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Notice2023-09721

Community Health Aide Program: Tribal Assessment & Planning

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Published

May 8, 2023

Issuing agencies

Health and Human Services DepartmentIndian Health Service

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<title>Federal Register, Volume 88 Issue 88 (Monday, May 8, 2023)</title>
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[Federal Register Volume 88, Number 88 (Monday, May 8, 2023)]
[Notices]
[Pages 29673-29681]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-09721]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service

Community Health Aide Program: Tribal Assessment & Planning

Announcement Type: New.
Funding Announcement Number: HHS-2023-IHS-TAP-0001.
Assistance Listing (Catalog of Federal Domestic Assistance or CFDA)
Number: 93.382.

Key Dates

Application Deadline Date: August 7, 2023.
Earliest Anticipated Start Date: September 20, 2023.

I. Funding Opportunity Description

Statutory Authority

The Indian Health Service (IHS) is accepting applications for
grants for the Community Health Aide Program (CHAP) Tribal Assessment
and Planning (TAP) program. 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. 1616l. The Assistance Listings
section of <a href="http://SAM.gov">SAM.gov</a> (<a href="https://sam.gov/content/home">https://sam.gov/content/home</a>) describes this
program under 93.382.

Background

The national CHAP will provide a network of health aides trained to
support licensed health professionals while providing direct health
care, health promotion, and disease prevention services. These
providers will work within a referral relationship under the
supervision of licensed clinical providers that includes clinics,
service units, and hospitals. The CHAP aides increased access to direct
health services, including inpatient and outpatient visits.
The Alaska CHAP has become a model for efficient and high quality
health care delivery in rural Alaska providing approximately 300,000
patient encounters per year and responding to emergencies 24 hours a
day, 7 days a week. Specialized providers in dental and behavioral
health were later introduced to respond to the needs of patients and
address the health disparities in oral health and mental health amongst
American Indian and Alaska Natives.
The national CHAP is a workforce model that includes three
different provider types that act as extenders of their licensed
clinical supervisor. The national CHAP currently includes a behavioral
health aide, community health aide, and dental health aide. Each of the
health aide categories operate in a tiered level practice system. The
national CHAP model provides an opportunity for increased access to
care through the extension of primary care, dental, and behavioral
health clinicians.
In 2010, under the permanent reauthorization of the Indian Health
Care Improvement Act (IHCIA), Congress provided the Secretary of Health
and Human Services, acting through the IHS, the authority to expand the
CHAP nationally. In 2016, the IHS initiated Tribal Consultation on
expanding the CHAP to the contiguous 48 states. In 2018, the HIS formed
the CHAP Tribal Advisory Group (TAG) and began developing the program.
In 2020, the IHS announced the national CHAP policy, which formally
created the national CHAP.

Purpose

The TAP program purpose is to support the assessment and planning
of Tribes and Tribal Organizations (T/TO) in determining the
feasibility of implementing CHAP in their respective communities. The
program is designed to support the regional flexibility required for T/
TO to design a program unique to the needs of their individual
communities across the country through the identification of
feasibility factors.
The focus of the program is to:
Part 1: Assess whether the T/TO can integrate CHAP into the Tribal
health system including the health care workforce.
Part 2: Identify systemic barriers that prohibit the complete
integration of CHAP into an existing health care system. The barriers
should be related to:
<bullet> Clinical infrastructure.
<bullet> Workforce barriers.
<bullet> Certification of providers.
<bullet> Training of providers.
<bullet> Inclusion of culture in the services provided by a CHAP
provider.
Part 3: Plan partnerships across the T/TO geographic region to
address the barriers including reimbursement, training, education,
clinical infrastructure, implementation cost, and determination of
system integration.

II. Award Information

Funding Instrument--Grant

Estimated Funds Available
The total funding identified for fiscal year (FY) 2023 is
approximately $1,500,000. Individual award amounts for the first budget
year are anticipated to be between $250,000 and $500,000. The funding
available for competing and subsequent continuation awards issued under
this announcement is subject to the availability of appropriations and
budgetary priorities

[[Page 29674]]

of the Agency. The IHS is under no obligation to make awards that are
selected for funding under this announcement.
Anticipated Number of Awards
The IHS anticipates issuing approximately three to five awards
under this program announcement.
Period of Performance
The period of performance is for 2 years.

