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Start Preamble how can i get diflucan over the counter Announcement Type. New. Funding Announcement how can i get diflucan over the counter Number. HHS-2021-IHS-TPI-0001.

Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) Number. 93.382. Key Dates Application Deadline Date. September 1, 2021.

Earliest Anticipated Start Date. September 30, 2021. I. Funding Opportunity Description Statutory Authority The Indian Health Service (IHS) is accepting applications for grants for the Community Health Aide Program (CHAP) Tribal Planning and Implementation (TPI) program.

The CHAP is authorized under the Snyder Act, 25 U.S.C. 13. The Transfer Act, 42 U.S.C. 2001(a).

And the Indian Health Care Improvement Act, 25 U.S.C. 16161. This grant program is described in the Assistance Listings located at https://beta.sam.gov (formerly known as Catalog of Federal Domestic Assistance) under 93.382. Background The national CHAP will provide a network of health aides trained to support licensed health professionals while providing direct health care, Start Printed Page 41045health promotion, and disease prevention services.

These providers will work within a referral relationship under the supervision of licensed clinical providers that includes clinics, service units, and hospitals. The program will increase access to direct health services, including inpatient and outpatient visits. The Alaska CHAP has become a model for efficient and high quality health care delivery in rural Alaska, providing approximately 300,000 patient encounters per year and responding to emergencies 24 hours a day, seven days a week. Specialized providers in dental and behavioral health were later introduced to respond to the needs of patients and address the health disparities in oral health and mental health among American Indians and Alaska Natives.

The national CHAP is a workforce model that includes three different provider types that act as extenders of their licensed clinical supervisor. The national CHAP currently includes a behavioral health aide, community health aide, and dental health aide. Each of the health aide categories operate in a tiered level practice system. The national CHAP model provides an opportunity for increased access to care through the extension of primary care, dental, and behavioral health clinicians.

In 2010, under the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), Congress provided the Secretary of the U.S. Department of Health and Human Services, acting through the IHS, the authority to expand the Alaska CHAP program. In 2016, the IHS initiated Tribal Consultation on expanding the CHAP to the contiguous 48 states. In 2018, the IHS formed the CHAP Tribal Advisory Group (TAG) and began developing the program.

In 2020, the IHS announced the national CHAP policy, which formally created the national CHAP. Purpose The purpose of the TPI program is to support the planning and implementation for Tribes and Tribal Organizations (T/TO) positioned to begin operating a CHAP or support a growing CHAP in the contiguous 48 states. The grant program is designed to support the regional flexibility required for T/TO to implement a CHAP unique to the needs of their individual communities across the country through the identification of feasibility factors. The focus of the program is to.

1. Develop clinical supervisor support for primary care, behavioral health, and dental health clinicians providing both direct and indirect supervision of prospective health aides. 2. Identify area and community-specific health care needs of patients that can be addressed by the health aides.

3. Identify and develop a technology infrastructure plan for the mobility and success of health aides in anticipation of providing services. 4. Develop a training plan to include partners across the T/TO's geographic region to enhance the training opportunities available to prospective health aides to include continuing education and clinical practice.

5. Identify best practices for integrating a CHAP workforce into an existing Tribal health system. 6. Address social determinants of health that impact the recruitment and retention of prospective health aides.

And 7. Identify the total cost of full implementation of a CHAP within an existing Tribal health system. II. Award Information Funding Instrument—Grant Estimated Funds Available The total funding identified for fiscal year (FY) 2021 is approximately $1,500,000.

Individual award amounts are anticipated to be between $450,000 and $500,000. The funding available for competing awards issued under this announcement is subject to the availability of appropriations and budgetary priorities of the Agency. The IHS is under no obligation to make awards that are selected for funding under this announcement. Anticipated Number of Awards Approximately three awards will be issued under this program announcement.

The IHS intends to award no more than one grant per IHS area. Period of Performance The period of performance is two years. III. Eligibility Information 1.

Eligibility To be eligible for this new FY 2021 funding opportunity, an applicant must be one of the following, as defined under 25 U.S.C. 1603. A federally recognized Indian Tribe as defined by 25 U.S.C. 1603(14).

The term “Indian Tribe” means any Indian Tribe, band, nation, or other organized group or community, including any Alaska Native village or group, or regional or village corporation, as defined in or established pursuant to the Alaska Native Claims Settlement Act (85 Stat. 688) [43 U.S.C. 1601 et seq.], which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians. A Tribal organization as defined by 25 U.S.C.

1603(26). The term “Tribal organization” has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304). €œTribal organization” means the recognized governing body of any Indian Tribe.

Any legally established organization of Indians which is controlled, sanctioned, or chartered by such governing body or which is democratically elected by the adult members of the Indian community to be served by such organization and which includes the maximum participation of Indians in all phases of its activities. Provided that, in any case where a contract is let or grant made to an organization to perform services benefiting more than one Indian Tribe, the approval of each such Indian Tribe shall be a prerequisite to the letting or making of such contract or grant. Applicant shall submit letters of support and/or Tribal Resolutions from the Tribes to be served. An applicant may not apply to both this opportunity, TPI, and the CHAP Tribal Assessment and Planning (TAP) opportunity (number HHS-2021-IHS-TAP-0001).

An organization currently carrying out a CHAP in the United States, in accordance with 25 U.S.C. 1616l through an Indian Self-Determination and Education Assistance Act (ISDEAA) agreement, is eligible to apply, but may not utilize the funds to carry out a CHAP. The Program Office will notify any applicants deemed ineligible. Note.

Please refer to Section IV.2 (Application and Submission Information/Subsection 2, Content and Form of Application Submission) for additional proof of applicant status documents required, such as Tribal Resolutions, proof of nonprofit status, etc. 2. Cost Sharing or Matching The IHS does not require matching funds or cost sharing for grants or cooperative agreements. 3.

Other Requirements Applications with budget requests that exceed the highest dollar amount outlined under Section II Award Information, Estimated Funds Available, or exceed the Period of Performance outlined under Section II Award Information, Period of Performance, will Start Printed Page 41046be considered not responsive and will not be reviewed. The Division of Grants Management (DGM) will notify the applicant. Additional Required Documentation Tribal Resolution The DGM must receive an official, signed Tribal Resolution prior to issuing a Notice of Award (NoA) to any applicant selected for funding. An Indian Tribe or Tribal organization that is proposing a project affecting another Indian Tribe must include resolutions from all affected Tribes to be served.

However, if an official, signed Tribal Resolution cannot be submitted with the application prior to the application deadline date, a draft Tribal Resolution must be submitted with the application by the deadline date in order for the application to be considered complete and eligible for review. The draft Tribal Resolution is not in lieu of the required signed resolution but is acceptable until a signed resolution is received. If an application without a signed Tribal Resolution is selected for funding, the applicant will be contacted by the Grants Management Specialist (GMS) listed in this funding announcement and given 90 days to submit an official, signed Tribal Resolution to the GMS. If the signed Tribal Resolution is not received within 90 days, the award will be forfeited.

Tribes organized with a governing structure other than a Tribal council may submit an equivalent document commensurate with their governing organization. Proof of Nonprofit Status Organizations claiming nonprofit status must submit a current copy of the 501(c)(3) Certificate with the application. IV. Application and Submission Information 1.

Obtaining Application Materials The application package and detailed instructions for this announcement are hosted on https://www.Grants.gov. Please direct questions regarding the application process to Mr. Paul Gettys at (301) 443-2114 or (301) 443-5204. 2.

Content and Form Application Submission Mandatory documents for all applicants include. Abstract (one page) summarizing the project. Application forms. 1.

SF-424, Application for Federal Assistance. 2. SF-424A, Budget Information—Non-Construction Programs. 3.

SF-424B, Assurances—Non-Construction Programs. Project Narrative (not to exceed 15 pages). See Section IV.2.A Project Narrative for instructions. 1.

Background information on the organization. 2. Proposed scope of work, objectives, and activities that provide a description of what the applicant plans to accomplish. Budget Justification and Narrative (not to exceed 5 pages).

See Section IV.2.B Budget Narrative for instructions. One-page Timeframe Chart. Tribal Resolution(s). Letters of Support from organization's Board of Directors (if applicable).

501(c)(3) Certificate. Biographical sketches for all Key Personnel. Contractor/Consultant resumes or qualifications and scope of work. Disclosure of Lobbying Activities (SF-LLL), if applicant conducts reportable lobbying.

Certification Regarding Lobbying (GG-Lobbying Form). Copy of current Negotiated Indirect Cost rate (IDC) agreement (required in order to receive IDC). Organizational Chart (optional). Documentation of current Office of Management and Budget (OMB) Financial Audit (if applicable).

Acceptable forms of documentation include. 1. Email confirmation from Federal Audit Clearinghouse (FAC) that audits were submitted. Or 2.

Face sheets from audit reports. Applicants can find these on the FAC website at https://harvester.census.gov/​facdissem/​Main.aspx. Public Policy Requirements All Federal public policies apply to IHS grants and cooperative agreements. Pursuant to 45 CFR 80.3(d), an individual shall not be deemed subjected to discrimination by reason of their exclusion from benefits limited by Federal law to individuals eligible for benefits and services from the IHS.

See https://www.hhs.gov/​grants/​grants/​grants-policies-regulations/​index.html. Requirements for Project and Budget Narratives A. Project Narrative This narrative should be a separate document that is no more than 15 pages and must. (1) Have consecutively numbered pages.

(2) use black font 12 points or larger. (3) be single-spaced. And (4) be formatted to fit standard letter paper (81/2 x 11 inches). Be sure to succinctly answer all questions listed under the evaluation criteria (refer to Section V.1, Evaluation Criteria) and place all responses and required information in the correct section noted below or they will not be considered or scored.

If the narrative exceeds the page limit, the application will be considered not responsive and will not be reviewed. The 15-page limit for the narrative does not include the work plan, standard forms, Tribal Resolutions, budget, budget justifications, narratives, and/or other items. There are three parts to the narrative. Part 1—Program Information.

Part 2—Program Plan. And Part 3—Program Evaluation. See below for additional details about what must be included in the narrative. The page limits below are for each narrative and budget submitted.

Part 1. Program Information (Limit—4 pages) Section 1. Community Profile Describe the demographics of the community including, but not limited to, geography, languages, age, and socioeconomic status. The community profile should include data specific to the community that would benefit from the implementation of CHAP.

Section 2. Health &. Infrastructure Needs Describe the community's current health disparities related to primary, behavioral, and oral health care. The needs section should provide facts and evidence related to infrastructure barriers (e.g., recruitment, retention, and access to facilities).

Section 3. Organizational Capacity Describe the T/TO's current health program activities, how long it has been operating, and what programs or services are currently being provided. Describe in full the organization's infrastructure and its ability to assess the feasibility of implementing a CHAP and identifying significant barriers that could prohibit the implementation. Part 2.

Program Plan (Limit—6 pages) Section 1. Program Plan Describe in full the direction the T/TO plans to take in the CHAP TPI. The program plan should identify the plan to address Tribal infrastructure needs specific to. Clinical supervisor support and clinical operations.

Enhanced scope of work to address community and region specific needs. Training infrastructure (including continuing education).Start Printed Page 41047 Technology infrastructure. System integration. Support to prospective health aides that address social determinants of health.

Section 2. Program Activities Describe in full how the applicant will develop a robust clinical support system for the clinical supervision of providers. The activities should also include how the applicant will correlate the community health needs to additional requirements to be included into the scope of work of health aides, a detailed plan of how to adjust the clinical operations to incorporate a CHAP, and the training plan to include continuing education for prospective health aides. Describe the resources the applicant will provide for health aides once the CHAP is operating, including technology investments to aide in mobility of providers and auxiliary supports to address critical social determinants of health.

The program plan activities should also include how the applicant plans to calculate the full implementation. Section 3. Staffing Plan Describe key staff tasked with carrying out the program activities in Section 2. Applicants are highly encouraged to partner with other key stakeholders within the T/TO's region for a robust understanding of the needs and implications of implementing a CHAP into their respective communities.

Section 4. Timeline Describe a timeline not to exceed two years for the completion of the program plan, activities, and evaluation plan. Provide a timeline chart depicting a realistic timeline that details all major activities, milestones, and applicable staffing plans. The timeline should include the projected progress report due at the midpoint of the project period.

The timeline chart should not exceed one page. Part 3. Program Evaluation (Limit—5 pages) Section 1. Evaluation Plan Please identify and describe significant program activities and achievements associated with the delivery of quality health services.

Provide a plan to provide a comparison of the actual accomplishments to the goals established for the project period, or if applicable, provide justification for the lack of progress. The evaluation plan should address major categories related to (See Sample Logic Model in Related Documents in Grants.gov). Clinical supervision support. Enhanced scope of practice.

Training infrastructure (including continuing education). Technology needs. Integration best practices. Auxiliary supports for prospective health aides working within the system.

Calculating total implementation cost. B. Budget Narrative (Limit—5 pages) Provide a budget narrative that explains the amounts requested for each line item of the budget from the SF-424A (Budget Information for Non-Construction Programs). The budget narrative should specifically describe how each item will support the achievement of proposed objectives.

Be very careful about showing how each item in the “Other” category is justified. For subsequent budget years (see Multi-Year Project Requirements in Section V.1. Application Review Information, Evaluation Criteria), the narrative should highlight the changes from year 1 or clearly indicate that there are no substantive budget changes during the period of performance. Do NOT use the budget narrative to expand the project narrative.

3. Submission Dates and Times Applications must be submitted through Grants.gov by 11:59 p.m. Eastern Time on the Application Deadline Date. Any application received after the application deadline will not be accepted for review.

Grants.gov will notify the applicant via email if the application is rejected. If technical challenges arise and assistance is required with the application process, contact Grants.gov Customer Support (see contact information at https://www.Grants.gov). If problems persist, contact Mr. Paul Gettys (Paul.Gettys@ihs.gov), Acting Director, DGM, by telephone at (301) 443-2114 or (301) 443-5204.

Please be sure to contact Mr. Gettys at least ten days prior to the application deadline. Please do not contact the DGM until you have received a Grants.gov tracking number. In the event you are not able to obtain a tracking number, call the DGM as soon as possible.

The IHS will not acknowledge receipt of applications. 4. Intergovernmental Review Executive Order 12372 requiring intergovernmental review is not applicable to this program. 5.

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

6. Electronic Submission Requirements All applications must be submitted via Grants.gov. Please use the https://www.Grants.gov website to submit an application. Find the application by selecting the “Search Grants” link on the homepage.

Follow the instructions for submitting an application under the Package tab. No other method of application submission is acceptable. If the applicant cannot submit an application through Grants.gov, a waiver must be requested. Prior approval must be requested and obtained from Mr.

Paul Gettys, Acting Director, DGM. A written waiver request must be sent to GrantsPolicy@ihs.gov with a copy to Paul.Gettys@ihs.gov. The waiver request must be documented in writing (emails are acceptable) before submitting an application by some other method, and include clear justification for the need to deviate from the required application submission process. Once the waiver request has been approved, the applicant will receive a confirmation of approval email containing submission instructions.

A copy of the written approval must be included with the application that is submitted to the DGM. Applications that are submitted without a copy of the signed waiver from the Acting Director of the DGM will not be reviewed. The Grants Management Officer of the DGM will notify the applicant via email of this decision. Applications submitted under waiver must be received by the DGM no later than 5:00 p.m., Eastern Time, on the Application Deadline Date.

Late applications will not be accepted for processing. Applicants that do not register for both the System for Award Management (SAM) and Grants.gov and/or fail to request timely assistance with technical issues will not be considered for a waiver to submit an application via alternative method. Please be aware of the following. Please search for the application package in https://www.Grants.gov by entering the Assistance Listing (CFDA) number or the Funding Opportunity Number.

Both numbers are located in the header of this announcement. If you experience technical challenges while submitting your application, please contact Grants.gov Customer Support (see contact information at https://www.Grants.gov).Start Printed Page 41048 Upon contacting Grants.gov, obtain a tracking number as proof of contact. The tracking number is helpful if there are technical issues that cannot be resolved and a waiver from the agency must be obtained. Applicants are strongly encouraged not to wait until the deadline date to begin the application process through Grants.gov as the registration process for SAM and Grants.gov could take up to 20 working days.

