&

Kamagra online australia

Early in http://natalievartanian.com/kamagra-for-sale-melbourne the erectile dysfunction treatment kamagra, the leaders of wealthy countries pledged to respond with “global solidarity.” But when treatments to prevent the disease were developed, those same leaders pushed low and middle-income countries to the back of the queue, outbidding poorer countries, as well as COVAX, a worldwide initiative developed to achieve equitable treatment access, to secure treatments for themselves.That came as little surprise to those of us involved in the fight against kamagra online australia the kamagra of HIV and AIDS. When governments of kamagra online australia high-income countries belatedly responded to the threat, they sided with pharmaceutical companies that were extracting profits from a global health crisis. Millions died then — and continue to die today — without affordable access to HIV/AIDS treatments.As the world awoke to the deadly toll of that ongoing kamagra, even the World Trade Organization resolved that intellectual property rules, which often prevent developing countries from manufacturing medicines, “should not prevent members from taking measures to protect public health.”advertisement But nearly three years into this latest kamagra, the same thing is happening again. World leaders and pharmaceutical companies have failed to kamagra online australia ensure equitable access to erectile dysfunction treatment medicines. Countless lives have been lost.

Communities have kamagra online australia been devastated. And the worst impacts have been felt by the poorest people.Once again, pledges of “equity” and “global solidarity” have been made, this time by the very pharmaceutical companies that prioritized selling high-priced doses of erectile dysfunction treatments to the richest companies over saving lives in the Global South.advertisement The “Berlin Declaration” is a proposal from the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) that vows to work toward “equitable access in kamagras.” The way I see it, the same pharmaceutical companies that created the inequity of the erectile dysfunction treatment kamagra are proposing to fix it in the next kamagra.The IFPMA proposes that governments will take a greater role to fund, support, de-risk, and provide data for drug research and development, but will then hand big pharmaceutical companies monopolies on the resulting drugs. Governments will even waive any liability for companies kamagra online australia to ensure their products are safe. What will the kamagra online australia pharmaceutical industry do in return?. Not very much.There is a long-established precedent in global health that the populations who provide samples of pathogens used in pharmaceutical research must have access to the therapies that result from the research.

Big pharmaceutical companies, however, want this to become a one-way street, kamagra online australia with a guarantee that governments will share pathogens but without the companies being obliged to share the resulting drugs and medical technologies in return.Instead, the IFPMA makes general pledges that its members will ensure access for low- and middle-income countries through voluntary mechanisms like donations, selling doses at not-for-profit prices, and licensing drugs to be made by factories in the Global South. These are the very measures that utterly failed the Global South in the erectile dysfunction treatment kamagra.To be sure, voluntary measures can offer a lifeline to populations who benefit from them. But they are often too limited in kamagra online australia scope. For example, when Viiv agreed to allow the Medicines Patent Pool to license generic versions of its new long-acting HIV antiretroviral medicines, the company excluded much of Latin America and Asia from the deal. The same can be said for deals kamagra online australia for Pfizer and Merck‘s erectile dysfunction treatments.

Or look kamagra online australia to a deal struck by BioNTech to open treatment manufacturing plants in Rwanda and Senegal. The companies will send ready-made factories in container ships, operated by a turnkey mechanism, along with scientists from the German company. It is kamagra online australia an outpost of their monopoly, not a transfer of technology to African countries. Donations, too, have proved utterly insufficient in this kamagra. Less than half of the treatments promised kamagra online australia to lower-income countries by G7 nations had been delivered by June of this year.When doses do arrive, there is often a total disregard for the needs of local populations.

As Dr. Saeed Mohamood from Somaliland’s Ministry of Health told the authors of a recent report, commissioned by The People’s treatment Alliance, the organization I co-chair, “Sometimes we will find out that the Somaliland shipment is on a plane in the air, en route, and we do not know when it’s going to expire and kamagra online australia how much resources we will have.”The pharmaceutical industry also promises to license more treatments and treatments to companies in the Global South. But when asked to do kamagra online australia this during the erectile dysfunction treatment kamagra, they declined. The World Health Organization’s erectile dysfunction technology sharing platform was boycotted and derided by big pharma. Pfizer’s CEO even called the program kamagra online australia “nonsense, and …also dangerous.”erectile dysfunction treatment makers Moderna, Pfizer, and BioNTech have all refused requests from the World Health Organization to share technology with its project that will transfer mRNA treatment technology to 15 low- and middle-income countries.

Without the cooperation of these companies, it will take years longer before the project can start rolling out treatments. Broad, overreaching patents filed by Moderna are threatening the program’s freedom to operate kamagra online australia. And BioNTech has even hired a consultancy to lobby against the project.In the ongoing fight against HIV/AIDS, relentless public pressure ultimately forced pharmaceutical companies to agree to voluntary measures to improve access to lifesaving drugs for people in developing countries. But relying on public pressure is neither a secure nor sustainable way kamagra online australia to ensure that low- and middle-income countries can fight deadly threats. And these measures are often used as a last resort to protect companies’ profits, market share, and monopoly rights — not to mention frustrate generic competition.With the “Berlin Declaration,” the pharmaceutical industry’s latest voluntary pledge comes after two years of international pressure to waive intellectual property rules for erectile dysfunction treatments and treatments, a solution that would have allowed low- and middle-income countries to produce themselves the therapies needed combat the erectile dysfunction, albeit at the expense of a portion of big pharma’s exorbitant profits.

And this kamagra online australia declaration was made just as governments are negotiating a kamagra treaty — an international agreement that will decide how the world responds to future kamagras. The treaty could help to build the foundations for a fairer response to the next global health crisis kamagra online australia. Or, if politicians listen to big pharma, it could bind future generations to the same approaches that sacrificed countless lives in the erectile dysfunction treatment and HIV/AIDS kamagras for profit. That is why kamagra online australia the People’s treatment Alliance has today published a comprehensive rebuttal of the misleading claims made in the Berlin Declaration.If world leaders want the next kamagra to be different from erectile dysfunction treatment and HIV/AIDS, they cannot accept kind words and voluntary pledges at face value. Big pharmaceutical companies are profit-driven entities.

Their interests kamagra online australia lie in securing monopolies for existing diseases and future kamagras. World leaders must ignore the siren calls of industry and instead build a fairer and more equitable system that guarantees the tools needed to combat kamagras to everyone, everywhere.Winnie Byanyima is executive director of UNAIDS and co-chair of the People’s treatment Alliance.The Food and Drug Administration announced Wednesday that it has authorized a booster shot for Novavax’s erectile dysfunction treatment.Unlike the latest boosters from Pfizer-BioNTech and Moderna, which target both the original strain of erectile dysfunction and the Omicron BA.4/5 variants, the Novavax booster only targets the original strain. The company announced in late May that it kamagra online australia was studying an Omicron-targeting strain, as well as a bivalent booster. But results of that work have not been revealed to date.The booster shot is authorized for people 18 and older who, for medical or accessibility reasons, cannot take one of the bivalent messenger RNA erectile dysfunction treatment boosters, or who otherwise would not take a kamagra online australia booster.advertisement It can only be used as a first booster shot. Anyone who has already had one or multiple boosters cannot opt to get this treatment at this point.

The booster shot is to be given kamagra online australia at least six months after the administration of the second dose of a primary series of erectile dysfunction treatment. The director of the Centers for Disease Control and Prevention, Rochelle Walensky, signed off on the extension of the Novavax emergency use authorization, meaning that people who want to and are eligible to get this booster shot should be able to do so soon.advertisement The company noted a substantial portion of Americans have not yet had a booster shot, and for those people, the Novavax booster is now an option.“According to CDC data, almost 50 percent of adults who received their primary series have yet to receive their first booster dose. Offering another treatment choice may help increase erectile dysfunction treatment booster vaccination rates for these adults,” said Stanley Erck, president and kamagra online australia chief executive officer. Novavax has presented data to the FDA that it said shows that its treatment induces a broadly cross-protective response to various strains of SARS-2, including Omicron variants BA.1, BA.2, and BA.5. Data from the CDC indicate that BA.5 remains the dominant kamagra strain at present, though a half-dozen or so other kamagra online australia Omicron variants are starting to replace it.

BA.1 and BA.2 kamagraes no longer kamagra online australia appear to be circulating in this country.Novavax’s erectile dysfunction treatment showed highly favorable results in initial trials, with efficacy close to that shown by the mRNA treatments. The Novavax treatment is made using a different approach, employing recombinant nanoparticle technology. Its treatment also uses an adjuvant, a compound that boosts the immune response the kamagra online australia treatment generates.The treatment, which is stored at fridge temperature, is given as a primary series as two doses administered three weeks apart.Prior to the kamagra Novavax was seen as a company with a promising technology, but no proven track record — having never brought a treatment to market — and no production facilities of its own. It has struggled mightily to produce its product since it entered the race to develop a erectile dysfunction treatment, only earning FDA authorization for its treatment in July, a full 19 months after Pfizer and Moderna.It has been hoped that the treatment would entice people who have resisted getting mRNA treatments to get vaccinated against erectile dysfunction treatment, but to date the number of takers in this country has been low. The latest data from the CDC shows that just over 35,000 doses of the treatment kamagra online australia have been administered.

More than 372 million doses of Pfizer’s treatment and nearly 236 million doses of Moderna’s treatment have been given in the U.S.Novavax has been approved in at least two countries — Canada and South Korea — and has been authorized for emergency use in a number of others, including Israel, Taiwan, Switzerland, the United Kingdom, South Africa, New Zealand, and in the European Union.∼ Correction. An earlier version kamagra online australia of this article incorrectly stated the Novavax booster was not available to people who had received an mRNA treatment as their primary series.Get your daily dose of health and medicine every weekday with STAT’s free newsletter Morning Rounds. Sign up here..