III. Eligibility Information

1. Eligibility

To be eligible for this funding opportunity applicant must be one
of the following, as defined by 25 U.S.C. 1603:
<bullet> 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 (U.S.) to Indians because of their status as
Indians.
<bullet> 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(l)): ``Tribal 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.
The Division of Grants Management (DGM) will notify any applicants
deemed ineligible.

2. Additional Information on Eligibility

The IHS does not fund concurrent projects. If an applicant is
successful under this announcement, any subsequent applications in
response to other TAP announcements from the same applicant will not be
funded. Applications on behalf of individuals (including sole
proprietorships) and foreign organizations are not eligible and will be
disqualified from competitive review and funding under this funding
opportunity.
Specifically, an applicant may not apply to both this opportunity,
TAP, and the CHAP Tribal Planning and Implementation (TPI) opportunity
(number HHS-2023-IHS-TPI-0001).
An organization currently carrying out a CHAP in the U.S. in
accordance with 25 U.S.C. 1616l through an Indian Self-Determination
and Education Assistance Act (ISDEAA) agreement is not eligible to
apply.

Note: Please refer to section IV.2 (Application and Submission
Information/Subsection 2, Content and Form of Application
Submission) for additional proof of applicant status documents
required, such as Tribal Resolutions, proof of nonprofit status,
etc.

3. Cost Sharing or Matching

The IHS does not require matching funds or cost sharing for grants
or cooperative agreements.

4. 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 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 T/TO 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.
Applicants 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

<a href="http://Grants.gov">Grants.gov</a> uses a Workspace model for accepting applications. The
Workspace consists of several online forms and three forms in which to
upload documents--Project Narrative, Budget Narrative, and Other
Documents. Give your files brief descriptive names. The filenames are
key in finding specific documents during the objective review and in
processing awards. Upload all requested and optional documents
individually, rather than combining them into a single file. Creating a
single file creates confusion when trying to find specific documents.
Such confusion can contribute to delays in processing awards, and could
lead to lower scores during the objective review.

1. Obtaining Application Materials

The application package and detailed instructions for this
announcement are available at <a href="https://www.Grants.gov">https://www.Grants.gov</a>.
Please direct questions regarding the application process to
<a href="/cdn-cgi/l/email-protection#f5b1b2b8b59c9d86db929a83">[email&#160;protected]</a>.

2. Content and Form Application Submission

Mandatory documents for all applicants include:
<bullet> 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.
<bullet> Project Narrative (not to exceed 15 pages). See section
IV.2.A, Project Narrative for instructions.
1. Background information on the organization.
2. Proposed scope of work, objectives, and activities that provide
a description of what the applicant plans to accomplish.

[[Page 29675]]