Please follow the instructions on Grants.gov to include additional documentation that may be requested by this funding announcement. Applicants must comply with any page limits described in this funding announcement. After submitting the application, the applicant will receive an automatic acknowledgment from Grants.gov that contains a Grants.gov tracking number. The IHS will not notify the applicant that the application has been received.

Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) Applicants and grantee organizations are required to obtain a DUNS number and maintain an active registration in the SAM database. The DUNS number is a unique 9-digit identification number provided by D&B that uniquely identifies each entity. The DUNS number is site specific. Therefore, each distinct performance site may be assigned a DUNS number.

Obtaining a DUNS number is easy, and there is no charge. To obtain a DUNS number, please access the request service through https://fedgov.dnb.com/​webform or call (866) 705-5711. The Federal Funding Accountability and Transparency Act of 2006, as amended (“Transparency Act”), requires all HHS recipients to report information on sub-awards. Accordingly, all IHS grantees must notify potential first-tier sub-recipients that no entity may receive a first-tier sub-award unless the entity has provided its DUNS number to the prime grantee organization.

This requirement ensures the use of a universal identifier to enhance the quality of information available to the public pursuant to the Transparency Act. System for Award Management (SAM) Organizations that are not registered with SAM must have a DUNS number first, then access the SAM online registration through the SAM home page at https://sam.gov (U.S. Organizations will also need to provide an Employer Identification Number from the Internal Revenue Service that may take an additional 2-5 weeks to become active). Please see SAM.gov for details on the registration process and timeline.

Registration with the SAM is free of charge but can take several weeks to process. Applicants may register online at https://sam.gov. Additional information on implementing the Transparency Act, including the specific requirements for DUNS and SAM, are available on the DGM Grants Management, Policy Topics web page. Https://www.ihs.gov/​dgm/​policytopics/​.

V. Application Review Information Possible points assigned to each section are noted in parentheses. The 15-page project narrative should include only the first year of activities. Information for multi-year projects should be included as a separate document.

See “Multi-year Project Requirements” at the end of this section for more information. The narrative section should be written in a manner that is clear to outside reviewers unfamiliar with prior related activities of the applicant. It should be well organized, succinct, and contain all information necessary for reviewers to fully understand the project. Points will be assigned to each evaluation criteria adding up to a total of 100 possible points.

Points are assigned as follows. 1. Evaluation Criteria A. Introduction and Need for Assistance (10 points) Identify the proposed project and plans to fully implement a CHAP within their community.

The needs should clearly identify the existing health system and how the CHAP will be integrated to meet the health needs of the community in the fields of behavioral, oral, and primary health care. B. Project Objective(s), Work Plan, and Approach (30 points) The work plan should be comprised of two key parts. Program Information and Program Plan.

Provide information related to three key sections. Community profile. Health and infrastructure. And organizational capacity.

The Program Information part should demonstrate a robust community profile that highlights the existing health system, demographic data of community members and user population, and a detailed description of the T/TO carrying out the proposed activity. An acceptable Program Plan expecting to receive full points should include details of the applicants plan to address the program objective. The Program Plan should address, at a minimum, key activities related to clinical supervisor support, scope of work, technology infrastructure, training infrastructure, integration best practices, and auxiliary support to health aides that address social determinants. C.

Program Evaluation (30 points) The program evaluation should be comprised of two key sections. Evaluation plan and outcome report. The evaluation plan should address major categories related to. Clinical supervisor support.

Enhanced scope of work. Technology infrastructure. Training infrastructure. Integration best practices.

Auxiliary support. And full implementation costs (See Sample Logic Model in Related Documents in Grants.gov). The evaluation plan should identify how the T/TO plans to fully integrate CHAP. The evaluation should include total implementation costs based on the implementation plan and program plan identified, including any significant implementation barriers.

List measurable and attainable goals with explicit timelines that detail expectation of findings. The Outcome Report should describe, in full, the findings of the program plan, evaluation, and determination on stage of readiness for implementation. The outcome report should organize the findings into at least five of the seven categories. 1.

Clinical Supervisor Support. 2. Scope of Work. 3.

Technology Infrastructure. 4. Training Infrastructure. 5.

Integration Planning. 6. Auxiliary Support. 7.

Implementation Cost. Applicants are encouraged to identify additional categories above the seven aforementioned and may choose to develop subcategories that best fit the program plan. D. Organizational Capabilities, Key Personnel, and Qualifications (10 points) Provide a detailed biographical sketch of each member of key personnel assigned to carry out the objectives of the program plan.

The sketches should detail the qualifications and expertise of identified staff. E. Categorical Budget and Budget Justification (20 points) Provide a detailed budget of each expenditure directly related to the identified program activities. Multi-Year Project Requirements Applications must include a brief project narrative and budget (one Start Printed Page 41049additional page per year) addressing the developmental plans for each additional year of the project.

This attachment will not count as part of the project narrative or the budget narrative. Additional documents can be uploaded as Other Attachments in Grants.gov Work plan, logic model, and/or timeline for proposed objectives. Position descriptions for key staff. Resumes of key staff that reflect current duties.

Consultant or contractor proposed scope of work and letter of commitment (if applicable). Current Indirect Cost Rate Agreement. Organizational chart. Map of area identifying project location(s).

Additional documents to support narrative (i.e., data tables, key news articles, etc.). 2. Review and Selection Each application will be prescreened for eligibility and completeness, as outlined in the funding announcement. Applications that meet the eligibility criteria shall be reviewed for merit by the Objective Review Committee (ORC) based on evaluation criteria.

Incomplete applications and applications that are not responsive to the administrative thresholds (budget limit, project period limit) will not be referred to the ORC and will not be funded. The applicant will be notified of this determination. Applicants must address all program requirements and provide all required documentation. 3.

Notifications of Disposition All applicants will receive an Executive Summary Statement from the IHS Office of Clinical and Preventive Services within 30 days of the conclusion of the ORC outlining the strengths and weaknesses of their application. The summary statement will be sent to the Authorizing Official identified on the face page (SF-424) of the application. A. Award Notices for Funded Applications The NoA is the authorizing document for which funds are dispersed to the approved entities and reflects the amount of Federal funds awarded, the purpose of the grant, the terms and conditions of the award, the effective date of the award, and the budget/project period.

Each entity approved for funding must have a user account in GrantSolutions in order to retrieve the NoA. Please see the Agency Contacts list in Section VII for the systems contact information. B. Approved But Unfunded Applications Approved applications not funded due to lack of available funds will be held for one year.

If funding becomes available during the course of the year, the application may be reconsidered. Note. Any correspondence other than the official NoA executed by an IHS grants management official announcing to the project director that an award has been made to their organization is not an authorization to implement their program on behalf of the IHS. VI.

Award Administration Information 1. Administrative Requirements Awards issued under this announcement are subject to, and are administered in accordance with, the following regulations and policies. A. The Criteria as Outlined in This Program Announcement B.

Administrative Regulations for Grants C. Grants Policy D. Cost Principles Uniform Administrative Requirements for HHS Awards, “Cost Principles,” at 45 CFR part 75, subpart E. E.

Audit Requirements Uniform Administrative Requirements for HHS Awards, “Audit Requirements,” at 45 CFR part 75, subpart F. F. As of August 13, 2020, 2 CFR 200 has been updated to include a prohibition on certain telecommunications and video surveillance services or equipment. This prohibition is described in 2 CFR 200.216.

This will also be described in the terms and conditions of every IHS grant and cooperative agreement awarded on or after August 13, 2020. 2. Indirect Costs This section applies to all recipients that request reimbursement of indirect costs (IDC) in their application budget. In accordance with HHS Grants Policy Statement, Part II-27, IHS requires applicants to obtain a current IDC rate agreement and submit it to the DGM prior to the DGM issuing an award.

The rate agreement must be prepared in accordance with the applicable cost principles and guidance as provided by the cognizant agency or office. A current rate covers the applicable grant activities under the current award's budget period. If the current rate agreement is not on file with the DGM at the time of award, the IDC portion of the budget will be restricted. The restrictions remain in place until the current rate agreement is provided to the DGM.

Per 45 CFR 75.414(f) Indirect (F&A) costs, “any non-Federal entity [i.e., applicant] that has never received a negotiated indirect cost rate,. . . May elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC) which may be used indefinitely.

As described in Section 75.403, costs must be consistently charged as either indirect or direct costs, but may not be double charged or inconsistently charged as both. If chosen, this methodology once elected must be used consistently for all Federal awards until such time as the non-Federal entity chooses to negotiate for a rate, which the non-Federal entity may apply to do at any time.” Electing to charge a de minimis rate of 10 percent only applies to applicants that have never received an approved negotiated indirect cost rate from HHS or another cognizant federal agency. Applicants awaiting approval of their indirect cost proposal may request the 10 percent de minimis rate. When the applicant chooses this method, costs included in the indirect cost pool must not be charged as direct costs to the grant.

Available funds are inclusive of direct and appropriate indirect costs. Approved indirect funds are awarded as part of the award amount, and no additional funds will be provided. Generally, IDC rates for IHS grantees are negotiated with the Division of Cost Allocation (DCA) at https://rates.psc.gov/​ or the Department of the Interior (Interior Business Center) at Start Printed Page 41050 https://ibc.doi.gov/​ICS/​tribal. For questions regarding the indirect cost policy, please call the Grants Management Specialist listed under “Agency Contacts” or the main DGM office at (301) 443-5204.

3. Reporting Requirements The grantee must submit required reports consistent with the applicable deadlines. Failure to submit required reports within the time allowed may result in suspension or termination of an active grant, withholding of additional awards for the project, or other enforcement actions such as withholding of payments or converting to the reimbursement method of payment. Continued failure to submit required reports may result in the imposition of special award provisions and/or the non-funding or non-award of other eligible projects or activities.

This requirement applies whether the delinquency is attributable to the failure of the awardee organization or the individual responsible for preparation of the reports. Per DGM policy, all reports must be submitted electronically by attaching them as a “Grant Note” in GrantSolutions. Personnel responsible for submitting reports will be required to obtain a login and password for GrantSolutions. Please see the Agency Contacts list in Section VII for the systems contact information.

The reporting requirements for this program are noted below. A. Progress Reports Program progress reports are required semi-annually. The progress reports are due within 30 days after the budget period ends (specific dates will be listed in the NoA Terms and Conditions).

These reports must include a brief comparison of actual accomplishments to the goals established for the period, a summary of progress to date or, if applicable, provide sound justification for the lack of progress, and other pertinent information as required. A final report must be submitted within 90 days of expiration of the period of performance. B. Financial Reports Federal Cash Transaction Reports are due 30 days after the close of every calendar quarter to the Payment Management Services at https://pms.psc.gov.

Failure to submit timely reports may result in adverse award actions blocking access to funds. Federal Financial Reports are due 30 days after the end of each budget period, and a final report is due 90 days after the end of the Period of Performance. Grantees are responsible and accountable for accurate information being reported on all required reports. The Progress Reports, the Federal Cash Transaction Report, and the Federal Financial Report.

C. Data Collection and Reporting At the conclusion of the program period, the outcome report should detail how the T/TO plans to completely integrate CHAP into their Tribal health system and list major barriers that could potentially impact full integration. The Outcome Report should describe, in full, the findings of the program plan and evaluation, and plans for implementation. The outcome report should organize the findings of the key categories.

1. Clinical Supervisor Support. 2. Scope of Practice.

3. Technology Infrastructure. 4. Training Plan.

5. System Integration. 6. Auxiliary Support to Address Social Determinants.

Based on the findings and measurable outcomes of the categories, the applicant should explicitly identify the implementation plan and projected cost associated with full implementation. D. Federal Sub-Award Reporting System (FSRS) This award may be subject to the Transparency Act sub-award and executive compensation reporting requirements of 2 CFR part 170. The Transparency Act requires the OMB to establish a single searchable database, accessible to the public, with information on financial assistance awards made by Federal agencies.

The Transparency Act also includes a requirement for recipients of Federal grants to report information about first-tier sub-awards and executive compensation under Federal assistance awards. IHS has implemented a Term of Award into all IHS Standard Terms and Conditions, NoAs, and funding announcements regarding the FSRS reporting requirement. This IHS Term of Award is applicable to all IHS grant and cooperative agreements issued on or after October 1, 2010, with a $25,000 sub-award obligation threshold met for any specific reporting period. For the full IHS award term implementing this requirement and additional award applicability information, visit the DGM Grants Management website at https://www.ihs.gov/​dgm/​policytopics/​.

E. Compliance With Executive Order 13166 Implementation of Services Accessibility Provisions for All Grant Application Packages and Funding Opportunity Announcements Recipients of Federal financial assistance (FFA) from HHS must administer their programs in compliance with Federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age, and, in some circumstances, religion, conscience, and sex. This includes ensuring programs are accessible to persons with limited English proficiency. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS.

Please see https://www.hhs.gov/​civil-rights/​for-providers/​provider-obligations/​index.html and http://www.hhs.gov/​ocr/​civilrights/​understanding/​section1557/​index.html. Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under Federal civil rights laws at https://www.hhs.gov/​ocr/​about-us/​contact-us/​index.html or call 1-800-368-1019 or TDD 1-800-537-7697. F. Federal Awardee Performance and Integrity Information System (FAPIIS) The IHS is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS) at https://www.fapiis.gov before making any award in excess of the simplified acquisition threshold (currently $250,000) over the period of performance.

An applicant may review and comment on any information about itself that a Federal awarding agency previously entered. The IHS will consider any comments by the applicant, in addition to other information in FAPIIS, in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 45 CFR 75.205. As required by 45 CFR part 75, appendix XII, of the Uniform Guidance, non-Federal entities (NFEs) are required to disclose in FAPIIS any information about criminal, civil, and administrative proceedings, and/or affirm that there is no new information to provide. This applies to NFEs that receive Federal awards (currently active grants, cooperative agreements, and procurement contracts) greater than $10,000,000 for any period of time during the period of performance of an award/project.

Mandatory Disclosure Requirements As required by 2 CFR part 200 of the Uniform Guidance and the HHS implementing regulations at 45 CFR part 75, the IHS must require an NFE or an applicant for a Federal award to disclose, in a timely manner, in writing to the IHS or pass-through entity all violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award. Submission is required for all applicants and recipients, in writing, to the IHS and to the HHS Office of Inspector General, all information related to violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award. 45 CFR 75.113. Disclosures must be sent in writing to.

U.S. Department of Health and Human Services, Indian Health Service, Division of Grants Management, ATTN. Paul Gettys, Acting Director, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, (Include “Mandatory Grant Disclosures” in subject line), Office.

(301) 443-5204, Fax. (301) 594-0899, Email. Paul.Gettys@ihs.gov. And U.S.

Department of Health and Human Services, Office of Inspector General, ATTN. Mandatory Grant Disclosures, Intake Coordinator, 330 Independence Avenue SW, Cohen Building, Room 5527, Washington, DC 20201, URL. Https://oig.hhs.gov/​fraud/​report-fraud/​, (Include “Mandatory Grant Disclosures” in subject line), Fax. (202) 205-0604 (Include “Mandatory Grant Disclosures” in subject line) or, Email.

MandatoryGranteeDisclosures@oig.hhs.gov. Failure to make required disclosures can result in any of the remedies described in 45 CFR 75.371 Remedies for noncompliance, including suspension or debarment (see 2 CFR parts 180 &. 376). VII.

Agency Contacts 1. Questions on the programmatic issues may be directed to. Minette C. Galindo, Public Health Advisor, Indian Health Service, Office of Clinical and Preventive Services, 5600 Fishers Lane, Mail Stop.

08N34A, Rockville, MD 20857, Phone. (301) 443-4644, Fax. (301) 594-6213, Email. IHSCHAP@ihs.gov.

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

(301) 443-2298, Email. Donald.Gooding@ihs.gov. 3. Questions on systems matters may be directed to.

Paul Gettys, Acting Director, Indian Health Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, Phone. (301) 443-2114. Or the DGM main line (301) 443-5204, email.