Kamagra oral jelly 100mg uk

	Kamagra	Cialis sublingual	Viagra oral jelly	Cialis oral jelly	Intagra
Best way to use	Yes	Yes	Online	Online	No
Price per pill	Order online	No	Order online	RX pharmacy	Order online
For womens	Twice a day	No more than once a day	Once a day	Once a day	Once a day

Statement Health Canada authorizes Medicago erectile dysfunction treatment for adults 18 to 64 years of age February 24, 2022 | Ottawa, ON | Health CanadaToday, Health Canada authorized Medicago's Covifenz erectile dysfunction treatment for the prevention of erectile dysfunction treatment in adults 18 to 64 years kamagra oral jelly 100mg uk of age. After a thorough and independent scientific review of the evidence, the Department has determined that the treatment meets Health Canada's stringent safety, efficacy and quality requirements, and that the benefits of this treatment outweigh the potential risks.This is the first authorized erectile dysfunction treatment developed by a Canadian-based company, and the first that uses a plant-based protein technology. Medicago's Covifenz is authorized as a two-dose regimen of 3.75 micrograms per kamagra oral jelly 100mg uk dose, to be administered 21 days apart.In clinical trials, the treatment was found to be 71 per cent effective against symptomatic and 100 per cent effective against severe disease caused by erectile dysfunction treatment. These studies were conducted while there were multiple variants in circulation. The data suggest efficacy against multiple variants, including Delta.

Clinical trials with Covifenz kamagra oral jelly 100mg uk showed efficacy against the Delta and Gamma variants, and data also suggesting efficacy against Alpha, Lambda and Mu variants. While additional confirmatory data are needed, preliminary and exploratory data shows that Covifenz produces neutralizing antibodies against the Omicron variant.Health Canada has placed terms and conditions on the authorization. Medicago must continue to provide information to Health Canada on the safety and efficacy of the treatment, kamagra oral jelly 100mg uk including protection against current and emerging variants of concern as soon as it is availableThe treatment is authorized for use in adults 18 to 64 years of age, based on the data that was reviewed by Health Canada. There was limited enrolment of participants older than 65 years of age in the clinical trials because a large proportion of older individuals were already vaccinated. Medicago is currently gathering data in older individuals to support regulatory authorization for this age group.In keeping with the Department's commitment to openness and transparency, Health Canada is publishing multiple documents related to its decision, including a high-level summary of the evidence it reviewed to support the authorization of the treatment.

More detailed information will be available in the coming weeks, including a detailed scientific summary and the full clinical trial results that support the use of this treatment.Health Canada and the Public Health Agency of Canada will continue to closely monitor the safety of kamagra oral jelly 100mg uk this treatment, and will take action if any safety concerns are identified.For detailed information on authorized treatments and treatments in Canada, visit the erectile dysfunction treatments and treatments portal. Related Links:Medicago treatment product pageerectile dysfunction treatments and treatments portal ContactsMedia RelationsHealth Canada613-957-2983media@hc-sc.gc.caerectile dysfunction treatment public enquiries:1-833-784-4397February 24, 2022 | Chester, Nova Scotia | Health Canada The erectile dysfunction treatment kamagra has highlighted long-standing challenges in Canada’s long-term care (LTC) homes. We have kamagra oral jelly 100mg uk seen gaps in prevention and control, staffing, and infrastructure, with tragic effects on residents, their families and those working in LTC homes. To keep seniors safe and improve their quality of life, the 2020 Fall Economic Statement committed up to $1 billion through the Safe Long-Term Care Fund (SLTCF) to help provinces and territories undertake activities to improve prevention and control in long-term care. These activities include hiring additional staff, implementing wage top-ups, as well as purchasing or renovating infrastructure including ventilation, and doing readiness assessments.

Today, on behalf of the Honourable Jean-Yves Duclos, Minister of Health, the Honourable Sean Fraser, Minister of Immigration, Refugees and Citizenship, along kamagra oral jelly 100mg uk with Darren Fisher, Parliamentary Secretary to the Minister of Seniors, announced the signing of a SLTCF agreement with Nova Scotia. They were joined by the Honourable Barbara Adams, Nova Scotia’s Minister of Seniors and Long-term Care and the Honourable Michelle Thompson, Nova Scotia’s Minister of Health and Wellness. Through this agreement, Nova Scotia is receiving more than $27 million, with kamagra oral jelly 100mg uk work already underway, to take better care of and protect seniors in LTC homes. With this investment, Nova Scotia has built on existing initiatives to improve prevention and control in long-term care homes by funding the following initiatives. Hiring of LTC assistants to help with activities related to prevention and control such as screening visitors and supporting visitation requirements.

Developing an prevention and control program with a team of five Nova Scotia Health Authority (NSHA) prevention and control clinicians along with support from the NSHA occupational kamagra oral jelly 100mg uk health and safety team. Promoting the Control designate role and providing funding for LTC homes to hire clinical nurses throughout the province to work in this role with NSHA’s prevention and control (IPAC) team. Increasing environmental supports to enhance prevention and control measures in kamagra oral jelly 100mg uk LTC homes. And Distributing PPE supplies to long-term care facilities as part of the erectile dysfunction treatment response. As we work to keep seniors safe and improve their quality of life, the federal government will continue to work collaboratively with provinces and territories, while respecting their jurisdiction over health care, including long-term care..

Statement Health Canada authorizes Medicago erectile dysfunction treatment for adults 18 to 64 years of age February 24, 2022 | Ottawa, ON | Health CanadaToday, Health Canada authorized Medicago's Covifenz erectile dysfunction treatment for the kamagra online australia prevention of erectile dysfunction treatment in adults 18 to 64 buy super kamagra online uk years of age. After a thorough and independent scientific review of the evidence, the Department has determined that the treatment meets Health Canada's stringent safety, efficacy and quality requirements, and that the benefits of this treatment outweigh the potential risks.This is the first authorized erectile dysfunction treatment developed by a Canadian-based company, and the first that uses a plant-based protein technology. Medicago's Covifenz is authorized as a two-dose regimen of 3.75 micrograms per dose, to be administered 21 days apart.In clinical trials, the treatment was found to be 71 per cent effective against symptomatic and 100 per cent effective kamagra online australia against severe disease caused by erectile dysfunction treatment. These studies were conducted while there were multiple variants in circulation.

The data suggest efficacy against multiple variants, including Delta. Clinical trials with Covifenz showed efficacy against the Delta and Gamma variants, and data also suggesting efficacy against Alpha, Lambda and Mu kamagra online australia variants. While additional confirmatory data are needed, preliminary and exploratory data shows that Covifenz produces neutralizing antibodies against the Omicron variant.Health Canada has placed terms and conditions on the authorization. Medicago must continue to provide information to Health Canada on the safety and efficacy of the treatment, including protection against kamagra online australia current and emerging variants of concern as soon as it is availableThe treatment is authorized for use in adults 18 to 64 years of age, based on the data that was reviewed by Health Canada.

There was limited enrolment of participants older than 65 years of age in the clinical trials because a large proportion of older individuals were already vaccinated. Medicago is currently gathering data in older individuals to support regulatory authorization for this age group.In keeping with the Department's commitment to openness and transparency, Health Canada is publishing multiple documents related to its decision, including a high-level summary of the evidence it reviewed to support the authorization of the treatment. More detailed information will be available kamagra online australia in the coming weeks, including a detailed scientific summary and the full clinical trial results that support the use of this treatment.Health Canada and the Public Health Agency of Canada will continue to closely monitor the safety of this treatment, and will take action if any safety concerns are identified.For detailed information on authorized treatments and treatments in Canada, visit the erectile dysfunction treatments and treatments portal. Related Links:Medicago treatment product pageerectile dysfunction treatments and treatments portal ContactsMedia RelationsHealth Canada613-957-2983media@hc-sc.gc.caerectile dysfunction treatment public enquiries:1-833-784-4397February 24, 2022 | Chester, Nova Scotia | Health Canada The erectile dysfunction treatment kamagra has highlighted long-standing challenges in Canada’s long-term care (LTC) homes.

We have seen gaps in prevention and control, staffing, https://www.moneyspace.com/summerholidays/ and infrastructure, with tragic effects on residents, kamagra online australia their families and those working in LTC homes. To keep seniors safe and improve their quality of life, the 2020 Fall Economic Statement committed up to $1 billion through the Safe Long-Term Care Fund (SLTCF) to help provinces and territories undertake activities to improve prevention and control in long-term care. These activities include hiring additional staff, implementing wage top-ups, as well as purchasing or renovating infrastructure including ventilation, and doing readiness assessments. Today, on behalf of the Honourable Jean-Yves Duclos, Minister of Health, the Honourable Sean Fraser, Minister of Immigration, Refugees and Citizenship, along with Darren Fisher, Parliamentary Secretary to the Minister of kamagra online australia Seniors, announced the signing of a SLTCF agreement with Nova Scotia.

They were joined by the Honourable Barbara Adams, Nova Scotia’s Minister of Seniors and Long-term Care and the Honourable Michelle Thompson, Nova Scotia’s Minister of Health and Wellness. Through this agreement, kamagra online australia Nova Scotia is receiving more than $27 million, with work already underway, to take better care of and protect seniors in LTC homes. With this investment, Nova Scotia has built on existing initiatives to improve prevention and control in long-term care homes by funding the following initiatives. Hiring of LTC assistants to help with activities related to prevention and control such as screening visitors and supporting visitation requirements.

Developing an prevention and control program with a team of five Nova Scotia Health Authority (NSHA) prevention and control clinicians along with support from the NSHA occupational health and safety team kamagra online australia. Promoting the Control designate role and providing funding for LTC homes to hire clinical nurses throughout the province to work in this role with NSHA’s prevention and control (IPAC) team. Increasing environmental supports to enhance prevention and kamagra online australia control measures in LTC homes. And Distributing PPE supplies to long-term care facilities as part of the erectile dysfunction treatment response.

As we work to keep seniors safe and improve their quality of life, the federal government will continue to work collaboratively with provinces and territories, while respecting their jurisdiction over health care, including long-term care..

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

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

• eye or vision problems, including a rare inherited eye disease called retinitis pigmentosa
• heart disease, angina, high or low blood pressure, a history of heart attack, or other heart problems
• kidney disease
• liver disease
• stroke
• an unusual or allergic reaction to sildenafil, other medicines, foods, dyes, or preservatives

Kamagra oral jelly best price

Start Preamble kamagra oral jelly best price Announcement Type. New. Funding Announcement Number kamagra oral jelly best price.

HHS-2022-IHS-PHN-0001. Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) Number. 93.383.

Key Dates Application Deadline Date. August 11, 2022. Earliest Anticipated Start Date.

September 26, 2022. I. Funding Opportunity Description Statutory Authority The Indian Health Service (IHS) is accepting applications for a cooperative agreement for Public Health Nursing Case Management.

Reducing Sexually Transmitted s. This program 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.

1621q, 1660e. This program is described in the Assistance Listings located at https://sam.gov/​content/​home (formerly known as the CFDA) under 93.383. Background The IHS Public Health Nursing (PHN) program is a community health nursing program that focuses on the goals of promoting health and quality of life, and preventing disease and disability.

