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Calyia Stringer had buy kamagra oral jelly online uk a smile on her face the day she posed for a photo with a yellow flower in her hand. The toddler beamed with pride as she showed off the bloom before handing it to her godmother, Jatoria Foster. “She was so happy,” buy kamagra oral jelly online uk Foster said. €œThat was one of the best memories I have of her.” No one thought the same image would end up on the lid of Calyia’s casket — until the unthinkable happened. The 3-year-old was killed buy kamagra oral jelly online uk last September when a stray bullet tore through her grandmother’s bedroom in East St.

Louis, Illinois. For Calyia’s funeral, her family wanted to remember the happiest moments of her life, so the funeral home decorated her casket with three photos of the girl. Calyia Stringer buy kamagra oral jelly online uk poses for a photo with a yellow flower in her hand after spending the day with her godmother, Jatoria Foster. Calyia was killed a month after her 3rd birthday.(Jatoria Foster) The art of wrapping a casket in imagery — similar to the way companies wrap logos around cars, trucks, and buses — is increasing in popularity as mourners look for memorable ways to celebrate their loved ones’ lives. Across the country, casket wrap companies buy kamagra oral jelly online uk create custom designs, often for grieving parents who have lost their children to trauma, including from gun violence.

Although diseases sometimes kill kids too young, firearm-related injuries were the leading cause of death for children in the United States in 2020, ahead of motor vehicle crashes, according to an analysis published in the New England Journal of Medicine. The wraps for children look like something one “would see in a child’s room, not as a child’s casket,” said Damian Ferek, president of CasketWraps, the West Virginia company that designed Calyia’s custom casket. His company has buy kamagra oral jelly online uk been creating them since 2014, when the marketing business he runs got a request to wrap a casket. Kids’ caskets often feature superheroes and rainbows, unicorns and teddy bears, alongside photos of the smiling children. Desmond Upton Patton, a professor of social work and sociology at Columbia University who researches grief and buy kamagra oral jelly online uk violence on social media, said this emerging art form is a coping mechanism for grieving families.

For some parents, he said, casket wraps allow them to “take control of an experience that they essentially had no control over.” In recent years, he has seen casket wraps pop up on Instagram, Facebook, and now TikTok as loved ones share the artwork. €œIt allows them to reimagine the narrative,” Patton said. €œIt’s a different way of telling the story of a loved one buy kamagra oral jelly online uk that moves beyond the pain and focuses on the beauty. That is a beautiful definition of resilience.” EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. Sukeena Gunner vividly remembers seeing her 14-year-old son’s casket after he was killed. A rising football buy kamagra oral jelly online uk star, Jaylon McKenzie died three years ago after shots rang out at a house party in Venice, Illinois, just across the Mississippi River from St.

Louis. €œOnce they opened the door, I saw my baby laying in that casket, it paralyzed me,” Gunner recalled. At that buy kamagra oral jelly online uk moment, Gunner said, she fell to her knees. But a series of photos, including images of Jaylon in his football uniform, embossed on the outside of his casket helped Gunner remember the highlights of Jaylon’s life, not just his death. Sukeena Gunner holds a pair of football cleats that belonged buy kamagra oral jelly online uk to her son, Jaylon McKenzie.

Jaylon, 14, died in 2019 after shots rang out at a house party in Venice, Illinois. (Cara Anthony / KHN) At her home in Belleville, Illinois, Sukeena Gunner thumbs through a copy of Sports Illustrated. Her son, Jaylon McKenzie, buy kamagra oral jelly online uk was featured in the magazine’s “Future Issue” in 2018. Seven months later, Jaylon was fatally shot at a house party in Venice, Illinois. (Cara Anthony / buy kamagra oral jelly online uk KHN) “He was a kid that would run 40 touchdowns a year, anywhere between four to five a game,” Gunner said.

The custom design was a first for Serenity Memorial Chapel, the funeral home in charge of Jaylon’s service. Serenity’s owner and president, Gerald T. Johnson, who has worked in the funeral business for more than 25 years, said his funeral home often takes care of the arrangements for victims of gunfire in the St buy kamagra oral jelly online uk. Louis region, where such violence is persistent. He has even seen violence outside one buy kamagra oral jelly online uk of the funerals his company arranged.

Earlier this year, three people were shot in the parking lot of Serenity’s St. Louis location. €œThe police did an investigation, took buy kamagra oral jelly online uk the tape down, and left,” Johnson said. €œAnd we still had the funeral.” Tan Gates, Serenity’s general manager, now regularly works with Ferek’s company to create custom casket wraps. She spends countless buy kamagra oral jelly online uk hours with grieving families.

€œIt’s not just wrapping a casket, it’s getting to know a person,” Gates said. €œPeople are looking at death, but we buy kamagra oral jelly online uk see life in what we’re doing.” That’s why she looks for ways to comfort families as they mourn the loss of children and young victims of gun violence. In addition to ordering casket wraps, Gates often goes shopping for a child’s favorite things, such as stuffed animals and balloons. The funeral workers and artists do become invested. In August, Ferek drove more than 600 miles buy kamagra oral jelly online uk from Morgantown, West Virginia, to Belleville, Illinois, to deliver five custom caskets himself ahead of a funeral for five children who died in an apartment fire.

Each casket featured the child’s name and a photograph of them. An apartment fire in East St buy kamagra oral jelly online uk. Louis, Illinois, left five children dead last August. Damian Ferek, president of CasketWraps, drove more than 600 miles from Morgantown, West Virginia, to southern Illinois to deliver five custom caskets ahead of the funeral for the children.(Theodore Terry) In Philadelphia, Harry Fash of Eastern Casket adds cartoon designs to caskets for children for free. He studied art at Temple buy kamagra oral jelly online uk University for a year before switching his major to business.

His skills as an artist help him create unique lid inscriptions for caskets. Located in the heart of North Philadelphia, buy kamagra oral jelly online uk Eastern Casket opened in 1972. But it wasn’t until 2010 that it started creating vinyl casket designs, too often for gun violence victims. Requests range from musical instruments to popular cartoon characters. In recent years, he said, he created a casket with a “Frozen” theme for a child killed in crossfire and a Spider-Man one for a child who died when another child accidentally fired a gun that wasn’t locked up buy kamagra oral jelly online uk.

€œWe are in an area called Nicetown,” Fash said. €œBut it’s really not that nice.” Casket buy kamagra oral jelly online uk wraps aren’t exclusively for children. In Los Angeles, Shameka Nicholas helped find an artist to decorate the casket of her friend Jermaine Carter, who had been a member of the Bloods and went by “O.Y.G. Redrum 781.” Carter spent years promoting peace in the streets of Los Angeles and across the country. Six weeks before Carter died of cancer at age 49, he described the kind of buy kamagra oral jelly online uk casket he wanted to be buried in.

One whose right half resembled a red bandanna and whose left looked like a blue bandanna, to represent peace in the streets between the Bloods and Crips. He wanted buy kamagra oral jelly online uk a black panther in the middle. Nicholas questioned whether Carter’s vision could become a reality, but Carter was confident. €œAn artist knows how to do it,” a video shows Carter whispering to Nicholas. €œAn artist knows how to make a black panther head with the mouth open, growling, with the green eyes, with the teeth buy kamagra oral jelly online uk.

They know what they’re doing. They’re professional.” Victoria Lanier of buy kamagra oral jelly online uk Los Angeles Casket Wraps designed a casket for Jermaine Carter, who had been a member of the Bloods and went by “O.Y.G. Redrum 781.” Carter requested this unique design six weeks before he died of cancer at 49.(Victoria Lanier) Victoria Lanier of Los Angeles Casket Wraps brought his vision to life. Carter’s custom casket cost about $2,000. But Lanier is thinking about turning the business into buy kamagra oral jelly online uk a nonprofit.

That way the public can make donations and she can serve more families who can’t afford to purchase a casket wrap. Lanier said requests buy kamagra oral jelly online uk for casket wraps have quadrupled since she started a few years ago. €œThat’s part of respect for the dead,” Lanier said. €œThey had a footprint on the Earth. It’s just buy kamagra oral jelly online uk a very lovely way of honoring them.” This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues.

Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to buy kamagra oral jelly online uk the nation. Cara Anthony. canthony@kff.org, @CaraRAnthony Related Topics Contact Us Submit a Story Tip.

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Start Preamble Office of Elementary and Secondary Education, Department kamagra blue pill of Education. Notice. The Department of Education (Department) is issuing a notice inviting applications for fiscal year (FY) 2022 for Start Printed Page 60138 the School-Based Mental Health Services (SBMH) kamagra blue pill Grant Program, Assistance Listing Number (ALN) number 84.184H. OMB has approved the information collection related to this notice.

Applications Available. October 4, kamagra blue pill 2022. Deadline for Transmittal of Applications. November 3, 2022.

Pre-Application Webinar kamagra blue pill Information. The Department will hold pre-application meetings via webinar for prospective applicants on October 11th and 19th, 2022, at 4:00 p.m. Eastern Time. For the addresses for obtaining and submitting an application, please refer to our Common Instructions for Applicants to Department of Education Discretionary Grant Programs, published in the Federal Register on December 27, 2021 (86 FR 73264) and available at kamagra blue pill www.federalregister.gov/​d/​2021-27979.

Please note that these Common Instructions supersede the version published on February 13, 2019, and, in part, describe the transition from the requirement to register in SAM.gov a Data Universal Numbering System (DUNS) number to the implementation of the Unique Entity Identifier (UEI). More information on the phase-out of DUNS numbers is available at https://www2.ed.gov/​about/​offices/​list/​ofo/​docs/​unique-entity-identifier-transition-fact-sheet.pdf. Start Further Info Amy Banks, U.S kamagra blue pill. Department of Education, 400 Maryland Avenue SW, Room 3E257, Washington, DC 20202-6450.

Telephone. (202) 453-6704 kamagra blue pill. Email. OESE.School.Mental.Health@ed.gov.

If you are deaf, hard of hearing, or have a kamagra blue pill speech disability and wish to access telecommunications relay services, please dial 7-1-1. End Further Info End Preamble Start Supplemental Information Full Text of Announcement I. Funding Opportunity Description Purpose of Program. The SBMH kamagra blue pill program provides competitive grants to State educational agencies (SEAs) (as defined in 20 U.S.C.

7801(30)), local educational agencies (LEAs) (as defined in 20 U.S.C. 7801(49), and consortia of LEAs to increase the number of credentialed (as defined in this document) school-based mental health services providers (as defined in 20 U.S.C. 7112(6)) providing mental health services to students kamagra blue pill in LEAs with demonstrated need (as defined in this document). Background.

Like good physical health, positive mental health promotes success in life. As defined by the Centers for Disease Control and Prevention (CDC), kamagra blue pill “Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices.

Mental health is important at every stage of life, from childhood and adolescence through adulthood.” [] The increases in mental health needs, including those resulting from traumatic events such as the Novel erectile dysfunction Disease 2019 (erectile dysfunction treatment) kamagra, community violence, and adverse childhood experiences, have brought on challenges kamagra blue pill for children and youth that impact their overall emotional, psychological, and social well-being and their ability to fully engage in learning. The disruptions in routines, relationships, and the learning environment have led to increased stress and trauma, social isolation, and anxiety. The Department aims to help address these mental health needs and provide support to students, families, and schools by using the increased funds available from the FY 2022 Appropriations Act and the Bipartisan Safer Communities Act to dramatically increase the number of credentialed school-based mental health services providers in LEAs with demonstrated need through awards in FYs 2022-2026 under the SBMH grant program. The priorities for the FY 2022 competition, described further in this notice, are intended to kamagra blue pill accomplish this goal by increasing recruitment and retention-related incentives for school-based mental health services providers.

Promoting the respecialization and professional retraining of existing mental health services providers to qualify them for work in LEAs with demonstrated need. And increasing the diversity, and cultural and linguistic competency, of school-based mental health services providers, including competency in providing identity-safe services. Note kamagra blue pill. The provision of medical services by such services providers is not an allowable use of funds under this grant.

Priorities. This competition has two absolute priorities and two kamagra blue pill competitive preference priorities. These priorities are from the notice of final priorities, requirements, and definitions published elsewhere in this issue of the Federal Register. Absolute Priority.

For FY 2022 and any subsequent year in which we make awards from the list of unfunded applications from this competition, these priorities are absolute kamagra blue pill priorities. Under 34 CFR 75.105(c)(3), we consider only applications that meet these absolute priorities. Absolute Priority 1 is only applicable to SEAs. Absolute Priority 2 is only kamagra blue pill applicable to LEAs or consortia of LEAs.

These priorities are. Priority 1—SEAs Proposing to Increase the Number of Credentialed School-Based Mental Health Services Providers in LEAs with Demonstrated Need. To meet this priority, an SEA must propose to increase the number of credentialed school-based kamagra blue pill mental health services providers by implementing plans that address recruitment (as defined in this document) and retention (as defined in this document) of services providers in LEAs with demonstrated need. Applicants must propose plans that include both of the following.

(a) Recruitment. An applicant must propose a kamagra blue pill plan to increase the number of credentialed services providers serving students in LEAs with demonstrated need. (b) Retention. An applicant must also propose a plan to increase the likelihood that credentialed services providers providing services in LEAs with demonstrated need stay in their position over time.

Priority 2—LEAs or Consortia of kamagra blue pill LEAs with Demonstrated Need Proposing to Increase the Number of Credentialed School-Based Mental Health Services Providers. To meet this priority, an LEA or consortium of LEAs with demonstrated need must propose measures to increase the number of credentialed school-based mental health services providers, including plans to address the recruitment and retention of credentialed services providers in the LEA(s). Applicants must propose plans that include both of the following. (a) Recruitment kamagra blue pill.

An applicant must propose a plan to increase the number of credentialed services providers serving students in the LEA(s) with demonstrated need. (b) Retention. An applicant must also propose a plan to improve the likelihood that credentialed services providers providing services in the LEA(s) with demonstrated kamagra blue pill need stay in their position over time. Note.

The Secretary intends to create two funding slates for SBMH applications, one for applications that meet Absolute Priority 1 (SEA applicants) and a separate slate for Start Printed Page 60139 applications that meet Absolute Priority 2 (LEA or a consortium of LEA applicants). As a result, the Secretary may fund applications out of the kamagra blue pill overall rank order. Competitive Preference Priorities. For FY 2022 and any subsequent year in which we make awards from the list of unfunded applications from this competition, these priorities are competitive preference priorities.

Under 34 CFR 75.105(c)(2)(i), we award an additional 5 points for Competitive Preference Priority 1 to any application from an SEA that kamagra blue pill addresses this priority. We award up to an additional 10 points for Competitive Preference Priority 2 to any application from an SEA, LEA, or consortium of LEAs, depending on how well the application meets the priority. The total number of competitive preference points an SEA applicant may compete for is 15. The total number of competitive kamagra blue pill preference points an LEA or consortium of LEAs applicant may compete for is 10.

As stated previously, these entities will not be competing against one another. An applicant must clearly identify in the project abstract and the project narrative section of its application the competitive preference priority or priorities it wishes the Department to consider for purposes of earning competitive preference priority points. These priorities kamagra blue pill are. Competitive Preference Priority 1—SEAs Proposing Respecialization, Professional Retraining, or Other Preparation Plan for Existing Mental Health Services Providers to Qualify Them for Work in LEAs with Demonstrated Need.

(Up to 5 points) To meet this priority, an applicant must propose a respecialization (as defined in this document), professional retraining, or other preparation plan that leads to a state credential as a school psychologist, school social worker, school counselor, or other school-based mental health services provider and that is designed to increase the number of services providers qualified to serve in LEAs with demonstrated need. Competitive Preference Priority 2—Increasing the Number of Credentialed School-Based Mental Health Services Providers in LEAs with Demonstrated Need Who Are from Diverse Backgrounds or from Communities Served by kamagra blue pill the LEAs with Demonstrated Need. (Up to 10 Points) To meet this priority, applicants must propose a plan to increase the number of credentialed school-based mental health services providers in LEAs with demonstrated need who are from diverse backgrounds or who are from communities served by the LEAs with demonstrated need.[] Applicants must describe how their proposal to increase the number of school-based mental health services providers who are from diverse backgrounds or who are from the communities served by the LEA with demonstrated need will help increase access to mental health services for students within the LEA with demonstrated need and best meet the mental health needs of the diverse populations of students to be served. Requirements.

These requirements are from the notice of final priorities, requirements, kamagra blue pill and definitions published elsewhere in this issue of the Federal Register. We are establishing these application and program requirements for the FY 2022 grant competition and any subsequent year in which we make awards from the list of unfunded applications from this competition. Application requirement (a) would apply to SEAs only, and kamagra blue pill application requirement (b) would apply to LEAs or a consortium of LEAs only. All of the remaining application requirements would apply to all eligible applicants.

For FY 2022 and any subsequent year in which we make awards from the list of unfunded applications from this competition, the following requirements apply. Eligible Applicants kamagra blue pill. SEAs, as defined in 20 U.S.C. 7801(49), or LEAs, as defined in 20 U.S.C.

7801(30), including consortia of LEAs kamagra blue pill. Program Requirements. (a) Applicants that receive an award under this program must ensure that any school-based mental health services provider hired under this grant, including any services provider that offers telehealth services, is credentialed by the State to work in an elementary school (as defined in 20 U.S.C. 7801(19)) or secondary kamagra blue pill school (as defined in 20 U.S.C.