Paul.Gettys@ihs.gov. VIII. Other Information The Public Health Service strongly encourages all grant, cooperative agreement, and contract recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of the facility) in which regular or routine education, library, day care, health care, or early childhood development services are provided to children.

This is consistent with the HHS mission to protect and advance the physical and mental health of the American people. Start Signature Elizabeth A. Fowler, Acting Director, Indian Health Service. End Signature End Preamble [FR Doc.

2021-16283 Filed 7-29-21. 8:45 am]BILLING CODE 4165-16-PStart Preamble Announcement Type. New. Funding Announcement Number.

HHS-2021-IHS-TAP-0001. Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) Number. 93.382. Key Dates Application Deadline Date.

September 6, 2021. Earliest Anticipated Start Date. September 30, 2021. I.

Funding Opportunity Description Statutory Authority The Indian Health Service (IHS) is accepting applications for grants for the Community Health Aide Program (CHAP) Tribal Assessment and Planning (TAP) program. The CHAP is authorized under the Snyder Act, 25 U.S.C. 13. The Transfer Act, 42 U.S.C.

2001(a). And the Indian Health Care Improvement Act, 25 U.S.C. 1616l. This grant program is described in the Assistance Listings located at https://sam.gov/​content/​home (formerly known as Catalog of Federal Domestic Assistance) under 93.382.

Background The national CHAP will provide a network of health aides trained to support licensed health professionals while providing direct health care, health promotion, and disease prevention services. These providers will work within a referral relationship under the supervision of licensed clinical providers that include clinics, service units, and hospitals. The CHAP aides will increase access to direct health services, including inpatient and outpatient visits.Start Printed Page 41052 The Alaska CHAP has become a model for efficient and high quality health care delivery in rural Alaska, providing approximately 300,000 patient encounters per year and responding to emergencies 24 hours a day, seven days a week. Specialized providers in dental and behavioral health were later introduced to respond to the needs of patients and address the health disparities in oral health and mental health among American Indian and Alaska Natives.

The national CHAP is a workforce model that includes three different provider types that act as extenders of their licensed clinical supervisor. The national CHAP currently includes a behavioral health aide, community health aide, and dental health aide. Each of the health aide categories operate in a tiered level practice system. The national CHAP model provides an opportunity for increased access to care through the extension of primary care, dental, and behavioral health clinicians.

In 2010, under the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), Congress provided the Secretary of the U.S. Department of Health and Human Services, acting through the IHS, the authority to expand the CHAP nationally. In 2016, the IHS initiated Tribal Consultation on expanding the CHAP to the contiguous 48 states. In 2018, the IHS formed the CHAP Tribal Advisory Group (TAG) and began developing the program.

In 2020, the IHS announced the national CHAP policy, which formally created the national CHAP. Purpose The purpose of the TAP program is to support the assessment and planning of Tribes and Tribal Organizations (T/TO) in determining the feasibility of implementing CHAP in their respective communities. The program is designed to support the regional flexibility required for T/TO to design a program unique to the needs of their individual communities across the country through the identification of feasibility factors. The focus of the program is to.

1. Assess whether the T/TO can integrate CHAP into the Tribal health system, including the health care workforce. 2. Identify systemic barriers that prohibit the complete integration of CHAP into an existing health care system.

The barriers should be related to. Clinical infrastructure. Workforce barriers. Certification of providers.

Training of providers. Inclusion of culture in the services provided by a CHAP provider. 3. Plan partnerships across the T/TO geographic region to address the barriers, including reimbursement, training, education, clinical infrastructure, implementation cost, and determination of system integration.

II. Award Information Funding Instrument—Grant Estimated Funds Available The total funding identified for fiscal year (FY) 2021 is approximately $2,340,000. Individual award amounts for the first budget year are anticipated to be between $250,000 and $260,000. The funding available for competing and subsequent continuation awards issued under this announcement is subject to the availability of appropriations and budgetary priorities of the Agency.

The IHS is under no obligation to make awards that are selected for funding under this announcement. Anticipated Number of Awards Approximately nine awards will be issued under this program announcement. The IHS intends to award no more than one grant per IHS area. Period of Performance The period of performance is two years.

III. Eligibility Information 1. Eligibility To be eligible for this new FY 2021 funding opportunity, an applicant must be one of the following, as defined under 25 U.S.C. 1603.

A federally recognized Indian Tribe as defined by 25 U.S.C. 1603(14). The term “Indian Tribe” means any Indian Tribe, band, nation, or other organized group or community, including any Alaska Native village or group, or regional or village corporation, as defined in or established pursuant to the Alaska Native Claims Settlement Act (85 Stat. 688) [43 U.S.C.

1601 et seq.], which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians. A Tribal organization as defined by 25 U.S.C. 1603(26). The term “Tribal organization” has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C.

5304). €œTribal organization” means the recognized governing body of any Indian Tribe. Any legally established organization of Indians which is controlled, sanctioned, or chartered by such governing body or which is democratically elected by the adult members of the Indian community to be served by such organization and which includes the maximum participation of Indians in all phases of its activities. Provided that, in any case where a contract is let or grant made to an organization to perform services benefiting more than one Indian Tribe, the approval of each such Indian Tribe shall be a prerequisite to the letting or making of such contract or grant.

Applicant shall submit letters of support and/or Tribal Resolutions from the Tribes to be served. An applicant may not apply to both this opportunity, TAP, and the CHAP Tribal Planning and Implementation (TPI) opportunity (number HHS-2021-IHS-TPI-0001). An organization currently carrying out a CHAP in the United States, in accordance with 25 U.S.C. 1616l through an Indian Self-Determination and Education Assistance Act (ISDEAA) agreement, is also not eligible to apply.

The Program office will notify any applicants deemed ineligible. Note. Please refer to Section IV.2 (Application and Submission Information/Subsection 2, Content and Form of Application Submission) for additional proof of applicant status documents required, such as Tribal Resolutions, proof of nonprofit status, etc. 2.

Cost Sharing or Matching The IHS does not require matching funds or cost sharing for grants or cooperative agreements. 3. Other Requirements Applications with budget requests that exceed the highest dollar amount outlined under Section II Award Information, Estimated Funds Available, or exceed the Period of Performance outlined under Section II Award Information, Period of Performance, will be considered not responsive and will not be reviewed. The Division of Grants Management (DGM) will notify the applicant.

Additional Required Documentation Tribal Resolution The DGM must receive an official, signed Tribal Resolution prior to issuing a Notice of Award (NoA) to any applicant selected for funding. An Indian Tribe or Tribal organization that is proposing a project affecting another Indian Tribe must include resolutions from all affected Tribes to be served. However, if an official, signed Tribal Resolution cannot be submitted with the application prior to the application Start Printed Page 41053deadline date, a draft Tribal Resolution must be submitted with the application by the deadline date in order for the application to be considered complete and eligible for review. The draft Tribal Resolution is not in lieu of the required signed resolution but is acceptable until a signed resolution is received.

If an application without a signed Tribal Resolution is selected for funding, the applicant will be contacted by the Grants Management Specialist (GMS) listed in this funding announcement and given 90 days to submit an official, signed Tribal Resolution to the GMS. If the signed Tribal Resolution is not received within 90 days, the award will be forfeited. Tribes organized with a governing structure other than a Tribal council may submit an equivalent document commensurate with their governing organization. Proof of Nonprofit Status Organizations claiming nonprofit status must submit a current copy of the 501(c)(3) Certificate with the application.

IV. Application and Submission Information 1. Obtaining Application Materials The application package and detailed instructions for this announcement are hosted on https://www.Grants.gov. Please direct questions regarding the application process to Mr.

Paul Gettys at (301) 443-2114 or (301) 443-5204. 2. Content and Form Application Submission Mandatory documents for all applicants include. Abstract (one page) summarizing the project.

Application forms. 1. SF-424, Application for Federal Assistance. 2.

SF-424A, Budget Information—Non-Construction Programs. 3. SF-424B, Assurances—Non-Construction Programs. Project Narrative (not to exceed 15 pages).

See Section IV.2.A Project Narrative for instructions. 1. Background information on the organization. 2.

Proposed scope of work, objectives, and activities that provide a description of what the applicant plans to accomplish. Budget Justification and Narrative (not to exceed 5 pages). See Section IV.2.B Budget Narrative for instructions. One-page Timeframe Chart.

Tribal Resolution(s). Letters of Support from organization's Board of Directors (if applicable). 501(c)(3) Certificate. Biographical sketches for all Key Personnel.

Contractor/Consultant resumes or qualifications and scope of work. Disclosure of Lobbying Activities (SF-LLL), if applicant conducts reportable lobbying. Certification Regarding Lobbying (GG-Lobbying Form). Copy of current Negotiated Indirect Cost rate (IDC) agreement (required in order to receive IDC).

Organizational Chart (optional). Documentation of current Office of Management and Budget (OMB) Financial Audit (if applicable). Acceptable forms of documentation include. 1.

Email confirmation from Federal Audit Clearinghouse (FAC) that audits were submitted. Or 2. Face sheets from audit reports. Applicants can find these on the FAC website at https://harvester.census.gov/​facdissem/​Main.aspx.

Public Policy Requirements All Federal public policies apply to IHS grants and cooperative agreements. Pursuant to 45 CFR 80.3(d), an individual shall not be deemed subjected to discrimination by reason of their exclusion from benefits limited by Federal law to individuals eligible for benefits and services from the IHS. See https://www.hhs.gov/​grants/​grants/​grants-policies-regulations/​index.html. Requirements for Project and Budget Narratives A.

Project Narrative This narrative should be a separate document that is no more than 15 pages and must. (1) Have consecutively numbered pages. (2) use black font 12 points or larger. (3) be single-spaced.

And (4) be formatted to fit standard letter paper (81/2 x 11 inches). Be sure to succinctly answer all questions listed under the evaluation criteria (refer to Section V.1, Evaluation Criteria) and place all responses and required information in the correct section noted below or they will not be considered or scored. If the narrative exceeds the page limit, the application will be considered not responsive and not be reviewed. The 15-page limit for the narrative does not include the work plan, standard forms, Tribal Resolutions, budget, budget justifications, narratives, and/or other items.

There are three parts to the narrative. Part 1—Program Information. Part 2—Program Plan. And Part 3—Program Evaluation and Outcome Report.

See below for additional details about what must be included in the narrative. The page limits below are for each narrative and budget submitted. Part 1. Program Information (Limit—4 Pages) Section 1.

Community Profile Describe the demographics of the community including, but not limited to, geography, languages, age, and socioeconomic status. The community profile should include data specific to the community that would benefit from the implementation of CHAP. Section 2. Health &.

Infrastructure Needs Describe the community's current health disparities related to primary, behavioral, and oral health care. Section 3. Organizational Capacity Describe the T/TO's current health program activities, how long it has been operating, and what programs or services are currently being provided. Describe in full the organization's infrastructure and its ability to assess the barriers that could impact the integration of CHAP and identify significant barriers that could prohibit the implementation.

Part 2. Program Plan (Limit—6 Pages) Section 1. Program Plan Describe in full the direction the T/TO plans to take in the CHAP TAP. The program plan should first clearly identify the problems within the community related to behavioral, primary, and oral health.

The program plan should then include the plan to assess the problem(s). This should include a timeline for the assessment. The program plan should identify a timeline to determine whether CHAP can address the barriers identified. Section 2.

Program Activities Describe in full the activities to identify problems creating barriers within the community related to behavioral, primary, and oral health. These activities should be categorized (at a minimum) within key factors related to clinical infrastructure, workforce barriers, training infrastructure, and cultural inclusion. Describe in full how the applicant plans to assess the problems identified. Finally, describe in detail the activities and associated timeline to determine whether CHAP is feasible and activities to quantify the cost associated with CHAP.

The program activities should detail which partners will aid in Start Printed Page 41054identifying and assessing barriers related to clinical infrastructure, workforce barriers, training infrastructure, and cultural inclusion. Section 3. Staffing Plan Describe key staff tasked with carrying out the program activities in Section 2. Applicants should account for potential stakeholder partnerships following the assessment of barriers in the staffing plan.

Section 4. Timeline Describe a timeline not to exceed two years for the completion of the program plan, activities, and evaluation plan. Provide a timeline chart depicting a realistic timeline that details all major activities, milestones, and applicable staffing plans. The timeline should include the projected progress report due at the midpoint of the project period.

The timeline chart should not exceed one page. Part 3. Program Evaluation &. Outcome Report (Limit—5 Pages) Section 1.

Evaluation Plan The evaluation plan should identify and describe significant program activities and achievements associated with the assessment and planning of whether CHAP can address identified barriers within the existing Tribal health system. Provide a comparison of the actual accomplishments to the goals established for the project period, or if applicable, provide justification for the lack of progress. The evaluation plan should organize all identified problems that lead to barriers into major categories related to clinical infrastructure, workforce barriers, training infrastructure, and cultural inclusion specific to the scope of practice of prospective CHAP providers. The evaluation plan should detail how these barriers can be quantified.

The evaluation plan should detail how the applicant will measure the assessment of whether CHAP can address the issues identified including number of partnerships for each major category of barriers, other factors that may impact feasibility, and sustainability. Finally, the evaluation plan should detail how the applicant plans to calculate the total cost associated with integrating CHAP as part of the planning process. Section 2. Outcome Report At the conclusion of the program period, using the findings from the evaluation, the T/TO should determine the feasibility of implementing a CHAP within their own community.

The Outcome Report should describe in full the findings of the program plan, evaluation, and determination on stage of readiness for implementation. The outcome report should organize the findings into at least five categories. 1. Clinical Infrastructure.

2. Workforce Barriers. 3. Training Infrastructure.

4. Cultural Inclusion. 5. Implementation Cost.

Based on the findings and measurable outcomes of the categories, the applicant should explicitly identify whether CHAP is feasible for implementation into their respective community. Applicants should develop an organized report that highlights the categories succinctly and includes data (quantitative or qualitative) from the evaluation plan. The outcome report should explicitly detail the cost associated with integrating CHAP if it is found that CHAP can address the barriers identified in the assessment phase. B.

Budget Narrative (Limit—5 Pages) Provide a budget narrative that explains the amounts requested for each line item of the budget from the SF-424A (Budget Information for Non-Construction Programs). The budget narrative should specifically describe how each item will support the achievement of proposed objectives. Be very careful about showing how each item in the “Other” category is justified. For subsequent budget years (see Multi-Year Project Requirements in Section V.1.

Application Review Information, Evaluation Criteria), the narrative should highlight the changes from year 1 or clearly indicate that there are no substantive budget changes during the period of performance. Do NOT use the budget narrative to expand the project narrative. 3. Submission Dates and Times Applications must be submitted through Grants.gov by 11:59 p.m.

Eastern Time on the Application Deadline Date. Any application received after the application deadline will not be accepted for review. Grants.gov will notify the applicant via email if the application is rejected. If technical challenges arise and assistance is required with the application process, contact Grants.gov Customer Support (see contact information at https://www.Grants.gov).

If problems persist, contact Mr. Paul Gettys (Paul.Gettys@ihs.gov), Acting Director, DGM, by telephone at (301) 443-2114 or (301) 443-5204. Please be sure to contact Mr. Gettys at least ten days prior to the application deadline.

Please do not contact the DGM until you have received a Grants.gov tracking number. In the event you are not able to obtain a tracking number, call the DGM as soon as possible. The IHS will not acknowledge receipt of applications. 4.

Intergovernmental Review Executive Order 12372 requiring intergovernmental review is not applicable to this program. 5. Funding Restrictions Pre-award costs are allowable up to 90 days before the start date of the award provided the costs are otherwise allowable if awarded. Pre-award costs are incurred at the risk of the applicant.

The available funds are inclusive of direct and indirect costs. Only one grant may be awarded per applicant. 6. Electronic Submission Requirements All applications must be submitted via Grants.gov.

Please use the https://www.Grants.gov website to submit an application. Find the application by selecting the “Search Grants” link on the homepage. Follow the instructions for submitting an application under the Package tab. No other method of application submission is acceptable.

If the applicant cannot submit an application through Grants.gov, a waiver must be requested. Prior approval must be requested and obtained from Mr. Paul Gettys, Acting Director, DGM. A written waiver request must be sent to GrantsPolicy@ihs.gov with a copy to Paul.Gettys@ihs.gov.