The PHN program provides quality, culturally sensitive health promotion and disease prevention nursing care services through primary, secondary, and tertiary prevention services to individuals, families, and community groups. Program funds provide critical support for direct health care services in the community, which improve Americans' access to health care. The PHN program supports population-focused services to promote healthier communities through community based nursing services, community development, and health promotion and/or disease prevention activities.

The PHN program promotes the establishment of program plans based on community assessments and evaluations to prevent disease, promote health, and implement community based programs. There is an emphasis on screening, home visits, immunizations, maternal-child health care, elder care, chronic disease, school services, health promotion and disease prevention, case management, population based services, and community disease surveillance. The PHN program is available to support transitions of care from the clinical setting into the community with an emphasis on the clinical, preventive, and public health needs of American Indian/Alaska Native (AI/AN) communities.

PHN patient care coordination activities aim to serve the patient and family in the home and in the community. Preventive health care informs populations, promotes healthy lifestyles, and provides early treatment for illnesses. The PHN's expertise in communicable disease assessment, outreach, investigation, and surveillance aids in the management and prevention of the spread of communicable diseases.

PHNs conduct nurse home visiting services via referral for communicable disease investigation and treatment, which includes such services as health education/behavioral counseling for health promotion, risk reduction, and immunizations to prevent illnesses with a goal to detect and treat problems in their early stages. The PHN's unique scope of service supports the goal of decreasing sexually transmitted diseases. Purpose The purpose of this IHS program is to mitigate the prevalence of sexually transmitted s (STI) within Indian Country through a case management model that utilizes the PHN as a case manager.

The emphasis is on raising awareness of STIs as a high-priority health issue among AI/AN communities and to support prevention and control activities of comorbid conditions. Case management involves the client, family, and other members of the health care team. Quality of care, continuity, and assurance of appropriate and timely interventions are also crucial.

In addition to reducing the cost of health care, case management has proven its worth in terms of improving rehabilitation, improving quality of life, and increasing client satisfaction and compliance by promoting client self-determination. The goals and outcomes of the PHN case management model are early detection, diagnosis, treatment, and evaluation that will improve health Start Printed Page 29347 outcomes in a cost effective manner. This model uses all prevention components of primary, secondary, and tertiary prevention in the home and community with patient and family.

The PHN Case Management program supports raising awareness of rising STI rates, increasing access to care, strengthening surveillance, and decreasing serious health consequences of undiagnosed STIs. This also supports timely linkage to care in follow-up and treatment to reduce the spread of STIs. The IHS goal is to support and strengthen surveillance systems to monitor STI trends, promote awareness, and identify effective interventions for reducing morbidity and improving outbreak response efforts.

Currently, AI/AN men and women are disproportionately affected by STIs compared to other populations within the United States. Chlamydia and gonorrhea rates are four to five times higher in AI/AN populations than non-Hispanic whites. Syphilis and human immunodeficiency kamagra (HIV) also have disproportionately higher impact on AI/AN people.

In 2019, AI/AN women had the highest syphilis rate at seven times the rate among non-Hispanic white females. Effective diagnosis, management, and prevention of STIs requires a combination of clinical and public health activities. Required, Optional, and Allowable Activities The community based case management model addresses the PHN scope of practice of working with individuals and families in a population-based practice.

The project will be applied in a phased approach, using the nursing process—assessment, planning, implementation, and evaluation. First Phase. Assessment—Complete a community assessment within the first six months after the project start date (most PHN programs have this readily available as a part of their annual program plans).

Include, if available, data from local community assessments and STI data in the assessment. In addition, obtain input from key stake-holders such as community members, Tribal leaders, health care administration, local social hygiene staff as subject matter experts, and community health groups to determine the STI health care priorities. Obtain approval for the establishment of the PHN case management program from health care administration, governing boards, and medical executive committees as needed.

Second Phase. Planning—Based on the community assessment, the population of need related to STIs is identified and the planning of the case management project begins. Develop case management services no later than 10 months after the project start date, which addresses the priority STIs identified from the community assessment.

Collaborate with local social hygiene and health care programs on planning in this phase. Plan specific guidelines for the case management services of the high-risk group of patients such as admission criteria, caseload size, policies and procedures, electronic health record reminders for providers and patients, and an evaluation plan to include data tracking for outcomes generated. Establish short and long term program goals.

Identify if there is a best practice case management model available to replicate to target the identified high risk population. Obtain additional staff training needed for the community based nurse case management model such as evidence based practices, motivational interviewing, nurse competencies, quality improvement, and any other educational training that would be applicable to the health issues identified in the case management model. Identify or develop patient education materials and community education materials for the program.

Develop plans for project sustainability. Third Phase. Implementation—The case management program includes admission criteria of the high risk population, caseload size, and appropriate health care standards.

Establish patient caseload no later than 12 months after the project start date. Monitor progress and make adjustments as needed. Track patient data outcomes.

Continue to plan ongoing sustainability of the program after the period of performance ends. Fourth Phase. Patient Satisfaction—In order to evaluate program services, initiate a patient satisfaction program no later than the start of the second year of the period of performance, such as one that provides patients with an opportunity to provide feedback on their experiences to assess the satisfaction of the services.

Analyze findings so a concentrated effort is made to relate the customer satisfaction results to internal process metrics, and examine trends over time in order to take action on a timely basis. Evaluate and revise the case management program if needed, review policies and procedures, education materials, and staff competencies semi-annually. To the extent permitted by law, report back to key stake-holders progress of the project, especially to inform clients about changes brought about as a direct result of listening to their needs.

Each site will share program material with the IHS Headquarters PHN program. This information will be shared IHS-wide for replication of the project across the IHS with credit given to the organization that developed the material. Poster or oral presentation will be given at national meetings and/or webinars.

II. Award Information Funding Instrument—Cooperative Agreement Estimated Funds Available The total funding identified for fiscal year (FY) 2022 is approximately $1,500,000. Individual award amounts for the first budget year are anticipated to be between $145,000 and $150,000.

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 10 awards will be issued under this program announcement.

Period of Performance The period of performance is 5 years. Cooperative Agreement Cooperative agreements awarded by the Department of Health and Human Services (HHS) are administered under the same policies as grants. However, the funding agency, IHS, is anticipated to have substantial programmatic involvement in the project during the entire period of performance.

Below is a detailed description of the level of involvement required of the IHS. Substantial Agency Involvement Description for Cooperative Agreement Provide funded organizations with ongoing consultation and technical assistance to plan, implement, and evaluate each component of the comprehensive program as described under Recipient Activities below. Consultation and technical assistance will include, but not be limited to, the following areas.

1. Interpretation of current literature related to epidemiology, statistics, surveillance, Healthy People 2030 Objectives, the Goals of the IHS National STD program, Centers for Disease Control and Prevention Sexually Transmitted s Start Printed Page 29348 Treatment Guidelines, 2021, Department of Health and Human Services STI Strategic Plan, and previous best practices of PHN Case Management recipient activities. 2.

Identify sources for additional staff training for the community based case management model and additional training needed such as evidence based practices, motivational interviewing, performance improvement and any other training that would be applicable to the STI issues addressed in the case management program. 3. Design and implementation of program components (including, but not limited to, program implementation methods, recommendation of a community assessment tool, surveillance, analysis, development of programmatic evaluation, and coordination of activities).

4. Identify, if available, previously established program management plans of PHN Case Management best practices (to replicate from previous demonstration PHN program awards). 5.

Conduct visits to assess program progress and mutually resolved problems, if travel funds are available. And, 6. Coordinate these activities with all IHS PHN activities on a national basis.

III. Eligibility Information 1. Eligibility To be eligible for this funding opportunity an applicant must be one of the following as defined by 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(1)). €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 Urban Indian organization, as defined by 25 U.S.C. 1603(29). The term “Urban Indian organization” means a nonprofit corporate body situated in an urban center, governed by an urban Indian controlled board of directors, and providing for the maximum participation of all interested Indian groups and individuals, which body is capable of legally cooperating with other public and private entities for the purpose of performing the activities described in 25 U.S.C.

1653(a). Applicants must provide proof of nonprofit status with the application, e.g., 501(c)(3). The program office will notify any applicants deemed ineligible.

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, are 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 Tribe or Tribal organization selected for funding. An applicant 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 available at 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.

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

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

SF-424B, Assurances—Non-Construction Programs. 4. Project Abstract Summary form.

Project Narrative (not to exceed 10 pages). See Section IV.2.A, Project Narrative for instructions. Budget Narrative (not to exceed four pages).

See Section IV.2.B, Budget Narrative for instructions. One-page Timeframe Chart. Tribal Resolution(s) as described in Section III, Eligibility (if applicable).

501(c)(3) Certificate as described in Section III, Eligibility (if applicable). Biographical sketches for all Key Personnel. • Contractor/Consultant resumes or qualifications and scope of work.

Start Printed Page 29349 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://facdissem.census.gov/​. 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 10 pages and must. (1) Have consecutively numbered pages. (2) use black font 12 points or larger (tables may be done in 10 point font).

(3) be single-spaced. And (4) be formatted to fit standard letter paper (8 1/2 x 11 inches). Do not combine this document with any others.

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 overall page limit, the application will be considered not responsive and will not be reviewed. The 10-page limit for the project narrative does not include the work plan, standard forms, Tribal Resolutions, budget, budget narratives, and/or other items.

Page limits for each section within the project narrative are guidelines, not hard limits. There are three parts to the project narrative. Part 1—Program Information.

Part 2—Program Planning and Evaluation. And Part 3—Program 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.

Needs Describe the Urban Program or Tribe's current social hygiene or STI program activities, how long it has been operating, and what programs or services are currently being provided. Describe how the applicant has determined it has the administrative infrastructure to support the activities to implement a Public Health Nursing Case Management Program and evaluate and sustain it. Explain previous planning activities the applicant has completed relevant to this or similar goals.

Describe any internal relationships or collaborative relationships with social hygiene/STI subject matter experts to support this activity. Part 2. Program Planning and Evaluation (Limit—4 Pages) Section 1.

Program Plans Describe fully and clearly the direction the applicant plans to take in the PHN Case Management Program, including plans to demonstrate improved sexual health outcomes of the identified group of patients and services to the community it serves. Include proposed timelines. Section 2.