7801(45)). (b) Applicants that receive an award under this program must ensure that any school-based mental health services provider offering services (including telehealth services) does so in an equitable manner and consistent with the Family Educational Rights and Privacy Act (FERPA), the Protection of Pupil Rights Amendment (PPRA), the Individuals with Disabilities Education Act (IDEA), Section 504 of the Rehabilitation Act, and the Americans with Disabilities Act, as well as all other applicable Federal, State, and local laws and profession-specific ethical obligations. Application kamagra blue pill Requirements. (a) Describe the LEAs with demonstrated need designated by the SEA to be served by the proposed project.

SEA applicants must describe the LEAs with demonstrated need designated to benefit from the SBMH program. (b) Describe how kamagra blue pill the LEA, or each LEA in the proposed consortium (if applicable), meets the definition of an LEA with demonstrated need. To meet this requirement, an LEA applicant or the lead LEA submitting an application on behalf of a consortium must describe how the LEA or each LEA in the consortium meets the definition of an LEA with demonstrated need. (c) Describe the importance and magnitude of the problem.

Applicants must describe the lack of kamagra blue pill school-based mental health services providers and its effect on students in the LEA(s) to be served by the grant. This must include a description of the nature of the problem for the LEA(s), based on information, including, but not limited to, the most recent available ratios of school-based mental health services providers to students enrolled in the LEA(s), or for SEA applicants, the LEAs designated by the SEA to benefit from the SBMH program. These data must be provided in the aggregate and disaggregated by profession ( e.g., school social workers, school psychologists, school counselors) as compared to local, State, or national data. The description may also include LEA-level or kamagra blue pill school-level demographic data (including rates of poverty.

Rates of chronic absenteeism. The percentage of students involved in the juvenile justice system, experiencing homelessness, or in foster care. And discipline data), kamagra blue pill school climate surveys, school violence/crime data, data related to suicide rates, and descriptions of barriers to hiring and retaining credentialed school-based mental health services providers in the LEA. (d) Logic Model.

The applicant must describe its approach to increase the number of credentialed school-based mental health services providers using a logic model (as defined in 34 CFR 77.1), including the key project components and relevant outcomes (as defined in 34 CFR 77.1). The description should indicate how the proposed approach taken under this program will improve or expand on any previous approaches, how the new approach will address barriers, and how the applicant will sustain the kamagra blue pill increased number of school-based mental health Start Printed Page 60140 services providers after the performance period has ended. (e) Detailed project budget, including matching funds. To promote the sustainability of the school-based mental health services, all applicants must include non-Federal matching funds in the amount of at least 25 percent of their budgets.

Budgets must describe how the applicant will meet the matching requirement for each budget period awarded under this grant and must indicate the kamagra blue pill source of the funds, such as State, local, or private resources. The Secretary may consider decreasing or waiving the matching requirement post award, on a case-by-case basis, if an applicant demonstrates a significant financial hardship. Budgets must also specify the portion of funds that will be used for respecialization, if applicable. Administrative costs for SEA applicants may not exceed 10 percent of the annual grant kamagra blue pill award.

This includes funding for State-level or LEA-level administrative costs that promote respecialization, if applicable. Administrative costs for applicants that are LEAs and consortia of LEAs may not exceed 5 percent of the annual grant award. (f) Number kamagra blue pill of providers. Applicants must include the most recent available data on the number of school-based mental health services providers in the identified LEA(s), disaggregated by profession ( e.g., school social workers, school psychologists, school counselors), and the projected number of school-based mental health services providers that will be placed into employment in the identified LEA(s) for each year of the plan using funds from this grant or matching funds.

If applicable, applicants should provide data on the current and projected unduplicated numbers of school-based mental health services providers disaggregated by profession ( e.g., school social workers, school psychologists, school counselors), offering telehealth services. (g) A plan for collaboration and coordination with kamagra blue pill related Federal, State, and local organizations, and school-based efforts. Applicants must propose a plan describing how they will collaborate and coordinate with related Federal, State, and local organizations, and school-based efforts ( e.g., professional associations. Colleges or universities, including Historically Black Colleges and Universities, Minority Serving Institutions, and Tribal Colleges and Universities.

Local mental health kamagra blue pill. Public health. Child welfare. Or other community agencies, including school-based health centers), kamagra blue pill to achieve plan goals and objectives of increasing the number of school-based mental health services providers in LEAs with demonstrated need.

The plan must include a description of how such collaboration and coordination will promote program success across multiple programs. (h) Use of grant funds to supplement, and not supplant, existing school-based mental health services funds and to expand, not duplicate, efforts to increase the number of providers. Applicants must describe how project funds will supplement, and not supplant, non-Federal funds that would otherwise be available kamagra blue pill for activities funded under this program. Applicants must describe how they will use the SBMH program funds to expand, rather than duplicate, existing or new efforts to increase the number of credentialed school-based mental health services providers in LEAs with demonstrated need and how they will integrate existing funding streams and efforts to support the plan.

(i) Plan for prompt delivery of services to students. For SEA applicants, applicants must describe their plan to ensure the prompt delivery of services to students ( i.e., as soon as possible, but no later than 180 days from award), including via subgrants kamagra blue pill to LEAs, as appropriate. For LEA applicants and consortia of LEAs, applicants must describe their plan to ensure the prompt delivery of services to students ( i.e., as soon as possible, but no later than 180 days from award). Additionally, SEA and LEA applicants must describe how leaders across all levels of the project will be engaged in the implementation and evaluation of the project.

Definitions kamagra blue pill. The definitions of “credentialed,” “LEA with demonstrated need,” “recruitment,” “respecialization,” “retention,” and “telehealth” are from the notice of priorities, requirements, and definitions published elsewhere in this issue of the Federal Register. The following definitions are from 34 CFR 77.1. €œambitious,” “baseline,” “logic model,” “project component,” and “relevant kamagra blue pill outcome.” The following definitions are from 20 U.S.C.

7801. €œlocal educational agency”, “State educational agency.” The definition of “school-based mental health services provider” is from 20 U.S.C. 7112. These definitions apply to the FY 2022 School-Based Mental Health Services Grant competition and any subsequent year in which we make awards from the list of unfunded applications from this competition.

Ambitious means promoting continued, meaningful improvement for program participants or for other individuals or entities affected by the grant, or representing a significant advancement in the field of education research, practices, or methodologies. When used to describe a performance target, whether a performance target is ambitious depends upon the context of the relevant performance measure and the baseline for that measure. Baseline means the starting point from which performance is measured and targets are set. Credentialed means an individual who possesses a valid license or certificate from the SEA or relevant regulatory body as a school psychologist, school counselor, or a school social worker, or other mental health services provider, approved by the State to provide school-based mental health services.

Local educational agency means a public board of education or other public authority legally constituted within a State for either administrative control or direction of, or to perform a service function for, public elementary schools or secondary schools in a city, county, township, school district, or other political subdivision of a State, or of or for a combination of school districts or counties that is recognized in a State as an administrative agency for its public elementary schools or secondary schools. (a) The term includes any other public institution or agency having administrative control and direction of a public elementary school or secondary school. (b) The term includes an elementary or secondary school funded by the Bureau of Indian Education but only to the extent that including the school makes the school eligible for programs for which specific eligibility is not provided to the school in another provision of law and the school does not have a student population that is smaller than the student population of the LEA receiving assistance under the Elementary and Secondary Education Act of 1965, as amended (ESEA) with the smallest student population, except that the school shall not be subject to the jurisdiction of any SEA other than the Bureau of Indian Education. (c) The term includes educational service agencies and consortia of those agencies.

(d) The term includes the SEA in a State in which the SEA is the sole educational agency for all public schools. LEA with demonstrated need means an LEA that has a significant need for Start Printed Page 60141 additional school-based mental health services providers based on— (1) High student to mental health services provider ratios as compared to other LEAs statewide or nationally. (2) High rates of community violence (including hate crimes), poverty, substance use (including opioid use), suicide, or trafficking. Or (3) A significant number of students who are migratory, experiencing homelessness, have a family member deployed in the military or with a military-service connected disability (including veterans), have experienced a natural or man-made disaster or a traumatic event, or have other adverse childhood experiences, such as repeated disciplinary exclusions from the learning environment.

Logic model (also referred to as a theory of action) means a framework that identifies key project components of the proposed project ( i.e., the active “ingredients” that are hypothesized to be critical to achieving the relevant outcomes) and describes the theoretical and operational relationships among the key project components and relevant outcomes. Project component means an activity, strategy, intervention, process, product, practice, or policy included in a project. Evidence may pertain to an individual project component or to a combination of project components ( e.g., training teachers on instructional practices for English learners and follow-on coaching for these teachers). Recruitment means strategies that help attract and hire credentialed school-based mental health services providers, including by doing at least one of the following.

(1) Providing an annual salary or stipend for school-based mental health services providers who maintain an active national certification. (2) Providing payment toward the school loans accrued by the school-based mental health services provider. (3) Creating pathways to grant cross-State credentialing reciprocity for school-based mental health services providers. (4) Providing incentives and supports to help mitigate shortages.

These may include, for example, increasing pay. Offering monetary incentives for relocation to high-need areas. Providing services via telehealth. Creating hybrid roles that allow for leadership, academic, or research opportunities.

Developing induction programs. Developing paid internship programs. Focusing on recruitment and support of underrepresented populations. And offering service scholarship programs such as those that provide grants in exchange for a commitment to serve in the LEA for a minimum number of years.

Relevant outcome means the student outcome(s) or other outcome(s) the key project component is designed to improve, consistent with the specific goals of the program. Respecialization means strategies that provide opportunities for professional retraining and alternative pathways to obtain a state credential, aligned with the standards of the relevant professional organization, as a school-based mental health services provider for individuals who hold, at a minimum, a degree in a related field ( e.g., special education, clinical psychology, community counseling), including by doing one or more of the following. (1) Revising, updating, or streamlining requirements for such individuals so that additional training or other requirements focus only on training needed to obtain a credential as a school-based mental health services provider. (2) Providing a stipend or making a payment to support the training needed to obtain a credential as a school-based mental health services provider.

(3) Offering flexible options for completing training that leads such professionals to meet State credentialing requirements as a school-based mental health services provider. (4) Establishing a provisional, time limited, and nonrenewable credential to allow individuals seeking respecialization to provide school-based mental health services under the direct supervision of a fully credentialed school-based mental health services provider of the same profession. (5) Offering other meaningful activities that result in existing mental health services providers obtaining a state credential as a school-based mental health services provider. Retention means strategies to help ensure that credentialed individuals stay in their position to avoid gaps in service and unfilled positions, including by— (1) Providing opportunities for advancement or leadership, such as career pathways programs, recognition and award programs, and mentorship programs.

And (2) Offering incentives and supports to help mitigate shortages. These may include, for example, increasing pay. Making payments toward student loans. Offering monetary incentives for relocation to high-need areas.

Providing services via telehealth. Offering service scholarship programs, such as those that provide grants in exchange for a commitment to serve in the LEA for a minimum number of years. And developing paid internship programs. School-based mental health services provider means a State-licensed or State-certified school counselor, school psychologist, school social worker, or other State licensed or certified mental health professional qualified under State law to provide mental health services to children and adolescents.

State educational agency means the agency primarily responsible for the State supervision of public elementary schools and secondary schools. Telehealth means the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and landline and wireless communications. Program Authority:20 U.S.C.

7281. Note. Projects will be awarded and must be operated in a manner consistent with the nondiscrimination requirements contained in Federal civil rights laws. Applicable Regulations.

(a) The Education Department General Administrative Regulations in 34 CFR parts 75, 77, 79, 81, 82, 84, 97, 98, and 99. (b) The Office of Management and Budget Guidelines to Agencies on Governmentwide Debarment and Suspension (Nonprocurement) in 2 CFR part 180, as adopted and amended as regulations of the Department in 2 CFR part 3485. (c) The Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards in 2 CFR part 200, as adopted and amended as regulations of the Department in 2 CFR part 3474. (d) The notice of final priorities, requirements, and definitions published elsewhere in this issue of the Federal Register.

II. Award Information Type of Award. Discretionary grants. Estimated Available Funds.

$143,900,000. Contingent upon the availability of funds and the quality of applications, we may make additional awards in subsequent years from the list of unfunded applications from this competition. Estimated Range of Awards. $500,000 to 3,000,000.

Estimated Average Size of Awards. $1,750,000. Estimated Number of Awards. 50-150.

Start Printed Page 60142 Note. The Department is not bound by any estimates in this notice. Project Period. Up to 60 months.

III. Eligibility Information 1. Eligible Applicants. SEAs, as defined in 20 U.S.C.

7801(49), or LEAs, as defined in 20 U.S.C. 7801(30), including consortia of LEAs. 2. Cost Sharing or Matching.

A. This program requires cost sharing or matching requirements. See “Application Requirements” in Section I. b.

Indirect Cost Rate Information. This program uses an unrestricted indirect cost rate. For more information regarding indirect costs, or to obtain a negotiated indirect cost rate, please see www2.ed.gov/​about/​offices/​list/​ocfo/​intro.html. c.

Administrative Cost Limitation. This program involves administrative costs for SEAs, LEAs and consortia of LEAs. See “Application Requirements” in Section I. 3.

Supplement-Not-Supplant. This program involves supplement-not-supplant funding requirements. See “Application Requirements” in Section I. 4.

Limitation on Awards. A. The Department will make only one award that serves any individual LEA. b.

The Department will only make an award to LEAs that are not subgrantees of a current SBMH project. 5. Subgrantees. Under 34 CFR 75.708(b) and (c) an SEA grantee under this competition may award subgrants to directly carry out project activities described in its application to the following types of entities.

LEAs. The SEA grantee may award subgrants to entities it has identified in an approved application or that it selects through a competition under procedures established by the grantees. However, an SEA grantee is not required to award subgrants and may instead administer the program directly. IV.

Application and Submission Information 1. Application Submission Instructions. Applicants are required to follow the Common Instructions for Applicants to Department of Education Discretionary Grant Programs, published in the Federal Register on December 27, 2021 (86 FR 73264) and available at www.federalregister.gov/​d/​2021-27979, which contain requirements and information on how to submit an application. Please note that these Common Instructions supersede the version published on February 13, 2019, and, in part, describe the transition from the requirement to register in SAM.gov a DUNS number to the implementation of the UEI.

More information on the phase-out of DUNS numbers is available at https://www2.ed.gov/​about/​offices/​list/​ofo/​docs/​unique-entity-identifier-transition-fact-sheet.pdf. 2. Intergovernmental Review. This competition is subject to Executive Order 12372 and the regulations in 34 CFR part 79.

However, under 34 CFR 79.8(a), we waive intergovernmental review in order to make awards by December 31, 2022. 3. Funding Restrictions. We reference regulations outlining funding restrictions in the Applicable Regulations section of this notice.

In addition, we remind applicants that sections 4001(a) and 4001(b) of the ESEA (20 U.S.C. 7101) apply to this program. Section 4001(a) requires entities receiving funds under this program to obtain prior, written, informed consent from the parent of each child who is under 18 years of age to participate in any mental-health assessment or service that is funded under this program and conducted in connection with an elementary or secondary school. Section 4001(b) prohibits the use of funds for medical services or drug treatment or rehabilitation, except for integrated student supports, specialized instructional support services, or referral to treatment for impacted students, which may include students who are victims of, or witnesses to, crime or who illegally use drugs.

This prohibition does not preclude the use of funds to support mental health counseling and support services, including those provided by a mental health services provider outside of school, so long as such services are not medical. 4. Recommended Page Limit. The application narrative is where you, the applicant, address the selection criteria that reviewers use to evaluate your application.

We recommend that you (1) limit the application narrative to no more than 25 pages and (2) use the following standards. A “page” is 8.5″ x 11″, on one side only, with 1″ margins at the top, bottom, and both sides. Double space (no more than three lines per vertical inch) all text in the application narrative, including titles, headings, footnotes, quotations, references, and captions, as well as all text in charts, tables, figures, and graphs. Use a font that is either 12 point or larger or no smaller than 10 pitch (characters per inch).

• Use one of the following fonts. Times New Roman, Courier, Courier New, or Arial. The recommended page limit does not apply to the cover sheet. The budget section, including the narrative budget justification.

The assurances and certifications. Or the one-page abstract, the resumes, the bibliography, or the letters of support. However, the recommended page limit does apply to all of the application narrative. V.

Application Review Information 1. Selection Criteria. The selection criteria for this program are from 34 CFR 75.210. The maximum score for all selection criteria is 100 points.

The points assigned to each criterion are indicated in parentheses. Non-Federal peer reviewers will evaluate and score each application program narrative against the following selection criteria. (a) Need for the Project (10 points). The Secretary considers the need for the proposed project.

In determining the need for the proposed project, the Secretary considers the extent to which specific gaps or weaknesses in services, infrastructure, or opportunities have been identified and will be addressed by the proposed project, including the nature and magnitude of those gaps or weaknesses. (Up to 10 points) (b) Quality of Project Personnel (30 points). (1) The Secretary considers the quality of the personnel who will carry out the proposed project. In determining the quality of project personnel, the Secretary considers the extent to which the applicant encourages applications for employment from persons who are members of groups that have traditionally been underrepresented based on race, color, national origin, gender, age, or disability.

(Up to 10 points) (2) In addition, the Secretary considers. (i) The qualifications, including relevant training and experience, of key project personnel. (Up to 10 points) (ii) The qualifications, including relevant training and experience, of project consultants or subcontractors. (Up to 10 points) (c) Quality of Project Design and Project Services (35 points).