<bullet> Budget Narrative (not to exceed 5 pages). See section
IV.2.B, Budget Narrative for instructions.
<bullet> One-page Timeframe Chart.
<bullet> Tribal Resolution(s) as described in section III,
Eligibility.
<bullet> Letters of Support from organization's Board of Directors.
<bullet> 501(c)(3) Certificate.
<bullet> Biographical sketches for all Key Personnel.
<bullet> Contractor/Consultant resumes or qualifications and scope
of work.
<bullet> Disclosure of Lobbying Activities (SF-LLL), if applicant
conducts reportable lobbying.
<bullet> Certification Regarding Lobbying (GG-Lobbying Form).
<bullet> Copy of current Negotiated Indirect Cost (IDC) rate
agreement (required in order to receive IDC).
<bullet> Organizational Chart (optional).
<bullet> 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 <a href="https://facdissem.census.gov/">https://facdissem.census.gov/</a> 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 <a href="https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html">https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html</a>.
Requirements for Project and Budget Narratives
A. Project Narrative: This narrative should be a separate document
that is no more than 15 pages and must: (1) have consecutively numbered
pages; (2) use black font 12 points or larger (applicants may use 10
point font for tables); (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 reviewers will be directed to
ignore any content beyond the page limit. The 15-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)
Describe the community and how it would benefit from the
implementation of CHAP. Describe the community's current health
disparities relating to primary, behavioral, and oral health care.
Describe the T/TO's current health program activities, how long it has
been operating and what programs or services are currently being
provided. Describe in full the organization's infrastructure and its
ability to identify and assess the barriers that could impact or
prohibit the integration of CHAP.
Part 2: Program Planning and Evaluation (limit--6 pages)
Section 1: Program Plans
Describe in full the direction the T/TO plans to take in the CHAP
TAP. The program plan should first clearly identify the problems within
the community related to behavioral, primary, and oral health. The
program plan should then include the plan to assess problem(s). This
should include a timeline for the assessment. The program plan should
identify a timeline to determine whether CHAP can address the barriers
identified.
Section 2: Program Activities
Describe in full the activities to identify problems creating
barriers within the community related to behavioral, primary, and oral
health. These activities should be categorized (at a minimum) within
key factors related to clinical infrastructure, workforce barriers,
training infrastructure, and cultural inclusion. Describe in full how
the applicant plans to assess the problems identified. Finally,
describe in detail the activities and associated timeline to determine
whether CHAP is feasible and activities to quantify the cost associated
with CHAP. The program activities should detail which partners will aid
in identifying and assessing barriers related to clinical
infrastructure, workforce barriers, training infrastructure, and
cultural inclusion.
Section 3: Staffing Plan
Describe key staff tasked with carrying out the program activities
in section 2. Applicants should account for potential stakeholder
partnerships following the assessment of barriers in the staffing plan.
Section 4: Timeline
Describe a timeline not to exceed two years for the completion of
the program plan, activities, and evaluation plan. Provide a timeline
chart depicting a realistic timeline that details all major activities,
milestones, and applicable staffing plans. The timeline should include
the projected progress report due at the midpoint of the project
period. The timeline chart should not exceed one page.
Section 5: Program Evaluation
The evaluation plan should identify and describe significant
program activities and achievements associated with the assessment and
planning of whether CHAP can address identified barriers within the
existing T/TO health system. The evaluation plan should organize all
identified problems that lead to barriers into major categories related
to clinical infrastructure, workforce barriers, training
infrastructure, and cultural inclusion specific to the scope of
practice of prospective CHAP providers. The evaluation plan should
detail how these barriers can be quantified. The evaluation plan should
outline a tentative plan on how the barriers can be overcome. Include
plans to incorporate CHAP into the existing infrastructure and where
new infrastructure will need to be built, where and how new workforce
can be recruited and/or developed if needed, where and how training for
new CHAP providers will be developed, how existing workforce will be
trained to support and integrate the CHAP program and how culture will
be integrated throughout the components. The evaluation plan should
detail how the applicant will measure the assessment of whether CHAP
can address the issues identified including number of partnerships for
each major category of barriers, other factors that may impact
feasibility, and sustainability. Finally, the evaluation plan should
detail how the applicant plans to calculate the total cost associated
with integrating CHAP as part of the planning process.

[[Page 29676]]