Program Evaluation Describe fully and clearly the improvements that will be made by the applicant to manage the PHN Case Management Program and identify the anticipated or expected benefits for the Tribe and AI/AN people served. Part 3. Program Report (Limit—2 Pages) Section 1.

Identify and describe significant program achievements associated with the delivery of quality health care services in the past 24 months as a part of implementing previous grant awards, cooperative agreements, or other related activities. Provide a comparison of the actual accomplishments to the goals established for the period of performance or, if applicable, provide justification for the lack of progress. B.

Budget Narrative (Limit—4 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 applicant can submit with the budget narrative a more detailed spreadsheet than is provided by the SF-424A (the spreadsheet will not be considered part of the budget narrative). 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 the first year 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 ), Deputy 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 not allowable. The available funds are inclusive of direct and indirect costs.

Only one cooperative agreement 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 you cannot submit an application through Grants.gov, you must request a Start Printed Page 29350 waiver prior to the application due date. This contact must be initiated prior to the application due date or your waiver request will be denied.

Prior approval must be requested and obtained from Mr. Paul Gettys, Deputy Director, DGM. You must send a written waiver request 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 must include clear justification for the need to deviate from the required application submission process. If the DGM approves your waiver request, you will receive a confirmation of approval email containing submission instructions. You must include a copy of the written approval with the application submitted to the DGM.

Applications that do not include a copy of the signed waiver from the Deputy 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 ). • 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, you will receive an automatic acknowledgment from Grants.gov that contains a Grants.gov tracking number. The IHS will not notify you that the application has been received. System for Award Management (SAM) Organizations that are not registered with SAM must access the SAM online registration through the SAM home page at https://sam.gov.

United States (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. Unique Entity Identifier Your SAM.gov registration now includes a Unique Entity Identifier (UEI), generated by SAM.gov, which replaces the DUNS number obtained from Dun and Bradstreet. SAM.gov registration no longer requires a DUNS number.

Check your organization's SAM.gov registration as soon as you decide to apply for this program. If your SAM.gov registration is expired, you will not be able to submit an application. It can take several weeks to renew it or resolve any issues with your registration, so do not wait.

Check your Grants.gov registration. Registration and role assignments in Grants.gov are self-serve functions. One user for your organization will have the authority to approve role assignments, and these must be approved for active users in order to ensure someone in your organization has the necessary access to submit an application.

The Federal Funding Accountability and Transparency Act of 2006, as amended (“Transparency Act”), requires all HHS awardees to report information on sub-awards. Accordingly, all IHS awardees must notify potential first-tier sub-awardees that no entity may receive a first-tier sub-award unless the entity has provided its UEI number to the prime awardee 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.

Additional information on implementing the Transparency Act, including the specific requirements for SAM, are available on the DGM Grants Management, Policy Topics web page at https://www.ihs.gov/​dgm/​policytopics/​. V. Application Review Information Possible points assigned to each section are noted in parentheses.

The project narrative and budget 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 project narrative 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 page limit for the narratives.

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 (5 Points) a. Provide demographic information, prevalence rates of sexually transmitted s, and baseline data to support the case management for the high risk group of patients.

B. Describe how data collection will support the project objectives and how it will support the project evaluation in order to determine the impact of the project. Address how the proposed project will result in health improvements.

B. Project Objective(s), Work Plan, and Approach (35 Points) a. Goals and Objectives (15 Points) Identify two to three measurable objectives of the program that will demonstrate outcome.

Goals/Objectives should be specific with a realistic timeline. B. Methodology/Activities (20 Points) Describe the activities that will be implemented in the program to meet the objectives.

This work plan should be directly related to the objectives. I. Describe how you will monitor the objectives (chart reviews, patient comments/feedback, data collection tools).

Ii. Describe any collaborative efforts with other programs or the local social hygiene program. C.

Program Evaluation (20 Points) Describe the methods for evaluating the project activities. Each proposed Start Printed Page 29351 project objective should have an evaluation component and the evaluation activities should appear on the program plan. At a minimum, projects should describe plans to collect or summarize evaluation information about all project activities.

Please address the following for each of the proposed objectives. (1) Describe the community assessment results and what data will be selected to evaluate the success of the objective(s). (2) Describe how the data and patient satisfaction information will be collected to assess the programs objective(s) ( e.g., methods used such as, but not limited to, providing mechanisms for patients to provide feedback on their experiences).

(3) Identify when the data will be collected and the data analysis completed. (4) Describe the extent to which there are specific datasets, databases, or registries already in place to measure/monitor meeting objective. (5) Describe who will collect the data and any cost of the evaluation (whether internal or external).

(6) Describe where, when, and to whom the data will be presented (only to the extent permitted by law, the data to be reported back to key stake-holders on the progress of the project, especially to inform clients about changes brought about as a direct result of listening to their needs). (7) Address anticipated obstacles to the success of the proposal such as underlying causes and the nature of their influence on accomplishing the objectives. (8) Describe how the community assessment will be used to identify a high risk group of patients.

(9) Describe the process that will be used to follow-up on the PHN Case Management Project findings/conclusions. D. Organizational Capabilities, Key Personnel, and Qualifications (25 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 outlined in the work plan. (1) Describe the organizational structure. (2) Describe what equipment and facility space ( i.e., office space) will be available for use during the proposed program.

Include information about any equipment not currently available that will be purchased throughout the agreement. (3) List key personnel who will work on the project. I.

Identify staffing plan, existing personnel, and new program staff to be hired. Ii. Include position descriptions and resumes for all key personnel.

Position descriptions should clearly describe each position and duties indicating desired qualifications, experience, and requirements related to the proposed project and how they will be supervised. iii. If the project requires additional personnel beyond those covered by the grant award ( i.e., information technology support, volunteers, interviewers, etc.), note these and address how these positions will be filled and, if funds are required, the source of these funds.

iv. If personnel are to be only partially funded by this grant, 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. (4) Capability.

I. Briefly describe the facility and user population. Ii.

Describe the organization's ability to conduct this initiative through linkages to community resources. Partnerships established to provide referrals for additional services as needed for specialized treatment, care, and counseling services. E.

Categorical Budget and Budget Justification (15 Points) Provide a clear estimate of the program costs and justification for expenses. The budget and budget justification should be consistent with the tasks identified in the work plan. The budget focus should be on developing and sustaining PHN case management services.

(1) Provide a budget narrative that serves as 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 allowable costs. (2) Provide a succinct description of specific roles and activities of each person involved in the proposed project budget.

(3) If indirect costs are claimed, indicate and apply the current negotiated rate to the budget. 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 not count as part of the project narrative or the budget narrative.

Additional documents can be uploaded as Other Attachments in Grants.gov. These can include. Work plan, logic model, and/or time line 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, period of performance limit) will not be referred to the ORC and will not be funded. The program office will notify the applicant 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 Public Health Nursing program 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 award, the terms and conditions of the award, the effective date of the award, the budget period, and period of performance.

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. Start Printed Page 29352 B.

Approved but Unfunded Applications Approved applications not funded due to lack of available funds will be held for 1 year. If funding becomes available during the course of the year, the application may be reconsidered. 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. • Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards currently in effect or implemented during the period of award, other Department regulations and policies in effect at the time of award, and applicable statutory provisions. At the time of publication, this includes 45 CFR part 75, at https://www.govinfo.gov/​content/​pkg/​CFR-2020-title45-vol1/​pdf/​CFR-2020-title45-vol1-part75.pdf.

• Please review all HHS regulatory provisions for Termination at 45 CFR 75.372, at https://www.ecfr.gov/​cgi-bin/​retrieveECFR?. €‹gp&​amp;​SID=​2970eec67399fab1413ede53d7895d99&​amp;​mc=​true&​amp;​n=​pt45.1.75&​amp;​r=​PART&​amp;​ty=​HTML&​amp;​se45.1.75_​1372#se45.1.75_​1372. C.

Grants Policy. • HHS Grants Policy Statement, Revised January 2007, at https://www.hhs.gov/​sites/​default/​files/​grants/​grants/​policies-regulations/​hhsgps107.pdf. D.

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 awardees that request reimbursement of IDC in their application budget.

In accordance with HHS Grants Policy Statement, Part II-27, the 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 (NFE) [ 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 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 NFE chooses to negotiate for a rate, which the NFE 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 recipients are negotiated with the Division of Cost Allocation at https://rates.psc.gov/​ or the Department of the Interior (Interior Business Center) at 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 awardee 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 reporting 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 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.

Awardees are responsible and accountable for reporting accurate information on all required reports. The Progress Reports and the Federal Financial Report. C.

Data Collection and Reporting The recipient must submit required reports consistent with the applicable deadlines. The recipient is required to identify two to three measurable objectives of the program to demonstrate and trend outcome. The objectives correspond to the work plan should be directly related to the targeted outcome.

Start Printed Page 29353 The recipient is to describe and report this information on a semi-annual timeline and in annual reports. 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. The 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.

Non-Discrimination Legal Requirements for Recipients of Federal Financial Assistance Should you successfully compete for an award, 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 (including gender identity, sexual orientation, and pregnancy). This includes ensuring programs are accessible to persons with limited English proficiency and persons with disabilities. 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 https://www.hhs.gov/​civil-rights/​for-individuals/​nondiscrimination/​index.html. • Recipients of FFA must ensure that their programs are accessible to persons with limited English proficiency. For guidance on meeting your legal obligation to take reasonable steps to ensure meaningful access to your programs or activities by limited English proficiency individuals, see https://www.hhs.gov/​civil-rights/​for-individuals/​special-topics/​limited-english-proficiency/​fact-sheet-guidance/​index.html and https://www.lep.gov.

• For information on your specific legal obligations for serving qualified individuals with disabilities, including reasonable modifications and making services accessible to them, see https://www.hhs.gov/​civil-rights/​for-individuals/​disability/​index.html. • HHS funded health and education programs must be administered in an environment free of sexual harassment. See https://www.hhs.gov/​civil-rights/​for-individuals/​sex-discrimination/​index.html.

• For guidance on administering your program in compliance with applicable Federal religious nondiscrimination laws and applicable Federal conscience protection and associated anti-discrimination laws, see https://www.hhs.gov/​conscience/​conscience-protections/​index.html and https://www.hhs.gov/​conscience/​religious-freedom/​index.html. 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 FAPIIS at https://www.fapiis.gov/​fapiis/​#/​home, 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, 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. All applicants and recipients must disclose in writing, in a timely manner, 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, Deputy 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 and 2 CFR part 376). VII.