(1) The Secretary considers the quality of the design of the proposed project and the quality of the services to be provided by the proposed project. In determining the quality of the design of the proposed project, the Secretary considers the extent to which the goals, objectives, and outcomes to be achieved by the proposed project are clearly Start Printed Page 60143 specified and measurable. (Up to 10 points) (2) In determining the quality of the services to be provided by the proposed project, the Secretary considers the quality and sufficiency of strategies for ensuring equal access and treatment for eligible project participants who are members of groups that have traditionally been underrepresented based on race, color, national origin, gender, age, or disability. (Up to 10 points) (3) In addition, the Secretary considers the extent to which the training or professional development services to be provided by the proposed project are likely to alleviate the personnel shortages that have been identified or are the focus of the proposed project.

(Up to 15 points) (d) Management Plan and Adequacy of Resources (25 points). The Secretary considers the management plan and adequacy of resources for the proposed project. In determining the quality of the management plan and the adequacy of resources for the proposed project, the Secretary considers. (1) The adequacy of mechanisms for ensuring high-quality products and services from the proposed project.

(Up to 10 points) (2) The relevance and demonstrated commitment of each partner in the proposed project to the implementation and success of the project. (Up to 5 points) (3) The potential for continued support of the project after Federal funding ends, including, as appropriate, the demonstrated commitment of appropriate entities to such support. (Up to 5 points) (4) The adequacy of the procedures for ensuring feedback and continuous improvement in the operation of the proposed project. (Up to 5 points) 2.

Review and Selection Process. We remind potential applicants that in reviewing applications in any discretionary grant competition, the Secretary may consider, under 34 CFR 75.217(d)(3), the past performance of the applicant in carrying out a previous award, such as the applicant's use of funds, achievement of project objectives, and compliance with grant conditions. The Secretary may also consider whether the applicant failed to submit a timely performance report or submitted a report of unacceptable quality. In addition, in making a competitive grant award, the Secretary requires various assurances, including those applicable to Federal civil rights laws that prohibit discrimination in programs or activities receiving Federal financial assistance from the Department (34 CFR 100.4, 104.5, 106.4, 108.8, and 110.23).

3. Risk Assessment and Specific Conditions. Consistent with 2 CFR 200.206, before awarding grants under this program the Department conducts a review of the risks posed by applicants. Under 2 CFR 200.208, the Secretary may impose specific conditions and, under 2 CFR 3474.10, in appropriate circumstances, high-risk conditions on a grant if the applicant or grantee is not financially stable.

Has a history of unsatisfactory performance. Has a financial or other management system that does not meet the standards in 2 CFR part 200, subpart D. Has not fulfilled the conditions of a prior grant. Or is otherwise not responsible.

4. Integrity and Performance System. If you are selected under this competition to receive an award that over the course of the project period may exceed the simplified acquisition threshold (currently $250,000), under 2 CFR 200.206(a)(2) we must make a judgment about your integrity, business ethics, and record of performance under Federal awards—that is, the risk posed by you as an applicant—before we make an award. In doing so, we must consider any information about you that is in the integrity and performance system (currently referred to as the Federal Awardee Performance and Integrity Information System (FAPIIS)), accessible through the System for Award Management.

You may review and comment on any information about yourself that a Federal agency previously entered and that is currently in FAPIIS. Please note that, if the total value of your currently active grants, cooperative agreements, and procurement contracts from the Federal Government exceeds $10,000,000, the reporting requirements in 2 CFR part 200, Appendix XII, require you to report certain integrity information to FAPIIS semiannually. Please review the requirements in 2 CFR part 200, Appendix XII, if this grant plus all the other Federal funds you receive exceed $10,000,000. 5.

In General. In accordance with the Office of Management and Budget's guidance located at 2 CFR part 200, all applicable Federal laws, and relevant Executive guidance, the Department will review and consider applications for funding pursuant to this notice inviting applications in accordance with. (a) Selecting recipients most likely to be successful in delivering results based on the program objectives through an objective process of evaluating Federal award applications (2 CFR 200.205). (b) Prohibiting the purchase of certain telecommunication and video surveillance services or equipment in alignment with section 889 of the National Defense Authorization Act of 2019 (Pub.

L. 115-232) (2 CFR 200.216). (c) Providing a preference, to the extent permitted by law, to maximize use of goods, products, and materials produced in the United States (2 CFR 200.322). And (d) Terminating agreements in whole or in part to the greatest extent authorized by law if an award no longer effectuates the program goals or agency priorities (2 CFR 200.340).

VI. Award Administration Information 1. Award Notices. If your application is successful, we notify your U.S.

Representative and U.S. Senators and send you a Grant Award Notification (GAN). Or we may send you an email containing a link to access an electronic version of your GAN. We may notify you informally, also.

If your application is not evaluated or not selected for funding, we notify you. 2. Administrative and National Policy Requirements. We identify administrative and national policy requirements in the application package and reference these and other requirements in the Applicable Regulations section of this notice.

We reference the regulations outlining the terms and conditions of an award in the Applicable Regulations section of this notice and include these and other specific conditions in the GAN. The GAN also incorporates your approved application as part of your binding commitments under the grant. 3. Open Licensing Requirements.

Unless an exception applies, if you are awarded a grant under this competition, you will be required to openly license to the public grant deliverables created in whole, or in part, with Department grant funds. When the deliverable consists of modifications to pre-existing works, the license extends only to those modifications that can be separately identified and only to the extent that open licensing is permitted under the terms of any licenses or other legal restrictions on the use of pre-existing works. Additionally, a grantee or subgrantee that is awarded competitive grant funds must have a plan to disseminate these public grant deliverables. This dissemination plan can be developed and submitted after your application has been reviewed and selected for funding.

For additional information on the open licensing requirements please refer to 2 CFR 3474.20. Start Printed Page 60144 4. Reporting. (a) If you apply for a grant under this competition, you must ensure that you have in place the necessary processes and systems to comply with the reporting requirements in 2 CFR part 170 should you receive funding under this competition.

This does not apply if you have an exception under 2 CFR 170.110(b). (b) At the end of your project period, you must submit a final performance report, including financial information, as directed by the Secretary. If you receive a multiyear award, you must submit an annual performance report that provides the most current performance and financial expenditure information as directed by the Secretary under 34 CFR 75.118. The Secretary may also require more frequent performance reports under 34 CFR 75.720(c).

For specific requirements on reporting, please go to www.ed.gov/​fund/​grant/​apply/​appforms/​appforms.html. (c) Under 34 CFR 75.250(b), the Secretary may provide a grantee with additional funding for data collection analysis and reporting. In this case the Secretary establishes a data collection period. 5.

Performance Measures. For the purpose of Department reporting under 34 CFR 75.110, we have established the following performance measures for the School-Based Mental Health Services Grant Program. (a) The unduplicated, cumulative number of new school-based mental health services providers hired for each LEA with demonstrated need as a result of the grant. (b) The unduplicated, cumulative number of school-based mental health services providers retained in LEAs with demonstrated need as a result of the grant.

(c) The ratio of students to school-based mental health services providers for each LEA with demonstrated need served by the grant, and the numbers of school-based mental health services providers and students used to calculate the ratio. (d) The attrition rate of school-based mental health services providers for each LEA with a demonstrated need that is participating in the grant. (e) The total number of students who received school-based mental health services as a result of the grant. (f) For grantees that addressed competitive preference priority 2, the number of such grantees that met their goal of increasing the diversity of school-based mental health services providers.

These measures constitute the Department's indicators of success for this program. Consequently, we advise an applicant for a grant under this program to give careful consideration to these measures in conceptualizing the approach for its proposed project plan. Each grantee will be required to provide, in its annual performance and final reports, data about its progress in meeting these measures. These data will be considered by the Department in making potential continuation awards.

Consistent with 34 CFR 75.591, grantees funded under this program must meet the requirements of any evaluation of the program conducted by the Department or an evaluator selected by the Department. Performance measure targets. The applicant must propose annual targets for the measures listed above in their application. Applicants must also provide the following information as directed under 34 CFR 75.110(b) and (c).

(1) An explanation of how each proposed performance target is ambitious (as defined in this notice) yet achievable compared to the baseline (as defined in this notice) for the performance measure. (2) An explanation of the data collection and reporting methods the applicant would use and why those methods are likely to yield reliable, valid, and meaningful performance data. And (3) An explanation of the applicant's capacity to collect and report reliable, valid, and meaningful performance data, as evidenced by high-quality data collection, analysis, and reporting in other projects or research. Note.

If the applicant does not have experience with collection and reporting of performance data through other projects or research, the applicant should provide other evidence of capacity to successfully carry out data collection and reporting for its proposed project. The reviewers of each application will score related selection criteria on the basis of how well an applicant has considered these measures in conceptualizing the approach and evaluation of the project. All grantees must submit an annual performance report and final performance report with information that is responsive to these performance measures. 6.

Continuation Awards. In making a continuation award under 34 CFR 75.253, the Secretary considers, among other things, whether a grantee has made substantial progress in achieving the goals and objectives of the project. Whether the grantee has expended funds in a manner that is consistent with its approved application and budget. And, if the Secretary has established performance measurement requirements, the performance targets in the grantee's approved application.

In making a continuation award, the Secretary also considers whether the grantee is operating in compliance with the assurances in its approved application, including those applicable to Federal civil rights laws that prohibit discrimination in programs or activities receiving Federal financial assistance from the Department (34 CFR 100.4, 104.5, 106.4, 108.8, and 110.23). VII. Other Information Accessible Format. On request to the program contact person listed under FOR FURTHER INFORMATION CONTACT , individuals with disabilities can obtain this document and a copy of the application package in an accessible format.

The Department will provide the requestor with an accessible format that may include Rich Text Format (RTF) or text format (txt), a thumb drive, an MP3 file, Braille, large print, audiotape, compact disc, or other accessible format. Electronic Access to This Document. The official version of this document is the document published in the Federal Register. You may access the official edition of the Federal Register and the Code of Federal Regulations at www.govinfo.gov.

At this site you can view this document, as well as all other documents of this Department published in the Federal Register , in text or Portable Document Format (PDF). To use PDF you must have Adobe Acrobat Reader, which is available free at the site. You may also access documents of the Department published in the Federal Register by using the article search feature at www.federalregister.gov. Specifically, through the advanced search feature at this site, you can limit your search to documents published by the Department.

Start Signature James F. Lane, Senior Advisor, Office of the Secretary, Delegated the Authority to Perform the Functions and Duties of the Assistant Secretary for the Office Elementary and Secondary Education. End Signature End Supplemental Information.

Start Preamble buy kamagra oral jelly online uk Office of Elementary and Secondary Education, Department of Education http://mchtranslations.com/ventolin-spray-price/. Notice. The Department of Education (Department) is issuing a notice inviting applications for fiscal year (FY) 2022 for Start Printed Page 60138 buy kamagra oral jelly online uk the School-Based Mental Health Services (SBMH) Grant Program, Assistance Listing Number (ALN) number 84.184H. OMB has approved the information collection related to this notice. Applications Available.

October 4, 2022 buy kamagra oral jelly online uk. Deadline for Transmittal of Applications. November 3, 2022. Pre-Application buy kamagra oral jelly online uk Webinar Information. The Department will hold pre-application meetings via webinar for prospective applicants on October 11th and 19th, 2022, at 4:00 p.m.

Eastern Time. For the addresses for obtaining and submitting an application, please refer to our buy kamagra oral jelly online uk Common Instructions for Applicants to Department of Education Discretionary Grant Programs, published in the Federal Register on December 27, 2021 (86 FR 73264) and available at www.federalregister.gov/​d/​2021-27979. Please note that these Common Instructions supersede the version published on February 13, 2019, and, in part, describe the transition from the requirement to register in SAM.gov a Data Universal Numbering System (DUNS) number to the implementation of the Unique Entity Identifier (UEI). More information on the phase-out of DUNS numbers is available at https://www2.ed.gov/​about/​offices/​list/​ofo/​docs/​unique-entity-identifier-transition-fact-sheet.pdf. Start Further Info Amy Banks, buy kamagra oral jelly online uk U.S.

Department of Education, 400 Maryland Avenue SW, Room 3E257, Washington, DC 20202-6450. Telephone. (202) 453-6704 buy kamagra oral jelly online uk. Email. OESE.School.Mental.Health@ed.gov.

If you buy kamagra oral jelly online uk are deaf, hard of hearing, or have a speech disability and wish to access telecommunications relay services, please dial 7-1-1. End Further Info End Preamble Start Supplemental Information Full Text of Announcement I. Funding Opportunity Description Purpose of Program. The SBMH program provides competitive buy kamagra oral jelly online uk grants to State educational agencies (SEAs) (as defined in 20 U.S.C. 7801(30)), local educational agencies (LEAs) (as defined in 20 U.S.C.

7801(49), and consortia of LEAs to increase the number of credentialed (as defined in this document) school-based mental health services providers (as defined in 20 U.S.C. 7112(6)) providing mental health buy kamagra oral jelly online uk services to students in LEAs with demonstrated need (as defined in this document). Background. Like good physical health, positive mental health promotes success in life. As defined by the Centers for buy kamagra oral jelly online uk Disease Control and Prevention (CDC), “Mental health includes our emotional, psychological, and social well-being.

It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices. Mental health is important at every stage of life, from childhood and adolescence buy kamagra oral jelly online uk through adulthood.” [] The increases in mental health needs, including those resulting from traumatic events such as the Novel erectile dysfunction Disease 2019 (erectile dysfunction treatment) kamagra, community violence, and adverse childhood experiences, have brought on challenges for children and youth that impact their overall emotional, psychological, and social well-being and their ability to fully engage in learning. The disruptions in routines, relationships, and the learning environment have led to increased stress and trauma, social isolation, and anxiety. The Department aims to help address these mental health needs and provide support to students, families, and schools by using the increased funds available from the FY 2022 Appropriations Act and the Bipartisan Safer Communities Act to dramatically increase the number of credentialed school-based mental health services providers in LEAs with demonstrated need through awards in FYs 2022-2026 under the SBMH grant program.

The priorities for the FY 2022 competition, described buy kamagra oral jelly online uk further in this notice, are intended to accomplish this goal by increasing recruitment and retention-related incentives for school-based mental health services providers. Promoting the respecialization and professional retraining of existing mental health services providers to qualify them for work in LEAs with demonstrated need. And increasing the diversity, and cultural and linguistic competency, of school-based mental health services providers, including competency in providing identity-safe services. Note buy kamagra oral jelly online uk. The provision of medical services by such services providers is not an allowable use of funds under this grant.

Priorities. This competition has buy kamagra oral jelly online uk two absolute priorities and two competitive preference priorities. These priorities are from the notice of final priorities, requirements, and definitions published elsewhere in this issue of the Federal Register. Absolute Priority. For FY 2022 and any subsequent year in which we make awards from the list of unfunded applications buy kamagra oral jelly online uk from this competition, these priorities are absolute priorities.

Under 34 CFR 75.105(c)(3), we consider only applications that meet these absolute priorities. Absolute Priority 1 is only applicable to SEAs. Absolute Priority 2 is only applicable to LEAs or consortia of LEAs buy kamagra oral jelly online uk. These priorities are. Priority 1—SEAs Proposing to Increase the Number of Credentialed School-Based Mental Health Services Providers in LEAs with Demonstrated Need.

To meet this priority, an SEA must propose to increase the number of credentialed school-based mental health services providers by implementing buy kamagra oral jelly online uk plans that address recruitment (as defined in this document) and retention (as defined in this document) of services providers in LEAs with demonstrated need. Applicants must propose plans that include both of the following. (a) Recruitment. An applicant must propose a plan to increase buy kamagra oral jelly online uk the number of credentialed services providers serving students in LEAs with demonstrated need. (b) Retention.

An applicant must also propose a plan to increase the likelihood that credentialed services providers providing services in LEAs with demonstrated need stay in their position over time. Priority 2—LEAs or Consortia of LEAs with Demonstrated Need Proposing to Increase the Number of Credentialed School-Based buy kamagra oral jelly online uk Mental Health Services Providers. To meet this priority, an LEA or consortium of LEAs with demonstrated need must propose measures to increase the number of credentialed school-based mental health services providers, including plans to address the recruitment and retention of credentialed services providers in the LEA(s). Applicants must propose plans that include both of the following. (a) Recruitment buy kamagra oral jelly online uk.

An applicant must propose a plan to increase the number of credentialed services providers serving students in the LEA(s) with demonstrated need. (b) Retention. An applicant must also propose a plan to improve the likelihood that credentialed services providers providing services in buy kamagra oral jelly online uk the LEA(s) with demonstrated need stay in their position over time. Note. The Secretary intends to create two funding slates for SBMH applications, one for applications that meet Absolute Priority 1 (SEA applicants) and a separate slate for Start Printed Page 60139 applications that meet Absolute Priority 2 (LEA or a consortium of LEA applicants).

As a result, the Secretary may fund applications out of the overall buy kamagra oral jelly online uk rank order. Competitive Preference Priorities. For FY 2022 and any subsequent year in which we make awards from the list of unfunded applications from this competition, these priorities are competitive preference priorities. Under 34 CFR 75.105(c)(2)(i), buy kamagra oral jelly online uk we award an additional 5 points for Competitive Preference Priority 1 to any application from an SEA that addresses this priority. We award up to an additional 10 points for Competitive Preference Priority 2 to any application from an SEA, LEA, or consortium of LEAs, depending on how well the application meets the priority.

The total number of competitive preference points an SEA applicant may compete for is 15. The total number of competitive preference buy kamagra oral jelly online uk points an LEA or consortium of LEAs applicant may compete for is 10. As stated previously, these entities will not be competing against one another. An applicant must clearly identify in the project abstract and the project narrative section of its application the competitive preference priority or priorities it wishes the Department to consider for purposes of earning competitive preference priority points. These priorities buy kamagra oral jelly online uk are.