Part 3: Program Report (limit--5 pages)
Section 1: Describe your organization's significant program
activities and accomplishments over the past 2 years associated with
the goals of this announcement.
At the conclusion of the program period, using the findings from
the evaluation, the T/TO should determine the feasibility of
implementing a CHAP within the T/TO's community. The Outcome Report
should describe in full the findings of the program plan, evaluation,
and determination on stage of readiness for implementation. The
findings should select from one of the following readiness assessment
levels:
1. The CHAP program is not a good fit for the needs of the
organization and/or the organization will not be ready to implement the
CHAP program in the foreseeable future.
2. The organization would be a good fit for the CHAP program but
the organization has a great deal of work to do in preparation for the
implementation of the CHAP program.
3. The findings show multiple areas of organizational readiness for
the implementation of the CHAP program.
The outcome report should organize the findings into at least 5
categories:
(1) Clinical Infrastructure: Describe assessments of clinical
infrastructure and plans for how to implement the CHAP program with the
current or modified clinical infrastructure. Include information as to
the facility workspace, information technology, transportation concerns
for CHAP providers, program collaborations, Area-level administration,
clinic staffing and leadership, legislative issues, and any other
infrastructure items relevant to the successful implementation of the
CHAP.
(2) Workforce Barriers: Describe assessments of workforce barriers
regarding the implementation of a CHAP program within the organization
and any proposed changes. Include information on identified recruitment
opportunities and partnerships, information on human resource ability
to manage additional recruitment activities, specifics relating to
capacity to provide CHAP supervision and ability to provide support for
students for any identified needs (such as transportation, childcare,
etc.), which may limit ability of potential CHAP providers to engage in
CHAP activities, and any other factors impacting the implementation of
a CHAP program.
(3) Training Infrastructure: Assess all identified realistic
sources for training of CHAP providers. Include any Tribal Colleges and
Universities, non-tribal institutions, other Tribal or non-tribal
training programs and any other resources, both local and non-local if
relationships are realistic for a sustainable CHAP program. Include
information on whether training would be in-situ, virtual or a hybrid
model. Include information on both classroom and hands-on skills-based
training. Also include information on supervisory training and
continuing education training.
(4) Cultural Inclusion: Detail assessment and plans to incorporate
cultural elements throughout all aspects of the CHAP program, both in
the training of CHAP providers and in all aspects of the delivery of
care through the CHAP program throughout the organization.
(5) Implementation Cost: Based on the findings and measurable
outcomes of the categories, the applicant should explicitly identify
whether CHAP is feasible for implementation into the T/TO's respective
community. Applicants should develop an organized report that
highlights the categories succinctly and includes data (quantitative or
qualitative) from the evaluation plan. The evaluation plan should
outline a tentative plan on how the barriers can be overcome if
applicable. The outcome report should explicitly detail the cost
associated with integrating CHAP if it is found that CHAP can address
the barriers identified in the assessment phase. Provide a comparison
of the actual accomplishments to the goals established for the project
period, or if applicable, provide justification for the lack of
progress.
B. Budget Narrative (limit--5 pages)
Provide a budget narrative that explains the amounts requested for
each line item of the budget from the SF-424A (Budget Information for
Non-Construction Programs) for the first year of the project. 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 would support the
achievement of proposed objectives. Be very careful about showing how
each item in the ``Other'' category is justified. Do NOT use the budget
narrative to expand the project narrative.

3. Submission Dates and Times

Applications must be submitted through <a href="http://Grants.gov">Grants.gov</a> 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.
<a href="http://Grants.gov">Grants.gov</a> will notify the applicant via email if the application is
rejected.
If technical challenges arise and assistance is required with the
application process, contact <a href="http://Grants.gov">Grants.gov</a> Customer Support (see contact
information at <a href="https://www.Grants.gov">https://www.Grants.gov</a>). If problems persist, contact
Mr. Paul Gettys, Deputy Director, DGM, by email at <a href="/cdn-cgi/l/email-protection#f2b6b5bfb29b9a81dc959d84">[email&#160;protected]</a>. Please
be sure to contact Mr. Gettys at least 10 days prior to the application
deadline. Please do not contact the DGM until you have received a
<a href="http://Grants.gov">Grants.gov</a> 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

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

6. Electronic Submission Requirements

All applications must be submitted via <a href="http://Grants.gov">Grants.gov</a>. Please use the
<a href="https://www.Grants.gov">https://www.Grants.gov</a> 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 <a href="http://Grants.gov">Grants.gov</a>, you must
request a waiver prior to the application due date. You must submit
your waiver request by email to <a href="/cdn-cgi/l/email-protection#185c5f555871706b367f776e">[email&#160;protected]</a>. Your waiver request must
include clear justification for the need to deviate from the required
application submission process. The IHS will not accept any
applications submitted through any means outside of <a href="http://Grants.gov">Grants.gov</a> without
an approved waiver.
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
waiver approval from 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

[[Page 29677]]