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

Jolene Tom, RN/BSN Project Officer, Indian Health Service, 5600 Fishers Lane, Mail Stop. 08N40C, Rockville, MD 20857, Phone. (301) 945-3215, Fax.

(301) 594-6213, Email. Jolene.tom@ihs.gov. 2.

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

(240) 535-9308, Email. Sheila.miller@ihs.gov. Start Printed Page 29354 3.

Questions on systems matters may be directed to. Paul Gettys, Deputy Director, Division of Grants Management, 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.

Start Preamble kamagra online australia Announcement Type https://financeinnovationlab.org/?acf=acf_page-details. New. Funding Announcement Number kamagra online australia.

HHS-2022-IHS-PHN-0001. Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) Number. 93.383.

Key Dates Application Deadline Date. August 11, 2022. Earliest Anticipated Start Date.

September 26, 2022. I. Funding Opportunity Description Statutory Authority The Indian Health Service (IHS) is accepting applications for a cooperative agreement for Public Health Nursing Case Management.

Reducing Sexually Transmitted s. This program 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.

1621q, 1660e. This program is described in the Assistance Listings located at https://sam.gov/​content/​home (formerly known as the CFDA) under 93.383. Background The IHS Public Health Nursing (PHN) program is a community health nursing program that focuses on the goals of promoting health and quality of life, and preventing disease and disability.

The PHN program provides quality, culturally sensitive health promotion and disease prevention nursing care services through primary, secondary, and tertiary prevention services to individuals, families, and community groups. Program funds provide critical support for direct health care services in the community, which improve Americans' access to health care. The PHN program supports population-focused services to promote healthier communities through community based nursing services, community development, and health promotion and/or disease prevention activities.

The PHN program promotes the establishment of program plans based on community assessments and evaluations to prevent disease, promote health, and implement community based programs. There is an emphasis on screening, home visits, immunizations, maternal-child health care, elder care, chronic disease, school services, health promotion and disease prevention, case management, population based services, and community disease surveillance. The PHN program is available to support transitions of care from the clinical setting into the community with an emphasis on the clinical, preventive, and public health needs of American Indian/Alaska Native (AI/AN) communities.

PHN patient care coordination activities aim to serve the patient and family in the home and in the community. Preventive health care informs populations, promotes healthy lifestyles, and provides early treatment for illnesses. The PHN's expertise in communicable disease assessment, outreach, investigation, and surveillance aids in the management and prevention of the spread of communicable diseases.

PHNs conduct nurse home visiting services via referral for communicable disease investigation and treatment, which includes such services as health education/behavioral counseling for health promotion, risk reduction, and immunizations to prevent illnesses with a goal to detect and treat problems in their early stages. The PHN's unique scope of service supports the goal of decreasing sexually transmitted diseases. Purpose The purpose of this IHS program is to mitigate the prevalence of sexually transmitted s (STI) within Indian Country through a case management model that utilizes the PHN as a case manager.

The emphasis is on raising awareness of STIs as a high-priority health issue among AI/AN communities and to support prevention and control activities of comorbid conditions. Case management involves the client, family, and other members of the health care team. Quality of care, continuity, and assurance of appropriate and timely interventions are also crucial.

In addition to reducing the cost of health care, case management has proven its worth in terms of improving rehabilitation, improving quality of life, and increasing client satisfaction and compliance by promoting client self-determination. The goals and outcomes of the PHN case management model are early detection, diagnosis, treatment, and evaluation that will improve health Start Printed Page 29347 outcomes in a cost effective manner. This model uses all prevention components of primary, secondary, and tertiary prevention in the home and community with patient and family.

The PHN Case Management program supports raising awareness of rising STI rates, increasing access to care, strengthening surveillance, and decreasing serious health consequences of undiagnosed STIs. This also supports timely linkage to care in follow-up and treatment to reduce the spread of STIs. The IHS goal is to support and strengthen surveillance systems to monitor STI trends, promote awareness, and identify effective interventions for reducing morbidity and improving outbreak response efforts.

Currently, AI/AN men and women are disproportionately affected by STIs compared to other populations within the United States. Chlamydia and gonorrhea rates are four to five times higher in AI/AN populations than non-Hispanic whites. Syphilis and human immunodeficiency kamagra (HIV) also have disproportionately higher impact on AI/AN people.

In 2019, AI/AN women had the highest syphilis rate at seven times the rate among non-Hispanic white females. Effective diagnosis, management, and prevention of STIs requires a combination of clinical and public health activities. Required, Optional, and Allowable Activities The community based case management model addresses the PHN scope of practice of working with individuals and families in a population-based practice.

The project will be applied in a phased approach, using the nursing process—assessment, planning, implementation, and evaluation. First Phase. Assessment—Complete a community assessment within the first six months after the project start date (most PHN programs have this readily available as a part of their annual program plans).

Include, if available, data from local community assessments and STI data in the assessment. In addition, obtain input from key stake-holders such as community members, Tribal leaders, health care administration, local social hygiene staff as subject matter experts, and community health groups to determine the STI health care priorities. Obtain approval for the establishment of the PHN case management program from health care administration, governing boards, and medical executive committees as needed.

Second Phase. Planning—Based on the community assessment, the population of need related to STIs is identified and the planning of the case management project begins. Develop case management services no later than 10 months after the project start date, which addresses the priority STIs identified from the community assessment.

Collaborate with local social hygiene and health care programs on planning in this phase. Plan specific guidelines for the case management services of the high-risk group of patients such as admission criteria, caseload size, policies and procedures, electronic health record reminders for providers and patients, and an evaluation plan to include data tracking for outcomes generated. Establish short and long term program goals.

Identify if there is a best practice case management model available to replicate to target the identified high risk population. Obtain additional staff training needed for the community based nurse case management model such as evidence based practices, motivational interviewing, nurse competencies, quality improvement, and any other educational training that would be applicable to the health issues identified in the case management model. Identify or develop patient education materials and community education materials for the program.

Develop plans for project sustainability. Third Phase. Implementation—The case management program includes admission criteria of the high risk population, caseload size, and appropriate health care standards.

Establish patient caseload no later than 12 months after the project start date. Monitor progress and make adjustments as needed. Track patient data outcomes.

Continue to plan ongoing sustainability of the program after the period of performance ends. Fourth Phase. Patient Satisfaction—In order to evaluate program services, initiate a patient satisfaction program no later than the start of the second year of the period of performance, such as one that provides patients with an opportunity to provide feedback on their experiences to assess the satisfaction of the services.

Analyze findings so a concentrated effort is made to relate the customer satisfaction results to internal process metrics, and examine trends over time in order to take action on a timely basis. Evaluate and revise the case management program if needed, review policies and procedures, education materials, and staff competencies semi-annually. To the extent permitted by law, report back to key stake-holders progress of the project, especially to inform clients about changes brought about as a direct result of listening to their needs.

Each site will share program material with the IHS Headquarters PHN program. This information will be shared IHS-wide for replication of the project across the IHS with credit given to the organization that developed the material. Poster or oral presentation will be given at national meetings and/or webinars.

II. Award Information Funding Instrument—Cooperative Agreement Estimated Funds Available The total funding identified for fiscal year (FY) 2022 is approximately $1,500,000. Individual award amounts for the first budget year are anticipated to be between $145,000 and $150,000.

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 10 awards will be issued under this program announcement.

Period of Performance The period of performance is 5 years. Cooperative Agreement Cooperative agreements awarded by the Department of Health and Human Services (HHS) are administered under the same policies as grants. However, the funding agency, IHS, is anticipated to have substantial programmatic involvement in the project during the entire period of performance.

Below is a detailed description of the level of involvement required of the IHS. Substantial Agency Involvement Description for Cooperative Agreement Provide funded organizations with ongoing consultation and technical assistance to plan, implement, and evaluate each component of the comprehensive program as described under Recipient Activities below. Consultation and technical assistance will include, but not be limited to, the following areas.

1. Interpretation of current literature related to epidemiology, statistics, surveillance, Healthy People 2030 Objectives, the Goals of the IHS National STD program, Centers for Disease Control and Prevention Sexually Transmitted s Start Printed Page 29348 Treatment Guidelines, 2021, Department of Health and Human Services STI Strategic Plan, and previous best practices of PHN Case Management recipient activities. 2.

Identify sources for additional staff training for the community based case management model and additional training needed such as evidence based practices, motivational interviewing, performance improvement and any other training that would be applicable to the STI issues addressed in the case management program. 3. Design and implementation of program components (including, but not limited to, program implementation methods, recommendation of a community assessment tool, surveillance, analysis, development of programmatic evaluation, and coordination of activities).

4. Identify, if available, previously established program management plans of PHN Case Management best practices (to replicate from previous demonstration PHN program awards). 5.

Conduct visits to assess program progress and mutually resolved problems, if travel funds are available. And, 6. Coordinate these activities with all IHS PHN activities on a national basis.

III. Eligibility Information 1. Eligibility To be eligible for this funding opportunity an applicant must be one of the following as defined by 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(1)). €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 Urban Indian organization, as defined by 25 U.S.C. 1603(29). The term “Urban Indian organization” means a nonprofit corporate body situated in an urban center, governed by an urban Indian controlled board of directors, and providing for the maximum participation of all interested Indian groups and individuals, which body is capable of legally cooperating with other public and private entities for the purpose of performing the activities described in 25 U.S.C.

1653(a). Applicants must provide proof of nonprofit status with the application, e.g., 501(c)(3). The program office will notify any applicants deemed ineligible.

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, are 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 Tribe or Tribal organization selected for funding. An applicant 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 available at 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.

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

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

SF-424B, Assurances—Non-Construction Programs. 4. Project Abstract Summary form.

Project Narrative (not to exceed 10 pages). See Section IV.2.A, Project Narrative for instructions. Budget Narrative (not to exceed four pages).

See Section IV.2.B, Budget Narrative for instructions. One-page Timeframe Chart. Tribal Resolution(s) as described in Section III, Eligibility (if applicable).

501(c)(3) Certificate as described in Section III, Eligibility (if applicable). Biographical sketches for all Key Personnel. • Contractor/Consultant resumes or qualifications and scope of work.

Start Printed Page 29349 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://facdissem.census.gov/​. 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 10 pages and must. (1) Have consecutively numbered pages. (2) use black font 12 points or larger (tables may be done in 10 point font).

(3) be single-spaced. And (4) be formatted to fit standard letter paper (8 1/2 x 11 inches). Do not combine this document with any others.