Competitive Preference Priority 1—SEAs Proposing Respecialization, Professional Retraining, or Other Preparation Plan for Existing Mental Health Services Providers to Qualify Them for Work in LEAs with Demonstrated Need. (Up to 5 points) To meet this priority, an applicant must propose a respecialization (as defined in this document), professional retraining, or other preparation plan that leads to a state credential as a school psychologist, school social worker, school counselor, or other school-based mental health services provider and that is designed to increase the number of services providers qualified to serve in LEAs with demonstrated need. Competitive Preference Priority 2—Increasing the Number of Credentialed School-Based Mental Health Services Providers in LEAs with Demonstrated Need Who Are from Diverse Backgrounds or from buy kamagra oral jelly online uk Communities Served by the LEAs with Demonstrated Need. (Up to 10 Points) To meet this priority, applicants must propose a plan to increase the number of credentialed school-based mental health services providers in LEAs with demonstrated need who are from diverse backgrounds or who are from communities served by the LEAs with demonstrated need.[] Applicants must describe how their proposal to increase the number of school-based mental health services providers who are from diverse backgrounds or who are from the communities served by the LEA with demonstrated need will help increase access to mental health services for students within the LEA with demonstrated need and best meet the mental health needs of the diverse populations of students to be served. Requirements.

These requirements are from the notice of final priorities, requirements, and definitions published elsewhere in this issue of the buy kamagra oral jelly online uk Federal Register. We are establishing these application and program requirements for the FY 2022 grant competition and any subsequent year in which we make awards from the list of unfunded applications from this competition. Application requirement (a) would apply to SEAs only, and application requirement (b) would apply to LEAs or a consortium of LEAs buy kamagra oral jelly online uk only. All of the remaining application requirements would apply to all eligible applicants. For FY 2022 and any subsequent year in which we make awards from the list of unfunded applications from this competition, the following requirements apply.

Eligible Applicants buy kamagra oral jelly online uk. SEAs, as defined in 20 U.S.C. 7801(49), or LEAs, as defined in 20 U.S.C. 7801(30), including consortia of buy kamagra oral jelly online uk LEAs. Program Requirements.

(a) Applicants that receive an award under this program must ensure that any school-based mental health services provider hired under this grant, including any services provider that offers telehealth services, is credentialed by the State to work in an elementary school (as defined in 20 U.S.C. 7801(19)) or secondary buy kamagra oral jelly online uk school (as defined in 20 U.S.C. 7801(45)). (b) Applicants that receive an award under this program must ensure that any school-based mental health services provider offering services (including telehealth services) does so in an equitable manner and consistent with the Family Educational Rights and Privacy Act (FERPA), the Protection of Pupil Rights Amendment (PPRA), the Individuals with Disabilities Education Act (IDEA), Section 504 of the Rehabilitation Act, and the Americans with Disabilities Act, as well as all other applicable Federal, State, and local laws and profession-specific ethical obligations. Application buy kamagra oral jelly online uk Requirements.

(a) Describe the LEAs with demonstrated need designated by the SEA to be served by the proposed project. SEA applicants must describe the LEAs with demonstrated need designated to benefit from the SBMH program. (b) Describe how the LEA, or each LEA in the proposed consortium (if applicable), meets the definition of an LEA with demonstrated buy kamagra oral jelly online uk need. To meet this requirement, an LEA applicant or the lead LEA submitting an application on behalf of a consortium must describe how the LEA or each LEA in the consortium meets the definition of an LEA with demonstrated need. (c) Describe the importance and magnitude of the problem.

Applicants must describe buy kamagra oral jelly online uk the lack of school-based mental health services providers and its effect on students in the LEA(s) to be served by the grant. This must include a description of the nature of the problem for the LEA(s), based on information, including, but not limited to, the most recent available ratios of school-based mental health services providers to students enrolled in the LEA(s), or for SEA applicants, the LEAs designated by the SEA to benefit from the SBMH program. These data must be provided in the aggregate and disaggregated by profession ( e.g., school social workers, school psychologists, school counselors) as compared to local, State, or national data. The description may also include LEA-level or school-level demographic data (including buy kamagra oral jelly online uk rates of poverty. Rates of chronic absenteeism.

The percentage of students involved in the juvenile justice system, experiencing homelessness, or in foster care. And discipline data), school climate surveys, school violence/crime data, data related to suicide rates, and descriptions of barriers buy kamagra oral jelly online uk to hiring and retaining credentialed school-based mental health services providers in the LEA. (d) Logic Model. The applicant must describe its approach to increase the number of credentialed school-based mental health services providers using a logic model (as defined in 34 CFR 77.1), including the key project components and relevant outcomes (as defined in 34 CFR 77.1). The description should indicate how the proposed approach taken under this program will improve or expand on any previous approaches, how buy kamagra oral jelly online uk the new approach will address barriers, and how the applicant will sustain the increased number of school-based mental health Start Printed Page 60140 services providers after the performance period has ended.

(e) Detailed project budget, including matching funds. To promote the sustainability of the school-based mental health services, all applicants must include non-Federal matching funds in the amount of at least 25 percent of their budgets. Budgets must describe how the applicant will meet the matching requirement for each budget period awarded under this grant and must indicate the source of the funds, such as State, local, buy kamagra oral jelly online uk or private resources. The Secretary may consider decreasing or waiving the matching requirement post award, on a case-by-case basis, if an applicant demonstrates a significant financial hardship. Budgets must also specify the portion of funds that will be used for respecialization, if applicable.

Administrative costs for SEA applicants may not exceed 10 percent of the annual grant award buy kamagra oral jelly online uk. This includes funding for State-level or LEA-level administrative costs that promote respecialization, if applicable. Administrative costs for applicants that are LEAs and consortia of LEAs may not exceed 5 percent of the annual grant award. (f) buy kamagra oral jelly online uk Number of providers. Applicants must include the most recent available data on the number of school-based mental health services providers in the identified LEA(s), disaggregated by profession ( e.g., school social workers, school psychologists, school counselors), and the projected number of school-based mental health services providers that will be placed into employment in the identified LEA(s) for each year of the plan using funds from this grant or matching funds.

If applicable, applicants should provide data on the current and projected unduplicated numbers of school-based mental health services providers disaggregated by profession ( e.g., school social workers, school psychologists, school counselors), offering telehealth services. (g) A plan for buy kamagra oral jelly online uk collaboration and coordination with related Federal, State, and local organizations, and school-based efforts. Applicants must propose a plan describing how they will collaborate and coordinate with related Federal, State, and local organizations, and school-based efforts ( e.g., professional associations. Colleges or universities, including Historically Black Colleges and Universities, Minority Serving Institutions, and Tribal Colleges and Universities. Local mental health buy kamagra oral jelly online uk.

Public health. Child welfare. Or other community agencies, including school-based health centers), to achieve plan goals and objectives of increasing the number of school-based mental health services buy kamagra oral jelly online uk providers in LEAs with demonstrated need. The plan must include a description of how such collaboration and coordination will promote program success across multiple programs. (h) Use of grant funds to supplement, and not supplant, existing school-based mental health services funds and to expand, not duplicate, efforts to increase the number of providers.

Applicants must buy kamagra oral jelly online uk describe how project funds will supplement, and not supplant, non-Federal funds that would otherwise be available for activities funded under this program. Applicants must describe how they will use the SBMH program funds to expand, rather than duplicate, existing or new efforts to increase the number of credentialed school-based mental health services providers in LEAs with demonstrated need and how they will integrate existing funding streams and efforts to support the plan. (i) Plan for prompt delivery of services to students. For SEA applicants, applicants buy kamagra oral jelly online uk must describe their plan to ensure the prompt delivery of services to students ( i.e., as soon as possible, but no later than 180 days from award), including via subgrants to LEAs, as appropriate. For LEA applicants and consortia of LEAs, applicants must describe their plan to ensure the prompt delivery of services to students ( i.e., as soon as possible, but no later than 180 days from award).

Additionally, SEA and LEA applicants must describe how leaders across all levels of the project will be engaged in the implementation and evaluation of the project. Definitions buy kamagra oral jelly online uk. The definitions of “credentialed,” “LEA with demonstrated need,” “recruitment,” “respecialization,” “retention,” and “telehealth” are from the notice of priorities, requirements, and definitions published elsewhere in this issue of the Federal Register. The following definitions are from 34 CFR 77.1. €œambitious,” “baseline,” buy kamagra oral jelly online uk “logic model,” “project component,” and “relevant outcome.” The following definitions are from 20 U.S.C.

7801. €œlocal educational agency”, “State educational agency.” The definition of “school-based mental health services provider” is from 20 U.S.C. 7112. These definitions apply to the FY 2022 School-Based Mental Health Services Grant competition and any subsequent year in which we make awards from the list of unfunded applications from this competition. Ambitious means promoting continued, meaningful improvement for program participants or for other individuals or entities affected by the grant, or representing a significant advancement in the field of education research, practices, or methodologies.

When used to describe a performance target, whether a performance target is ambitious depends upon the context of the relevant performance measure and the baseline for that measure. Baseline means the starting point from which performance is measured and targets are set. Credentialed means an individual who possesses a valid license or certificate from the SEA or relevant regulatory body as a school psychologist, school counselor, or a school social worker, or other mental health services provider, approved by the State to provide school-based mental health services. Local educational agency means a public board of education or other public authority legally constituted within a State for either administrative control or direction of, or to perform a service function for, public elementary schools or secondary schools in a city, county, township, school district, or other political subdivision of a State, or of or for a combination of school districts or counties that is recognized in a State as an administrative agency for its public elementary schools or secondary schools. (a) The term includes any other public institution or agency having administrative control and direction of a public elementary school or secondary school.

(b) The term includes an elementary or secondary school funded by the Bureau of Indian Education but only to the extent that including the school makes the school eligible for programs for which specific eligibility is not provided to the school in another provision of law and the school does not have a student population that is smaller than the student population of the LEA receiving assistance under the Elementary and Secondary Education Act of 1965, as amended (ESEA) with the smallest student population, except that the school shall not be subject to the jurisdiction of any SEA other than the Bureau of Indian Education. (c) The term includes educational service agencies and consortia of those agencies. (d) The term includes the SEA in a State in which the SEA is the sole educational agency for all public schools. LEA with demonstrated need means an LEA that has a significant need for Start Printed Page 60141 additional school-based mental health services providers based on— (1) High student to mental health services provider ratios as compared to other LEAs statewide or nationally. (2) High rates of community violence (including hate crimes), poverty, substance use (including opioid use), suicide, or trafficking.

Or (3) A significant number of students who are migratory, experiencing homelessness, have a family member deployed in the military or with a military-service connected disability (including veterans), have experienced a natural or man-made disaster or a traumatic event, or have other adverse childhood experiences, such as repeated disciplinary exclusions from the learning environment. Logic model (also referred to as a theory of action) means a framework that identifies key project components of the proposed project ( i.e., the active “ingredients” that are hypothesized to be critical to achieving the relevant outcomes) and describes the theoretical and operational relationships among the key project components and relevant outcomes. Project component means an activity, strategy, intervention, process, product, practice, or policy included in a project. Evidence may pertain to an individual project component or to a combination of project components ( e.g., training teachers on instructional practices for English learners and follow-on coaching for these teachers). Recruitment means strategies that help attract and hire credentialed school-based mental health services providers, including by doing at least one of the following.

(1) Providing an annual salary or stipend for school-based mental health services providers who maintain an active national certification. (2) Providing payment toward the school loans accrued by the school-based mental health services provider. (3) Creating pathways to grant cross-State credentialing reciprocity for school-based mental health services providers. (4) Providing incentives and supports to help mitigate shortages. These may include, for example, increasing pay.

Offering monetary incentives for relocation to high-need areas. Providing services via telehealth. Creating hybrid roles that allow for leadership, academic, or research opportunities. Developing induction programs. Developing paid internship programs.

Focusing on recruitment and support of underrepresented populations. And offering service scholarship programs such as those that provide grants in exchange for a commitment to serve in the LEA for a minimum number of years. Relevant outcome means the student outcome(s) or other outcome(s) the key project component is designed to improve, consistent with the specific goals of the program. Respecialization means strategies that provide opportunities for professional retraining and alternative pathways to obtain a state credential, aligned with the standards of the relevant professional organization, as a school-based mental health services provider for individuals who hold, at a minimum, a degree in a related field ( e.g., special education, clinical psychology, community counseling), including by doing one or more of the following. (1) Revising, updating, or streamlining requirements for such individuals so that additional training or other requirements focus only on training needed to obtain a credential as a school-based mental health services provider.

(2) Providing a stipend or making a payment to support the training needed to obtain a credential as a school-based mental health services provider. (3) Offering flexible options for completing training that leads such professionals to meet State credentialing requirements as a school-based mental health services provider. (4) Establishing a provisional, time limited, and nonrenewable credential to allow individuals seeking respecialization to provide school-based mental health services under the direct supervision of a fully credentialed school-based mental health services provider of the same profession. (5) Offering other meaningful activities that result in existing mental health services providers obtaining a state credential as a school-based mental health services provider. Retention means strategies to help ensure that credentialed individuals stay in their position to avoid gaps in service and unfilled positions, including by— (1) Providing opportunities for advancement or leadership, such as career pathways programs, recognition and award programs, and mentorship programs.

And (2) Offering incentives and supports to help mitigate shortages. These may include, for example, increasing pay. Making payments toward student loans. Offering monetary incentives for relocation to high-need areas. Providing services via telehealth.

Offering service scholarship programs, such as those that provide grants in exchange for a commitment to serve in the LEA for a minimum number of years. And developing paid internship programs. School-based mental health services provider means a State-licensed or State-certified school counselor, school psychologist, school social worker, or other State licensed or certified mental health professional qualified under State law to provide mental health services to children and adolescents. State educational agency means the agency primarily responsible for the State supervision of public elementary schools and secondary schools. Telehealth means the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration.

Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and landline and wireless communications. Program Authority:20 U.S.C. 7281. Note. Projects will be awarded and must be operated in a manner consistent with the nondiscrimination requirements contained in Federal civil rights laws.

Applicable Regulations. (a) The Education Department General Administrative Regulations in 34 CFR parts 75, 77, 79, 81, 82, 84, 97, 98, and 99. (b) The Office of Management and Budget Guidelines to Agencies on Governmentwide Debarment and Suspension (Nonprocurement) in 2 CFR part 180, as adopted and amended as regulations of the Department in 2 CFR part 3485. (c) The Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards in 2 CFR part 200, as adopted and amended as regulations of the Department in 2 CFR part 3474. (d) The notice of final priorities, requirements, and definitions published elsewhere in this issue of the Federal Register.

II. Award Information Type of Award. Discretionary grants. Estimated Available Funds. $143,900,000.

Contingent upon the availability of funds and the quality of applications, we may make additional awards in subsequent years from the list of unfunded applications from this competition. Estimated Range of Awards. $500,000 to 3,000,000. Estimated Average Size of Awards. $1,750,000.

Estimated Number of Awards. 50-150. Start Printed Page 60142 Note. The Department is not bound by any estimates in this notice. Project Period.

Up to 60 months. III. Eligibility Information 1. Eligible Applicants. SEAs, as defined in 20 U.S.C.

7801(49), or LEAs, as defined in 20 U.S.C. 7801(30), including consortia of LEAs. 2. Cost Sharing or Matching. A.

This program requires cost sharing or matching requirements. See “Application Requirements” in Section I. b. Indirect Cost Rate Information. This program uses an unrestricted indirect cost rate.

For more information regarding indirect costs, or to obtain a negotiated indirect cost rate, please see www2.ed.gov/​about/​offices/​list/​ocfo/​intro.html. c. Administrative Cost Limitation. This program involves administrative costs for SEAs, LEAs and consortia of LEAs. See “Application Requirements” in Section I.

3. Supplement-Not-Supplant. This program involves supplement-not-supplant funding requirements. See “Application Requirements” in Section I. 4.

Limitation on Awards. A. The Department will make only one award that serves any individual LEA. b. The Department will only make an award to LEAs that are not subgrantees of a current SBMH project.

5. Subgrantees. Under 34 CFR 75.708(b) and (c) an SEA grantee under this competition may award subgrants to directly carry out project activities described in its application to the following types of entities. LEAs. The SEA grantee may award subgrants to entities it has identified in an approved application or that it selects through a competition under procedures established by the grantees.

However, an SEA grantee is not required to award subgrants and may instead administer the program directly. IV. Application and Submission Information 1. Application Submission Instructions. Applicants are required to follow the Common Instructions for Applicants to Department of Education Discretionary Grant Programs, published in the Federal Register on December 27, 2021 (86 FR 73264) and available at www.federalregister.gov/​d/​2021-27979, which contain requirements and information on how to submit an application.

Please note that these Common Instructions supersede the version published on February 13, 2019, and, in part, describe the transition from the requirement to register in SAM.gov a DUNS number to the implementation of the UEI. More information on the phase-out of DUNS numbers is available at https://www2.ed.gov/​about/​offices/​list/​ofo/​docs/​unique-entity-identifier-transition-fact-sheet.pdf. 2. Intergovernmental Review. This competition is subject to Executive Order 12372 and the regulations in 34 CFR part 79.

However, under 34 CFR 79.8(a), we waive intergovernmental review in order to make awards by December 31, 2022. 3. Funding Restrictions. We reference regulations outlining funding restrictions in the Applicable Regulations section of this notice. In addition, we remind applicants that sections 4001(a) and 4001(b) of the ESEA (20 U.S.C.