The waiver request must. (1) Be documented in writing (emails are acceptable) before submitting an application by some other method, and (2) include clear justification for the need to deviate from the required application submission process. Once the waiver request has been approved, the applicant will receive a confirmation of approval email containing submission instructions. A copy of the written approval must be included with the application that is submitted to the DGM.

Applications that are submitted without a copy of the signed waiver from the Acting Director of the DGM will not be reviewed. The Grants Management Officer of the DGM will notify the applicant via email of this decision. Applications submitted under waiver must be received by the DGM no later than 5:00 p.m., Eastern Time, on the Application Deadline Date. Late applications will not be accepted for processing.

Applicants that do not register for both the System for Award Management (SAM) and Grants.gov and/or fail to request timely assistance with technical issues will not be Start Printed Page 41055considered for a waiver to submit an application via alternative method. Please be aware of the following. Please search for the application package in https://www.Grants.gov by entering the Assistance Listing (CFDA) number or the Funding Opportunity Number. Both numbers are located in the header of this announcement.

If you experience technical challenges while submitting your application, please contact Grants.gov Customer Support (see contact information at https://www.Grants.gov). Upon contacting Grants.gov, obtain a tracking number as proof of contact. The tracking number is helpful if there are technical issues that cannot be resolved and a waiver from the agency must be obtained. Applicants are strongly encouraged not to wait until the deadline date to begin the application process through Grants.gov as the registration process for SAM and Grants.gov could take up to 20 working days.

Please follow the instructions on Grants.gov to include additional documentation that may be requested by this funding announcement. Applicants must comply with any page limits described in this funding announcement. After submitting the application, the applicant will receive an automatic acknowledgment from Grants.gov that contains a Grants.gov tracking number. The IHS will not notify the applicant that the application has been received.

Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) Applicants and grantee organizations are required to obtain a DUNS number and maintain an active registration in the SAM database. The DUNS number is a unique 9-digit identification number provided by D&B that uniquely identifies each entity. The DUNS number is site specific. Therefore, each distinct performance site may be assigned a DUNS number.

Obtaining a DUNS number is easy, and there is no charge. To obtain a DUNS number, please access the request service through https://fedgov.dnb.com/​webform or call (866) 705-5711. The Federal Funding Accountability and Transparency Act of 2006, as amended (“Transparency Act”), requires all HHS recipients to report information on sub-awards. Accordingly, all IHS grantees must notify potential first-tier sub-recipients that no entity may receive a first-tier sub-award unless the entity has provided its DUNS number to the prime grantee organization.

This requirement ensures the use of a universal identifier to enhance the quality of information available to the public pursuant to the Transparency Act. System for Award Management (SAM) Organizations that are not registered with SAM must have a DUNS number first, then access the SAM online registration through the SAM home page at https://sam.gov (U.S. Organizations will also need to provide an Employer Identification Number from the Internal Revenue Service that may take an additional 2-5 weeks to become active). Please see SAM.gov for details on the registration process and timeline.

Registration with the SAM is free of charge but can take several weeks to process. Applicants may register online at https://sam.gov. Additional information on implementing the Transparency Act, including the specific requirements for DUNS and SAM, are available on the DGM Grants Management, Policy Topics web page. Https://www.ihs.gov/​dgm/​policytopics/​.

V. Application Review Information Possible points assigned to each section are noted in parentheses. The 15-page project narrative should include only the first year of activities. Information for multi-year projects should be included as a separate document.

See “Multi-year Project Requirements” at the end of this section for more information. The narrative section should be written in a manner that is clear to outside reviewers unfamiliar with prior related activities of the applicant. It should be well organized, succinct, and contain all information necessary for reviewers to fully understand the project. Attachments requested in the criteria do not count toward the 15-page limit for the project narrative.

Points will be assigned to each evaluation criteria adding up to a total of 100 possible points. Points are assigned as follows. 1. Evaluation Criteria A.

Introduction and Need for Assistance (10 Points) Identify the proposed project and plans to identify the feasibility of implementing a CHAP within their community. The needs should clearly identify the existing health system and how the CHAP may be a viable workforce model for the community needs. B. Project Objective(s), Work Plan, and Approach (30 Points) The work plan should be comprised of two key parts.

Program Information and Program Plan. Acceptable Program Information should provide information related to three (3) key sections. Community profile. Health and infrastructure.

And organizational capacity. The Program Information part should demonstrate a robust community profile that highlights the existing health system, demographic data of community members and user population, and a detailed description of the T/TO carrying out the proposed activity. An acceptable Program Plan should include details of the applicant's plan to address the program objective. The Program Plan should address, at a minimum, key activities related to clinical infrastructure, workforce barriers, and training infrastructure.

C. Program Evaluation (30 Points) The program evaluation should address how the applicant intends to measure major categories related to clinical infrastructure. Workforce barriers. Training infrastructure.

Cultural inclusion (See Sample Logic Model in Related Documents in Grants.gov) specific to the scope of practice of prospective CHAP providers. And implementation costs. The evaluation plan should identify. how the applicant plans to determine the feasibility of CHAP integration into the Tribal system.

Measurement of significant systematic barriers. Implementation cost associated with CHAP. And planning for the scope of work. The applicant may choose to develop a readiness assessment to measure the feasibility.

List measurable and attainable goals with explicit timelines that detail expectation of findings. D. Organizational Capabilities, Key Personnel, and Qualifications (10 Points) Provide a detailed biographical sketch of each member of key personnel assigned to carry out the objectives of the program plan. The sketches should detail the qualifications and expertise of identified staff.

E. Categorical Budget and Budget Justification (20 Points) Provide a detailed budget of each expenditure directly related to the identified program activities. Multi-Year Project Requirements Applications must include a brief project narrative and budget (one additional page per year) addressing the developmental plans for each additional year of the project. This attachment will Start Printed Page 41056not count as part of the project narrative or the budget narrative.

Additional documents can be uploaded as Other Attachments in Grants.gov. Work plan, logic model, and/or timeline for proposed objectives. Position descriptions for key staff. Resumes of key staff that reflect current duties.

Consultant or contractor proposed scope of work and letter of commitment (if applicable). Current Indirect Cost Rate Agreement. Organizational chart. Map of area identifying project location(s).

Additional documents to support narrative (i.e., data tables, key news articles, etc.). 2. Review and Selection Each application will be prescreened for eligibility and completeness, as outlined in the funding announcement. Applications that meet the eligibility criteria shall be reviewed for merit by the Objective Review Committee (ORC) based on evaluation criteria.

Incomplete applications and applications that are not responsive to the administrative thresholds (budget limit, project period limit) will not be referred to the ORC and will not be funded. The applicant will be notified of this determination. Applicants must address all program requirements and provide all required documentation. 3.

Notifications of Disposition All applicants will receive an Executive Summary Statement from the IHS Office of Clinical and Preventive Services within 30 days of the conclusion of the ORC outlining the strengths and weaknesses of their application. The summary statement will be sent to the Authorizing Official identified on the face page (SF-424) of the application. A. Award Notices for Funded Applications The NoA is the authorizing document for which funds are dispersed to the approved entities and reflects the amount of Federal funds awarded, the purpose of the grant, the terms and conditions of the award, the effective date of the award, and the budget/project period.

Each entity approved for funding must have a user account in GrantSolutions in order to retrieve the NoA. Please see the Agency Contacts list in Section VII for the systems contact information. B. Approved but Unfunded Applications Approved applications not funded due to lack of available funds will be held for one year.

If funding becomes available during the course of the year, the application may be reconsidered. Note. Any correspondence other than the official NoA executed by an IHS grants management official announcing to the project director that an award has been made to their organization is not an authorization to implement their program on behalf of the IHS. VI.

Award Administration Information 1. Administrative Requirements Awards issued under this announcement are subject to, and are administered in accordance with, the following regulations and policies. A. The Criteria as Outlined in This Program Announcement B.

Administrative Regulations for Grants C. Grants Policy D. Cost Principles Uniform Administrative Requirements for HHS Awards, “Cost Principles,” at 45 CFR part 75, subpart E. E.

Audit Requirements Uniform Administrative Requirements for HHS Awards, “Audit Requirements,” at 45 CFR part 75, subpart F. F. As of August 13, 2020, 2 CFR 200 was updated to include a prohibition on certain telecommunications and video surveillance services or equipment. This prohibition is described in 2 CFR 200.216.

This will also be described in the terms and conditions of every IHS grant and cooperative agreement awarded on or after August 13, 2020. 2. Indirect Costs This section applies to all recipients that request reimbursement of indirect costs (IDC) in their application budget. In accordance with HHS Grants Policy Statement, Part II-27, IHS requires applicants to obtain a current IDC rate agreement and submit it to the DGM prior to the DGM issuing an award.

The rate agreement must be prepared in accordance with the applicable cost principles and guidance as provided by the cognizant agency or office. A current rate covers the applicable grant activities under the current award's budget period. If the current rate agreement is not on file with the DGM at the time of award, the IDC portion of the budget will be restricted. The restrictions remain in place until the current rate agreement is provided to the DGM.

Per 45 CFR 75.414(f) Indirect (F&A) costs, “any non-Federal entity [i.e., applicant] that has never received a negotiated indirect cost rate,. . . May elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC) which may be used indefinitely.

As described in Section 75.403, costs must be consistently charged as either indirect or direct costs, but may not be double charged or inconsistently charged as both. If chosen, this methodology once elected must be used consistently for all Federal awards until such time as the non-Federal entity chooses to negotiate for a rate, which the non-Federal entity may apply to do at any time.” Electing to charge a de minimis rate of 10 percent only applies to applicants that have never received an approved negotiated indirect cost rate from HHS or another cognizant federal agency. Applicants awaiting approval of their indirect cost proposal may request the 10 percent de minimis rate. When the applicant chooses this method, costs included in the indirect cost pool must not be charged as direct costs to the grant.

Available funds are inclusive of direct and appropriate indirect costs. Approved indirect funds are awarded as part of the award amount, and no additional funds will be provided. Generally, IDC rates for IHS grantees are negotiated with the Division of Cost Allocation (DCA) at https://rates.psc.gov/​ or the Department of the Interior (Interior Business Center) at https://ibc.doi.gov/​ICS/​tribal. For Start Printed Page 41057questions regarding the indirect cost policy, please call the Grants Management Specialist listed under “Agency Contacts” or the main DGM office at (301) 443-5204.

3. Reporting Requirements The grantee must submit required reports consistent with the applicable deadlines. Failure to submit required reports within the time allowed may result in suspension or termination of an active grant, withholding of additional awards for the project, or other enforcement actions such as withholding of payments or converting to the reimbursement method of payment. Continued failure to submit required reports may result in the imposition of special award provisions and/or the non-funding or non-award of other eligible projects or activities.

This requirement applies whether the delinquency is attributable to the failure of the awardee organization or the individual responsible for preparation of the reports. Per DGM policy, all reports must be submitted electronically by attaching them as a “Grant Note” in GrantSolutions. Personnel responsible for submitting reports will be required to obtain a login and password for GrantSolutions. Please see the Agency Contacts list in Section VII for the systems contact information.

The reporting requirements for this program are noted below. A. Progress Reports Program progress reports are required semi-annually. The progress reports are due within 30 days after the budget period ends (specific dates will be listed in the NoA Terms and Conditions).

These reports must include a brief comparison of actual accomplishments to the goals established for the period, a summary of progress to date or, if applicable, provide sound justification for the lack of progress, and other pertinent information as required. A final report must be submitted within 90 days of expiration of the period of performance. B. Financial Reports Federal Cash Transaction Reports are due 30 days after the close of every calendar quarter to the Payment Management Services at https://pms.psc.gov.

Failure to submit timely reports may result in adverse award actions blocking access to funds. Federal Financial Reports are due 30 days after the end of each budget period, and a final report is due 90 days after the end of the Period of Performance. Grantees are responsible and accountable for accurate information being reported on all required reports. The Progress Reports and Federal Financial Report.

C. Data Collection and Reporting To satisfy the reporting requirements, the applicant is expected to develop an outcome report. The outcome report should explicitly state whether CHAP implementation and integration into the existing health care system is viable or not. The Outcome Report should describe, in full, the findings of the program plan, evaluation, and determination on stage of readiness for implementation.

The outcome report should organize the findings into at least five categories. 1. Clinical Infrastructure. 2.

Workforce Barriers. 3. Training Infrastructure. 4.

Cultural Inclusion. 5. Implementation Cost. Applicants are encouraged to identify additional categories above the five aforementioned and may choose to develop subcategories that best fit the program plan.

D. Federal Sub-Award Reporting System (FSRS) This award may be subject to the Transparency Act sub-award and executive compensation reporting requirements of 2 CFR part 170. The Transparency Act requires the OMB to establish a single searchable database, accessible to the public, with information on financial assistance awards made by Federal agencies. The Transparency Act also includes a requirement for recipients of Federal grants to report information about first-tier sub-awards and executive compensation under Federal assistance awards.

IHS has implemented a Term of Award into all IHS Standard Terms and Conditions, NoAs, and funding announcements regarding the FSRS reporting requirement. This IHS Term of Award is applicable to all IHS grant and cooperative agreements issued on or after October 1, 2010, with a $25,000 sub-award obligation threshold met for any specific reporting period. For the full IHS award term implementing this requirement and additional award applicability information, visit the DGM Grants Management website at https://www.ihs.gov/​dgm/​policytopics/​. E.

Compliance With Executive Order 13166 Implementation of Services Accessibility Provisions for All Grant Application Packages and Funding Opportunity Announcements Recipients of Federal financial assistance (FFA) from HHS must administer their programs in compliance with Federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age, and, in some circumstances, religion, conscience, and sex. This includes ensuring programs are accessible to persons with limited English proficiency. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. Please see https://www.hhs.gov/​civil-rights/​for-providers/​provider-obligations/​index.html and http://www.hhs.gov/​ocr/​civilrights/​understanding/​section1557/​index.html.

Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under Federal civil rights laws at https://www.hhs.gov/​ocr/​about-us/​contact-us/​index.html or call 1-800-368-1019 or TDD 1-800-537-7697. F. Federal Awardee Performance and Integrity Information System (FAPIIS) The IHS is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS), at https://www.fapiis.gov, before making any award in excess of the simplified acquisition threshold (currently $250,000) over the period of performance. An applicant may review and comment on any information about itself that a Federal awarding agency previously entered.

IHS will consider any comments by the applicant, in addition to other information in FAPIIS, in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 45 CFR 75.205. As required by 45 CFR part 75, appendix XII, of the Uniform Guidance, non-Federal entities (NFEs) are required to disclose in FAPIIS any information about criminal, civil, and administrative proceedings, and/or affirm that there is no new information to provide. This applies to NFEs that receive Federal awards (currently active grants, cooperative agreements, and procurement contracts) greater than $10,000,000 for any period of time during the period of performance of an award/project. Mandatory Disclosure Requirements As required by 2 CFR part 200 of the Uniform Guidance and the HHS implementing regulations at 45 CFR part 75, the IHS must require an NFE or an applicant for a Federal award to disclose, in a timely manner, in writing to the IHS or pass-through entity all violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award.

Submission is required for all applicants and recipients, in writing, to the IHS and to the HHS Office of Inspector General of all information related to violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award. 45 CFR 75.113. Disclosures must be sent in writing to. U.S.

Department of Health and Human Services, Indian Health Service, Division of Grants Management, ATTN. Paul Gettys, Acting Director, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857 (Include “Mandatory Grant Disclosures” in subject line), Office. (301) 443-5204, Fax.

(301) 594-0899, Email. Paul.Gettys@ihs.gov. And U.S. Department of Health and Human Services, Office of Inspector General, ATTN.

Mandatory Grant Disclosures, Intake Coordinator, 330 Independence Avenue SW, Cohen Building, Room 5527, Washington, DC 20201, URL. Https://oig.hhs.gov/​fraud/​report-fraud/​ (Include “Mandatory Grant Disclosures” in subject line), Fax. (202) 205-0604 (Include “Mandatory Grant Disclosures” in subject line) or Email. MandatoryGranteeDisclosures@oig.hhs.gov.

