for up to five applicants. Up to $2 million will be available in FY 1994 and an average of $2 million for each of the next four fiscal years. RESEARCH OBJECTIVES Overview The Senate Committee Report on FY 1994 Appropriations (Report 103-143) directed AHCPR to "give grants or cooperative agreements to rural States or health sciences centers for planning (including an evaluation plan) and initiating a statewide or regional managed care system incorporating features of primary care, clinical preventive care services, and essential information networks to facilitate information transfer, including information on health care costs, quality measurement, and overall health care system performance." The Committee states that "because access to care is a major problem in rural States, the managed care network will be in a State" that has: 1. Limited public transportation infrastructure, 2. Geographic features that limit transportation, 3. Significant health status problems in the population, 4. Limited managed care penetration statewide, 5. Unemployment rates above the national average, 6. High percentage of the rural area designated as health professional shortage areas. The AHCPR supports and conducts health services research, including evaluations of health systems. This request for applications is for the planning and implementing of demonstration projects aimed at improving access to quality health care for rural residents, using managed care principles. These demonstration projects should be in States that reflect the six criteria specified in the Senate Committee report, as listed above. Through these activities the Centers, in collaboration with AHCPR and its consultants, will provide technical expertise to improve the effectiveness of health care services delivered to rural populations. Rural populations have been found to be in poorer health than most groups in urban and suburban communities. Some rural States with isolated populations have not provided for the inclusion of these citizens in managed care networks in spite of the anticipated role of such networks in health care reform. In many rural States provider networks, rural networks, and State managed care networks have not been formed, or, if formed, they may not be a part of a linked network of State and regional services. (A rural health network is a locally directed or governed organization that provides a set of defined health related and administrative services needed in the community served by the network.) These demonstrations are to be performed in the context of health care reform and on a statewide or regional basis. Because the involvement of many organizations, agencies, and individuals is essential to develop viable managed care systems, the participation of consortia is strongly encouraged. Consortia should include the appropriate public health authorities, health care providers, and analytic and technical expertise. The establishment of Centers will strengthen the effectiveness of consortia and facilitate collaborative arrangements among State health agencies, academic health science centers, and other groups necessary to design, implement, and monitor system changes in the delivery of health services in rural areas. Objectives and Scope The objective of this RFA for AHCPR Rural Centers is to provide support for planning, implementing, and monitoring health care system demonstrations. This solicitation is part of the Rural Health Initiative of AHCPR. Awards will be made for up to five Rural Centers (no more than one in each of the following HHS Regions: I (CT, MA, ME, NH, RI, and VT); III (DE, MD, PA, VA, and WV); VI (AR, LA, NM, OK, and TX); VII (IA, KS, MO, and NE); and IX (AZ, CA, HI, and NV). The Rural Centers will engage in the development and technical assistance required to implement the demonstrations, supported by substantial input from staff and consultants at AHCPR. As stated above, priority will be given to the demonstration of organized networks of health services delivered to underserved rural populations. AHCPR will arrange for the conduct of independent evaluations of these demonstrations. As an earlier step in its Rural Health Initiative, AHCPR contracted for five AHCPR Rural Centers in FY 1993, one each in Regions II (State University of New York at Buffalo), IV (University of North Carolina at Chapel Hill), V (University of Minnesota), VIII (Center for Health Policy Research, Denver), and X (University of Washington, Seattle). This solicitation is aimed at addressing needs in the remaining five Regions through cooperative agreements with rural States themselves, their academic health sciences centers, or other appropriate organizations. An application may be submitted jointly by State authorities with responsibility for rural health care and academic health centers engaged in rural health research activities. The awards will enable the designated AHCPR Rural Centers in those HHS Regions that do not presently have an AHCPR Rural Center to plan and initiate statewide or regional managed care system demonstration projects. As stated in the Senate Committee Report, the managed care systems shall incorporate features of primary care, clinical preventive services, and essential information networks. Most definitions of managed care characterize it as a system that integrates the financing and delivery of appropriate medical care by means of contracts with selected physicians and hospitals that: furnish a comprehensive set of health care services to enrolled members, usually for a predetermined monthly premium; utilize quality controls that providers