7101) apply to this program. Section 4001(a) requires entities receiving funds under this program to obtain prior, written, informed consent from the parent of each child who is under 18 years of age to participate in any mental-health assessment or service that is funded under this program and conducted in connection with an elementary or secondary school. Section 4001(b) prohibits the use of funds for medical services or drug treatment or rehabilitation, except for integrated student supports, specialized instructional support services, or referral to treatment for impacted students, which may include students who are victims of, or witnesses to, crime or who illegally use drugs. This prohibition does not preclude the use of funds to support mental health counseling and support services, including those provided by a mental health services provider outside of school, so long as such services are not medical. 4.

Recommended Page Limit. The application narrative is where you, the applicant, address the selection criteria that reviewers use to evaluate your application. We recommend that you (1) limit the application narrative to no more than 25 pages and (2) use the following standards. A “page” is 8.5″ x 11″, on one side only, with 1″ margins at the top, bottom, and both sides. Double space (no more than three lines per vertical inch) all text in the application narrative, including titles, headings, footnotes, quotations, references, and captions, as well as all text in charts, tables, figures, and graphs.

Use a font that is either 12 point or larger or no smaller than 10 pitch (characters per inch). • Use one of the following fonts. Times New Roman, Courier, Courier New, or Arial. The recommended page limit does not apply to the cover sheet. The budget section, including the narrative budget justification.

The assurances and certifications. Or the one-page abstract, the resumes, the bibliography, or the letters of support. However, the recommended page limit does apply to all of the application narrative. V. Application Review Information 1.

Selection Criteria. The selection criteria for this program are from 34 CFR 75.210. The maximum score for all selection criteria is 100 points. The points assigned to each criterion are indicated in parentheses. Non-Federal peer reviewers will evaluate and score each application program narrative against the following selection criteria.

(a) Need for the Project (10 points). The Secretary considers the need for the proposed project. In determining the need for the proposed project, the Secretary considers the extent to which specific gaps or weaknesses in services, infrastructure, or opportunities have been identified and will be addressed by the proposed project, including the nature and magnitude of those gaps or weaknesses. (Up to 10 points) (b) Quality of Project Personnel (30 points). (1) The Secretary considers the quality of the personnel who will carry out the proposed project.

In determining the quality of project personnel, the Secretary considers the extent to which the applicant encourages applications for employment from persons who are members of groups that have traditionally been underrepresented based on race, color, national origin, gender, age, or disability. (Up to 10 points) (2) In addition, the Secretary considers. (i) The qualifications, including relevant training and experience, of key project personnel. (Up to 10 points) (ii) The qualifications, including relevant training and experience, of project consultants or subcontractors. (Up to 10 points) (c) Quality of Project Design and Project Services (35 points).

(1) The Secretary considers the quality of the design of the proposed project and the quality of the services to be provided by the proposed project. In determining the quality of the design of the proposed project, the Secretary considers the extent to which the goals, objectives, and outcomes to be achieved by the proposed project are clearly Start Printed Page 60143 specified and measurable. (Up to 10 points) (2) In determining the quality of the services to be provided by the proposed project, the Secretary considers the quality and sufficiency of strategies for ensuring equal access and treatment for eligible project participants who are members of groups that have traditionally been underrepresented based on race, color, national origin, gender, age, or disability. (Up to 10 points) (3) In addition, the Secretary considers the extent to which the training or professional development services to be provided by the proposed project are likely to alleviate the personnel shortages that have been identified or are the focus of the proposed project. (Up to 15 points) (d) Management Plan and Adequacy of Resources (25 points).

The Secretary considers the management plan and adequacy of resources for the proposed project. In determining the quality of the management plan and the adequacy of resources for the proposed project, the Secretary considers. (1) The adequacy of mechanisms for ensuring high-quality products and services from the proposed project. (Up to 10 points) (2) The relevance and demonstrated commitment of each partner in the proposed project to the implementation and success of the project. (Up to 5 points) (3) The potential for continued support of the project after Federal funding ends, including, as appropriate, the demonstrated commitment of appropriate entities to such support.

(Up to 5 points) (4) The adequacy of the procedures for ensuring feedback and continuous improvement in the operation of the proposed project. (Up to 5 points) 2. Review and Selection Process. We remind potential applicants that in reviewing applications in any discretionary grant competition, the Secretary may consider, under 34 CFR 75.217(d)(3), the past performance of the applicant in carrying out a previous award, such as the applicant's use of funds, achievement of project objectives, and compliance with grant conditions. The Secretary may also consider whether the applicant failed to submit a timely performance report or submitted a report of unacceptable quality.

In addition, in making a competitive grant award, the Secretary requires various assurances, including those applicable to Federal civil rights laws that prohibit discrimination in programs or activities receiving Federal financial assistance from the Department (34 CFR 100.4, 104.5, 106.4, 108.8, and 110.23). 3. Risk Assessment and Specific Conditions. Consistent with 2 CFR 200.206, before awarding grants under this program the Department conducts a review of the risks posed by applicants. Under 2 CFR 200.208, the Secretary may impose specific conditions and, under 2 CFR 3474.10, in appropriate circumstances, high-risk conditions on a grant if the applicant or grantee is not financially stable.

Has a history of unsatisfactory performance. Has a financial or other management system that does not meet the standards in 2 CFR part 200, subpart D. Has not fulfilled the conditions of a prior grant. Or is otherwise not responsible. 4.

Integrity and Performance System. If you are selected under this competition to receive an award that over the course of the project period may exceed the simplified acquisition threshold (currently $250,000), under 2 CFR 200.206(a)(2) we must make a judgment about your integrity, business ethics, and record of performance under Federal awards—that is, the risk posed by you as an applicant—before we make an award. In doing so, we must consider any information about you that is in the integrity and performance system (currently referred to as the Federal Awardee Performance and Integrity Information System (FAPIIS)), accessible through the System for Award Management. You may review and comment on any information about yourself that a Federal agency previously entered and that is currently in FAPIIS. Please note that, if the total value of your currently active grants, cooperative agreements, and procurement contracts from the Federal Government exceeds $10,000,000, the reporting requirements in 2 CFR part 200, Appendix XII, require you to report certain integrity information to FAPIIS semiannually.

Please review the requirements in 2 CFR part 200, Appendix XII, if this grant plus all the other Federal funds you receive exceed $10,000,000. 5. In General. In accordance with the Office of Management and Budget's guidance located at 2 CFR part 200, all applicable Federal laws, and relevant Executive guidance, the Department will review and consider applications for funding pursuant to this notice inviting applications in accordance with. (a) Selecting recipients most likely to be successful in delivering results based on the program objectives through an objective process of evaluating Federal award applications (2 CFR 200.205).

(b) Prohibiting the purchase of certain telecommunication and video surveillance services or equipment in alignment with section 889 of the National Defense Authorization Act of 2019 (Pub. L. 115-232) (2 CFR 200.216). (c) Providing a preference, to the extent permitted by law, to maximize use of goods, products, and materials produced in the United States (2 CFR 200.322). And (d) Terminating agreements in whole or in part to the greatest extent authorized by law if an award no longer effectuates the program goals or agency priorities (2 CFR 200.340).

VI. Award Administration Information 1. Award Notices. If your application is successful, we notify your U.S. Representative and U.S.

Senators and send you a Grant Award Notification (GAN). Or we may send you an email containing a link to access an electronic version of your GAN. We may notify you informally, also. If your application is not evaluated or not selected for funding, we notify you. 2.

Administrative and National Policy Requirements. We identify administrative and national policy requirements in the application package and reference these and other requirements in the Applicable Regulations section of this notice. We reference the regulations outlining the terms and conditions of an award in the Applicable Regulations section of this notice and include these and other specific conditions in the GAN. The GAN also incorporates your approved application as part of your binding commitments under the grant. 3.

Open Licensing Requirements. Unless an exception applies, if you are awarded a grant under this competition, you will be required to openly license to the public grant deliverables created in whole, or in part, with Department grant funds. When the deliverable consists of modifications to pre-existing works, the license extends only to those modifications that can be separately identified and only to the extent that open licensing is permitted under the terms of any licenses or other legal restrictions on the use of pre-existing works. Additionally, a grantee or subgrantee that is awarded competitive grant funds must have a plan to disseminate these public grant deliverables. This dissemination plan can be developed and submitted after your application has been reviewed and selected for funding.

For additional information on the open licensing requirements please refer to 2 CFR 3474.20. Start Printed Page 60144 4. Reporting. (a) If you apply for a grant under this competition, you must ensure that you have in place the necessary processes and systems to comply with the reporting requirements in 2 CFR part 170 should you receive funding under this competition. This does not apply if you have an exception under 2 CFR 170.110(b).

(b) At the end of your project period, you must submit a final performance report, including financial information, as directed by the Secretary. If you receive a multiyear award, you must submit an annual performance report that provides the most current performance and financial expenditure information as directed by the Secretary under 34 CFR 75.118. The Secretary may also require more frequent performance reports under 34 CFR 75.720(c). For specific requirements on reporting, please go to www.ed.gov/​fund/​grant/​apply/​appforms/​appforms.html. (c) Under 34 CFR 75.250(b), the Secretary may provide a grantee with additional funding for data collection analysis and reporting.

In this case the Secretary establishes a data collection period. 5. Performance Measures. For the purpose of Department reporting under 34 CFR 75.110, we have established the following performance measures for the School-Based Mental Health Services Grant Program. (a) The unduplicated, cumulative number of new school-based mental health services providers hired for each LEA with demonstrated need as a result of the grant.

(b) The unduplicated, cumulative number of school-based mental health services providers retained in LEAs with demonstrated need as a result of the grant. (c) The ratio of students to school-based mental health services providers for each LEA with demonstrated need served by the grant, and the numbers of school-based mental health services providers and students used to calculate the ratio. (d) The attrition rate of school-based mental health services providers for each LEA with a demonstrated need that is participating in the grant. (e) The total number of students who received school-based mental health services as a result of the grant. (f) For grantees that addressed competitive preference priority 2, the number of such grantees that met their goal of increasing the diversity of school-based mental health services providers.

These measures constitute the Department's indicators of success for this program. Consequently, we advise an applicant for a grant under this program to give careful consideration to these measures in conceptualizing the approach for its proposed project plan. Each grantee will be required to provide, in its annual performance and final reports, data about its progress in meeting these measures. These data will be considered by the Department in making potential continuation awards. Consistent with 34 CFR 75.591, grantees funded under this program must meet the requirements of any evaluation of the program conducted by the Department or an evaluator selected by the Department.

Performance measure targets. The applicant must propose annual targets for the measures listed above in their application. Applicants must also provide the following information as directed under 34 CFR 75.110(b) and (c). (1) An explanation of how each proposed performance target is ambitious (as defined in this notice) yet achievable compared to the baseline (as defined in this notice) for the performance measure. (2) An explanation of the data collection and reporting methods the applicant would use and why those methods are likely to yield reliable, valid, and meaningful performance data.

And (3) An explanation of the applicant's capacity to collect and report reliable, valid, and meaningful performance data, as evidenced by high-quality data collection, analysis, and reporting in other projects or research. Note. If the applicant does not have experience with collection and reporting of performance data through other projects or research, the applicant should provide other evidence of capacity to successfully carry out data collection and reporting for its proposed project. The reviewers of each application will score related selection criteria on the basis of how well an applicant has considered these measures in conceptualizing the approach and evaluation of the project. All grantees must submit an annual performance report and final performance report with information that is responsive to these performance measures.

6. Continuation Awards. In making a continuation award under 34 CFR 75.253, the Secretary considers, among other things, whether a grantee has made substantial progress in achieving the goals and objectives of the project. Whether the grantee has expended funds in a manner that is consistent with its approved application and budget. And, if the Secretary has established performance measurement requirements, the performance targets in the grantee's approved application.

In making a continuation award, the Secretary also considers whether the grantee is operating in compliance with the assurances in its approved application, including those applicable to Federal civil rights laws that prohibit discrimination in programs or activities receiving Federal financial assistance from the Department (34 CFR 100.4, 104.5, 106.4, 108.8, and 110.23). VII. Other Information Accessible Format. On request to the program contact person listed under FOR FURTHER INFORMATION CONTACT , individuals with disabilities can obtain this document and a copy of the application package in an accessible format. The Department will provide the requestor with an accessible format that may include Rich Text Format (RTF) or text format (txt), a thumb drive, an MP3 file, Braille, large print, audiotape, compact disc, or other accessible format.

Electronic Access to This Document. The official version of this document is the document published in the Federal Register. You may access the official edition of the Federal Register and the Code of Federal Regulations at www.govinfo.gov. At this site you can view this document, as well as all other documents of this Department published in the Federal Register , in text or Portable Document Format (PDF). To use PDF you must have Adobe Acrobat Reader, which is available free at the site.

You may also access documents of the Department published in the Federal Register by using the article search feature at www.federalregister.gov. Specifically, through the advanced search feature at this site, you can limit your search to documents published by the Department. Start Signature James F. Lane, Senior Advisor, Office of the Secretary, Delegated the Authority to Perform the Functions and Duties of the Assistant Secretary for the Office Elementary and Secondary Education. End Signature End Supplemental Information.

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Myall Lakes residents this article have been given their first look at the $100 million Stage 2 redevelopment of Manning kamagra jelly vs viagra Base Hospital with the master plan unveiled today.Minister for Regional Health Bronnie Taylor said Stage 2 builds on the $40 million upgrade completed as part of Stage 1 in mid-2020. "We know that more people are choosing kamagra jelly vs viagra to escape to the country from our big cities, and this is about delivering the health infrastructure that growing regions like Myall Lakes need," Mrs Taylor said. "This masterplan meets what the community expects and our health staff deserve, and today marks an important milestone in the delivery of a world-class hospital for the region." Health Minister Brad Hazzard said the redevelopment will ensure the health needs of the local community are met now and into the future.

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Myall Lakes residents have been given their first look at the $100 million Stage 2 redevelopment of Manning Base Hospital with the master plan unveiled today.Minister for Regional Health Bronnie Taylor said Stage 2 builds on the $40 million upgrade completed try here as part of buy kamagra oral jelly online uk Stage 1 in mid-2020. "We know that more people are choosing to escape to the country from our big cities, and this is about delivering the health infrastructure that growing regions like Myall Lakes need," Mrs Taylor said buy kamagra oral jelly online uk. "This masterplan meets what the community expects and our health staff deserve, and today marks an important milestone in the delivery of a world-class hospital for the region." Health Minister Brad Hazzard said the redevelopment will ensure the health needs of the local community are met now and into the future. "Stage 2 of the redevelopment will deliver upgraded inpatient beds and accommodation and modern facilities to support best practice models of care," Mr Hazzard said."These enhanced health facilities and services will strengthen the region's healthcare and provide positive social benefits in Taree and surrounding communities."Member for Myall Lakes Stephen Bromhead said work on site is expected to start once project planning is complete and statutory planning approvals have been achieved."It is vital that Myall Lakes residents have access to the best healthcare facilities and Stage 2 of the redevelopment will continue to buy kamagra oral jelly online uk ensure that," Mr Bromhead said.

"This follows the completion of the $40 million Stage 1 redevelopment, which improved renal and cancer services and provided a buy kamagra oral jelly online uk new medical imaging unit. A further $100 million for Stage 2 will deliver a first-class hospital to meet the growing needs of patients right across our community."The NSW Government has invested $140 million as part of Stages 1 and 2 of the Manning Base Hospital redevelopment.This next stage is part of the NSW Government's record $10.7 billion investment in health infrastructure to 2024, with nearly a third of the capital allocation in this financial year going towards regional and rural health facilities. The Manning Hospital Redevelopment is buy kamagra oral jelly online uk being delivered in partnership with Health Infrastructure and Hunter New England Local Health District. Along with the redevelopment of the Manning Hospital, other projects underway in this health district include:$835 million John Hunter Health and Innovation Precinct$500 million new Maitland Hospital$20 million for Glen Innes Hospital Redevelopment$45 million for Stage 3 of the Muswellbrook Hospital Redevelopment$80 million for Moree Hospital Redevelopment$53 million for Gunnedah Hospital Redevelopment..

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Start Preamble kamagra uk next day Centers for Medicare https://mission4water.org/memory-joyce-morgan/ &. Medicaid Services (CMS), Department of Health and Human Services (HHS). Notice. This notice announces the final Federal share (FS) disproportionate share hospital (DSH) allotments for Federal fiscal year (FY) 2018 and FY 2019, and the preliminary FS DSH allotments for FY 2020 and FY 2021.

This notice also announces the final FY 2018 and FY 2019 and the preliminary FY 2020 and FY 2021 limitations on aggregate DSH payments that States may make to institutions for mental disease and other mental health facilities. In addition, this notice includes background information describing the methodology for determining the amounts of States' FY DSH allotments. The allotments announced in this notice are effective April 15, 2022. The final allotments and limitations set forth in this notice are applicable for the fiscal years specified.

Start Further Info Stuart Goldstein, (410) 786-0694 and Richard Cuno, (410) 786-1111. End Further Info End Preamble Start Supplemental Information I. Background A. Fiscal Year DSH Allotments A State's Federal fiscal year (FY) disproportionate share hospital (DSH) allotment represents the aggregate limit on the Federal share (FS) amount of the State's DSH payments to DSH hospitals in the State for the FY.

The amount of such allotment is determined in accordance with the provisions of section 1923(f) of the Social Security Act (the Act), with some State-specific exceptions as specified in section 1923(f) of the Act. Under such provisions, in general, a State's FY DSH allotment is calculated by increasing the amount of its DSH allotment for the preceding FY by the percentage change in the Consumer Price Index for all Urban Consumers (CPI-U) for the previous FY. The Patient Protection and Affordable Care Act of 2010 (Pub. L.