Failure to make required disclosures can result in any of the remedies described in 45 CFR 75.371 Remedies for noncompliance, including suspension or debarment (see 2 CFR parts 180 &. 376). VII. Agency Contacts 1.

Questions on the programmatic issues may be directed to. Minette C. Galindo, Public Health Advisor, Indian Health Service, Office of Clinical and Preventive Services, 5600 Fishers Lane, Mail Stop. 08N34A, Rockville, MD 20857, Phone.

(301) 443-4644, Email. IHSCHAP@ihs.gov. 2. Questions on grants management and fiscal matters may be directed to.

Donald Gooding, Grants Management Specialist, Indian Health Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, Phone. (301) 443-2298, Email. Donald.Gooding@ihs.gov.

3. Questions on systems matters may be directed to. Paul Gettys, Acting Director, Indian Health Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop. 09E70, Rockville, MD 20857, Phone.

(301) 443-2114. Or the DGM main line (301) 443-5204, Email. Paul.Gettys@ihs.gov. VIII.

Other Information The Public Health Service strongly encourages all grant, cooperative agreement and contract recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of the facility) in which regular or routine education, library, day care, health care, or early childhood development services are provided to children. This is consistent with the HHS mission to protect and advance the physical and mental health of the American people. Start Signature Elizabeth A.

Fowler, Acting Director, Indian Health Service. End Signature End Preamble [FR Doc. 2021-16280 Filed 7-29-21. 8:45 am]BILLING CODE 4165-16-P.

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Lauren Gambill, buy diflucan walmart MDPediatrician, AustinMember, Texas Medical Association (TMA) Committee Web Site on Child and Adolescent HealthExecutive Board Member, Texas Pediatric SocietyDoctors are community leaders. This role has become even more important during the antifungal medication diflucan. As patients navigate our new reality, they are looking to us to determine what buy diflucan walmart is safe, how to protect their families, and the future of their health care. As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net. The U.S.

Census helps determine funding for those resources, and that is why it is of the upmost importance that each and every Texan, no matter address, immigration status, or buy diflucan walmart age, respond to the 2020 U.S. Census. The deadline has been cut short one month and now closes Sept buy diflucan walmart. 30.antifungal medication has only increased the importance of completing the census to help our local communities and economies recover. The novel antifungals has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more.

Schools also have been stretched thin, with teachers scrambling buy diflucan walmart to teach students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago. Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the diflucan’s fallout. Therefore, it is vital that all Texans be counted.The federal dollars Texas receives generally depends buy diflucan walmart on our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example.

Federal funds pay for 60% of the state’s program, which provides health buy diflucan walmart coverage for two out of five Texas children, one in three individuals with disabilities, and 53% of all births. The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texas’ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars. If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or physician and provider payments, any of which are potentially detrimental.The census data also is key to funding other aspects of a community’s social safety net:Health careThe Children’s Health Insurance Program (CHIP) provides low-cost health insurance to children whose parents make too much to qualify for Medicaid, but not enough to afford buy diflucan walmart quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census.

Texas also uses this federal funding to study and respond to maternal mortality and perinatal depression.Food and housing As unemployment rises and families struggle financially, many buy diflucan walmart live with uncertainty as to where they will find their next meal. Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the diflucan continues. The Central Texas Food buy diflucan walmart Bank saw a 206% rise in clients in March. Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census.

Funding for local housing programs also is calculated via the census. An accurate count will help ensure that people who lose their homes during buy diflucan walmart this economic crisis have better hope of finding shelter while our communities recover. Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by antifungals, more parents are taking on roles as breadwinner, parent, teacher, and caretaker. This stress buy diflucan walmart highlights the desperate need for affordable childcare. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families.

The good news is you still have time to complete the census. Visit 2020census.gov to take it buy diflucan walmart. It takes less than five minutes to complete. Then talk to your family, neighbors, buy diflucan walmart and colleagues about doing the same. If you are wondering who counts, the answer is everyone, whether it’s a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the diflucan.

Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R). UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson Cortino, faculty advisor Kaparaboyna Kumar, MD, Ryan Wealther, Sidney buy diflucan walmart Akabogu, Irma Ruiz, and Frank Jung pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditor’s Note. August is National Immunization Awareness Month. This article is part of a Me&My Doctor series highlighting and promoting the use of vaccinations.“Can the flu buy diflucan walmart shot give you the flu?.

€â€œIs it dangerous for pregnant women to get a flu shot?. €â€œCan treatments cause autism? buy diflucan walmart. €These were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu treatment discussion. It is easy to see why these questions were asked, as treatment misinformation is common today.UTHSA medical student Frank Jing (left) gets a treatment fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan Wealther“No” is the answer to all the questions. These were exactly the types of myths we set buy diflucan walmart out to dispel at our vaccination drive.UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the treatment drive at Alpha Home with the support of TMA’s Be Wise – Immunize℠ program, a public health initiative that aims to increase vaccinations and treatment awareness through shot clinics and education.

Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general treatment myths. The Alpha Home residents could ask us questions during the program.We were interested to see if our educational program could answer Alpha Home residents’ questions about vaccinations and allay their hesitations about getting a flu buy diflucan walmart vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define treatment hesitancy. treatment hesitancy is a concept defined by the World Health Organization. It relates to when patients do not vaccinate despite having access to treatments buy diflucan walmart.

treatment hesitancy is a problem because it prevents individuals from receiving their vaccinations. That makes them more susceptible to getting sick from treatment-preventable diseases.)We surveyed the residents’ opinions about vaccinations before and after our educational program. While opinions about shots improved with each survey question, we saw the most significant attitude change reflected in answers to the questions “I am concerned that vaccinations might not be safe,” and “How likely are you to receive a flu buy diflucan walmart shot today?. € We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about treatments, after learning more about their effectiveness by trusted members of the medical community. Graph by Ryan buy diflucan walmart WealtherWhy is this important?.

First, our findings confirm what we already knew. Education by a trusted member of the medical community can effect change. In fact, it is widely known that physician recommendation of vaccination is one of the most critical factors affecting whether patients receive an influenza buy diflucan walmart vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me “Dr. Truth” by buy diflucan walmart the end of the evening.Second, our findings add to our understanding of adult treatment hesitancy.

This is significant because most of what we know about treatment hesitancy is limited to parental attitudes toward their children’s vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults need some vaccinations as well, like the yearly buy diflucan walmart influenza treatment. After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu treatment. Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the antifungal medication diflucan because it decreases illnesses and conserves health care resources.

Thousands of people each year are hospitalized from the flu, and with hospitals filling up with antifungals patients, we buy diflucan walmart could avoid adding dangerously ill flu patients to the mix. Lastly, these findings are important because once a antifungal medication vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the antifungal medication treatment is still in development, it is not immune to treatment buy diflucan walmart hesitancy. Recent polls have indicated up to one-third of Americans would not receive a antifungal medication treatment even if it were accessible and affordable. Work is already being done to try to raise awareness and acceptance.

In addition, misinformation about the antifungal medication treatment buy diflucan walmart is circulating widely. (Someone recently asked me if the antifungal medication treatment will implant a microchip in people, and I have seen the same myth circulating on social media. It will not.) This myth, however, illustrates the need for health care professionals to answer patients’ questions and to assuage their concerns.treatments work best when buy diflucan walmart many people in a community receive them, and treatment hesitancy can diminish vaccination rates, leaving people who can't get certain treatments susceptible to these treatment-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots.

As the antifungal medication diflucan progresses, we need to ensure children and adults receive their vaccinations as recommended by their physician buy diflucan walmart and the Centers for Disease Control and Prevention. I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, we’re more than happy to answer your questions..

Lauren Gambill, MDPediatrician, AustinMember, Texas Medical Association (TMA) Committee on Child and Adolescent HealthExecutive Board Member, Texas Pediatric how can i get diflucan over the counter SocietyDoctors are community leaders. This role has become even more important during the antifungal medication diflucan. As patients navigate our new reality, they are looking to us to determine what is safe, how to protect their families, and the future of their health how can i get diflucan over the counter care. As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net.

The U.S. Census helps determine funding for those resources, and that is why it is of the upmost importance that each and every Texan, no matter how can i get diflucan over the counter address, immigration status, or age, respond to the 2020 U.S. Census. The deadline has been cut short one month how can i get diflucan over the counter and now closes Sept.

30.antifungal medication has only increased the importance of completing the census to help our local communities and economies recover. The novel antifungals has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more. Schools also have been how can i get diflucan over the counter stretched thin, with teachers scrambling to teach students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago.

Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the diflucan’s fallout. Therefore, it is vital how can i get diflucan over the counter that all Texans be counted.The federal dollars Texas receives generally depends on our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example. Federal funds pay for 60% of the state’s program, which provides health coverage how can i get diflucan over the counter for two out of five Texas children, one in three individuals with disabilities, and 53% of all births.

The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texas’ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars. If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or physician and provider how can i get diflucan over the counter payments, any of which are potentially detrimental.The census data also is key to funding other aspects of a community’s social safety net:Health careThe Children’s Health Insurance Program (CHIP) provides low-cost health insurance to children whose parents make too much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census.

Texas also uses this federal funding to study and respond to maternal mortality and perinatal depression.Food and housing As unemployment rises and families struggle financially, many live with uncertainty as to where they will find their next meal how can i get diflucan over the counter. Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the diflucan continues. The Central Texas Food Bank saw a 206% rise in clients in March how can i get diflucan over the counter.

Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census. Funding for local housing programs also is calculated via the census. An accurate count will help how can i get diflucan over the counter ensure that people who lose their homes during this economic crisis have better hope of finding shelter while our communities recover. Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by antifungals, more parents are taking on roles as breadwinner, parent, teacher, and caretaker.

This stress how can i get diflucan over the counter highlights the desperate need for affordable childcare. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families. The good news is you still have time to complete the census. Visit 2020census.gov to take how can i get diflucan over the counter it.

It takes less than five minutes to complete. Then talk how can i get diflucan over the counter to your family, neighbors, and colleagues about doing the same. If you are wondering who counts, the answer is everyone, whether it’s a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the diflucan. Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R).

UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson Cortino, faculty advisor Kaparaboyna Kumar, MD, Ryan Wealther, Sidney Akabogu, Irma Ruiz, and Frank Jung pose with the TMA Be Wise Immunize how can i get diflucan over the counter banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditor’s Note. August is National Immunization Awareness Month. This article is part of how can i get diflucan over the counter a Me&My Doctor series highlighting and promoting the use of vaccinations.“Can the flu shot give you the flu?.

€â€œIs it dangerous for pregnant women to get a flu shot?. €â€œCan treatments cause how can i get diflucan over the counter autism?. €These were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu treatment discussion. It is easy to see why these questions were asked, as treatment misinformation is common today.UTHSA medical student Frank Jing (left) gets a treatment fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan Wealther“No” is the answer to all the questions.

These were exactly the types of myths we set out to dispel at our vaccination drive.UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the treatment drive at Alpha Home with the support of TMA’s Be Wise – Immunize℠ program, a public health initiative that aims to increase vaccinations and treatment awareness through shot how can i get diflucan over the counter clinics and education. Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general treatment myths. The Alpha Home residents could ask us questions during the how can i get diflucan over the counter program.We were interested to see if our educational program could answer Alpha Home residents’ questions about vaccinations and allay their hesitations about getting a flu vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define treatment hesitancy.

treatment hesitancy is a concept defined by the World Health Organization. It relates to when patients do not how can i get diflucan over the counter vaccinate despite having access to treatments. treatment hesitancy is a problem because it prevents individuals from receiving their vaccinations. That makes them more susceptible to getting sick from treatment-preventable diseases.)We surveyed the residents’ opinions about vaccinations before and after our educational program.

While opinions about shots improved with each survey question, we saw the most significant attitude change reflected in answers to the questions “I am concerned that vaccinations might not be safe,” and “How likely are you to receive how can i get diflucan over the counter a flu shot today?. € We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about treatments, after learning more about their effectiveness by trusted members of the medical community. Graph by Ryan WealtherWhy is this how can i get diflucan over the counter important?. First, our findings confirm what we already knew.

Education by a trusted member of the medical community can effect change. In fact, it is widely known that physician recommendation of vaccination is one of the most critical factors affecting whether patients how can i get diflucan over the counter receive an influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me “Dr. Truth” by the end of the evening.Second, our findings add how can i get diflucan over the counter to our understanding of adult treatment hesitancy.

This is significant because most of what we know about treatment hesitancy is limited to parental attitudes toward their children’s vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults how can i get diflucan over the counter need some vaccinations as well, like the yearly influenza treatment. After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu treatment.

Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the antifungal medication diflucan because it decreases illnesses and conserves health care resources. Thousands of people each year are hospitalized from how can i get diflucan over the counter the flu, and with hospitals filling up with antifungals patients, we could avoid adding dangerously ill flu patients to the mix. Lastly, these findings are important because once a antifungal medication vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the antifungal medication treatment how can i get diflucan over the counter is still in development, it is not immune to treatment hesitancy.

Recent polls have indicated up to one-third of Americans would not receive a antifungal medication treatment even if it were accessible and affordable. Work is already being done to try to raise awareness and acceptance. In addition, misinformation about how can i get diflucan over the counter the antifungal medication treatment is circulating widely. (Someone recently asked me if the antifungal medication treatment will implant a microchip in people, and I have seen the same myth circulating on social media.

It will not.) This myth, however, illustrates the need for health care professionals to answer patients’ questions and to assuage their concerns.treatments work best when many people in a community receive them, and treatment how can i get diflucan over the counter hesitancy can diminish vaccination rates, leaving people who can't get certain treatments susceptible to these treatment-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots. As the antifungal medication diflucan progresses, how can i get diflucan over the counter we need to ensure children and adults receive their vaccinations as recommended by their physician and the Centers for Disease Control and Prevention.

I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, we’re more than happy to answer your questions..

What should I watch for while taking Diflucan?

Visit your doctor or health care professional for regular checkups. If you are taking Diflucan for a long time you may need blood work. Tell your doctor if your symptoms do not improve. Some fungal s need many weeks or months of treatment to cure.

Alcohol can increase possible damage to your liver. Avoid alcoholic drinks.

If you have a vaginal , do not have sex until you have finished your treatment. You can wear a sanitary napkin. Do not use tampons. Wear freshly washed cotton, not synthetic, panties.

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Start Preamble Centers for diflucan online Medicare &. Medicaid Services (CMS), HHS. Extension of diflucan online timeline for publication of final rule. This notice announces an extension of the timeline for publication of a Medicare final rule in accordance with the Social Security Act, which allows us to extend the timeline for publication of the final rule. As of August 26, 2020, the timeline for diflucan online publication of the final rule to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021.

Start Further Info Lisa O. Wilson, (410) 786-8852. End Further Info End Preamble Start Supplemental diflucan online Information In the October 17, 2019 Federal Register (84 FR 55766), we published a proposed rule that addressed undue regulatory impact and burden of the physician self-referral law. The proposed rule was issued in conjunction with the Centers for Medicare &. Medicaid Services' (CMS) Patients over Paperwork diflucan online initiative and the Department of Health and Human Services' (the Department or HHS) Regulatory Sprint to Coordinated Care.

In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician. A new exception for diflucan online donations of cybersecurity technology and related services. And amendments to the existing exception for electronic health records (EHR) items and services. The proposed rule also provides critically necessary guidance for physicians and health care providers and suppliers whose financial relationships are governed by the physician self-referral statute and diflucan online regulations.

This notice announces an extension of the timeline for publication of the final rule and the continuation of effectiveness of the proposed rule. Section 1871(a)(3)(A) of the Social Security Act (the Act) requires us to establish and publish a regular timeline for the publication of final regulations based on the previous publication of a proposed regulation. In accordance with section 1871(a)(3)(B) of the Act, the timeline may vary among diflucan online different regulations based on differences in the complexity of the regulation, the number and scope of comments received, and other relevant factors, but may not be longer than 3 years except under exceptional circumstances. In addition, in accordance with section 1871(a)(3)(B) of the Act, the Secretary may extend the initial targeted publication date of the final regulation if the Secretary, no later than the regulation's previously established proposed publication date, publishes a notice with the new target date, and such notice includes a brief explanation of the justification for the variation. We announced in the Spring 2020 Unified Agenda diflucan online (June 30, 2020, www.reginfo.gov) that we would issue the final rule in August 2020.