agree to accept; incorporate financial incentives for patients to use the providers and facilities associated with the plan; and include an assumption of some financial risk by providers. These awards may be used to establish new centers and/or expand existing centers that address policy and health services research issues of special importance to rural populations (e.g., the effect on the rural population of the health care reform initiatives of the State). The Rural Centers demonstration projects should address, as appropriate, some of the following issues: o Arranging for primary care in rural areas, including such aspects as financing, recruitment, retention, and effective use of primary care providers and mid-level health care practitioners and the intended effect of these primary care arrangements on access to care. o Monitoring the appropriateness and effectiveness of rural health care services and procedures, including patient outcomes, and the effect of rural practice networks on quality of care. o Expanding existing networks or developing new managed care system models that provide access to high quality of care to the diverse rural populations within a State or region. o Linking appropriate rural health care delivery services and academic health science centers into consortia. o Linking providers in underserved areas with each other, and with responsible health care institutions and academic health centers, through information systems and telecommunications. o Developing internal and external information networks to facilitate information transfer, including information on health care costs, quality measurement, and overall health care system performance. o Developing community practice networks and community health plans that integrate health professionals and health care organizations supported through public funding with other providers. o Addressing the issues raised by border-crossing for rural managed care networks and antitrust concerns for newly forming health care networks and accountable health plans. Within the limits of these resources, the proposed Centers will plan, implement, and monitor the required demonstration projects and broadly disseminate project information and results. In addition to data collection and monitoring activities, including the associated assessment of processes and progress necessary for sound management of the projects, Centers must accommodate requirements of independent evaluations that may be arranged for by AHCPR. Centers will be expected to coordinate internal data collection and monitoring efforts with the independent evaluation to ensure the collection of data essential for both efforts. Work carried out by each Center will be multidisciplinary and must address important health services delivery issues (e.g., managed care systems; provider health networks; and State health care insurance reforms with special attention to their effects on access, cost, and quality for rural populations). It is expected that successful applicant organizations will include on their team appropriate multidisciplinary administrative and scientific personnel (e.g., experts in health services research and administration, medicine, dentistry, nursing, epidemiology, psychology, statistics, geography, economics, organizational behavior, law, and public health); and pertinent State official(s) responsible for health care reform and managed care in the State through cooperative relationships. Further priority consideration will be given to those applicants with a documented plan to coordinate with the overall State-level health system planning efforts. Successful applicant organizations must incorporate the scientific, technical, organizational, and physical resources necessary to carry out: (1) health services demonstrations; (2) technical assistance to health care providers and others; and (3) dissemination of project information and results. Many funding agencies in addition to AHCPR are providing resources for improving parts of the system for delivery of health care services to rural populations. These organizations include other parts of the Department of Health and Human Services (DHHS), including the Office of Rural Health Policy of the Health Resources and Services Administration (HRSA), the Health Care Financing Administration (HCFA), and the National Institutes of Health (NIH). They also include private philanthropic organizations such as the Robert Wood Johnson (RWJ) and Kellogg Foundations. This RFA encourages synergy of existing and developing resources in preparation for health care reform at the State or regional level. Appropriate and judicious use of these or other funding sources to complement each other where there are common goals is specifically endorsed and should be noted in the application under "Other Support," or sections 2 or 5 of the "Research Plan," as appropriate. Center Structure The Center Director must be a manager who can provide strong administrative leadership and be committed to this activity for at least 50 percent of his\her time. The Director will be responsible for the organization and operation of the Center and liaison with the research community and key State officials involved in the State's health care reform. The Center should be structured to facilitate appropriate cooperative arrangements among all members of the consortium such as State health departments; State or regional academic health centers; and outside entities including professional societies, subcontractors, rural provider networks and rural health alliances, and consumer groups. Personnel and