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 overall page limit, the application will be considered not responsive and will not be reviewed. The 10-page limit for the project narrative does not include the work plan, standard forms, Tribal Resolutions, budget, budget narratives, and/or other items.

Page limits for each section within the project narrative are guidelines, not hard limits. There are three parts to the project narrative. Part 1—Program Information.

Part 2—Program Planning and Evaluation. And Part 3—Program 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.

Needs Describe the Urban Program or Tribe's current social hygiene or STI program activities, how long it has been operating, and what programs or services are currently being provided. Describe how the applicant has determined it has the administrative infrastructure to support the activities to implement a Public Health Nursing Case Management Program and evaluate and sustain it. Explain previous planning activities the applicant has completed relevant to this or similar goals.

Describe any internal relationships or collaborative relationships with social hygiene/STI subject matter experts to support this activity. Part 2. Program Planning and Evaluation (Limit—4 Pages) Section 1.

Program Plans Describe fully and clearly the direction the applicant plans to take in the PHN Case Management Program, including plans to demonstrate improved sexual health outcomes of the identified group of patients and services to the community it serves. Include proposed timelines. Section 2.

Program Evaluation Describe fully and clearly the improvements that will be made by the applicant to manage the PHN Case Management Program and identify the anticipated or expected benefits for the Tribe and AI/AN people served. Part 3. Program Report (Limit—2 Pages) Section 1.

Identify and describe significant program achievements associated with the delivery of quality health care services in the past 24 months as a part of implementing previous grant awards, cooperative agreements, or other related activities. Provide a comparison of the actual accomplishments to the goals established for the period of performance or, if applicable, provide justification for the lack of progress. B.

Budget Narrative (Limit—4 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 applicant can submit with the budget narrative a more detailed spreadsheet than is provided by the SF-424A (the spreadsheet will not be considered part of the budget narrative). 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 the first year 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 ), Deputy 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 not allowable. The available funds are inclusive of direct and indirect costs.

Only one cooperative agreement 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 you cannot submit an application through Grants.gov, you must request a Start Printed Page 29350 waiver prior to the application due date. This contact must be initiated prior to the application due date or your waiver request will be denied.

Prior approval must be requested and obtained from Mr. Paul Gettys, Deputy Director, DGM. You must send a written waiver request 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 must include clear justification for the need to deviate from the required application submission process. If the DGM approves your waiver request, you will receive a confirmation of approval email containing submission instructions. You must include a copy of the written approval with the application submitted to the DGM.

Applications that do not include a copy of the signed waiver from the Deputy 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 ). • 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, you will receive an automatic acknowledgment from Grants.gov that contains a Grants.gov tracking number. The IHS will not notify you that the application has been received. System for Award Management (SAM) Organizations that are not registered with SAM must access the SAM online registration through the SAM home page at https://sam.gov.

United States (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. Unique Entity Identifier Your SAM.gov registration now includes a Unique Entity Identifier (UEI), generated by SAM.gov, which replaces the DUNS number obtained from Dun and Bradstreet. SAM.gov registration no longer requires a DUNS number.

Check your organization's SAM.gov registration as soon as you decide to apply for this program. If your SAM.gov registration is expired, you will not be able to submit an application. It can take several weeks to renew it or resolve any issues with your registration, so do not wait.

Check your Grants.gov registration. Registration and role assignments in Grants.gov are self-serve functions. One user for your organization will have the authority to approve role assignments, and these must be approved for active users in order to ensure someone in your organization has the necessary access to submit an application.

The Federal Funding Accountability and Transparency Act of 2006, as amended (“Transparency Act”), requires all HHS awardees to report information on sub-awards. Accordingly, all IHS awardees must notify potential first-tier sub-awardees that no entity may receive a first-tier sub-award unless the entity has provided its UEI number to the prime awardee 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.

Additional information on implementing the Transparency Act, including the specific requirements for SAM, are available on the DGM Grants Management, Policy Topics web page at https://www.ihs.gov/​dgm/​policytopics/​. V. Application Review Information Possible points assigned to each section are noted in parentheses.

The project narrative and budget 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 project narrative 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 page limit for the narratives.

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 (5 Points) a. Provide demographic information, prevalence rates of sexually transmitted s, and baseline data to support the case management for the high risk group of patients.

B. Describe how data collection will support the project objectives and how it will support the project evaluation in order to determine the impact of the project. Address how the proposed project will result in health improvements.

B. Project Objective(s), Work Plan, and Approach (35 Points) a. Goals and Objectives (15 Points) Identify two to three measurable objectives of the program that will demonstrate outcome.

Goals/Objectives should be specific with a realistic timeline. B. Methodology/Activities (20 Points) Describe the activities that will be implemented in the program to meet the objectives.

This work plan should be directly related to the objectives. I. Describe how you will monitor the objectives (chart reviews, patient comments/feedback, data collection tools).

Ii. Describe any collaborative efforts with other programs or the local social hygiene program. C.

Program Evaluation (20 Points) Describe the methods for evaluating the project activities. Each proposed Start Printed Page 29351 project objective should have an evaluation component and the evaluation activities should appear on the program plan. At a minimum, projects should describe plans to collect or summarize evaluation information about all project activities.

Please address the following for each of the proposed objectives. (1) Describe the community assessment results and what data will be selected to evaluate the success of the objective(s). (2) Describe how the data and patient satisfaction information will be collected to assess the programs objective(s) ( e.g., methods used such as, but not limited to, providing mechanisms for patients to provide feedback on their experiences).

(3) Identify when the data will be collected and the data analysis completed. (4) Describe the extent to which there are specific datasets, databases, or registries already in place to measure/monitor meeting objective. (5) Describe who will collect the data and any cost of the evaluation (whether internal or external).

(6) Describe where, when, and to whom the data will be presented (only to the extent permitted by law, the data to be reported back to key stake-holders on the progress of the project, especially to inform clients about changes brought about as a direct result of listening to their needs). (7) Address anticipated obstacles to the success of the proposal such as underlying causes and the nature of their influence on accomplishing the objectives. (8) Describe how the community assessment will be used to identify a high risk group of patients.

(9) Describe the process that will be used to follow-up on the PHN Case Management Project findings/conclusions. D. Organizational Capabilities, Key Personnel, and Qualifications (25 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 outlined in the work plan. (1) Describe the organizational structure. (2) Describe what equipment and facility space ( i.e., office space) will be available for use during the proposed program.

Include information about any equipment not currently available that will be purchased throughout the agreement. (3) List key personnel who will work on the project. I.

Identify staffing plan, existing personnel, and new program staff to be hired. Ii. Include position descriptions and resumes for all key personnel.

Position descriptions should clearly describe each position and duties indicating desired qualifications, experience, and requirements related to the proposed project and how they will be supervised. iii. If the project requires additional personnel beyond those covered by the grant award ( i.e., information technology support, volunteers, interviewers, etc.), note these and address how these positions will be filled and, if funds are required, the source of these funds.

iv. If personnel are to be only partially funded by this grant, 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. (4) Capability.

I. Briefly describe the facility and user population. Ii.

Describe the organization's ability to conduct this initiative through linkages to community resources. Partnerships established to provide referrals for additional services as needed for specialized treatment, care, and counseling services. E.

Categorical Budget and Budget Justification (15 Points) Provide a clear estimate of the program costs and justification for expenses. The budget and budget justification should be consistent with the tasks identified in the work plan. The budget focus should be on developing and sustaining PHN case management services.

(1) Provide a budget narrative that serves as 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 allowable costs. (2) Provide a succinct description of specific roles and activities of each person involved in the proposed project budget.

(3) If indirect costs are claimed, indicate and apply the current negotiated rate to the budget. 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 not count as part of the project narrative or the budget narrative.

Additional documents can be uploaded as Other Attachments in Grants.gov. These can include. Work plan, logic model, and/or time line 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, period of performance limit) will not be referred to the ORC and will not be funded. The program office will notify the applicant 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 Public Health Nursing program 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 award, the terms and conditions of the award, the effective date of the award, the budget period, and period of performance.

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. Start Printed Page 29352 B.

Approved but Unfunded Applications Approved applications not funded due to lack of available funds will be held for 1 year. If funding becomes available during the course of the year, the application may be reconsidered. 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. • Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards currently in effect or implemented during the period of award, other Department regulations and policies in effect at the time of award, and applicable statutory provisions. At the time of publication, this includes 45 CFR part 75, at https://www.govinfo.gov/​content/​pkg/​CFR-2020-title45-vol1/​pdf/​CFR-2020-title45-vol1-part75.pdf.

• Please review all HHS regulatory provisions for Termination at 45 CFR 75.372, at https://www.ecfr.gov/​cgi-bin/​retrieveECFR?. €‹gp&​amp;​SID=​2970eec67399fab1413ede53d7895d99&​amp;​mc=​true&​amp;​n=​pt45.1.75&​amp;​r=​PART&​amp;​ty=​HTML&​amp;​se45.1.75_​1372#se45.1.75_​1372. C.

Grants Policy. • HHS Grants Policy Statement, Revised January 2007, at https://www.hhs.gov/​sites/​default/​files/​grants/​grants/​policies-regulations/​hhsgps107.pdf. D.

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 awardees that request reimbursement of IDC in their application budget.

In accordance with HHS Grants Policy Statement, Part II-27, the 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 (NFE) [ 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 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 NFE chooses to negotiate for a rate, which the NFE 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 recipients are negotiated with the Division of Cost Allocation at https://rates.psc.gov/​ or the Department of the Interior (Interior Business Center) at 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 awardee 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 reporting 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 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.

Awardees are responsible and accountable for reporting accurate information on all required reports. The Progress Reports and the Federal Financial Report. C.

Data Collection and Reporting The recipient must submit required reports consistent with the applicable deadlines. The recipient is required to identify two to three measurable objectives of the program to demonstrate and trend outcome. The objectives correspond to the work plan should be directly related to the targeted outcome.

Start Printed Page 29353 The recipient is to describe and report this information on a semi-annual timeline and in annual reports. 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. The 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.

Non-Discrimination Legal Requirements for Recipients of Federal Financial Assistance Should you successfully compete for an award, 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 (including gender identity, sexual orientation, and pregnancy). This includes ensuring programs are accessible to persons with limited English proficiency and persons with disabilities. 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 https://www.hhs.gov/​civil-rights/​for-individuals/​nondiscrimination/​index.html. • Recipients of FFA must ensure that their programs are accessible to persons with limited English proficiency. For guidance on meeting your legal obligation to take reasonable steps to ensure meaningful access to your programs or activities by limited English proficiency individuals, see https://www.hhs.gov/​civil-rights/​for-individuals/​special-topics/​limited-english-proficiency/​fact-sheet-guidance/​index.html and https://www.lep.gov.