However, we are still working through the Start Printed Page 52941complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date. This notice extends the timeline for publication of diflucan online the final rule until August 31, 2021. Start Signature Dated. August 24, 2020. Wilma M diflucan online.

Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services. End Signature diflucan online End Supplemental Information [FR Doc. 2020-18867 Filed 8-26-20. 8:45 am]BILLING CODE 4120-01-PStart Preamble Notice of amendment. The Secretary issues this amendment pursuant to section 319F-3 of the Public Health Service Act to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he diflucan online recommends the administration or use of the Covered Countermeasures.

This amendment to the Declaration published on March 17, 2020 (85 FR 15198) is effective as of August 24, 2020. Start Further diflucan online Info Robert P. Kadlec, MD, MTM&H, MS, Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201. Telephone. 202-205-2882.

End Further Info End Preamble Start Supplemental Information The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of Health and Human Services (the Secretary) to issue a Declaration to provide liability immunity to certain individuals and entities (Covered Persons) against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures (Covered Countermeasures), except for claims involving “willful misconduct” as defined in the PREP Act. Under the PREP Act, a Declaration may be amended as circumstances warrant. The PREP Act was enacted on December 30, 2005, as Public Law 109-148, Division C, § 2. It amended the Public Health Service (PHS) Act, adding section 319F-3, which addresses liability immunity, and section 319F-4, which creates a compensation program. These sections are codified at 42 U.S.C.

247d-6d and 42 U.S.C. 247d-6e, respectively. Section 319F-3 of the PHS Act has been amended by the diflucan and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013 and the antifungals Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, Start Printed Page 521372020, to expand Covered Countermeasures under the PREP Act. On January 31, 2020, the Secretary declared a public health emergency pursuant to section 319 of the PHS Act, 42 U.S.C. 247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the antifungal medication outbreak.

Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration on April 26, 2020, and July 25, 2020. On March 10, 2020, the Secretary issued a Declaration under the PREP Act for medical countermeasures against antifungal medication (85 FR 15198, Mar. 17, 2020) (the Declaration). On April 10, the Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020).

On June 4, the Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm antifungal medication might otherwise cause. The Secretary now amends section V of the Declaration to identify as qualified persons covered under the PREP Act, and thus authorizes, certain State-licensed pharmacists to order and administer, and pharmacy interns (who are licensed or registered by their State board of pharmacy and acting under the supervision of a State-licensed pharmacist) to administer, any treatment that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule (ACIP-recommended treatments).[] The Secretary also amends section VIII of the Declaration to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures includes not only antifungal medication caused by antifungals or a diflucan mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by antifungal medication, antifungals, or a diflucan mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Description of This Amendment by Section Section V. Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under subsection (b) has been issued with respect to such countermeasure. €œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed.

Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act. 42 U.S.C. 247d-6d(i)(8).[] By this amendment to the Declaration, the Secretary identifies an additional category of persons who are qualified persons under section 247d-6d(i)(8)(B).[] On May 8, 2020, CDC reported, “The identified declines in routine pediatric treatment ordering and doses administered might indicate that U.S. Children and their communities face increased risks for outbreaks of treatment-preventable diseases,” and suggested that a decrease in rates of routine childhood vaccinations were due to changes in healthcare access, social distancing, and other antifungal medication mitigation strategies.[] The report also stated that “[p]arental concerns about potentially exposing their children to antifungal medication during well child visits might contribute to the declines observed.” [] On July 10, 2020, CDC reported its findings of a May survey it conducted to assess the capacity of pediatric health care practices to provide immunization services to children during the antifungal medication diflucan. The survey, which was limited to practices participating in the treatments for Children program, found that, as of mid-May, 15 percent of Northeast pediatric practices were closed, 12.5 percent of Midwest practices were closed, 6.2 percent of practices in the South were closed, and 10 percent of practices in the West were closed.

Most practices had reduced office hours for in-person visits. When asked whether their practices would likely be able to accommodate new patients for immunization services through August, 418 practices (21.3 percent) either responded that this was not likely or the practice was permanently closed or not resuming immunization services for all patients, and 380 (19.6 percent) responded that they were unsure. Urban practices and those in the Northeast were less likely to be able to accommodate new patients compared with rural practices and those in the South, Midwest, or West.[] In response to these troubling developments, CDC and the American Academy of Pediatrics have stressed, “Well-child visits and vaccinations are essential services and help make sure children are protected.” [] The Secretary re-emphasizes that important recommendation to parents and legal guardians here. If your child is due for a well-child visit, contact your pediatrician's or other primary-care provider's office and ask about ways that the office safely offers well-child visits and vaccinations. Many medical offices are taking extra steps to make sure that well-child visits can occur safely during the antifungal medication diflucan, including.

Scheduling sick visits and well-child visits during different times of the Start Printed Page 52138day or days of the week, or at different locations. Asking patients to remain outside until it is time for their appointments to reduce the number of people in waiting rooms. Adhering to recommended social (physical) distancing and other -control practices, such as the use of masks. The decrease in childhood-vaccination rates is a public health threat and a collateral harm caused by antifungal medication. Together, the United States must turn to available medical professionals to limit the harm and public health threats that may result from decreased immunization rates.

We must quickly do so to avoid preventable s in children, additional strains on our healthcare system, and any further increase in avoidable adverse health consequences—particularly if such complications coincide with additional resurgence of antifungal medication. Together with pediatricians and other healthcare professionals, pharmacists are positioned to expand access to childhood vaccinations. Many States already allow pharmacists to administer treatments to children of any age.[] Other States permit pharmacists to administer treatments to children depending on the age—for example, 2, 3, 5, 6, 7, 9, 10, 11, or 12 years of age and older.[] Few States restrict pharmacist-administered vaccinations to only adults.[] Many States also allow properly trained individuals under the supervision of a trained pharmacist to administer those treatments.[] Pharmacists are well positioned to increase access to vaccinations, particularly in certain areas or for certain populations that have too few pediatricians and other primary-care providers, or that are otherwise medically underserved.[] As of 2018, nearly 90 percent of Americans lived within five miles of a community pharmacy.[] Pharmacies often offer extended hours and added convenience. What is more, pharmacists are trusted healthcare professionals with established relationships with their patients. Pharmacists also have strong relationships with local medical providers and hospitals to refer patients as appropriate.

For example, pharmacists already play a significant role in annual influenza vaccination. In the early 2018-19 season, they administered the influenza treatment to nearly a third of all adults who received the treatment.[] Given the potential danger of serious influenza and continuing antifungal medication outbreaks this autumn and the impact that such concurrent outbreaks may have on our population, our healthcare system, and our whole-of-nation response to the antifungal medication diflucan, we must quickly expand access to influenza vaccinations. Allowing more qualified pharmacists to administer the influenza treatment to children will make vaccinations more accessible. Therefore, the Secretary amends the Declaration to identify State-licensed pharmacists (and pharmacy interns acting under their supervision if the pharmacy intern is licensed or registered by his or her State board of pharmacy) as qualified persons under section 247d-6d(i)(8)(B) when the pharmacist orders and either the pharmacist or the supervised pharmacy intern administers treatments to individuals ages three through 18 pursuant to the following requirements. The treatment must be FDA-authorized or FDA-approved.

The vaccination must be ordered and administered according to ACIP's standard immunization schedule.[] The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training Start Printed Page 52139program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.[] The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.[] The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation.[] The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.[] The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment.[] The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregivers accompanying the children of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate.[] These requirements are consistent with those in many States that permit licensed pharmacists to order and administer treatments to children and permit licensed or registered pharmacy interns acting under their supervision to administer treatments to children.[] Administering vaccinations to children age three and older is less complicated and requires less training and resources than administering vaccinations to younger children. That is because ACIP generally recommends administering intramuscular injections in the deltoid muscle for individuals age three and older.[] For individuals less than three years of age, ACIP generally recommends administering intramuscular injections in the anterolateral aspect of the thigh muscle.[] Administering injections in the thigh muscle often presents additional complexities and requires additional training and resources including additional personnel to safely position the child while another healthcare professional injects the treatment.[] Moreover, as of 2018, 40% of three-year-olds were enrolled in preprimary programs (i.e. Preschool or kindergarten programs).[] Preprimary programs are beginning in the coming weeks or months, so the Secretary has concluded that it is particularly important for individuals ages three through 18 to receive ACIP-recommended treatments according to ACIP's standard immunization schedule.

All States require children to be vaccinated against certain communicable diseases as a condition of school attendance. These laws often apply to both public and private schools with identical immunization and exemption provisions.[] As nurseries, preschools, kindergartens, and schools reopen, increased access to childhood vaccinations is essential to ensuring children can return. Notwithstanding any State or local scope-of-practice legal requirements, (1) qualified licensed pharmacists are identified as qualified persons to order and administer ACIP-recommended treatments and (2) qualified State-licensed or registered pharmacy interns are identified as qualified persons to administer the ACIP-recommended treatments ordered by their supervising qualified licensed pharmacist.[] Both the PREP Act and the June 4, 2020 Second Amendment to the Declaration define “covered countermeasures” to include qualified diflucan and epidemic products that “limit the harm such diflucan or epidemic might otherwise cause.” [] The troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by Start Printed Page 52140antifungal medication as set forth in Sections VI and VIII of this Declaration.[] Hence, such vaccinations are “covered countermeasures” under the PREP Act and the June 4, 2020 Second Amendment to the Declaration. Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C.

300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other terms and conditions of the Declaration apply to such covered countermeasures. Section VIII. Category of Disease, Health Condition, or Threat As discussed, the troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by antifungal medication.

The Secretary therefore amends section VIII, which describes the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures, to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures is not only antifungal medication caused by antifungals or a diflucan mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by antifungal medication, antifungals, or a diflucan mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against antifungal medication. Sections V and VIII of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against antifungal medication, as amended April 10, 2020 and June 4, 2020, are further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below. All other sections of the Declaration remain in effect as published at 85 FR 15198 (Mar. 17, 2020) and amended at 85 FR 21012 (Apr.

15, 2020) and 85 FR 35100 (June 8, 2020). 1. Covered Persons, section V, delete in full and replace with. V. Covered Persons 42 U.S.C.

247d-6d(i)(2), (3), (4), (6), (8)(A) and (B) Covered Persons who are afforded liability immunity under this Declaration are “manufacturers,” “distributors,” “program planners,” “qualified persons,” and their officials, agents, and employees, as those terms are defined in the PREP Act, and the United States. In addition, I have determined that the following additional persons are qualified persons. (a) Any person authorized in accordance with the public health and medical emergency response of the Authority Having Jurisdiction, as described in Section VII below, to prescribe, administer, deliver, distribute or dispense the Covered Countermeasures, and their officials, agents, employees, contractors and volunteers, following a Declaration of an emergency. (b) any person authorized to prescribe, administer, or dispense the Covered Countermeasures or who is otherwise authorized to perform an activity under an Emergency Use Authorization in accordance with Section 564 of the FD&C Act. (c) any person authorized to prescribe, administer, or dispense Covered Countermeasures in accordance with Section 564A of the FD&C Act.

And (d) a State-licensed pharmacist who orders and administers, and pharmacy interns who administer (if the pharmacy intern acts under the supervision of such pharmacist and the pharmacy intern is licensed or registered by his or her State board of pharmacy), treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule. Such State-licensed pharmacists and the State-licensed or registered interns under their supervision are qualified persons only if the following requirements are met. The treatment must be FDA-authorized or FDA-approved. The vaccination must be ordered and administered according to ACIP's standard immunization schedule. The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE).

This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.

The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate. Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq.

Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other Start Printed Page 52141terms and conditions of the Declaration apply to such covered countermeasures. 2. Category of Disease, Health Condition, or Threat, section VIII, delete in full and replace with. VIII.

Category of Disease, Health Condition, or Threat 42 U.S.C. 247d-6d(b)(2)(A) The category of disease, health condition, or threat for which I recommend the administration or use of the Covered Countermeasures is not only antifungal medication caused by antifungals or a diflucan mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by antifungal medication, antifungals, or a diflucan mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Start Authority 42 U.S.C. 247d-6d. End Authority Start Signature Dated.

August 19, 2020. Alex M. Azar II, Secretary of Health and Human Services. End Signature End Supplemental Information [FR Doc. 2020-18542 Filed 8-20-20.

Start Preamble http://mydatinghangovers.com/2011/04/featured-blog-post-of-the-week-toddler-man/ Centers how can i get diflucan over the counter for Medicare &. Medicaid Services (CMS), HHS. Extension of timeline for publication of final rule how can i get diflucan over the counter.

This notice announces an extension of the timeline for publication of a Medicare final rule in accordance with the Social Security Act, which allows us to extend the timeline for publication of the final rule. As of August 26, 2020, the timeline for publication of the final rule to how can i get diflucan over the counter finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021. Start Further Info Lisa O.

Wilson, (410) 786-8852. End Further Info End Preamble Start Supplemental Information In the October 17, 2019 Federal Register (84 FR 55766), we published a proposed rule that addressed undue regulatory impact and burden of the physician self-referral law how can i get diflucan over the counter. The proposed rule was issued in conjunction with the Centers for Medicare &.

Medicaid Services' (CMS) Patients over Paperwork initiative and how can i get diflucan over the counter the Department of Health and Human Services' (the Department or HHS) Regulatory Sprint to Coordinated Care. In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician.

A new exception for how can i get diflucan over the counter donations of cybersecurity technology and related services. And amendments to the existing exception for electronic health records (EHR) items and services. The proposed how can i get diflucan over the counter rule also provides critically necessary guidance for physicians and health care providers and suppliers whose financial relationships are governed by the physician self-referral statute and regulations.

This notice announces an extension of the timeline for publication of the final rule and the continuation of effectiveness of the proposed rule. Section 1871(a)(3)(A) of the Social Security Act (the Act) requires us to establish and publish a regular timeline for the publication of final regulations based on the previous publication of a proposed regulation. In accordance with section 1871(a)(3)(B) of the Act, the timeline may vary among different regulations based on differences in the complexity of the regulation, the number and scope of comments received, and how can i get diflucan over the counter other relevant factors, but may not be longer than 3 years except under exceptional circumstances.

In addition, in accordance with section 1871(a)(3)(B) of the Act, the Secretary may extend the initial targeted publication date of the final regulation if the Secretary, no later than the regulation's previously established proposed publication date, publishes a notice with the new target date, and such notice includes a brief explanation of the justification for the variation. We announced in the Spring 2020 how can i get diflucan over the counter Unified Agenda (June 30, 2020, www.reginfo.gov) that we would issue the final rule in August 2020. However, we are still working through the Start Printed Page 52941complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date.

This notice extends the timeline for publication of the how can i get diflucan over the counter final rule until August 31, 2021. Start Signature Dated. August 24, 2020.

Wilma M how can i get diflucan over the counter. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services. End Signature End Supplemental Information [FR Doc how can i get diflucan over the counter.

2020-18867 Filed 8-26-20. 8:45 am]BILLING CODE 4120-01-PStart Preamble Notice of amendment. The Secretary issues this amendment pursuant to section 319F-3 of the Public Health Service Act to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he how can i get diflucan over the counter recommends the administration or use of the Covered Countermeasures.

This amendment to the Declaration published on March 17, 2020 (85 FR 15198) is effective as of August 24, 2020. Start Further how can i get diflucan over the counter Info Robert P. Kadlec, MD, MTM&H, MS, Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201.

Telephone. 202-205-2882. End Further Info End Preamble Start Supplemental Information The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of Health and Human Services (the Secretary) to issue a Declaration to provide liability immunity to certain individuals and entities (Covered Persons) against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures (Covered Countermeasures), except for claims involving “willful misconduct” as defined in the PREP Act.

Under the PREP Act, a Declaration may be amended as circumstances warrant. The PREP Act was enacted on December 30, 2005, as Public Law 109-148, Division C, § 2. It amended the Public Health Service (PHS) Act, adding section 319F-3, which addresses liability immunity, and section 319F-4, which creates a compensation program.