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 <a href="http://Grants.gov">Grants.gov</a> 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:
<bullet> Please search for the application package in <a href="https://www.Grants.gov">https://www.Grants.gov</a> by entering the Assistance Listing number or the Funding
Opportunity Number. Both numbers are located in the header of this
announcement.
<bullet> If you experience technical challenges while submitting
your application, please contact <a href="http://Grants.gov">Grants.gov</a> Customer Support (see
contact information at <a href="https://www.Grants.gov">https://www.Grants.gov</a>).
<bullet> Upon contacting <a href="http://Grants.gov">Grants.gov</a>, 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.
<bullet> Applicants are strongly encouraged not to wait until the
deadline date to begin the application process through <a href="http://Grants.gov">Grants.gov</a> as
the registration process for SAM and <a href="http://Grants.gov">Grants.gov</a> could take up to 20
working days.
<bullet> Please follow the instructions on <a href="http://Grants.gov">Grants.gov</a> to include
additional documentation that may be requested by this funding
announcement.
<bullet> Applicants must comply with any page limits described in
this funding announcement.
<bullet> After submitting the application, you will receive an
automatic acknowledgment from <a href="http://Grants.gov">Grants.gov</a> that contains a <a href="http://Grants.gov">Grants.gov</a>
tracking number. The IHS will not notify you that the application has
been received.
System for Award Management
Organizations that are not registered with the System for Award
Management (SAM) must access the SAM online registration through the
SAM home page at <a href="https://sam.gov">https://sam.gov</a>. Organizations based in the U.S. 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 <a href="http://SAM.gov">SAM.gov</a> 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
<a href="https://sam.gov">https://sam.gov</a>.
Unique Entity Identifier
Your <a href="http://SAM.gov">SAM.gov</a> registration now includes a Unique Entity Identifier
(UEI), generated by <a href="http://SAM.gov">SAM.gov</a>, which replaces the DUNS number obtained
from Dun and Bradstreet. <a href="http://SAM.gov">SAM.gov</a> registration no longer requires a DUNS
number.
Check your organization's <a href="http://SAM.gov">SAM.gov</a> registration as soon as you
decide to apply for this program. If your <a href="http://SAM.gov">SAM.gov</a> 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 <a href="http://Grants.gov">Grants.gov</a> registration. Registration and role
assignments in <a href="http://Grants.gov">Grants.gov</a> 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-recipients 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 <a href="https://www.ihs.gov/dgm/policytopics/">https://www.ihs.gov/dgm/policytopics/</a>.

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. 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 (10 points)
Identify the proposed project and plans to identify the feasibility
of implementing a CHAP within the T/TO community. The needs should
clearly identify the existing health system and how the CHAP may be a
viable workforce model for the community needs.
The feasibility report should organize the findings into at least
five categories:
a. Clinical Infrastructure: Describe assessments of clinical
infrastructure and plans for how to implement the CHAP program with the
current or modified clinical infrastructure. Include information as to
the facility workspace, information technology, transportation concerns
for CHAP providers, program collaborations, Area-level administration,
clinic staffing and leadership, legislative issues and any other
infrastructure items relevant to the successful implementation of the
CHAP.
b. Workforce Barriers: Describe assessments of workforce barriers
regarding the implementation of a CHAP program within the organization
and any proposed changes. Include information on identified recruitment
opportunities and partnerships, information on human resource ability
to manage additional recruiting activities, specifics relating to
capacity to provide CHAP supervision and ability to provide support for
students for any identified needs (such as transportation, childcare,
etc.), which may limit ability of potential CHAP providers to engage in
CHAP activities and any other factors impacting the implementation of a
CHAP program.
c. Training Infrastructure: Assess all identified realistic sources
for training of CHAP providers. Include any Tribal Colleges and
Universities, non-tribal institutions, other tribal training programs
and any other resources, both local and non-local if relationships are
realistic for a sustainable CHAP program. Include information on
whether training would be in-situ, virtual or a hybrid model. Include
information on both classroom and hands-on skills-based training. Also
include information on supervisory training and continuing education
training.
d. Cultural Inclusion: Detail assessment and plans to incorporate
cultural elements throughout all aspects of the CHAP program, both in
the training of CHAP providers and in all aspects of the delivery of
care through the CHAP program throughout the organization.
e. Implementation Cost: Based on the findings and measurable
outcomes of the categories, the applicant should explicitly identify
whether CHAP is feasible for implementation into the T/TO's respective
community. Applicants

[[Page 29678]]