institutional resources capable of developing and maintaining a substantial commitment to rural health services demonstrations must be available, and that availability should be documented by letters of commitment in the application under "Appendix." The Center may consist of core staff with significant time commitments to the demonstration and affiliate staff with lesser time commitments. Multidisciplinary collaboration within the Center is essential. In addition, the applicant must show a strong commitment to the Center and its development, including plans to support the organizational and management structure of the Center. Each Center is generally expected to share common resources with other components or departments of the applicant organization including: technical, clerical, and administrative personnel; instrumentation; computer resources; subject populations; and data bases. The Center may be a consortium of organizations operating within the State or Region. It is expected that members of a consortium will provide collateral or supplemental support to the applicant organization. It is expected that each funded Center will have an advisory committee that includes representation of those involved in preparing or implementing health care reforms for rural areas in the proposed demonstration State or region. Core funds may be used to support costs associated with an advisory committee, including the convening of periodic committee meetings to advise about management and programs. This advisory committee would typically be composed of: representatives from the Center's collaborating institutions; appropriate State officials; and senior national and regional representatives from outside of the consortium including health care policymakers, health services researchers, health care providers, and consumers. Budget and Related Issues A maximum of $400,000 first year total costs (direct plus indirect) may be requested for center support, and a maximum of $2,000,000 in total costs may be requested per application for the entire project period, which is not to exceed five years. In preparing budget requests, applicants are reminded that the reasonableness of proposed budgets is among the criteria to be used in the peer review of applications. Applicants should justify whether the scope of their applications calls for the full five years allowable duration and the maximum $2,000,000 (i.e., five years times $400,000) amount. If successful completion of the goals is anticipated within a shorter duration of time and/or at less cost, the application should reflect this. SPECIAL REQUIREMENTS The issuance of awards will be contingent on the availability of funds and on the quality of the applications. No awards will be made if, as result of the scientific and technical review, applications are not judged to be of high merit. The initial review committee may recommend support for less than the requested period or amount. Terms and Conditions of Award The administrative and funding instrument to be used for this program will be the cooperative agreement (U54), an assistance mechanism (rather than an acquisition mechanism), in which substantial AHCPR scientific and programmatic involvement with the awardee(s) is anticipated during the performance of the activity. Under the terms of these cooperative agreements, the awardee determines the organization and management of the Center as specified by this announcement and retains responsibility for all aspects of performance of the Center. The AHCPR, however, anticipates substantial programmatic involvement in the planning, implementation, and monitoring of demonstrations and in the provision of advice and technical assistance to the awardee. 1. Awardee Responsibilities The awardee(s) will have primary and lead responsibility for all activities and should describe in the application the plans to: o Establish and maintain appropriate collaborative arrangements with State agencies, academic health science centers, health care providers, and others appropriate to effect health care system changes; o Make available appropriate types of administrative, scientific, and analytical expertise to design proposed system changes for the demonstration(s); o Manage the process of implementing demonstration(s); o Participate in an independent evaluation arranged for by AHCPR in executing a rigorous evaluation plan; o Develop an information system that can generate the required data for measuring changes in health care delivery and health status; o Provide technical assistance in the planning and implementing of demonstrations, as appropriate, to collaborative groups and participants; o Disseminate project information and results based on system changes, especially in collaboration with AHCPR; and o Collaborate with AHCPR on data analysis, the preparation of background information, or other analytical activities relating to the appropriateness and effectiveness of health care for rural populations. The AHCPR is committed to disseminating the products of the Rural Centers as rapidly as possible. In this context, products include both written reports of project information and results, and the data themselves. The AHCPR will have access to the products of the Rural Centers upon request. All rights of access to the data will be consistent with AHCPR regulations 42 CFR 67, Subpart A, as well as with section 903(c) of the PHS Act. 2. AHCPR Staff Responsibilities The AHCPR Project Officer and other AHCPR staff will have substantial scientific and programmatic involvement during the conduct of this activity, through technical