These sections are codified at 42 U.S.C. 247d-6d and 42 U.S.C. 247d-6e, respectively.

Section 319F-3 of the PHS Act has been amended by the diflucan and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013 and the antifungals Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, Start Printed Page 521372020, to expand Covered Countermeasures under the PREP Act. On January 31, 2020, the Secretary declared a public health emergency pursuant to section 319 of the PHS Act, 42 U.S.C. 247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the antifungal medication outbreak.

Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration on April 26, 2020, and July 25, 2020. On March 10, 2020, the Secretary issued a Declaration under the PREP Act for medical countermeasures against antifungal medication (85 FR 15198, Mar. 17, 2020) (the Declaration).

On April 10, the Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020). On June 4, the Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm antifungal medication might otherwise cause.

The Secretary now amends section V of the Declaration to identify as qualified persons covered under the PREP Act, and thus authorizes, certain State-licensed pharmacists to order and administer, and pharmacy interns (who are licensed or registered by their State board of pharmacy and acting under the supervision of a State-licensed pharmacist) to administer, any treatment that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule (ACIP-recommended treatments).[] The Secretary also amends section VIII of the Declaration to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures includes not only antifungal medication caused by antifungals or a diflucan mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by antifungal medication, antifungals, or a diflucan mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Description of This Amendment by Section Section V. Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under subsection (b) has been issued with respect to such countermeasure.

€œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed. Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act. 42 U.S.C.

247d-6d(i)(8).[] By this amendment to the Declaration, the Secretary identifies an additional category of persons who are qualified persons under section 247d-6d(i)(8)(B).[] On May 8, 2020, CDC reported, “The identified declines in routine pediatric treatment ordering and doses administered might indicate that U.S. Children and their communities face increased risks for outbreaks of treatment-preventable diseases,” and suggested that a decrease in rates of routine childhood vaccinations were due to changes in healthcare access, social distancing, and other antifungal medication mitigation strategies.[] The report also stated that “[p]arental concerns about potentially exposing their children to antifungal medication during well child visits might contribute to the declines observed.” [] On July 10, 2020, CDC reported its findings of a May survey it conducted to assess the capacity of pediatric health care practices to provide immunization services to children during the antifungal medication diflucan. The survey, which was limited to practices participating in the treatments for Children program, found that, as of mid-May, 15 percent of Northeast pediatric practices were closed, 12.5 percent of Midwest practices were closed, 6.2 percent of practices in the South were closed, and 10 percent of practices in the West were closed.

Most practices had reduced office hours for in-person visits. When asked whether their practices would likely be able to accommodate new patients for immunization services through August, 418 practices (21.3 percent) either responded that this was not likely or the practice was permanently closed or not resuming immunization services for all patients, and 380 (19.6 percent) responded that they were unsure. Urban practices and those in the Northeast were less likely to be able to accommodate new patients compared with rural practices and those in the South, Midwest, or West.[] In response to these troubling developments, CDC and the American Academy of Pediatrics have stressed, “Well-child visits and vaccinations are essential services and help make sure children are protected.” [] The Secretary re-emphasizes that important recommendation to parents and legal guardians here.

If your child is due for a well-child visit, contact your pediatrician's or other primary-care provider's office and ask about ways that the office safely offers well-child visits and vaccinations. Many medical offices are taking extra steps to make sure that well-child visits can occur safely during the antifungal medication diflucan, including. Scheduling sick visits and well-child visits during different times of the Start Printed Page 52138day or days of the week, or at different locations.

Asking patients to remain outside until it is time for their appointments to reduce the number of people in waiting rooms. Adhering to recommended social (physical) distancing and other -control practices, such as the use of masks. The decrease in childhood-vaccination rates is a public health threat and a collateral harm caused by antifungal medication.

Together, the United States must turn to available medical professionals to limit the harm and public health threats that may result from decreased immunization rates. We must quickly do so to avoid preventable s in children, additional strains on our healthcare system, and any further increase in avoidable adverse health consequences—particularly if such complications coincide with additional resurgence of antifungal medication. Together with pediatricians and other healthcare professionals, pharmacists are positioned to expand access to childhood vaccinations.

Many States already allow pharmacists to administer treatments to children of any age.[] Other States permit pharmacists to administer treatments to children depending on the age—for example, 2, 3, 5, 6, 7, 9, 10, 11, or 12 years of age and older.[] Few States restrict pharmacist-administered vaccinations to only adults.[] Many States also allow properly trained individuals under the supervision of a trained pharmacist to administer those treatments.[] Pharmacists are well positioned to increase access to vaccinations, particularly in certain areas or for certain populations that have too few pediatricians and other primary-care providers, or that are otherwise medically underserved.[] As of 2018, nearly 90 percent of Americans lived within five miles of a community pharmacy.[] Pharmacies often offer extended hours and added convenience. What is more, pharmacists are trusted healthcare professionals with established relationships with their patients. Pharmacists also have strong relationships with local medical providers and hospitals to refer patients as appropriate.

For example, pharmacists already play a significant role in annual influenza vaccination. In the early 2018-19 season, they administered the influenza treatment to nearly a third of all adults who received the treatment.[] Given the potential danger of serious influenza and continuing antifungal medication outbreaks this autumn and the impact that such concurrent outbreaks may have on our population, our healthcare system, and our whole-of-nation response to the antifungal medication diflucan, we must quickly expand access to influenza vaccinations. Allowing more qualified pharmacists to administer the influenza treatment to children will make vaccinations more accessible.

Therefore, the Secretary amends the Declaration to identify State-licensed pharmacists (and pharmacy interns acting under their supervision if the pharmacy intern is licensed or registered by his or her State board of pharmacy) as qualified persons under section 247d-6d(i)(8)(B) when the pharmacist orders and either the pharmacist or the supervised pharmacy intern administers treatments to individuals ages three through 18 pursuant to the following requirements. The treatment must be FDA-authorized or FDA-approved. The vaccination must be ordered and administered according to ACIP's standard immunization schedule.[] The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE).

This training Start Printed Page 52139program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.[] The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.[] The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation.[] The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.[] The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment.[] The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregivers accompanying the children of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate.[] These requirements are consistent with those in many States that permit licensed pharmacists to order and administer treatments to children and permit licensed or registered pharmacy interns acting under their supervision to administer treatments to children.[] Administering vaccinations to children age three and older is less complicated and requires less training and resources than administering vaccinations to younger children. That is because ACIP generally recommends administering intramuscular injections in the deltoid muscle for individuals age three and older.[] For individuals less than three years of age, ACIP generally recommends administering intramuscular injections in the anterolateral aspect of the thigh muscle.[] Administering injections in the thigh muscle often presents additional complexities and requires additional training and resources including additional personnel to safely position the child while another healthcare professional injects the treatment.[] Moreover, as of 2018, 40% of three-year-olds were enrolled in preprimary programs (i.e.

Preschool or kindergarten programs).[] Preprimary programs are beginning in the coming weeks or months, so the Secretary has concluded that it is particularly important for individuals ages three through 18 to receive ACIP-recommended treatments according to ACIP's standard immunization schedule. All States require children to be vaccinated against certain communicable diseases as a condition of school attendance. These laws often apply to both public and private schools with identical immunization and exemption provisions.[] As nurseries, preschools, kindergartens, and schools reopen, increased access to childhood vaccinations is essential to ensuring children can return.

Notwithstanding any State or local scope-of-practice legal requirements, (1) qualified licensed pharmacists are identified as qualified persons to order and administer ACIP-recommended treatments and (2) qualified State-licensed or registered pharmacy interns are identified as qualified persons to administer the ACIP-recommended treatments ordered by their supervising qualified licensed pharmacist.[] Both the PREP Act and the June 4, 2020 Second Amendment to the Declaration define “covered countermeasures” to include qualified diflucan and epidemic products that “limit the harm such diflucan or epidemic might otherwise cause.” [] The troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by Start Printed Page 52140antifungal medication as set forth in Sections VI and VIII of this Declaration.[] Hence, such vaccinations are “covered countermeasures” under the PREP Act and the June 4, 2020 Second Amendment to the Declaration. Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C.

300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other terms and conditions of the Declaration apply to such covered countermeasures.

Section VIII. Category of Disease, Health Condition, or Threat As discussed, the troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by antifungal medication. The Secretary therefore amends section VIII, which describes the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures, to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures is not only antifungal medication caused by antifungals or a diflucan mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by antifungal medication, antifungals, or a diflucan mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases.

Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against antifungal medication. Sections V and VIII of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against antifungal medication, as amended April 10, 2020 and June 4, 2020, are further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below. All other sections of the Declaration remain in effect as published at 85 FR 15198 (Mar.

17, 2020) and amended at 85 FR 21012 (Apr. 15, 2020) and 85 FR 35100 (June 8, 2020). 1.

Covered Persons, section V, delete in full and replace with. V. Covered Persons 42 U.S.C.

247d-6d(i)(2), (3), (4), (6), (8)(A) and (B) Covered Persons who are afforded liability immunity under this Declaration are “manufacturers,” “distributors,” “program planners,” “qualified persons,” and their officials, agents, and employees, as those terms are defined in the PREP Act, and the United States. In addition, I have determined that the following additional persons are qualified persons. (a) Any person authorized in accordance with the public health and medical emergency response of the Authority Having Jurisdiction, as described in Section VII below, to prescribe, administer, deliver, distribute or dispense the Covered Countermeasures, and their officials, agents, employees, contractors and volunteers, following a Declaration of an emergency.

(b) any person authorized to prescribe, administer, or dispense the Covered Countermeasures or who is otherwise authorized to perform an activity under an Emergency Use Authorization in accordance with Section 564 of the FD&C Act. (c) any person authorized to prescribe, administer, or dispense Covered Countermeasures in accordance with Section 564A of the FD&C Act. And (d) a State-licensed pharmacist who orders and administers, and pharmacy interns who administer (if the pharmacy intern acts under the supervision of such pharmacist and the pharmacy intern is licensed or registered by his or her State board of pharmacy), treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule.

Such State-licensed pharmacists and the State-licensed or registered interns under their supervision are qualified persons only if the following requirements are met. The treatment must be FDA-authorized or FDA-approved. The vaccination must be ordered and administered according to ACIP's standard immunization schedule.

The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE.

This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.

The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate. Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program.

Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program.

All other Start Printed Page 52141terms and conditions of the Declaration apply to such covered countermeasures. 2. Category of Disease, Health Condition, or Threat, section VIII, delete in full and replace with.

VIII. Category of Disease, Health Condition, or Threat 42 U.S.C. 247d-6d(b)(2)(A) The category of disease, health condition, or threat for which I recommend the administration or use of the Covered Countermeasures is not only antifungal medication caused by antifungals or a diflucan mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by antifungal medication, antifungals, or a diflucan mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases.

Start Authority 42 U.S.C. 247d-6d. End Authority Start Signature Dated.

August 19, 2020. Alex M. Azar II, Secretary of Health and Human Services.

End Signature End Supplemental Information [FR Doc. 2020-18542 Filed 8-20-20. 4:15 pm]BILLING CODE 4150-03-P.

Diflucan pill otc

Nov. 24, 2021 -- Countries across Europe are facing another surge in antifungals cases, which could lead to another 700,000 deaths by March 1 if current trends continue, the WHO announced on Tuesday.More than 1.5 million people have already died from antifungal medication in the 53 countries that make up the World Health Organization’s European region. That means the death toll could top 2.2 million by early 2022.Europe “remains firmly in the grip of the antifungal medication diflucan,” the WHO said, noting that the antifungals is the leading cause of death across Europe and Central Asia.

Between now and March, intensive care units in 49 of the 53 countries will face “high or extreme stress.”The WHO reported more than 2.4 million new cases across the region last week, which made up 67% of all antifungal medication cases worldwide during that time. Deaths increased to nearly 4,200 per day, doubling the 2,100 daily deaths reported at the end of September. France reported more than 30,000 new antifungal medication s on Tuesday, marking the first time since August that the country had so many cases in 24 hours, according to Reuters.

Daily cases are up 54%, compared to last week, and the week-over-week increase has been around 50% for 11 days straight.“That is a very major increase in the rate, which shows that we really are, unfortunately, in a fifth wave of the epidemic,” Olivier Veran, the country’s health minister, told lawmakers on Tuesday.Germany also set a diflucan record on Monday with a 7-day average of more than 51,000 daily new cases, according to CNBC. Russia reported a record high of more than 1,200 daily deaths for the week that ended Monday.The WHO said the latest wave is being fueled by several things. The more contagious Delta variant, people moving indoors due to colder weather, the easing of restrictions, and slow treatment uptake in some countries.About 53% of the population is fully vaccinated in the WHO’s European region, but rates vary from 10% to more than 80% across countries.

Many eastern countries have lower rates, with 24% of the population fully vaccinated in Bulgaria, as compared to about 87% in Portugal, 78% in Demark, 71% in Germany, and 65% in Austria. €œAs we approach the end of 2021, let’s do everything we can by getting vaccinated and taking personal protective measures to avoid the last resort of lockdowns and school closures,” Hans Kluge, WHO’s regional director for Europe, said in the WHO statement.Some countries are putting strict measures into place again to contain the spread of the diflucan, which has sparked protests, according to The New York Times. On Monday, Austria returned to lockdown for at least 10 days, closing shops, restaurants, and holiday markets.

The Netherlands also began a partial lockdown during the weekend, and Germany may announce new restrictions this week.In addition, more countries are approving booster shots for fully vaccinated people, including France, Germany, and Greece, according to the BBC. More evidence is showing that treatment protection is waning and breakthrough cases are becoming more common, according to the WHO, which encouraged countries to approve booster doses for vulnerable groups, health care workers, and people over age 60. Europe and Central Asia face “a challenging winter ahead,” Kluge said.

He called for a “treatment plus” approach, which includes getting vaccinated, following physical distancing guidelines, and wearing masks.Face masks reduce antifungals transmission by 53%, the WHO said, which could prevent more than 160,000 deaths by March 1.The U.S. State Department has responded to the European surge by adding Denmark and Germany to its “Do Not Travel” list, which is the highest-risk category for travel, according to The Washington Post.The Level 4 designation means that both the CDC and State Department recommend against traveling to those countries, even if people are vaccinated. Other European countries were added to the Level 4 list last week, including the Czech Republic, Hungary, and Iceland.No more harmful than an unwanted pregnancy Women who receive a wanted abortion often fare much better than those denied an abortion, added Diana Greene Foster, a professor with the University of California, San Francisco's Bixby Center for Global Reproductive Health.

Foster cited the Turnaway Study, a long-term research effort that recruited nearly 1,000 women from 30 abortion facilities across the nation over a three-year period. A quarter of the women were turned away and didn't receive an abortion. It turned out that there was little difference between the two groups in terms of mental health.

"Women who were denied abortions actually experienced more anxiety and lower self-esteem at the time of abortion denial than those who received their abortion," Foster said. "But the groups converged by six to 12 months, and we don't see a difference after that point. And on the outcomes like depression, suicidal ideation, post-traumatic stress, life satisfaction, we actually don't see a difference at any point between the two groups." "That's not because those who receive an abortion and those who are denied are both doing badly.

In fact, both groups improve over time," Foster continued. However, taking an unwanted pregnancy to term has serious health effects for women, she said. They are more likely to suffer gestational high blood pressure, joint pain, and headaches or migraines.

Further, two of the 200 women in the study who were denied abortion died during childbirth, Foster added. "That's an astronomical death rate. It's much higher than Dr.

Prager presented to you," Foster said. "And I think it's a sign. It's an indication that carrying a pregnancy to term is associated with a lot of risks.

And when people don't feel ready to do it, this is a very big physical health risk that they didn't necessarily sign up for." Women denied abortions also face more economic hardships than those who obtain a wanted abortion, Foster added. They were more likely to fall into poverty, and more likely to wind up in a single-parent household. "It is not the case that, when a woman is denied an abortion, that somehow that the man involved in the pregnancy helps support the family," Foster said.

"There is no difference in the chance that she's actually still with him in a romantic relationship and that he's supporting the child.".