should develop an organized report that highlights the categories
succinctly and includes data (quantitative or qualitative) from the
evaluation plan. The evaluation plan should outline a tentative plan on
how the barriers can be overcome if applicable. The outcome report
should explicitly detail the cost associated with integrating CHAP if
it is found that CHAP can address the barriers identified in the
assessment phase. Provide a comparison of the actual accomplishments to
the goals established for the project period, or if applicable, provide
justification for the lack of progress.
B. Project Objective(s), Work Plan and Approach (30 points)
The work plan should be comprised of two key parts: Program
Information and Program Plan. Acceptable Program Information should
provide information related to three key sections: community profile;
health and infrastructure; and organizational capacity. The Program
Information part should demonstrate a robust community profile that
highlights the existing health system, demographic data of community
members and user population, and a detail of the T/TO carrying out the
proposed activity. An acceptable Program Plan should include details of
the applicant's plan to address the program objective. The Program Plan
should address, at a minimum, key activities related to clinical
infrastructure, workforce barriers, and training infrastructure.
C. Program Evaluation (30 points)
The program evaluation should address how the applicant intends to
measure major categories related to clinical infrastructure, workforce
barriers, training infrastructure, cultural inclusion (See Sample Logic
Model in Appendix Related Documents in <a href="http://Grants.gov">Grants.gov</a>) specific to the
scope of practice of prospective CHAP providers, and implementation
costs. The evaluation plan should identify how the applicant plans to
determine the feasibility of CHAP integration into the Tribal system,
measurement of significant systematic barriers, implementation cost
associated with CHAP, and planning for the scope of work. List
measurable and attainable goals with explicit timelines that detail
expectation of findings. The program evaluation report should organize
the findings into at least 5 categories:
a. Clinical Infrastructure: Describe assessments of clinical
infrastructure and plans for how to implement the CHAP program with the
current or modified clinical infrastructure. Include information as to
the facility workspace, information technology, transportation concerns
for CHAP providers, program collaborations, Area-level administration,
clinic staffing and leadership, legislative issues and any other
infrastructure items relevant to the successful implementation of the
CHAP.
b. Workforce Barriers: Describe assessments of workforce barriers
regarding the implementation of a CHAP program within the organization
and any proposed changes. Include information on identified recruitment
opportunities and partnerships, information on human resource ability
to manage additional recruiting activities, specifics relating to
capacity to provide CHAP supervision and ability to provide support for
students for any identified needs (such as transportation, childcare,
etc.), which may limit ability of potential CHAP providers to engage in
CHAP activities and any other factors impacting the implementation of a
CHAP program.
c. Training Infrastructure: Assess all identified realistic sources
for training of CHAP providers. Include any Tribal Colleges and
Universities, non-tribal institutions, other tribal training programs
and any other resources, both local and non-local if relationships are
realistic for a sustainable CHAP program. Include information on
whether training would be in-situ, virtual or a hybrid model. Include
information on both classroom and hands-on skills-based training. Also
include information on supervisory training and continuing education
training.
d. Cultural Inclusion: Detail assessment and plans to incorporate
cultural elements throughout all aspects of the CHAP program, both in
the training of CHAP providers and in all aspects of the delivery of
care through the CHAP program throughout the organization.
e. Implementation Cost: Based on the findings and measurable
outcomes of the categories, the applicant should explicitly identify
whether CHAP is feasible for implementation into the T/TO's respective
community. Applicants should develop an organized report that
highlights the categories succinctly and includes data (quantitative or
qualitative) from the evaluation plan. The evaluation plan should
outline a tentative plan on how the barriers can be overcome if
applicable.
D. Organizational Capabilities, Key Personnel, and Qualifications (10
Points)
Provide a detailed biographical sketch of each member of key
personnel assigned to carry out the objectives of the program plan. The
sketches should detail the qualifications and expertise of identified
staff.
E. Categorical Budget and Budget Justification (20 Points)
Provide a detailed budget of each expenditure directly related to
the identified program activities.
Additional documents can be uploaded as Other Attachments in
<a href="http://Grants.gov">Grants.gov</a>. These can include:
<bullet> Work plan, logic model, and/or timeline for proposed
objectives.
<bullet> Position descriptions for key staff.
<bullet> Resumes of key staff that reflect current duties.
<bullet> Consultant or contractor proposed scope of work and letter
of commitment (if applicable).
<bullet> Current Indirect Cost Rate Agreement.
<bullet> Organizational chart.
<bullet> Map of area identifying project location(s).
<bullet> 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 Review
Committee (RC) based on the 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 RC and will not be funded. The DGM 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 Office of Clinical and Preventative Services (OCPS) 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

[[Page 29679]]

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.
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.