111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152) (collectively, the Affordable Care Act), amended Medicaid DSH provisions, adding section 1923(f)(7) of the Act. Section 1923(f)(7) of the Act would have required reductions to States' FY DSH allotments from FY 2014 through FY 2020, the calculation of which was described in the Disproportionate Share Hospital Payment Reduction final rule published in the September 18, 2013 Federal Register (78 FR 57293).

Subsequent legislation, most recently the Consolidated Appropriations Act, 2021 (Pub. L. 116-260, enacted December 27, 2020), delayed the start of these reductions until FY 2024. The final rule delineating a revised methodology for the calculation of DSH allotment reductions beginning in 2020 (subsequently delayed by further statutory enactment) was published in the September 25, 2019 Federal Register (84 FR 50308).

Because there are no reductions to DSH allotments for FY 2018 through FY 2023 under section 1923(f)(7) of the Act, as amended, this notice contains only the State-specific final FY 2018 and FY 2019 DSH allotments and preliminary FY 2020 and FY 2021 DSH allotments, as calculated under the statute without application of the reductions that would have been imposed beginning as early as FY 2014 under prior versions of section 1923(f)(7) of the Act. This notice also provides information on the calculation of the FY DSH allotments, the calculation of the States' institution for mental diseases (IMD) DSH limits, and the amounts of States' final FY 2018 and FY 2019 IMD DSH limits and preliminary FY 2020 and FY 2021 IMD DSH limits. B. Determination of Fiscal Year DSH Allotments Generally, in accordance with the methodology specified under section 1923(f)(3) of the Act, a State's FY DSH allotment is calculated by increasing the amount of its DSH allotment for the preceding FY by the percentage change in the CPI-U for the previous FY.

Also, in accordance with section 1923(f)(3) of Start Printed Page 14859 the Act, a State's DSH allotment for a FY is subject to the limitation that an increase to a State's DSH allotment for a FY cannot result in the DSH allotment exceeding the greater of the State's DSH allotment for the previous FY or 12 percent of the State's total medical assistance expenditures for the allotment year (this is referred to as the 12 percent limit). Furthermore, under section 1923(h) of the Act, Federal financial participation (FFP) for DSH payments to IMDs and other mental health facilities is limited to State-specific aggregate amounts. Under this provision, the aggregate limit for DSH payments to IMDs and other mental health facilities is the lesser of a State's FY 1995 total computable (State and FS) IMD and other mental health facility DSH expenditures applicable to the State's FY 1995 DSH allotment (as reported on the Form CMS-64 as of January 1, 1997), or the amount equal to the product of the State's current year total computable DSH allotment and the applicable percentage specified in section 1923(h) of the Act. C.

Determination of Fiscal Year DSH Allotments for FY 2020 and FY 2021 The Families First erectile dysfunction Response Act's (FFCRA) (Pub. L. 116-127, enacted March 18, 2020) temporary Federal medical assistance percentage (FMAP) increase of 6.2 percentage points went into effect on January 1, 2020 for eligible States, as provided in section 6008 of the FFCRA. As relevant to this notice, this FMAP increase applies to eligible Medicaid expenditures including DSH payments for FY 2020 (with the exception of the 1st quarter, from October 1, 2019 through December 31, 2019), and FY 2021, and all States currently are receiving the temporary FFCRA FMAP increase.

For States that exhaust their entire DSH allotment, the FFCRA FMAP increase would effectively reduce the amount of total computable (TC) DSH payments that such States could pay to qualifying providers. To avoid this reduction in TC DSH allotments, section 9819 of the American Rescue Plan Act of 2021 (ARP) (Pub. L. 117-2, enacted March 11, 2021) added section 1923(f)(3)(F) of the Act, adjusting FS DSH allotments during periods when and for States where the temporary 6.2 percentage point FMAP increase under section 6008 of the FFCRA is in effect.

As directed by the ARP, we are required to recalculate FS DSH allotments to an amount that will allow States to make the same amount of TC DSH payments as they would have been otherwise able to make in the absence of the FFCRA FMAP increase. In accordance with section 1923(f)(3)(B) of the Act, a State's DSH allotment for a FY is subject to the limitation that an increase to a State's DSH allotment for a FY cannot result in the DSH allotment exceeding the greater of the State's DSH allotment for the previous FY or 12 percent of the State's total medical assistance expenditures for the allotment year. Because States incur medical assistance expenditures throughout the fiscal year, the calculations for the 12 percent limit under section 1923(f)(3)(B)(ii) of the Act were performed using a prorated FMAP for FY 2020. To arrive at the stated limits, we prorated each State's FY 2020 FMAP rate because the temporary 6.2 percentage point FMAP increase under section 6008 of the FFCRA does not apply to the 1st quarter of FY 2020.

For the calculation of the 12 percent limit for FY 2021, we used the FFCRA FMAP rate (that is, the otherwise applicable FMAP rate plus the temporary 6.2 percentage point FFCRA FMAP increase), because the FFCRA FMAP rate applies to the entire FY for qualifying States, and medical assistance expenditures are made throughout the year. Section 1923(f)(3)(F)(i) of the Act requires us to recalculate the annual DSH allotment, including the DSH allotment specified under paragraph (6)(A)(vi), to ensure that the total DSH payments (including both Federal and State shares) that a State may make related to a fiscal year is equal to the total DSH payments that the State could have made for such fiscal year without such FMAP increase. To meet the statutory requirement to enable States to make the same amount of TC DSH payments as if the FFCRA FMAP increase were not in effect, we have used the full (non-prorated) FFCRA-increased FMAP rate in the calculation of the increased FY 2020 and FY 2021 FS DSH allotments. We used the full FFCRA-increased FMAP rate rather than a prorated FMAP rate for the FY 2020 calculation, despite it not being applicable to the 1st quarter of FY 2020, to ensure this provision applies to all States consistent with the statutory requirement, including a State that made all DSH payments for FY 2020 in quarters other than the first fiscal quarter of that fiscal year.

While States have distinct payment methodologies that specify when DSH payments are made to providers, States may not claim TC DSH payments in excess of the amount they would have otherwise been able to claim without the application of the temporary 6.2 percentage point FFCRA FMAP rate increase. This is regardless of whether a portion of unspent FS DSH allotment as adjusted to account for section 1923(f)(3)(F) of the Act, as added by section 9819 of the ARP, remains. For example, if the State made all DSH payments for FY 2020 during the first quarter of that FY, then no increase to the State's DSH allotment is available for that year, since the temporary 6.2 percentage point FMAP increase under section 6008 of the FFCRA was not available for that quarter and section 1923(f)(3)(F) therefore has no effect. We will monitor both the FS and TC DSH allotments to ensure that States do not exceed statutory authority to claim DSH payments.

Consistent with previous guidance by CMS during the public health emergency, States should follow existing Federal requirements regarding the applicability of a particular match rate available for a given quarter, including reporting prior period adjustments. For calculation of the FY 2020 and FY 2021 IMD limits determined under section 1923(h) of the Act, we used the ARP-adjusted DSH allotments and the associated non-prorated FFCRA-increased FMAP rates for FY 2020 and FY 2021, to reflect the maximum DSH allotment amount and IMD limit that might be available to a State, for FY 2020, depending on the State's timing of DSH payments. In general, we determine States' DSH allotments for a FY and the IMD DSH limits for the same FY using the most recent available estimates of or actual medical assistance expenditures, including DSH expenditures and the most recent available CPI-U data for the FY in accordance with the methodology prescribed in the statute. The indicated estimated or actual expenditures are obtained from States for each relevant FY from the most recent available quarterly Medicaid budget reports (Form CMS-37) or quarterly Medicaid expenditure reports (Form CMS-64), respectively, submitted by the States.

For example, as part of the initial determination of a State's FY DSH allotment (referred to as the preliminary DSH allotments) that is determined before the beginning of the FY for which the DSH allotments and IMD DSH limits are being determined, we use estimated expenditures for the FY obtained from the August submission of the CMS-37 submitted by States prior to the beginning of the FY. Such estimated expenditures are subject to update and revision during the FY before actual expenditure data become available. We also use the most recent available estimated CPI-U percentage change that Start Printed Page 14860 is available before the beginning of the FY for determining the States' preliminary FY DSH allotments. Such estimated CPI-U percentage change is subject to update and revision during the FY before the actual CPI-U percentage change becomes available.

In determining the final DSH allotments and IMD DSH limits for a FY we use the actual expenditures for the FY and actual CPI-U percentage change for the previous FY. II. Provisions of the Notice A. Calculation of the Final FY 2018 and FY 2019 FS State DSH Allotments and the Preliminary FY 2020 and FY 2021 FS State DSH Allotments 1.

Final FY 2018 FS State DSH Allotments Addendum 1 to this notice provides the States' final FY 2018 DSH allotments determined in accordance with section 1923(f)(3) of the Act. As described in the background section, in general, the DSH allotment for a FY is calculated by increasing the FY DSH allotment for the preceding FY by the CPI-U increase for the previous fiscal year. For purposes of calculating the States' final FY 2018 DSH allotments, the preceding final fiscal year DSH allotments (for FY 2017) were published in the February 11, 2019 Federal Register (84 FR 3169). For purposes of calculating the States' final FY 2018 DSH allotments we are using the actual Medicaid expenditures for FY 2018.

Finally, for purposes of calculating the States' final FY 2018 DSH allotments, the applicable historical percentage change in the CPI-U for the previous FY (FY 2017) was 2.1 percent. We note that this is lower than the estimated 2.4 percentage change in the CPI-U for FY 2017 that was available and used in the calculation of the preliminary FY 2018 DSH allotments which were published in the July 6, 2018 Federal Register (83 FR 31536). 2. Final FY 2019 FS State DSH Allotments Addendum 2 to this notice provides the States' final FY 2019 DSH allotments determined in accordance with section 1923(f)(3) of the Act.

As described in the background section, in general, the DSH allotment for a FY is calculated by increasing the FY DSH allotment for the preceding FY by the CPI-U increase for the previous fiscal year. For purposes of calculating the States' final FY 2019 DSH allotments, the preceding final fiscal year DSH allotments (for FY 2018) are being published in this notice. For purposes of calculating the States' final FY 2019 DSH allotments we are using the actual Medicaid expenditures for FY 2019. Finally, for purposes of calculating the States' final FY 2019 DSH allotments, the applicable historical percentage change in the CPI-U for the previous FY (FY 2018) was 2.4 percent.

We note that this is the same as the estimated 2.4 percentage change in the CPI-U for FY 2018 that was available and used in the calculation of the preliminary FY 2019 DSH allotments which were published in the February 11, 2019 Federal Register (84 FR 3169). 3. Calculation of the Preliminary FY 2020 FS State DSH Allotments Addendum 3 to this notice provides the preliminary FY 2020 DSH allotments determined in accordance with section 1923(f)(3) of the Act. The preliminary FY 2020 DSH allotments contained in this notice were determined based on the most recent available estimates from States of their FY 2020 total computable Medicaid expenditures and by increasing the preliminary FY 2019 DSH allotments.

The applicable historical percentage change in the CPI-U for FY 2019 was 1.9 percent (we originally published the preliminary FY 2019 DSH allotments in the February 11, 2019 Federal Register (84 FR 3169)). We then used each State's FS DSH allotment divided by its respective regular FMAP rate in order to determine the TC amount of DSH payments each State would have otherwise been able to make without application of the FFCRA-increased FMAP rate. We then multiplied each State's TC DSH payment amount by its respective FFCRA-increased FMAP rate in order to calculate the increased FY 2020 DSH allotment. We will publish States' final FY 2020 DSH allotments in a future notice based on the States' four quarterly Medicaid expenditure reports (Form CMS-64) for FY 2020 available following the end of FY 2020 utilizing the actual change in the CPI-U for FY 2019.

4. Calculation of the Preliminary FY 2021 FS State DSH Allotments Addendum 4 to this notice provides the preliminary FY 2021 DSH allotments determined in accordance with section 1923(f)(3) of the Act. The preliminary FY 2021 DSH allotments contained in this notice were determined based on the most recent available estimates from States of their FY 2021 total computable Medicaid expenditures and by increasing the preliminary FY 2020 DSH allotments calculated prior to the application of the ARP adjustment. The applicable historical percentage change in the CPI-U for FY 2020 was 1.5 percent (we are publishing the preliminary FY 2020 DSH allotments in this notice).

We then used each State's FS DSH allotment divided by its respective regular FMAP rate in order to determine the TC amount of DSH payments each State would have otherwise been able to make without application of the FFCRA-increased FMAP rate. We then multiplied each State's TC DSH payment amount by its respective FFCRA-increased FMAP rate in order to calculate the ARP-adjusted FY 2021 DSH allotment. We will publish States' final FY 2021 DSH allotments in a future notice based on the States' four quarterly Medicaid expenditure reports (Form CMS-64) for FY 2021 available following the end of FY 2021. B.

Calculation of the Final FY 2018 and FY 2019 and Preliminary FY 2020 and FY 2021 IMD DSH Limits Section 1923(h) of the Act specifies the methodology to be used to establish the limits on the amount of DSH payments that a State can make to IMDs and other mental health facilities. FFP is not available for DSH payments to IMDs or other mental health facilities that exceed the IMD DSH limits. In this notice, we are publishing the final FY 2018 and FY 2019 and the preliminary FY 2020 and FY 2021 IMD DSH limits determined in accordance with the provisions discussed above. Addendums 5 through 8 to this notice detail each State's final FY 2018 and FY 2019 and preliminary FY 2020 and FY 2021 IMD DSH limits, respectively, determined in accordance with section 1923(h) of the Act.

III. Collection of Information Requirements As it important site relates to the Paperwork Reduction Act of 1995 (PRA. 44 U.S.C. 3501 et seq.

), this notice does not impose any new or revised “collection of information” requirements or burden. With respect to the PRA and this section of the preamble, collection of information is defined under 5 CFR 1320.3(c) of the PRA's implementing regulations. While discussed in sections I.B., I.C., II.A.3., II.A.4., and in Addendums 3 through 8 of this notice, the requirements and burden associated with form CMS-37 and form CMS-64 are unaffected by this notice. Both forms are approved by the Office of Management and Budget (OMB) under control number 0938-1265, which expires on April 30, 2024.

Since this notice will not impose any new or revised collection of information requirements/burden, we are not Start Printed Page 14861 making any changes under that control number. IV. Regulatory Impact Analysis We have examined the impact of this notice as required by Executive Order 12866 on Regulatory Planning and Review (September 1993), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L.

96-354), section 1102(b) of the Act, section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4. Enacted on March 22, 1995) (UMRA `95), Executive Order 13132 on Federalism (August 4, 1999) and the Congressional Review Act (5 U.S.C.

804(2)). Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). This notice reaches the $100 million economic threshold and thus has been designated a major rule under the Congressional Review Act by the Office of Information and Regulatory Affairs.

The final FY 2018 DSH allotments being published in this notice are $36 million less than the preliminary FY 2018 DSH allotments published in the July 6, 2018 Federal Register (83 FR 31536). This is due to the actual percentage change in the CPI-U for FY 2017 used in the calculation of the final FY 2018 allotments (2.1 percent) being less than the estimated percentage change in the CPI-U for FY 2017 used in the calculation of the preliminary FY 2018 allotments (2.4 percent). The final FY 2018 IMD DSH limits being published in this notice are $2.4 million less than the preliminary FY 2018 IMD DSH limits published in the July 6, 2018 Federal Register (83 FR 31536). Since the final FY 2018 DSH allotments were less than the preliminary FY 2018 DSH allotments, the associated FY 2018 IMD DSH limits also decreased.

The final FY 2019 DSH allotments being published in this notice are $36 million less than the preliminary FY 2019 DSH allotments published in the February 11, 2019 Federal Register (84 FR 3169). The decrease in the final FY 2019 DSH allotments is a result of being calculated by multiplying the actual increase in the CPI-U for 2018 by the final FY 2018 DSH allotments, while the preliminary FY 2019 DSH allotments were calculated by multiplying the estimated CPI-U for 2018 by the preliminary FY 2018 DSH allotments. Although the estimated and actual increase in the CPI-U remained the same at 2.4 percent, the preliminary FY 2018 DSH allotments were higher than the final FY 2018 DSH allotments and therefore the final FY 2019 DSH allotments are lower than the preliminary FY 2019 DSH allotments. The final FY 2019 IMD DSH limits being published in this notice are approximately $2 million lower than the preliminary FY 2019 IMD DSH limits published in the February 11, 2019 Federal Register (84 FR 3169).

The decreases in the IMD DSH limits are because the DSH allotment for a FY is a factor in the determination of the IMD DSH limit for the FY. Since the final FY 2019 DSH allotments were decreased as compared to the preliminary FY 2019 DSH allotments, the associated FY 2019 IMD DSH limits for some States were also decreased. This is a result of statutory provision, discussed above, that the aggregate limit for DSH payments to IMDs and other mental health facilities is the lesser of a State's FY 1995 total computable IMD and other mental health facility DSH expenditures applicable to the State's FY 1995 DSH allotment or the amount equal to the product of the State's current year total computable DSH allotment and the applicable percentage specified in section 1923(h) of the Act. As a result of the final FY 2019 DSH allotments decreasing from the preliminary FY 2019 DSH allotments, States that had applicable percentages of their current year's total computable DSH allotments lower than FY 1995 total computable IMD and other mental health facility DSH expenditures had their IMD limits decreased as a result.