assistance, advice, and coordination beyond the normal program stewardship for grants. Collaboration on study design, protocol development, and design of an independent evaluation will occur after the award(s) is (are) made. Specifically, AHCPR's role during the project period will include providing technical assistance, advice, and support to the Principal Investigator in the areas of: o Facilitating program development and priority setting; o Planning and implementing of the demonstration(s); o Monitoring the Center's demonstrations; and o Disseminating the Center's project information and results through AHCPR's publication program and assisting in selecting additional mechanisms for effective dissemination. AHCPR may conduct or arrange for the conduct of a rigorous evaluation of each demonstration project, which could include specific before and after measurements for evaluating the effect(s) of system changes on the delivery and outcomes of rural health care. Each year's continuation award is subject to a progress review by AHCPR, in addition to the availability of funds. The progress review may involve a site visit to the Center by AHCPR staff and expert consultants to AHCPR. The progress review will address the Center's productivity, general compliance with the basic review criteria listed below, and adherence to the provisions of its approved application. If such a continuation review indicates that insufficient progress has been made, AHCPR may decide not to continue to fund the Center for the full project period. The substantial AHCPR involvement will apply in addition to and not in lieu of otherwise applicable PHS policies and Federal regulations. STUDY POPULATIONS SPECIAL INSTRUCTIONS TO APPLICANTS CONCERNING INCLUSION OF WOMEN AND MINORITIES IN RESEARCH STUDY POPULATIONS The AHCPR requires all applicants for research grants to include minorities and women in study populations so that research findings can be of benefit to all persons at risk of the disease, disorder, or condition under study. Special emphasis must be placed on including minorities and women in studies of diseases, disorders, and conditions which disproportionately affect them. This policy applies to males and females of all ages. If women or minorities are excluded or inadequately represented in research, a clear and compelling rationale should be provided. The AHCPR will not make awards for applications which do not comply. If the application does not contain the required information, it will be returned without review. The composition of the proposed study population must be described in terms of gender and racial/ethnic group. In addition, gender and racial/ethnic issues should be addressed in developing a research design and sample size appropriate for the scientific objectives of the study. This information should be included in the form PHS 398 in the Research Plan and summarized in the Section on Human Subjects. Applicants are urged to assess carefully the feasibility of including the broadest possible representation of minority groups. However, AHCPR recognizes that it may not be feasible or appropriate in all research projects to include representation of the full array of United States racial/ethnic minority populations (i.e., American Indians/Alaskan Natives, Asian/Pacific Islanders, African Americans, Hispanics). Where appropriate, the applicant must provide the rationale for studies on single minority population groups. Peer reviewers will address specifically whether the applicant's research plan conforms to these policies. If the representation of women or minorities in a study design is inadequate to answer the scientific questions(s) addressed and the justification for the selected study population is inadequate, it will be considered a scientific weakness or deficiency in the study design and will be reflected in assigning the priority score to the application. LETTER OF INTENT Prospective applicants are asked to submit, by April 15, 1994, a letter of intent that includes the name, address, and telephone number of the Principal Investigator; states the number and title of the RFA in response to which the application may be submitted; and identifies all co-investigators and other key personnel and member institutions, community-based organizations, and any other participating organizations or institutions. Although a letter of intent is not required, is not binding, and does not enter into the consideration of any subsequent applications, the information allows AHCPR staff to estimate the potential review workload and avoid conflict of interest in the review. The Letter of Intent is to be sent to Dr. Norman W. Weissman at the address listed under INQUIRIES. APPLICATION PROCEDURES Applications are to be submitted on the grant application form PHS 398 (rev. 9/91). State and local government applicants may use form PHS 5161, Application for Federal Assistance. These forms are available at most institutional offices of sponsored research; the Office of Grants Information, Division of Research Grants, National Institutes of Health, Westwood Building, Room 449, Bethesda, MD 20892, telephone (301) 435-0714; and from the Scientific Review Branch, Agency for Health Care Policy and Research, Suite 602, 2101 East Jefferson Street, Rockville, MD 20852, telephone (301) 594-1449. The RFA label available in the PHS 398 application form must be affixed to the bottom of the face page of the original copy of the application. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for review. In addition, type "RFA HS-94-006" and "AHCPR RURAL CENTERS" in Section 2a on the face page of the application form and the YES box must be marked. Complete information about the proposed Center must be submitted with the application. Consortium arrangements typically take the form of a formal agreement between the grantee and other organization(s). In the grant application, a separate budget must be included for each organization involved in the proposed consortium arrangement. The application must describe how the proposed Center will meet the awardee responsibilities described earlier under Terms and Conditions of Award. Follow the instructions for form PHS 398 where appropriate. However, the form PHS 398 was developed primarily for research project grants rather than Centers. Therefore, substitute the following headings for Sections 1 through 9 of Section C of the application and address the following issues (see Research Plan, pages 20- 24, of the instructions). (State and local governments using form PHS 5161 should address all of these following areas in the Program Narrative section of their application). For Sections 1 - 8 below, suggested page lengths are listed in parentheses. However, the cumulative length of these sections cannot exceed 25 pages. 1. Introduction and background; any special emphases of the proposed Center. (1 - 2 pages) 2. Currently available organizational resources. What resources such as staff and areas of expertise, ongoing rural research, organizational support and relationships, funds, and equipment, are available now to develop and implement the proposed Center? (2 - 3 pages) 3. Organizational changes that will be implemented to develop the proposed AHCPR Rural Center. What activities and organizational alignments will be undertaken to institute the proposed Center? (2 - 4 pages) 4. The nature of proposed and existing organizational relationships of the Center. Include, for example, the proposed Center's relationship with health care providers, State and local governments and other policy makers, the proposed advisory committee, and the research community. (2 - 4 pages) 5. The proposed Center's agenda in rural demonstrations, technical assistance, information system development, dissemination, and research projects. What activities and projects are currently in place with regard to rural health and/or health care reform? What problems in care delivery will be addressed by the demonstration project(s)? (8 - 12 pages) 6. The process of decisionmaking and lines of authority within the proposed Center. (1 - 2 pages) 7. The expected accomplishments of the proposed Center. (2 - 6 pages) 8. Human subjects. (the same as in '5' in the application instructions, page 22) 9. Consultants/collaborators. (the same as in '7' in the application instructions, page 23) 10. Consortium/contractual arrangements. (the same as in '8' in the application instructions, page 23) 11. Literature cited. (the same as in '9' in the application instructions, page 24) The completed original application, including the Checklist, and four legible copies (two copies when using the PHS 5161) must be sent or delivered to: Division of Research Grants National Institutes of Health Westwood Building, Room 240 Bethesda, MD 20892** Applications submitted under this RFA must be received by the Division of Research Grants, NIH, by May 17, 1994. If an application is received after that date, it will be returned to the applicant. One copy, labeled "Advance Copy," must be submitted simultaneously to: Norman W. Weissman, Ph.D. Center for General Health Services Extramural Research Agency for Health Care Policy and Research 2101 East Jefferson Street, Room 502 Rockville, MD 20852-4908 Conference for Prospective Applicants The AHCPR plans to convene a conference for prospective applicants in Kansas City, Missouri on March 29, 1994, if there is sufficient interest from prospective applicants. At this proposed conference, AHCPR plans to discuss the programmatic and administrative details of the AHCPR Rural Centers and respond to questions concerning this RFA. Attendance is not a prerequisite to applying. Attendees must pay for their own travel and accommodation costs. Individuals with questions concerning this announcement, or unable to attend the conference, may contact Ms. Jean Carmody at telephone (301) 594-1357, extension 130, FAX (301) 594-2155. Those interested in attending the conference should mail or FAX their names, addresses, and telephone numbers to: Ms. Jean Carmody Center for General Health Services Extramural Research Agency for Health Care Policy and Research 2101 East Jefferson Street, Suite 502 Rockville, MD 20852-4908 REVIEW CONSIDERATIONS Upon receipt, applications will be reviewed by the Referral Office, Division of Research Grants, NIH, for completeness, and by AHCPR staff for responsiveness to the RFA. Incomplete and/or non- responsive applications will be returned to the applicant without further consideration. The determination of any application as nonresponsive will be the sole responsibility of the AHCPR. All responsive applications will undergo peer review for scientific merit by a review committee of experts convened by AHCPR. When an application is reviewed, the peer review committee may recommend further consideration for funding or no further consideration. The committee also assigns priority scores to the applications for which further consideration was recommended. Recommendations of the peer review committee will be reviewed subsequently by AHCPR's National Advisory Council for Health Care Policy, Research, and Evaluation. The peer review process is rigorous, and only those applications judged