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

VI. Award Administration Information

1. Administrative Requirements

Awards issued under this announcement are subject to, and are
administered in accordance with, the following regulations and
policies:
A. The criteria as outlined in this program announcement.
B. Administrative Regulations for Grants:
<bullet> 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 <a href="https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75.pdf">https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75.pdf</a>.
<bullet> Please review all HHS regulatory provisions for
Termination at 45 CFR 75.372, at the time of this publication located
at <a href="https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-sec75-372.pdf">https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-sec75-372.pdf</a>.
C. Grants Policy:
<bullet> HHS Grants Policy Statement, Revised January 2007, at
<a href="https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf">https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf</a>.
D. Cost Principles:
<bullet> Uniform Administrative Requirements for HHS Awards, ``Cost
Principles,'' at 45 CFR part 75 subpart E, at the time of this
publication located at <a href="https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75-subpartE.pdf">https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75-subpartE.pdf</a>.
E. Audit Requirements:
<bullet> Uniform Administrative Requirements for HHS Awards,
``Audit Requirements,'' at 45 CFR part 75 subpart F, at the time of
this publication located at <a href="https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75-subpartF.pdf">https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75-subpartF.pdf</a>.
F. As of August 13, 2020, 2 CFR part 200 was updated to include a
prohibition on certain telecommunications and video surveillance
services or equipment. This prohibition is described in 2 CFR part
200.216. This will also be described in the terms and conditions of
every IHS grant and cooperative agreement awarded on or after August
13, 2020.

2. Indirect Costs

This section applies to all recipients that request reimbursement
of 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 award
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 2 CFR 200.414(f) Indirect (F&A) costs,

any non-Federal entity (NFE) [i.e., applicant] that does not have a
current negotiated 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 200.403, 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 can be used by
applicants that have 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
award.
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 <a href="https://rates.psc.gov/">https://rates.psc.gov/</a> or the Department
of the Interior (Interior Business Center) at <a href="https://ibc.doi.gov/ICS/tribal">https://ibc.doi.gov/ICS/tribal</a>. For questions regarding the indirect cost policy, please write
to <a href="/cdn-cgi/l/email-protection#5612111b163f3e2578313920">[email&#160;protected]</a>.

3. Reporting Requirements

The recipient 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
award, 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 recipient
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 use the form under the
Recipient User section of <a href="https://www.grantsolutions.gov/home/getting-started-request-a-user-account/">https://www.grantsolutions.gov/home/getting-started-request-a-user-account/</a>. Download the Recipient User Account
Request Form, fill it out completely, and submit it as described on the
web page and in the form.
The reporting requirements for this program are noted below.
A. Progress Reports
Program progress reports are required 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 120 days of the period of performance end date.
B. Financial Reports
Federal Financial Reports are due 90 days after the end of each
budget period, and a final report is due 120 days after the end of the
period of performance.

[[Page 29680]]

Recipients are responsible and accountable for reporting accurate
information on all required reports: the Progress Reports and the
Federal Financial Report.
Failure to submit timely reports may result in adverse award
actions blocking access to funds.
C. Data Collection and Reporting
To satisfy the reporting requirements, the applicant is expected to
develop an outcome report. The outcome report should explicitly state
whether CHAP implementation and integration into existing healthcare
system is viable or not. The Outcome Report should describe in full the
findings of the program plan, evaluation, and determination on stage of
readiness for implementation. The Outcome Report should organize the
findings into at least five categories:
1. Clinical Infrastructure.
2. Workforce Barriers.
3. Training Infrastructure.
4. Cultural Inclusion.
5. Implementation Cost.
Applicants are encouraged to identify additional categories above
the five aforementioned and may choose to develop subcategories that
best fit the program plan.
D. Federal Sub-Award Reporting System (FSRS)
This award may be subject to the Transparency Act sub-award and
executive compensation reporting requirements of 2 CFR part 170.
The Transparency Act requires the OMB to establish a single
searchable database, accessible to the public, with information on
financial assistance awards made by Federal agencies. The Transparency
Act also includes a requirement for recipients of Federal grants to
report information about first-tier sub-awards and executive
compensation under Federal assistance awards.
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 <a href="https://www.ihs.gov/dgm/policytopics/">https://www.ihs.gov/dgm/policytopics/</a>.
E. Non-Discrimination Legal Requirements for Awardees of Federal
Financial Assistance
The recipient must administer the project in compliance with
Federal civil rights laws, where applicable, that prohibit
discrimination on the basis of race, color, national origin,
disability, age, and comply with applicable conscience protections. The
recipient must comply with applicable laws that prohibit discrimination
on the basis of sex, which includes discrimination on the basis of
gender identity, sexual orientation, and pregnancy. Compliance with
these laws requires taking reasonable steps to provide meaningful
access to persons with limited English proficiency and providing
programs that are accessible to and usable by persons with
disabilities. The HHS Office for Civil Rights provides guidance on
complying with civil rights laws enforced by HHS. See <a href="https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html">https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html</a>
and <a href="https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html">https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html</a>.
<bullet> 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 <a href="https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/fact-sheet-guidance/index.html">https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/fact-sheet-guidance/index.html</a> and <a href="https://www.lep.gov">https://www.lep.gov</a>.
<bullet> For information on your specific legal obligations for
serving qualified individuals with disabilities, including reasonable
modifications and making services accessible to them, see <a href="https://www.hhs.gov/civil-rights/for-individuals/disability/index.html">https://www.hhs.gov/civil-rights/for-individuals/disability/index.html</a>.
<bullet> HHS funded health and education programs must be
administered in an environment free of sexual harassment. See <a href="https://www.hhs.gov/civil-rights/for-individuals/sex-discrimination/index.html">https://www.hhs.gov/civil-rights/for-individuals/sex-discrimination/index.html</a>.
<bullet> 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 <a href="https://www.hhs.gov/conscience/conscience-protections/index.html">https://www.hhs.gov/conscience/conscience-protections/index.html</a>
and <a href="https://www.hhs.gov/conscience/religious-freedom/index.html">https://www.hhs.gov/conscience/religious-freedom/index.html</a>.
<bullet> 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.
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 <a href="https://www.fapiis.gov/fapiis/#/home">https://www.fapiis.gov/fapiis/#/home</a> 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 million 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: Marsha Brookins, Director, 5600
Fishers Lane, Mail Stop: 09E70, Rockville, MD 20857 (Include
``Mandatory Grant Disclosures'' in subject line), Office: (301) 443-
5204,