The preliminary FY 2020 DSH allotments being published in this notice have been increased by approximately $1.6 billion more than the preliminary FY 2019 DSH allotments published in the February 11, 2019 Federal Register (84 FR 3169). The increase in the DSH allotments is due to the application of the statutory formula for calculating DSH allotments under which the prior fiscal year allotments are increased by the percentage increase in the CPI-U for the prior fiscal year, and to the ARP adjustment, as discussed in more detail in the next paragraph. The preliminary FY 2020 IMD DSH limits being published in this notice are approximately $246 million more than the preliminary FY 2019 IMD DSH limits published in the February 11, 2019 Federal Register (84 FR 3169). The increases in the IMD DSH limits are because the DSH allotment for a FY is a factor in the determination of the IMD DSH limit for the FY.

Since the preliminary FY 2020 DSH allotments are greater than the preliminary FY 2019 DSH allotments, the associated preliminary FY 2020 IMD DSH limits for some States also increased. The preliminary FY 2020 DSH allotments (before application of the ARP adjustment) being published in this in this notice are approximately $238 million more than the final FY 2019 DSH allotments being published in this notice. This increase is attributable to the application of the statutory formula for calculating DSH allotments under which the prior fiscal year allotments are increased by the percentage increase in the CPI-U for the prior fiscal year. The applicable historical percentage change in the CPI-U for FY 2019 was 1.9 percent.

The preliminary FY 2020 DSH allotments were further increased by approximately $1.4 billion in order to comply with the statutory provisions of the ARP requiring us to recalculate FS DSH allotments to an amount that will allow States to make the same amount of TC DSH payments as they would have been otherwise able to make in the absence of the FFCRA FMAP increase. The preliminary FY 2021 DSH allotments (before application of the ARP adjustment) being published in this notice are approximately $192 million more than the preliminary FY 2020 DSH allotments published in this notice. The increase in the DSH allotments is due to the application of the statutory formula for calculating DSH allotments under which the prior fiscal year allotments are increased by the percentage increase in the CPI-U for the prior fiscal year. The applicable historical percentage change in the CPI-U for FY 2020 was 1.5 percent.

The preliminary FY 2020 DSH allotments were increased by approximately $1.4 billion in order to comply with the statutory provisions of the ARP requiring us to recalculate FS DSH allotments to an amount that will allow States to make the same amount of TC DSH payments as they would have been otherwise able to make in the absence of the FFCRA FMAP increase. The preliminary FY 2021 DSH allotments were further increased by approximately $1.4 billion in order to comply with the statutory provisions of the ARP requiring us to recalculate FS DSH allotments to an amount that will allow States to make the same amount of TC DSH payments as they would have been otherwise able to make in the absence of the FFCRA FMAP increase. Start Printed Page 14862 The preliminary FY 2021 IMD DSH limits being published in this notice are approximately $16 million more than the preliminary FY 2020 IMD DSH limits published in this notice. The increases in the IMD DSH limits are because the DSH allotment for a FY is a factor in the determination of the IMD DSH limit for the FY.

Since the preliminary FY 2021 DSH allotments are greater than the preliminary FY 2020 DSH allotments, the associated preliminary FY 2021 IMD DSH limits for some States also increased. The RFA requires agencies to analyze options for regulatory relief of small businesses, if a rule has a significant impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of less than $8.0 million to $41.5 million in any one year.

Individuals and States are not included in the definition of a small entity. We are not preparing an analysis for the RFA because the Secretary has determined that this notice will not have significant economic impact on a substantial number of small entities. Specifically, any impact on providers is due to the effect of the various controlling statutes. Providers are not impacted as a result of the independent regulatory action in publishing this notice.

The purpose of the notice is to announce the latest DSH allotments and IMD DSH limits, as required by the statute. In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Core-Based Statistical Area for Medicaid payment regulations and has fewer than 100 beds.

We are not preparing analysis for section 1102(b) of the Act because the Secretary has determined that this notice will not have a significant impact on the operations of a substantial number of small rural hospitals. The Medicaid statute specifies the methodology for determining the amounts of States' DSH allotments and IMD DSH limits. And as described previously, the application of the methodology specified in statute results in the decreases or increases in States' DSH allotments and IMD DSH limits for the applicable FYs. The statute applicable to these allotments and limits does not apply to the determination of the amounts of DSH payments made to specific DSH hospitals.

Rather, these allotments and limits represent an overall limit on the total of such DSH payments. For this reason, we do not believe that this notice will have a significant economic impact on a substantial number of small entities. Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. In 2021, that threshold is approximately $158 million.

This notice will have no consequential effect on spending by State, local, or tribal governments, in the aggregate, or on the private sector. Executive Order 13132 establishes certain requirements that an agency must meet when it issues a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. Since this notice does not impose any costs on State or local governments or otherwise have Federalism implications, the requirements of E.O. 13132 are not applicable.

A. Alternatives Considered Because the FFCRA temporary FMAP increase of 6.2 percentage points was not applicable to the 1st quarter of FY 2020, we considered utilizing prorated FMAP rates in the calculation of the ARP-adjusted FY 2020 DSH allotments. However, this could have been contrary to the statutory language at section 1923(f)(3)(F) of the Act requiring us to recalculate FS DSH allotments to an amount to allow for States to make the same amount of TC DSH payments as they would have been otherwise able to make in the absence of the FFCRA FMAP increase, depending on States' timing of their DSH payments to eligible providers. The methodologies for determining the States' fiscal year DSH allotments and IMD DSH limits, as reflected in this notice, were established in accordance with the methodologies and formula for determining States' allotments and limits as specified in statute.

This notice does not put forward any further discretionary administrative policies for determining such allotments and limits, or otherwise. B. Accounting Statement As required by OMB Circular A-4 (available at https://obamawhitehouse.archives.gov/​omb/​circulars_​a004_​a-4/​ ), in Tables 1 and 2, we have prepared an accounting statement showing the classification of the estimated expenditures associated with the provisions of this notice. Table 1 provides our best estimate of the change (decrease) in the FS of States' Medicaid DSH payments resulting from the application of the provisions of the Medicaid statute relating to the calculation of States' FY DSH allotments and the increase in the FY DSH allotments from FY 2019 to FY 2020.

Table 2 provides our best estimate of the change (decrease) in the FS of States' Medicaid DSH payments resulting from the application of the provisions of the Medicaid statute relating to the calculation of States' FY DSH allotments and the increase in the FY DSH allotments from FY 2020 to FY 2021. Table 1—Accounting Statement. Classification of Estimated Expenditures, From the FY 2019 to FY 2020[In millions]CategoryTransfersAnnualized Monetized Transfers$238.From Whom To Whom?. Federal Government to States.

Table 2—Accounting Statement. Classification of Estimated Expenditures, From the FY 2020 to FY 2021[In millions]CategoryTransfersAnnualized Monetized Transfers$192.From Whom To Whom?. Federal Government to States. C.

Congressional Review Act This document is subject to the Congressional Review Act provisions of the Small Business Regulatory Enforcement Fairness Act of 1996 (5 U.S.C. 801 et seq. ) and has been transmitted to the Congress and the Comptroller General for review. Start Printed Page 14863 In accordance with the provisions of Executive Order 12866, this notice was reviewed by the Office of Management and Budget.

Chiquita Brooks-LaSure, Administrator of the Centers for Medicare &. Medicaid Services, approved this document on February 1, 2022. Start Signature Dated. March 9, 2022.

Xavier Becerra, Secretary, Department of Health and Human Services. End Signature Start Printed Page 14864 Start Printed Page 14865 Start Printed Page 14866 Start Printed Page 14867 Start Printed Page 14868 Start Printed Page 14869 Start Printed Page 14870 Start Printed Page 14871 Start Printed Page 14872 Start Printed Page 14873 Start Printed Page 14874 Start Printed Page 14875 Start Printed Page 14876 Start Printed Page 14877 Start Printed Page 14878 Start Printed Page 14879 Start Printed Page 14880 Start Printed Page 14881 Start Printed Page 14882 Start Printed Page 14883 Start Printed Page 14884 Start Printed Page 14885 Start Printed Page 14886 Start Printed Page 14887 Start Printed Page 14888 End Supplemental Information.

Start Preamble Centers for buy kamagra oral jelly online uk Medicare &. Medicaid Services (CMS), Department of Health and Human Services (HHS). Notice. This notice announces the final Federal share (FS) disproportionate share hospital (DSH) allotments for Federal fiscal year (FY) 2018 and FY 2019, and the preliminary FS DSH allotments for FY 2020 and FY 2021. This notice also announces the final FY 2018 and FY 2019 and the preliminary FY 2020 and FY 2021 limitations on aggregate DSH payments that States may make to institutions for mental disease and other mental health facilities.

In addition, this notice includes background information describing the methodology for determining the amounts of States' FY DSH allotments. The allotments announced in this notice are effective April 15, 2022. The final allotments and limitations set forth in this notice are applicable for the fiscal years specified. Start Further Info Stuart Goldstein, (410) 786-0694 and Richard Cuno, (410) 786-1111. End Further Info End Preamble Start Supplemental Information I.

Background A. Fiscal Year DSH Allotments A State's Federal fiscal year (FY) disproportionate share hospital (DSH) allotment represents the aggregate limit on the Federal share (FS) amount of the State's DSH payments to DSH hospitals in the State for the FY. The amount of such allotment is determined in accordance with the provisions of section 1923(f) of the Social Security Act (the Act), with some State-specific exceptions as specified in section 1923(f) of the Act. Under such provisions, in general, a State's FY DSH allotment is calculated by increasing the amount of its DSH allotment for the preceding FY by the percentage change in the Consumer Price Index for all Urban Consumers (CPI-U) for the previous FY. The Patient Protection and Affordable Care Act of 2010 (Pub.

L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152) (collectively, the Affordable Care Act), amended Medicaid DSH provisions, adding section 1923(f)(7) of the Act. Section 1923(f)(7) of the Act would have required reductions to States' FY DSH allotments from FY 2014 through FY 2020, the calculation of which was described in the Disproportionate Share Hospital Payment Reduction final rule published in the September 18, 2013 Federal Register (78 FR 57293).

Subsequent legislation, most recently the Consolidated Appropriations Act, 2021 (Pub. L. 116-260, enacted December 27, 2020), delayed the start of these reductions until FY 2024. The final rule delineating a revised methodology for the calculation of DSH allotment reductions beginning in 2020 (subsequently delayed by further statutory enactment) was published in the September 25, 2019 Federal Register (84 FR 50308). Because there are no reductions to DSH allotments for FY 2018 through FY 2023 under section 1923(f)(7) of the Act, as amended, this notice contains only the State-specific final FY 2018 and FY 2019 DSH allotments and preliminary FY 2020 and FY 2021 DSH allotments, as calculated under the statute without application of the reductions that would have been imposed beginning as early as FY 2014 under prior versions of section 1923(f)(7) of the Act.

This notice also provides information on the calculation of the FY DSH allotments, the calculation of the States' institution for mental diseases (IMD) DSH limits, and the amounts of States' final FY 2018 and FY 2019 IMD DSH limits and preliminary FY 2020 and FY 2021 IMD DSH limits. B. Determination of Fiscal Year DSH Allotments Generally, in accordance with the methodology specified under section 1923(f)(3) of the Act, a State's FY DSH allotment is calculated by increasing the amount of its DSH allotment for the preceding FY by the percentage change in the CPI-U for the previous FY. Also, in accordance with section 1923(f)(3) of Start Printed Page 14859 the Act, a State's DSH allotment for a FY is subject to the limitation that an increase to a State's DSH allotment for a FY cannot result in the DSH allotment exceeding the greater of the State's DSH allotment for the previous FY or 12 percent of the State's total medical assistance expenditures for the allotment year (this is referred to as the 12 percent limit). Furthermore, under section 1923(h) of the Act, Federal financial participation (FFP) for DSH payments to IMDs and other mental health facilities is limited to State-specific aggregate amounts.

Under this provision, the aggregate limit for DSH payments to IMDs and other mental health facilities is the lesser of a State's FY 1995 total computable (State and FS) IMD and other mental health facility DSH expenditures applicable to the State's FY 1995 DSH allotment (as reported on the Form CMS-64 as of January 1, 1997), or the amount equal to the product of the State's current year total computable DSH allotment and the applicable percentage specified in section 1923(h) of the Act. C. Determination of Fiscal Year DSH Allotments for FY 2020 and FY 2021 The Families First erectile dysfunction Response Act's (FFCRA) (Pub. L. 116-127, enacted March 18, 2020) temporary Federal medical assistance percentage (FMAP) increase of 6.2 percentage points went into effect on January 1, 2020 for eligible States, as provided in section 6008 of the FFCRA.

As relevant to this notice, this FMAP increase applies to eligible Medicaid expenditures including DSH payments for FY 2020 (with the exception of the 1st quarter, from October 1, 2019 through December 31, 2019), and FY 2021, and all States currently are receiving the temporary FFCRA FMAP increase. For States that exhaust their entire DSH allotment, the FFCRA FMAP increase would effectively reduce the amount of total computable (TC) DSH payments that such States could pay to qualifying providers. To avoid this reduction in TC DSH allotments, section 9819 of the American Rescue Plan Act of 2021 (ARP) (Pub. L. 117-2, enacted March 11, 2021) added section 1923(f)(3)(F) of the Act, adjusting FS DSH allotments during periods when and for States where the temporary 6.2 percentage point FMAP increase under section 6008 of the FFCRA is in effect.

As directed by the ARP, we are required to recalculate FS DSH allotments to an amount that will allow States to make the same amount of TC DSH payments as they would have been otherwise able to make in the absence of the FFCRA FMAP increase. In accordance with section 1923(f)(3)(B) of the Act, a State's DSH allotment for a FY is subject to the limitation that an increase to a State's DSH allotment for a FY cannot result in the DSH allotment exceeding the greater of the State's DSH allotment for the previous FY or 12 percent of the State's total medical assistance expenditures for the allotment year. Because States incur medical assistance expenditures throughout the fiscal year, the calculations for the 12 percent limit under section 1923(f)(3)(B)(ii) of the Act were performed using a prorated FMAP for FY 2020. To arrive at the stated limits, we prorated each State's FY 2020 FMAP rate because the temporary 6.2 percentage point FMAP increase under section 6008 of the FFCRA does not apply to the 1st quarter of FY 2020. For the calculation of the 12 percent limit for FY 2021, we used the FFCRA FMAP rate (that is, the otherwise applicable FMAP rate plus the temporary 6.2 percentage point FFCRA FMAP increase), because the FFCRA FMAP rate applies to the entire FY for qualifying States, and medical assistance expenditures are made throughout the year.

Section 1923(f)(3)(F)(i) of the Act requires us to recalculate the annual DSH allotment, including the DSH allotment specified under paragraph (6)(A)(vi), to ensure that the total DSH payments (including both Federal and State shares) that a State may make related to a fiscal year is equal to the total DSH payments that the State could have made for such fiscal year without such FMAP increase. To meet the statutory requirement to enable States to make the same amount of TC DSH payments as if the FFCRA FMAP increase were not in effect, we have used the full (non-prorated) FFCRA-increased FMAP rate in the calculation of the increased FY 2020 and FY 2021 FS DSH allotments. We used the full FFCRA-increased FMAP rate rather than a prorated FMAP rate for the FY 2020 calculation, despite it not being applicable to the 1st quarter of FY 2020, to ensure this provision applies to all States consistent with the statutory requirement, including a State that made all DSH payments for FY 2020 in quarters other than the first fiscal quarter of that fiscal year. While States have distinct payment methodologies that specify when DSH payments are made to providers, States may not claim TC DSH payments in excess of the amount they would have otherwise been able to claim without the application of the temporary 6.2 percentage point FFCRA FMAP rate increase. This is regardless of whether a portion of unspent FS DSH allotment as adjusted to account for section 1923(f)(3)(F) of the Act, as added by section 9819 of the ARP, remains.

For example, if the State made all DSH payments for FY 2020 during the first quarter of that FY, then no increase to the State's DSH allotment is available for that year, since the temporary 6.2 percentage point FMAP increase under section 6008 of the FFCRA was not available for that quarter and section 1923(f)(3)(F) therefore has no effect. We will monitor both the FS and TC DSH allotments to ensure that States do not exceed statutory authority to claim DSH payments. Consistent with previous guidance by CMS during the public health emergency, States should follow existing Federal requirements regarding the applicability of a particular match rate available for a given quarter, including reporting prior period adjustments. For calculation of the FY 2020 and FY 2021 IMD limits determined under section 1923(h) of the Act, we used the ARP-adjusted DSH allotments and the associated non-prorated FFCRA-increased FMAP rates for FY 2020 and FY 2021, to reflect the maximum DSH allotment amount and IMD limit that might be available to a State, for FY 2020, depending on the State's timing of DSH payments. In general, we determine States' DSH allotments for a FY and the IMD DSH limits for the same FY using the most recent available estimates of or actual medical assistance expenditures, including DSH expenditures and the most recent available CPI-U data for the FY in accordance with the methodology prescribed in the statute.

The indicated estimated or actual expenditures are obtained from States for each relevant FY from the most recent available quarterly Medicaid budget reports (Form CMS-37) or quarterly Medicaid expenditure reports (Form CMS-64), respectively, submitted by the States. For example, as part of the initial determination of a State's FY DSH allotment (referred to as the preliminary DSH allotments) that is determined before the beginning of the FY for which the DSH allotments and IMD DSH limits are being determined, we use estimated expenditures for the FY obtained from the August submission of the CMS-37 submitted by States prior to the beginning of the FY. Such estimated expenditures are subject to update and revision during the FY before actual expenditure data become available. We also use the most recent available estimated CPI-U percentage change that Start Printed Page 14860 is available before the beginning of the FY for determining the States' preliminary FY DSH allotments. Such estimated CPI-U percentage change is subject to update and revision during the FY before the actual CPI-U percentage change becomes available.