to be of greatest merit will be recommended for further consideration. The general review criteria for AHCPR grant applications are: significance and originality from a scientific and technical viewpoint; adequacy of the proposed method(s); availability of data or proposed plan to collect data required for the project; adequacy of the plan for organizing and carrying out the project; qualifications and experience of the principal investigator and proposed staff; reasonableness of the proposed budget; and adequacy of the facilities and resources available to the applicant. Special Review Criteria In addition to the review criteria noted above, the review committee will independently evaluate each application in response to this RFA to assess: the quality of the proposed Center's program and general approach, including its proposed demonstration agenda, technical assistance, and dissemination plans; and the degree to which the Center's agenda reflects a realistic and well-conceived program in view of available skills, funding resources, and health care issues pertinent to the particular rural population(s) to be addressed. The following special scientific and technical review criteria will apply: o The extent to which the planned demonstration site(s) reflects the extreme challenges to rural health care delivery system reform as reflected by: 1. Limited public transportation infrastructure; 2. Geographic features that limit transportation; 3. Significant health status problems in the population; 4. Limited managed care penetration statewide; 5. Unemployment rates above the national average; and 6. A high percentage of the rural area designated as health professional shortage areas. o The quality of the organizational and institutional arrangements to operate the proposed Center, including plans for the use of an advisory committee by the Center; and links with State-level health planning efforts. Also, in the case of consortium applications, the degree of clarity in the differentiation of activities and a description of coordination efforts among organizational participants. Each component's role and responsibilities must be clearly described. This description must include the nature and extent of collateral or supplemental support provided to the applicant organization by other consortium members. o Evidence of the commitment of the applicant organization(s) to the provision of, and/or study of health care to rural populations, including plans to attract or retain other funding sources in support of its demonstration(s). o The actual and planned level of commitment of the applicant institution(s) to the proposed Center, including its specific plans to support its organizational and management structure. o The extent to which the proposed Center's plan reflects specificity in identifying problems to be addressed, and an awareness of significant methodological and data problems in designing, implementing, and monitoring rural health services demonstrations, such as availability of defined health status baseline information for the State or region, population based statistics on penetration of managed care, and available rural health care facility and related resource information. o The coordination of the proposed Center's planning and demonstration efforts, including the structure for sustaining ongoing monitoring of the processes for implementing the demonstration and progress towards its objectives, separate from AHCPR's independent and time- limited evaluation activity. o The degree to which the proposed Center's program includes representation from multiple appropriate scientific and administrative disciplines, including analytic and technical expertise, capable of planning and implementing demonstrations on rural issues and problems. o The qualifications, achievements, commitment, and number of senior personnel of the proposed Center, including the appropriateness of their specific time commitments. o The appropriateness of the proposed budget and the extent to which the fiscal plan provides assurance that effective use would be made of the funds awarded, including delineation of the service area(s) for which the proposed Center will be providing technical assistance in developing rural health demonstrations. AWARD CRITERIA Applications will compete for available funds with all other applications for this RFA. No awards will be made if, as result of the scientific and technical review, applications are not judged to be of high merit. The following will be considered in making funding decisions: quality of the proposed project as determined by peer review, program balance, and availability of funds. INQUIRIES Written and telephone inquiries concerning this RFA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: Norman W. Weissman, Ph.D. Center for General Health Services Extramural Research Agency for Health Care Policy and Research 2101 East Jefferson Street, Suite 502 Rockville, MD 20852-4908 Telephone: (301) 594-1357, ext. 130 Direct inquiries regarding fiscal matters to: Ralph L. Sloat Agency for Health Care Policy and Research 2101 East Jefferson Street, Suite 601 Rockville, MD 20852-4908 Telephone: (301) 594-1447 AUTHORITIES AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance number 93.226. Awards are made under authorization of the Public Health Service Act, Title IX, and administered under the PHS Grants Policy Statement and Federal Regulations 42 CFR 67, Subpart A. This program is not subject to the intergovernmental review requirements of Executive Order 12372. .
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