[[Page 29681]]

Fax: (301) 594-0899, Email: <a href="/cdn-cgi/l/email-protection#80c4c7cdc0e9e8f3aee7eff6">[email&#160;protected]</a>.
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: <a href="https://oig.hhs.gov/fraud/report-fraud/">https://oig.hhs.gov/fraud/report-fraud/</a> (Include
``Mandatory Grant Disclosures'' in subject line), Fax: (202) 205-0604
(Include ``Mandatory Grant Disclosures'' in subject line) or Email:
<a href="/cdn-cgi/l/email-protection#cc81ada2a8adb8a3beb58bbeada2b8a9a988a5bfafa0a3bfb9bea9bf8ca3a5abe2a4a4bfe2aba3ba">[email&#160;protected]</a>.

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 part 180 and 2 CFR part
376).

VII. Agency Contacts

1. Questions on the program matters may be directed to:

Donna E. Enfield, Public Health Advisor, Office of Clinical and
Preventative Services, 5600 Fishers Lane, Rockville, MD 20857, Phone:
(301) 526-6966, Email: <a href="/cdn-cgi/l/email-protection#80c9c8d3c3c8c1d0c0e9e8f3aee7eff6">[email&#160;protected]</a>.

2. Questions on grants management and fiscal matters may be
directed to:

Indian Health Service, Division of Grants Management, 5600 Fishers
Lane, Mail Stop: 09E70, Rockville, MD 20857, Email: <a href="/cdn-cgi/l/email-protection#84c0c3c9c4edecf7aae3ebf2">[email&#160;protected]</a>.

3. For technical assistance with <a href="http://Grants.gov">Grants.gov</a>, please contact the
<a href="http://Grants.gov">Grants.gov</a> help desk at (800) 518-4726, or by email at
<a href="/cdn-cgi/l/email-protection#9feceaefeff0edebdff8edfef1ebecb1f8f0e9">[email&#160;protected]</a>.
4. For technical assistance with GrantSolutions, please contact the
GrantSolutions help desk at (866) 577-0771, or by email at
<a href="/cdn-cgi/l/email-protection#4f272a233f0f283d2e213b3c20233a3b2620213c61282039">[email&#160;protected]</a>.

VIII. Other Information

The Public Health Service strongly encourages all grant,
cooperative agreement, and contract awardees 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.

Roselyn Tso,
Director, Indian Health Service.
[FR Doc. 2023-09721 Filed 5-5-23; 8:45 am]
BILLING CODE 4165-16-P

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