In determining the final DSH allotments and IMD DSH limits for a FY we use the actual expenditures for the FY and actual CPI-U percentage change for the previous FY. II. Provisions of the Notice A. Calculation of the Final FY 2018 and FY 2019 FS State DSH Allotments and the Preliminary FY 2020 and FY 2021 FS State DSH Allotments 1. Final FY 2018 FS State DSH Allotments Addendum 1 to this notice provides the States' final FY 2018 DSH allotments determined in accordance with section 1923(f)(3) of the Act.

As described in the background section, in general, the DSH allotment for a FY is calculated by increasing the FY DSH allotment for the preceding FY by the CPI-U increase for the previous fiscal year. For purposes of calculating the States' final FY 2018 DSH allotments, the preceding final fiscal year DSH allotments (for FY 2017) were published in the February 11, 2019 Federal Register (84 FR 3169). For purposes of calculating the States' final FY 2018 DSH allotments we are using the actual Medicaid expenditures for FY 2018. Finally, for purposes of calculating the States' final FY 2018 DSH allotments, the applicable historical percentage change in the CPI-U for the previous FY (FY 2017) was 2.1 percent. We note that this is lower than the estimated 2.4 percentage change in the CPI-U for FY 2017 that was available and used in the calculation of the preliminary FY 2018 DSH allotments which were published in the July 6, 2018 Federal Register (83 FR 31536).

2. Final FY 2019 FS State DSH Allotments Addendum 2 to this notice provides the States' final FY 2019 DSH allotments determined in accordance with section 1923(f)(3) of the Act. As described in the background section, in general, the DSH allotment for a FY is calculated by increasing the FY DSH allotment for the preceding FY by the CPI-U increase for the previous fiscal year. For purposes of calculating the States' final FY 2019 DSH allotments, the preceding final fiscal year DSH allotments (for FY 2018) are being published in this notice. For purposes of calculating the States' final FY 2019 DSH allotments we are using the actual Medicaid expenditures for FY 2019.

Finally, for purposes of calculating the States' final FY 2019 DSH allotments, the applicable historical percentage change in the CPI-U for the previous FY (FY 2018) was 2.4 percent. We note that this is the same as the estimated 2.4 percentage change in the CPI-U for FY 2018 that was available and used in the calculation of the preliminary FY 2019 DSH allotments which were published in the February 11, 2019 Federal Register (84 FR 3169). 3. Calculation of the Preliminary FY 2020 FS State DSH Allotments Addendum 3 to this notice provides the preliminary FY 2020 DSH allotments determined in accordance with section 1923(f)(3) of the Act. The preliminary FY 2020 DSH allotments contained in this notice were determined based on the most recent available estimates from States of their FY 2020 total computable Medicaid expenditures and by increasing the preliminary FY 2019 DSH allotments.

The applicable historical percentage change in the CPI-U for FY 2019 was 1.9 percent (we originally published the preliminary FY 2019 DSH allotments in the February 11, 2019 Federal Register (84 FR 3169)). We then used each State's FS DSH allotment divided by its respective regular FMAP rate in order to determine the TC amount of DSH payments each State would have otherwise been able to make without application of the FFCRA-increased FMAP rate. We then multiplied each State's TC DSH payment amount by its respective FFCRA-increased FMAP rate in order to calculate the increased FY 2020 DSH allotment. We will publish States' final FY 2020 DSH allotments in a future notice based on the States' four quarterly Medicaid expenditure reports (Form CMS-64) for FY 2020 available following the end of FY 2020 utilizing the actual change in the CPI-U for FY 2019. 4.

Calculation of the Preliminary FY 2021 FS State DSH Allotments Addendum 4 to this notice provides the preliminary FY 2021 DSH allotments determined in accordance with section 1923(f)(3) of the Act. The preliminary FY 2021 DSH allotments contained in this notice were determined based on the most recent available estimates from States of their FY 2021 total computable Medicaid expenditures and by increasing the preliminary FY 2020 DSH allotments calculated prior to the application of the ARP adjustment. The applicable historical percentage change in the CPI-U for FY 2020 was 1.5 percent (we are publishing the preliminary FY 2020 DSH allotments in this notice). We then used each State's FS DSH allotment divided by its respective regular FMAP rate in order to determine the TC amount of DSH payments each State would have otherwise been able to make without application of the FFCRA-increased FMAP rate. We then multiplied each State's TC DSH payment amount by its respective FFCRA-increased FMAP rate in order to calculate the ARP-adjusted FY 2021 DSH allotment.

We will publish States' final FY 2021 DSH allotments in a future notice based on the States' four quarterly Medicaid expenditure reports (Form CMS-64) for FY 2021 available following the end of FY 2021. B. Calculation of the Final FY 2018 and FY 2019 and Preliminary FY 2020 and FY 2021 IMD DSH Limits Section 1923(h) of the Act specifies the methodology to be used to establish the limits on the amount of DSH payments that a State can make to IMDs and other mental health facilities. FFP is not available for DSH payments to IMDs or other mental health facilities that exceed the IMD DSH limits. In this notice, we are publishing the final FY 2018 and FY 2019 and the preliminary FY 2020 and FY 2021 IMD DSH limits determined in accordance with the provisions discussed above.

Addendums 5 through 8 to this notice detail each State's final FY 2018 and FY 2019 and preliminary FY 2020 and FY 2021 IMD DSH limits, respectively, determined in accordance with section 1923(h) of the Act. III. Collection of Information Requirements As it relates to the Paperwork Reduction Act of 1995 (PRA. 44 U.S.C. 3501 et seq.

), this notice does not impose any new or revised “collection of information” requirements or burden. With respect to the PRA and this section of the preamble, collection of information is defined under 5 CFR 1320.3(c) of the PRA's implementing regulations. While discussed in sections I.B., I.C., II.A.3., II.A.4., and in Addendums 3 through 8 of this notice, the requirements and burden associated with form CMS-37 and form CMS-64 are unaffected by this notice. Both forms are approved by the Office of Management and Budget (OMB) under control number 0938-1265, which expires on April 30, 2024. Since this notice will not impose any new or revised collection of information requirements/burden, we are not Start Printed Page 14861 making any changes under that control number.

IV. Regulatory Impact Analysis We have examined the impact of this notice as required by Executive Order 12866 on Regulatory Planning and Review (September 1993), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354), section 1102(b) of the Act, section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L.

104-4. Enacted on March 22, 1995) (UMRA `95), Executive Order 13132 on Federalism (August 4, 1999) and the Congressional Review Act (5 U.S.C. 804(2)). Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year).

This notice reaches the $100 million economic threshold and thus has been designated a major rule under the Congressional Review Act by the Office of Information and Regulatory Affairs. The final FY 2018 DSH allotments being published in this notice are $36 million less than the preliminary FY 2018 DSH allotments published in the July 6, 2018 Federal Register (83 FR 31536). This is due to the actual percentage change in the CPI-U for FY 2017 used in the calculation of the final FY 2018 allotments (2.1 percent) being less than the estimated percentage change in the CPI-U for FY 2017 used in the calculation of the preliminary FY 2018 allotments (2.4 percent). The final FY 2018 IMD DSH limits being published in this notice are $2.4 million less than the preliminary FY 2018 IMD DSH limits published in the July 6, 2018 Federal Register (83 FR 31536). Since the final FY 2018 DSH allotments were less than the preliminary FY 2018 DSH allotments, the associated FY 2018 IMD DSH limits also decreased.

The final FY 2019 DSH allotments being published in this notice are $36 million less than the preliminary FY 2019 DSH allotments published in the February 11, 2019 Federal Register (84 FR 3169). The decrease in the final FY 2019 DSH allotments is a result of being calculated by multiplying the actual increase in the CPI-U for 2018 by the final FY 2018 DSH allotments, while the preliminary FY 2019 DSH allotments were calculated by multiplying the estimated CPI-U for 2018 by the preliminary FY 2018 DSH allotments. Although the estimated and actual increase in the CPI-U remained the same at 2.4 percent, the preliminary FY 2018 DSH allotments were higher than the final FY 2018 DSH allotments and therefore the final FY 2019 DSH allotments are lower than the preliminary FY 2019 DSH allotments. The final FY 2019 IMD DSH limits being published in this notice are approximately $2 million lower than the preliminary FY 2019 IMD DSH limits published in the February 11, 2019 Federal Register (84 FR 3169). The decreases in the IMD DSH limits are because the DSH allotment for a FY is a factor in the determination of the IMD DSH limit for the FY.

Since the final FY 2019 DSH allotments were decreased as compared to the preliminary FY 2019 DSH allotments, the associated FY 2019 IMD DSH limits for some States were also decreased. This is a result of statutory provision, discussed above, that the aggregate limit for DSH payments to IMDs and other mental health facilities is the lesser of a State's FY 1995 total computable IMD and other mental health facility DSH expenditures applicable to the State's FY 1995 DSH allotment or the amount equal to the product of the State's current year total computable DSH allotment and the applicable percentage specified in section 1923(h) of the Act. As a result of the final FY 2019 DSH allotments decreasing from the preliminary FY 2019 DSH allotments, States that had applicable percentages of their current year's total computable DSH allotments lower than FY 1995 total computable IMD and other mental health facility DSH expenditures had their IMD limits decreased as a result. The preliminary FY 2020 DSH allotments being published in this notice have been increased by approximately $1.6 billion more than the preliminary FY 2019 DSH allotments published in the February 11, 2019 Federal Register (84 FR 3169). The increase in the DSH allotments is due to the application of the statutory formula for calculating DSH allotments under which the prior fiscal year allotments are increased by the percentage increase in the CPI-U for the prior fiscal year, and to the ARP adjustment, as discussed in more detail in the next paragraph.

The preliminary FY 2020 IMD DSH limits being published in this notice are approximately $246 million more than the preliminary FY 2019 IMD DSH limits published in the February 11, 2019 Federal Register (84 FR 3169). The increases in the IMD DSH limits are because the DSH allotment for a FY is a factor in the determination of the IMD DSH limit for the FY. Since the preliminary FY 2020 DSH allotments are greater than the preliminary FY 2019 DSH allotments, the associated preliminary FY 2020 IMD DSH limits for some States also increased. The preliminary FY 2020 DSH allotments (before application of the ARP adjustment) being published in this in this notice are approximately $238 million more than the final FY 2019 DSH allotments being published in this notice. This increase is attributable to the application of the statutory formula for calculating DSH allotments under which the prior fiscal year allotments are increased by the percentage increase in the CPI-U for the prior fiscal year.

The applicable historical percentage change in the CPI-U for FY 2019 was 1.9 percent. The preliminary FY 2020 DSH allotments were further increased by approximately $1.4 billion in order to comply with the statutory provisions of the ARP requiring us to recalculate FS DSH allotments to an amount that will allow States to make the same amount of TC DSH payments as they would have been otherwise able to make in the absence of the FFCRA FMAP increase. The preliminary FY 2021 DSH allotments (before application of the ARP adjustment) being published in this notice are approximately $192 million more than the preliminary FY 2020 DSH allotments published in this notice. The increase in the DSH allotments is due to the application of the statutory formula for calculating DSH allotments under which the prior fiscal year allotments are increased by the percentage increase in the CPI-U for the prior fiscal year. The applicable historical percentage change in the CPI-U for FY 2020 was 1.5 percent.

The preliminary FY 2020 DSH allotments were increased by approximately $1.4 billion in order to comply with the statutory provisions of the ARP requiring us to recalculate FS DSH allotments to an amount that will allow States to make the same amount of TC DSH payments as they would have been otherwise able to make in the absence of the FFCRA FMAP increase. The preliminary FY 2021 DSH allotments were further increased by approximately $1.4 billion in order to comply with the statutory provisions of the ARP requiring us to recalculate FS DSH allotments to an amount that will allow States to make the same amount of TC DSH payments as they would have been otherwise able to make in the absence of the FFCRA FMAP increase. Start Printed Page 14862 The preliminary FY 2021 IMD DSH limits being published in this notice are approximately $16 million more than the preliminary FY 2020 IMD DSH limits published in this notice. The increases in the IMD DSH limits are because the DSH allotment for a FY is a factor in the determination of the IMD DSH limit for the FY. Since the preliminary FY 2021 DSH allotments are greater than the preliminary FY 2020 DSH allotments, the associated preliminary FY 2021 IMD DSH limits for some States also increased.

The RFA requires agencies to analyze options for regulatory relief of small businesses, if a rule has a significant impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of less than $8.0 million to $41.5 million in any one year. Individuals and States are not included in the definition of a small entity. We are not preparing an analysis for the RFA because the Secretary has determined that this notice will not have significant economic impact on a substantial number of small entities.

Specifically, any impact on providers is due to the effect of the various controlling statutes. Providers are not impacted as a result of the independent regulatory action in publishing this notice. The purpose of the notice is to announce the latest DSH allotments and IMD DSH limits, as required by the statute. In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA.

For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Core-Based Statistical Area for Medicaid payment regulations and has fewer than 100 beds. We are not preparing analysis for section 1102(b) of the Act because the Secretary has determined that this notice will not have a significant impact on the operations of a substantial number of small rural hospitals. The Medicaid statute specifies the methodology for determining the amounts of States' DSH allotments and IMD DSH limits. And as described previously, the application of the methodology specified in statute results in the decreases or increases in States' DSH allotments and IMD DSH limits for the applicable FYs. The statute applicable to these allotments and limits does not apply to the determination of the amounts of DSH payments made to specific DSH hospitals.

Rather, these allotments and limits represent an overall limit on the total of such DSH payments. For this reason, we do not believe that this notice will have a significant economic impact on a substantial number of small entities. Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. In 2021, that threshold is approximately $158 million. This notice will have no consequential effect on spending by State, local, or tribal governments, in the aggregate, or on the private sector.

Executive Order 13132 establishes certain requirements that an agency must meet when it issues a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. Since this notice does not impose any costs on State or local governments or otherwise have Federalism implications, the requirements of E.O. 13132 are not applicable. A. Alternatives Considered Because the FFCRA temporary FMAP increase of 6.2 percentage points was not applicable to the 1st quarter of FY 2020, we considered utilizing prorated FMAP rates in the calculation of the ARP-adjusted FY 2020 DSH allotments.

However, this could have been contrary to the statutory language at section 1923(f)(3)(F) of the Act requiring us to recalculate FS DSH allotments to an amount to allow for States to make the same amount of TC DSH payments as they would have been otherwise able to make in the absence of the FFCRA FMAP increase, depending on States' timing of their DSH payments to eligible providers. The methodologies for determining the States' fiscal year DSH allotments and IMD DSH limits, as reflected in this notice, were established in accordance with the methodologies and formula for determining States' allotments and limits as specified in statute. This notice does not put forward any further discretionary administrative policies for determining such allotments and limits, or otherwise. B. Accounting Statement As required by OMB Circular A-4 (available at https://obamawhitehouse.archives.gov/​omb/​circulars_​a004_​a-4/​ ), in Tables 1 and 2, we have prepared an accounting statement showing the classification of the estimated expenditures associated with the provisions of this notice.

Table 1 provides our best estimate of the change (decrease) in the FS of States' Medicaid DSH payments resulting from the application of the provisions of the Medicaid statute relating to the calculation of States' FY DSH allotments and the increase in the FY DSH allotments from FY 2019 to FY 2020. Table 2 provides our best estimate of the change (decrease) in the FS of States' Medicaid DSH payments resulting from the application of the provisions of the Medicaid statute relating to the calculation of States' FY DSH allotments and the increase in the FY DSH allotments from FY 2020 to FY 2021. Table 1—Accounting Statement. Classification of Estimated Expenditures, From the FY 2019 to FY 2020[In millions]CategoryTransfersAnnualized Monetized Transfers$238.From Whom To Whom?. Federal Government to States.

Table 2—Accounting Statement. Classification of Estimated Expenditures, From the FY 2020 to FY 2021[In millions]CategoryTransfersAnnualized Monetized Transfers$192.From Whom To Whom?. Federal Government to States. C. Congressional Review Act This document is subject to the Congressional Review Act provisions of the Small Business Regulatory Enforcement Fairness Act of 1996 (5 U.S.C.

801 et seq. ) and has been transmitted to the Congress and the Comptroller General for review. Start Printed Page 14863 In accordance with the provisions of Executive Order 12866, this notice was reviewed by the Office of Management and Budget. Chiquita Brooks-LaSure, Administrator of the Centers for Medicare &. Medicaid Services, approved this document on February 1, 2022.

Start Signature Dated. March 9, 2022. Xavier Becerra, Secretary, Department of Health and Human Services. End Signature Start Printed Page 14864 Start Printed Page 14865 Start Printed Page 14866 Start Printed Page 14867 Start Printed Page 14868 Start Printed Page 14869 Start Printed Page 14870 Start Printed Page 14871 Start Printed Page 14872 Start Printed Page 14873 Start Printed Page 14874 Start Printed Page 14875 Start Printed Page 14876 Start Printed Page 14877 Start Printed Page 14878 Start Printed Page 14879 Start Printed Page 14880 Start Printed Page 14881 Start Printed Page 14882 Start Printed Page 14883 Start Printed Page 14884 Start Printed Page 14885 Start Printed Page 14886 Start Printed Page 14887 Start Printed Page 14888 End Supplemental Information.