• For information on your specific legal obligations for serving qualified individuals with disabilities, including reasonable modifications and making services accessible to them, see https://www.hhs.gov/​civil-rights/​for-individuals/​disability/​index.html. • HHS funded health and education programs must be administered in an environment free of sexual harassment. See https://www.hhs.gov/​civil-rights/​for-individuals/​sex-discrimination/​index.html.

• For guidance on administering your program in compliance with applicable Federal religious nondiscrimination laws and applicable Federal conscience protection and associated anti-discrimination laws, see https://www.hhs.gov/​conscience/​conscience-protections/​index.html and https://www.hhs.gov/​conscience/​religious-freedom/​index.html. 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 FAPIIS at https://www.fapiis.gov/​fapiis/​#/​home, 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, 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. All applicants and recipients must disclose in writing, in a timely manner, 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, Deputy 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 and 2 CFR part 376). VII.

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

Jolene Tom, RN/BSN Project Officer, Indian Health Service, 5600 Fishers Lane, Mail Stop. 08N40C, Rockville, MD 20857, Phone. (301) 945-3215, Fax.

(301) 594-6213, Email. Jolene.tom@ihs.gov. 2.

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

(240) 535-9308, Email. Sheila.miller@ihs.gov. Start Printed Page 29354 3.

Questions on systems matters may be directed to. Paul Gettys, Deputy Director, Division of Grants Management, 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.

Kamagra wirkung

See rules on household size here kamagra wirkung hop over to this website. Non-MAGI - 2022 Disabled, 65+ or Blind ("DAB" or SSI-Related) and have Medicare MAGI (2022) (<. 65, Does not have Medicare)(OR has Medicare and has dependent child <. 18 or < kamagra wirkung. 19 in school) 138% FPL*** Children <.

5 and pregnant women have HIGHER LIMITS than shown ESSENTIAL PLAN (2022) For MAGI-eligible people over MAGI income limit up to 200% FPL No long term care. See info here 1 2 1 2 3 1 2 Income $934 (up from $884 in 2021) add $20 for standard deduction $1367 (up from $1,300 in 2021) add $20 for kamagra wirkung standard deduction $1,563 $2,106 $2,649 $2,266 $3,052 Resources $16,800 (up from $15,900 in 2021) $24,600 (up from $23,400 in 2020) NO LIMIT** NO LIMIT Source for all levels based on the Federal Poverty Line (FPL)- GIS 22 MA/01 Attachment I. Source for non-MAGI levels that are not based on the FPL. GIS 21 MA/25 Attachment I (only for non-MAGI limits for Aged, Blind &. Disabled - non-MAGI) GIS 21 MA/25 Attachment kamagra wirkung II - only for non-MAGI levels (this is now partly replaced by the 2022 GIS) GIS 21 MA/25 Attachment V (PDF) PICKLE reduction factors - see more about Pickle here erectile dysfunction treatment NOTE - Because of the ongoing Public Health Emergency, current Medicaid recipients will have eligibility continued under their current budgets.

Though income for many increased in 2022 with the 5.9% COLA for Social Security, their spend-down will not be increased at this time. However, when the Public Health Emergency is declared over, probably in 2022, the next renewals will redetermine their elgbibility using 2022 income and limits. See kamagra wirkung this article for tips on renewals. Note that the 2022 increase in the Medicare Part B premium (($170.10/mo increased from $148.50 in 2021 ) will offset some of the increased Social Security income. But for new applications filed or approved in 2022, the 2022 limits will be used for non-MAGI.

NEED TO KNOW PAST MEDICAID INCOME AND RESOURCE kamagra wirkung LEVELS?. WHAT IS THE HOUSEHOLD SIZE?. See rules here. They are not kamagra wirkung intuitive!. !.

!. !. HOW TO READ THE HRA Medicaid Levels chart - Boxes 1 and 2 are NON-MAGI Income and Resource levels -- Age 65+, Blind or Disabled and other adults who need to use "spend-down" because they are over the MAGI income levels. Box 11 are the MAGI income levels -- The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers. People in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a "spend-down." They have NO resource limit.

Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care &. Nursing Homes and Box 9 on page 5 has the Transfer Penalty rates for nursing home eligibility Box 5 has Medicaid Buy-In for Working People with Disabilities Under Age 65 Box 6 - Family Planning Benefit Program Box 7 are Medicare Savings Program levels Box 8 - annual Medicare figures Box 9 are monthly regional Nursing Home rates, used to calculate the transfer penalty for nursing home care. If and when the lookback begins for home care and Assisted Living Program, the same rates will be used for the transfer penalty. See this article Box 10 - Fair Market Regional Rates for Special Standard for Housing Expenses - an extra income disregard for people enrolled in MLTC when they return home after 30+ days in a nursing home or adult home. See this article.

Box 11 are the MAGI income levels -- for those under 65 NOT on Medicare (with some exceptions) -- have expanded eligibility up to 138% of the Federal Poverty Line. They have NO resource limit.B Box 12 - MAGI limits for children under 18 and pregnant women Box 13 - Child Health Plus limits for children under age 19 who are not Mediacid-eligible Box 14 - Disabled Adult Child (DAC) income limits Box 15 - Congregate Care Levels I, II, and III - these are the income limits used in the Assisted Living Program and in Adult Homes (adult care facilities) and other congregate facilties. These levels are published by the NYS Office of Temporary &. Disability Assistance (OTDA) each year - most recently at 2022 Levels 21-INF-09 Attachment 1 - 2022 SSI and SSP Maximum Monthly Benefit Levels Chart. (IF this isn't updated, look at OTDA Policy Directives for recent INF directives.

Prior years in ARCHIVES link. MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND MAGI can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school. 42 C.F.R. § 435.4. Certain populations have an even higher income limit - 224% FPL for pregnant women and babies <.

Age 1, 154% FPL for children age 1 - 19. CAUTION. What is counted as income may not be what you think. For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline and these charts on income disregards. However, for the MAGI population - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under new rules, based on federal income tax concepts - called "Modifed Adjusted Gross Income" (MAGI).

There are good changes and bad changes. GOOD. Veteran's benefits, Workers compensation, and gifts from family or others no longer count as income. BAD. There is no more "spousal" or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules.

For all of the rules see. ALSO SEE 2018 Manual on Lump Sums and Impact on Public Benefits - with resource rules HOW TO DETERMINE SIZE OF HOUSEHOLD TO IDENTIFY WHICH INCOME LIMIT APPLIES The income limits increase with the "household size." In other words, the income limit for a family of 5 may be higher than the income limit for a single person. HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even logical. There are different rules depending on the "category" of the person seeking Medicaid. Here are the 2 basic categories and the rules for calculating their household size.

People who are Disabled, Aged 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household size. These same rules apply to the Medicare Savings Program, with some exceptions explained in this article. Everyone else -- MAGI - All children and adults under age 65, including people with disabilities who are not yet on Medicare -- this is the new "MAGI" population. Their household size will be determined using federal income tax rules, which are very complicated. New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF) pp.

8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size. See slides 28-49. Also seeLegal Aid Society and Empire Justice Center materials OLD RULE used until end of 2013 -- Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient. Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st "DAB" category. Under this rule, a child may be excluded from the household if that child's income causes other family members to lose Medicaid eligibility.

See 18 NYCRR 360-4.2, MRG p. 573, NYS GIS 2000 MA-007 CAUTION. Different people in the same household may be in different "categories" and hence have different household sizes AND Medicaid income and resource limits. If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife's is under Category 2/MAGI. The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid.

Prenatal Care Assistance Program (PCAP) was Medicaid for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL). Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as "S/CC" category for Singles and Childless Couples. This category had lower income limits than DAB/ADC-related, but had no asset limits. It did not allow "spend down" of excess income.

GIS 21 MA/25 Attachment I (only for non-MAGI Buy viagra online cheap limits for Aged, kamagra online australia Blind &. Disabled - non-MAGI) GIS 21 MA/25 Attachment II - only for non-MAGI levels (this is now partly replaced by the 2022 GIS) GIS 21 MA/25 Attachment V (PDF) PICKLE reduction factors - see more about Pickle here erectile dysfunction treatment NOTE - Because of the ongoing Public Health Emergency, current Medicaid recipients will have eligibility continued under their current budgets. Though income for many increased in 2022 with the 5.9% COLA for Social Security, their spend-down will not be increased at this time. However, when the Public Health Emergency is declared kamagra online australia over, probably in 2022, the next renewals will redetermine their elgbibility using 2022 income and limits. See this article for tips on renewals.

Note that the 2022 increase in the Medicare Part B premium (($170.10/mo increased from $148.50 in 2021 ) will offset some of the increased Social Security income. But for new applications filed or approved in 2022, the 2022 limits will be used kamagra online australia for non-MAGI. NEED TO KNOW PAST MEDICAID INCOME AND RESOURCE LEVELS?. WHAT IS THE HOUSEHOLD SIZE?. See kamagra online australia rules here.

They are not intuitive!. !. !. !. HOW TO READ THE HRA Medicaid Levels chart - Boxes 1 and 2 are NON-MAGI Income and Resource levels -- Age 65+, Blind or Disabled and other adults who need to use "spend-down" because they are over the MAGI income levels.

Box 11 are the MAGI income levels -- The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers. People in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a "spend-down." They have NO resource limit. Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care &. Nursing Homes and Box 9 on page 5 has the Transfer Penalty rates for nursing home eligibility Box 5 has Medicaid Buy-In for Working People with Disabilities Under Age 65 Box 6 - Family Planning Benefit Program Box 7 are Medicare Savings Program levels Box 8 - annual Medicare figures Box 9 are monthly regional Nursing Home rates, used to calculate the transfer penalty for nursing home care. If and when the lookback begins for home care and Assisted Living Program, the same rates will be used for the transfer penalty.

See this article Box 10 - Fair Market Regional Rates for Special Standard for Housing Expenses - an extra income disregard for people enrolled in MLTC when they return home after 30+ days in a nursing home or adult home. See this article. Box 11 are the MAGI income levels -- for those under 65 NOT on Medicare (with some exceptions) -- have expanded eligibility up to 138% of the Federal Poverty Line. They have NO resource limit.B Box 12 - MAGI limits for children under 18 and pregnant women Box 13 - Child Health Plus limits for children under age 19 who are not Mediacid-eligible Box 14 - Disabled Adult Child (DAC) income limits Box 15 - Congregate Care Levels I, II, and III - these are the income limits used in the Assisted Living Program and in Adult Homes (adult care facilities) and other congregate facilties. These levels are published by the NYS Office of Temporary &.

Disability Assistance (OTDA) each year - most recently at 2022 Levels 21-INF-09 Attachment 1 - 2022 SSI and SSP Maximum Monthly Benefit Levels Chart. (IF this isn't updated, look at OTDA Policy Directives for recent INF directives. Prior years in ARCHIVES link. MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND MAGI can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school. 42 C.F.R.

§ 435.4. Certain populations have an even higher income limit - 224% FPL for pregnant women and babies <. Age 1, 154% FPL for children age 1 - 19. CAUTION. What is counted as income may not be what you think.

For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline and these charts on income disregards. However, for the MAGI population - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under new rules, based on federal income tax concepts - called "Modifed Adjusted Gross Income" (MAGI). There are good changes and bad changes. GOOD. Veteran's benefits, Workers compensation, and gifts from family or others no longer count as income.

BAD. There is no more "spousal" or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules. For all of the rules see. ALSO SEE 2018 Manual on Lump Sums and Impact on Public Benefits - with resource rules HOW TO DETERMINE SIZE OF HOUSEHOLD TO IDENTIFY WHICH INCOME LIMIT APPLIES The income limits increase with the "household size." In other words, the income limit for a family of 5 may be higher than the income limit for a single person. HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even logical.

There are different rules depending on the "category" of the person seeking Medicaid. Here are the 2 basic categories and the rules for calculating their household size. People who are Disabled, Aged 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household size. These same rules apply to the Medicare Savings Program, with some exceptions explained in this article. Everyone else -- MAGI - All children and adults under age 65, including people with disabilities who are not yet on Medicare -- this is the new "MAGI" population.

Their household size will be determined using federal income tax rules, which are very complicated. New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF) pp. 8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size. See slides 28-49. Also seeLegal Aid Society and Empire Justice Center materials OLD RULE used until end of 2013 -- Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient.

Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st "DAB" category. Under this rule, a child may be excluded from the household if that child's income causes other family members to lose Medicaid eligibility. See 18 NYCRR 360-4.2, MRG p. 573, NYS GIS 2000 MA-007 CAUTION. Different people in the same household may be in different "categories" and hence have different household sizes AND Medicaid income and resource limits.

If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife's is under Category 2/MAGI. The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid. Prenatal Care Assistance Program (PCAP) was Medicaid for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL). Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as "S/CC" category for Singles and Childless Couples.

This category had lower income limits than DAB/ADC-related, but had no asset limits. It did not allow "spend down" of excess income. This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL. Family Health Plus - this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL. This has now been folded into the new MAGI adult group whose limit is 138% FPL.

For applicants between 138%-150% FPL, they will be eligible for a new program where Medicaid will subsidize their purchase of Qualified Health Plans on the Exchange. PAST INCOME &. RESOURCE LEVELS -- Past Medicaid income and resource levels in NYS are shown on these oldNYC HRA charts for 2001 through 2021, in chronological order. These include Medicaid levels for MAGI and non-MAGI populations, Child Health Plus, MBI-WPD, Medicare Savings Programs and other public health programs in NYS. This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group..

Kamagra tabletten wirkung

Health Canada has updated and renamed the guidance https://wolf-garten.at/online-pharmacy-viagra/ document that kamagra tabletten wirkung was created for the interim orders No. 1 and No. 2 for kamagra tabletten wirkung erectile dysfunction treatment-related clinical trials.

The new name is Guidance on applications for erectile dysfunction treatment drug clinical trials under the Clinical Trials for Medical Devices and Drugs Relating to erectile dysfunction treatment Regulations.Note. This notice excludes medical devices. A separate notice kamagra tabletten wirkung of intent and guidance on applications for erectile dysfunction treatment clinical trials for medical devices is available.

On this page PurposeThe Clinical Trials for Medical Devices and Drugs Relating to erectile dysfunction treatment Regulations (the Regulations) make it possible for erectile dysfunction treatment medical device and drug clinical trials to continue under a flexible regulatory pathway. Sponsors may apply for authorization under this optional pathway, or under Part C, Division 5 of the Food and Drug Regulations.The updated guidance document has information and guidance for. Applicants seeking authorization to conduct erectile dysfunction treatment drug clinical trials under the Regulations, instead of the Food and Drug Regulations authorization holders of erectile dysfunction treatment drug clinical trials that were approved under the repealed IOs No kamagra tabletten wirkung.

1 and No. 2 ScopeThe guidance document applies to erectile dysfunction treatment clinical trials for pharmaceutical and biologic drugs (including blood and blood components). It also kamagra tabletten wirkung applies to authorization holders of erectile dysfunction treatment drug clinical trials under IO No.

1 and IO No. 2.For non-erectile dysfunction treatment-related clinical trials and those outside the scope of the Regulations, the Food and Drug Regulations, Natural Health Products Regulations and Medical Devices Regulations and related guidance continue to apply. What the Regulations kamagra tabletten wirkung mean for applicantsThe Regulations maintain all the flexibilities that were available through the repealed IOs No.

1 and No. 2. These flexibilities include kamagra tabletten wirkung.

Fewer requirements for assessing new uses of marketed drugs for erectile dysfunction treatment flexible ways to obtain informed consent for certain patients a broader range of qualified health care professionals to carry out drug trials a broader range of applicants who are able to apply for medical device trialsThe reduced administrative burden that was in place under IOs No. 1 and No. 2 is also kamagra tabletten wirkung maintained.

What's new in the RegulationsThe Regulations continue the optional pathway that was in place under IO No. 2 for any drug and medical device clinical trial related to erectile dysfunction treatment therapies. It ensures that all authorizations, suspensions and exemptions for clinical trials issued kamagra tabletten wirkung under IOs No.

1 and No. 2 remain in effect. This includes any terms and conditions.The short-term records retention periods required by the temporary nature of the IOs have been replaced with longer kamagra tabletten wirkung periods in the Regulations, including a 15-year retention period for clinical trials of erectile dysfunction treatment drugs.

ImplementationThe provisions of IO No. 2 are set to expire on May 3, 2022. They will be replaced by the kamagra tabletten wirkung Regulations, which came into force on February 27, 2022.The Regulations maintain the flexibilities set out by IO No.

2 until the framework established through the Clinical Trials Modernization Initiative is in place.Sponsors of erectile dysfunction treatment drug clinical trials may apply for authorization under either. The Regulations or Part C, Division 5 of the Food and Drug RegulationsOnce sponsors apply for authorization under the Regulations, they must proceed with that pathway.Trials not authorized under IO No. 2 and that have already started cannot be transitioned under the kamagra tabletten wirkung Regulations.

These trials must follow the regulations under which they were originally submitted. Contact us Related links.

Health Canada kamagra online australia has updated and renamed the guidance document that was created for the interim orders No. 1 and No. 2 for erectile dysfunction treatment-related clinical trials kamagra online australia.

The new name is Guidance on applications for erectile dysfunction treatment drug clinical trials under the Clinical Trials for Medical Devices and Drugs Relating to erectile dysfunction treatment Regulations.Note. This notice excludes medical devices. A separate notice of kamagra online australia intent and guidance on applications for erectile dysfunction treatment clinical trials for medical devices is available.

On this page PurposeThe Clinical Trials for Medical Devices and Drugs Relating to erectile dysfunction treatment Regulations (the Regulations) make it possible for erectile dysfunction treatment medical device and drug clinical trials to continue under a flexible regulatory pathway. Sponsors may apply for authorization under this optional pathway, or under Part C, Division 5 of the Food and Drug Regulations.The updated guidance document has information and guidance for. Applicants seeking authorization to conduct erectile dysfunction treatment drug clinical trials under the kamagra online australia Regulations, instead of the Food and Drug Regulations authorization holders of erectile dysfunction treatment drug clinical trials that were approved under the repealed IOs No.

1 and No. 2 ScopeThe guidance document applies to erectile dysfunction treatment clinical trials for pharmaceutical and biologic drugs (including blood and blood components). It also kamagra online australia applies to authorization holders of erectile dysfunction treatment drug clinical trials under IO No.

1 and IO No. 2.For non-erectile dysfunction treatment-related clinical trials and those outside the scope of the Regulations, the Food and Drug Regulations, Natural Health Products Regulations and Medical Devices Regulations and related guidance continue to apply. What the Regulations mean for applicantsThe Regulations kamagra online australia maintain all the flexibilities that were available through the repealed IOs No.

1 and No. 2. These flexibilities kamagra online australia include.

Fewer requirements for assessing new uses of marketed drugs for erectile dysfunction treatment flexible ways to obtain informed consent for certain patients a broader range of qualified health care professionals to carry out drug trials a broader range of applicants who are able to apply for medical device trialsThe reduced administrative burden that was in place under IOs No. 1 and No. 2 is kamagra online australia also maintained.

What's new in the RegulationsThe Regulations continue the optional pathway that was in place under IO No. 2 for any drug and medical device clinical trial related to erectile dysfunction treatment therapies. It ensures that all authorizations, suspensions and kamagra online australia exemptions for clinical trials issued under IOs No.

1 and No. 2 remain in effect. This includes any terms and conditions.The kamagra online australia short-term records retention periods required by the temporary nature of the IOs have been replaced with longer periods in the Regulations, including a 15-year retention period for clinical trials of erectile dysfunction treatment drugs.

ImplementationThe provisions of IO No. 2 are set to expire on May 3, 2022. They will be replaced by the Regulations, which came into force on February 27, 2022.The Regulations maintain the flexibilities set out kamagra online australia by IO No.

2 until the framework established through the Clinical Trials Modernization Initiative is in place.Sponsors of erectile dysfunction treatment drug clinical trials may apply for authorization under either. The Regulations or Part C, Division 5 of the Food and Drug RegulationsOnce sponsors apply for authorization under the Regulations, they must proceed with that pathway.Trials not authorized under IO No. 2 and that kamagra online australia have already started cannot be transitioned under the Regulations.

These trials must follow the regulations under which they were originally submitted. Contact us Related links.

;