Nov http://www.hund-entwurmen.de/ how can i get diflucan over the counter. 24, 2021 -- Countries across Europe are facing another surge in antifungals cases, which could lead to another 700,000 deaths by March 1 if current trends continue, the WHO announced on Tuesday.More than 1.5 million people have already died from antifungal medication in the 53 countries that make up the World Health Organization’s European region. That means the death toll could top how can i get diflucan over the counter 2.2 million by early 2022.Europe “remains firmly in the grip of the antifungal medication diflucan,” the WHO said, noting that the antifungals is the leading cause of death across Europe and Central Asia. Between now and March, intensive care units in 49 of the 53 countries will face “high or extreme stress.”The WHO reported more than 2.4 million new cases across the region last week, which made up 67% of all antifungal medication cases worldwide during that time.

Deaths increased to nearly 4,200 per day, doubling how can i get diflucan over the counter the 2,100 daily deaths reported at the end of September. France reported more than 30,000 new antifungal medication s on Tuesday, marking the first time since August that the country had so many cases in 24 hours, according to Reuters. Daily cases are up 54%, compared to last week, and the week-over-week increase has been around 50% for 11 days straight.“That is a very major increase in the rate, which shows that we really are, unfortunately, in a how can i get diflucan over the counter fifth wave of the epidemic,” Olivier Veran, the country’s health minister, told lawmakers on Tuesday.Germany also set a diflucan record on Monday with a 7-day average of more than 51,000 daily new cases, according to CNBC. Russia reported a record high of more than 1,200 daily deaths for the week that ended Monday.The WHO said the latest wave is being fueled by several things.

The more contagious Delta variant, people moving indoors due to colder weather, the easing of restrictions, and slow treatment uptake in some countries.About 53% of the population is fully vaccinated how can i get diflucan over the counter in the WHO’s European region, but rates vary from 10% to more than 80% across countries. Many eastern countries have lower rates, with 24% of the population fully vaccinated in Bulgaria, as compared to about 87% in Portugal, 78% in Demark, 71% in Germany, and 65% in Austria. €œAs we approach the end of 2021, let’s do everything we can by getting vaccinated and taking personal protective measures to avoid the last resort how can i get diflucan over the counter of lockdowns and school closures,” Hans Kluge, WHO’s regional director for Europe, said in the WHO statement.Some countries are putting strict measures into place again to contain the spread of the diflucan, which has sparked protests, according to The New York Times. On Monday, Austria returned to lockdown for at least 10 days, closing shops, restaurants, and holiday markets.

The Netherlands also began a partial lockdown during the weekend, and Germany may announce new restrictions this week.In addition, more how can i get diflucan over the counter countries are approving booster shots for fully vaccinated people, including France, Germany, and Greece, according to the BBC. More evidence is showing that treatment protection is waning and breakthrough cases are becoming more common, according to the WHO, which encouraged countries to approve booster doses for vulnerable groups, health care workers, and people over age 60. Europe and Central Asia face “a challenging winter ahead,” Kluge how can i get diflucan over the counter said. He called for a “treatment plus” approach, which includes getting vaccinated, following physical distancing guidelines, and wearing masks.Face masks reduce antifungals transmission by 53%, the WHO said, which could prevent more than 160,000 deaths by March 1.The U.S.

State Department has responded to how can i get diflucan over the counter the European surge by adding Denmark and Germany to its “Do Not Travel” list, which is the highest-risk category for travel, according to The Washington Post.The Level 4 designation means that both the CDC and State Department recommend against traveling to those countries, even if people are vaccinated. Other European countries were added to the Level 4 list last week, including the Czech Republic, Hungary, and Iceland.No more harmful than an unwanted pregnancy Women who receive a wanted abortion often fare much better than those denied an abortion, added Diana Greene Foster, a professor with the University of California, San Francisco's Bixby Center for Global Reproductive Health. Foster cited the Turnaway Study, a long-term research effort that recruited nearly 1,000 women from 30 abortion facilities how can i get diflucan over the counter across the nation over a three-year period. A quarter of the women were turned away and didn't receive an abortion.

It turned out that there was little difference between the two groups in terms how can i get diflucan over the counter of mental health. "Women who were denied abortions actually experienced more anxiety and lower self-esteem at the time of abortion denial than those who received their abortion," Foster said. "But the groups converged by six to 12 months, and we don't see a difference after that point how can i get diflucan over the counter. And on the outcomes like depression, suicidal ideation, post-traumatic stress, life satisfaction, we actually don't see a difference at any point between the two groups." "That's not because those who receive an abortion and those who are denied are both doing badly.

In fact, both groups how can i get diflucan over the counter improve over time," Foster continued. However, taking an unwanted pregnancy to term has serious health effects for women, she said. They are more likely to suffer gestational how can i get diflucan over the counter high blood pressure, joint pain, and headaches or migraines. Further, two of the 200 women in the study who were denied abortion died during childbirth, Foster added.

"That's an how can i get diflucan over the counter astronomical death rate. It's much higher than Dr. Prager presented how can i get diflucan over the counter to you," Foster said. "And I think it's a sign.

It's an indication that carrying a pregnancy to term is associated with how can i get diflucan over the counter a lot of risks. And when people don't feel ready to do it, this is a very big physical health risk that they didn't necessarily sign up for." Women denied abortions also face more economic hardships than those who obtain a wanted abortion, Foster added. They were more likely to fall into poverty, and how can i get diflucan over the counter more likely to wind up in a single-parent household. "It is not the case that, when a woman is denied an abortion, that somehow that the man involved in the pregnancy helps support the family," Foster said.

"There is no difference in the chance that she's actually still with him in a romantic relationship and that he's supporting the child.".

How many diflucan for yeast

Today, the how many diflucan for yeast buy generic diflucan U.S. Department of Health and Human Services (HHS) awarded $10.7 million from the American Rescue Plan (ARP) to expand pediatric mental health care access by integrating telehealth services into pediatric care. The awards were made through the Health Resources and Services Administration (HRSA)."I'm proud to announce nearly $11 million in grants to expand access how many diflucan for yeast to pediatric mental health care through telehealth, made possible by President Biden's American Rescue Plan," said HHS Secretary Xavier Becerra. "The antifungal medication diflucan has taken a toll on all of us, especially children. This critical funding will not only improve the livelihoods of children and their families, but also secure the future of our country.

We will continue to make investments that ensure our youngest Americans grow up strong and healthy." The Pediatric Mental Health Care Access Program supports state and regional networks of how many diflucan for yeast pediatric mental health care teams. These teams provide tele-consultation, training, technical assistance, and care coordination for pediatric primary care and other providers to diagnose, treat, and refer children and youth with mental health conditions and substance use disorders. The expansion announced today broadens the program's reach from 21 awards in 21 states to 45 awards in 40 states, as well as the District of Columbia, the U.S. Virgin Islands, and the Republic of Palau how many diflucan for yeast . It also provides support to two Tribal areas – the Chickasaw Nation and the Red Lake Band of the Chippewa Indians.

Currently, nearly 22 percent how many diflucan for yeast of children ages 3 to 17 in the United States are affected by a mental, emotional, developmental, or behavioral condition. Only about 20 percent of children with mental, emotional, or behavioral disorders, however, receive care from a specialized provider. "Primary care providers strive to address the many mental health challenges children and families are experiencing due to the diflucan, but they need more support," said HRSA Acting Administrator Diana Espinosa. "Expanding the Pediatric Mental Health Care Access program offers new opportunities for providers to offer families the mental and behavioral health services they need but that often aren't easily accessible." To learn more about HRSA's Pediatric Mental Health Care Access how many diflucan for yeast program, visit. Https://mchb.hrsa.gov/training/pgm-pmhca.asp.

For a list of awards, visit. Https://mchb.hrsa.gov/maternal-child-health-initiatives/mental-behavioral-health/arp-pediatric-mental-health.Share this story Published August 25th, 2021 how many diflucan for yeast at 6:00 AM Above image credit. Jason and Keri Medows during a recording for Illinois Farm Bureau Women in Ag. Jason launched the "Ag State of Mind" podcast to discuss mental health issues in rural America. (Contributed | Jason Medows) A couple of years ago, Jason Medows, a how many diflucan for yeast farmer and pharmacist who works in Rolla, Missouri, was desperate for mental health care.

Finding that care was nearly impossible. €œI called not how many diflucan for yeast one, not two, not three providers in Rolla, but four and was not able to be seen,” he said. Two of the lines he called were even disconnected. €œI’m a health care worker. I understand (the system) and I was frustrated,” how many diflucan for yeast he said.

€œSo I could not imagine what it would be like for someone who is not in my shoes, who doesn’t have an understanding of the system, how they would be discouraged.” Ask someone in rural America what the biggest challenge is to mental health care and they’ll most likely say “access.” Not only is there a lack of mental health professionals in rural communities, experts say, but people often have to travel long distances to find those professionals. Even then, there are issues with getting it covered by insurance. According to how many diflucan for yeast the University of Missouri Extension, all of the 99 rural counties in Missouri have a shortage of mental health professionals. In 57 of those counties there are no mental health professionals. This isn’t just a rural problem, either.

Less than 6% of mental health needs are met in Missouri, according to a 2021 report by the Bureau of Health how many diflucan for yeast Workforce, Health Resources and Services Administration and the U.S. Department of Health &. Human Services how many diflucan for yeast . That’s less than any other state. In Kansas, about 32% of needs are met.

Changing a how many diflucan for yeast Rural Mindset Garret Hawkins, president of the Missouri Farm Bureau, said the first obstacle to mental health care for farmers is acknowledging its need. As a farmer himself, Hawkins said he knows the physically demanding lifestyle of a farmer or rancher encourages a do-it-yourself mentality. And not in a Pinterest, make-your-own-coffee-table type of way, but in a way that stigmatizes asking for help. €œWe’re known for being tough and resilient, yet at the same time, we’re not how many diflucan for yeast always the best about asking for help when we need it,” Hawkins said. €œAnd so one of the roles that we have taken on as the state’s largest farm organization is to work with others to tear down the stigma, to let our members know it’s okay to not be okay.” Garrett Hawkins, president of the Missouri Farm Bureau.

(Courtesy | Missouri Farm Bureau) Hawkins said Missouri Farm Bureau has been working with the University of Missouri and other partners to normalize conversations around mental health amongst its members. While others might be able to admit they need how many diflucan for yeast help, they might feel a social stigma around entering a mental health care facility or trying to seek help. Kansas Farm Bureau (KFB) and K-State Research and Extension for Farm Stress are also working on bringing more mental health awareness in rural Kansas. Erin Petersilie, assistant director of how many diflucan for yeast health plans at KFB, said in a town where common knowledge travels fast it can be uncomfortable to seek care. €œWe also need to think about the fact that there is still very much a stigma surrounding mental health and it is very hard in those small towns when we think about how everybody knows everybody,” Petersilie said.

€œSo the last thing people want to have happen is to have a vehicle parked in front of a mental health office, because they are going to get talked about.” KFB and K-State Research and Extension have teamed up to provide more education on mental health warning signs and different numbers and hotlines people can call if they need help. Amy May, clinical director at North Central Missouri Mental Health, how many diflucan for yeast said her rural offices have typically only dealt with severe mental health illnesses like schizophrenia or bipolar disorder. But in the past year or so she’s seen more patients dealing with suicide and depression. Despite the increase in patients, May said many still feel uncomfortable in seeking mental health care. €œI still feel like there is this stigma of we still just how many diflucan for yeast don’t want to talk about it.

Or we don’t want people to know we’re getting services, especially here,” May said. “I feel like our offices are kind of in outlying locations and yet I still have clients … they’ll drive to another office just because they don’t want, and they flat out said, ‘I don’t want people to see my car in your parking lot.’ ” Even at the school level, Polo R-VII school counselor Rebecca Chambers-Arway said the invisible illness can be hard for her students to take seriously. She worked with a student for a while who said her friends would make jokes about her how many diflucan for yeast counseling sessions. Chambers-Arway’s advice was to remind them that mental well-being is a serious health issue even though it’s not always visible. Someone goes to how many diflucan for yeast the doctor for a broken bone, Chambers-Arway noted.

How is it any different to seek help for a broken spirit?. “It’s hard because I still think kids think that a mental illness is a weakness, but so many of us deal with it on a daily basis,” Chambers-Arway said. €œIt’s just how many diflucan for yeast (that) it’s hidden. You can’t see it.” Chambers-Arway said she works to simplify complex emotions, like anxiety, and instead helps children to recognize the things they are worried about. Those simplified conversations can evolve as the students age to better understand the way they are feeling.

€œI think so many times those feelings aren’t normalized when they’re little, how many diflucan for yeast so that’s what they grow up learning,” Chambers-Arway said. It’s not an issue that can be solved or normalized overnight. Chambers-Arway said she hopes to see more involvement with mental health first aid training both at school and in the community. These sessions can help instructors and parents to recognize signs of mental health issues and know how to intervene, but she said the response in how many diflucan for yeast Polo hasn’t been huge. “I think it’s just going to be a constant battle until people, not people, society, embraces it and recognizes that it is something that needs to be addressed,” Chambers-Arway said.

In the same vein, Hawkins said the Missouri Farm Bureau is working how many diflucan for yeast to teach people the warning signs of mental illness. In early 2020, the bureau was part of a study noting the effect of economic changes, congressional action and severe weather conditions on the mental well-being of Missouri agriculture producers. Since then, Hawkins said the antifungal medication diflucan exacerbated mental health conditions as supply chain disruptions and increased isolation caused more stress to farmers. €œJust knowing how many diflucan for yeast that family and friends are facing issues makes it even more imperative that maybe we do check-ins more frequently, just to see how folks are doing,” Hawkins said, “Just asking the question, ‘How are you doing?. €™ It’s really that simple.” Thankfully, as studies emerge about this issue, Hawkins said more resources have been made available through the University of Missouri Extension and through the USDA’s Farm and Ranch Stress Assistance Network.

Telehealth Counseling Out of Reach After someone in a rural area has identified the signs of mental illness and decided to seek help, where do they turn?. Hawkins serves on his local hospital board and said the number one issue it is currently faced with, and how many diflucan for yeast doesn’t provide, is mental health counseling. €œOne of the challenges that we have as a critical access hospital is how to provide all the services that are needed in our community and the outlying rural areas for our farm and ranch families,” Hawkins said. Telehealth presents itself as a golden solution to reaching rural communities, but access to strong internet connection remains an obstacle. €œIn my hometown of Appleton City, we have the technology to do telehealth, but we don’t have strong enough bandwidth to provide telehealth on a consistent basis how many diflucan for yeast that is adequate for the provider, as well as the patient,” Hawkins said.

Because Missouri has such a shortage of mental health professionals, Hawkins said telehealth is logistically the best way to reach communities far and wide. €œIf we have that physical shortage it only makes sense that opportunities provided with telehealth allow us to cast a wider net to try to reach more providers to improve accessibility how many diflucan for yeast for farm, ranch and rural families,” Hawkins said. Medows is a big proponent for telehealth counseling. After his unsuccessful search for in-person care, Medows went online, where he was finally able to get help. He now uses a virtual service called Better Health, which allows him to instant message and video conference with licensed how many diflucan for yeast professionals.

Medows is fortunate because he has access to high-speed internet, but that’s not the case for many in rural communities. According to the Federal Communications Commission (FCC), just one-fourth of the rural population in America has broadband access. But even this data how many diflucan for yeast has been criticized for not being granular enough, meaning that ratio is likely even smaller. Jason Medows, host of the “Ag State of Mind” podcast. (Contributed | Jason Medows) “There is no such thing as affordable high speed internet out here,” Medows said.

€œI mean, that’s like a unicorn, as far as I’m how many diflucan for yeast concerned. We’re fortunate to where we can afford it, but even what we afford isn’t very good. We pay $190 a month for internet and it’s not even that good.” Petersilie of KFB said that the bureau has some initiatives to improve how many diflucan for yeast broadband access and stressed the importance of making care as accessible as possible. €œHow do farmers access this system?. € Petersilie said.

€œWe also need to look how many diflucan for yeast at the flip side of that point. How does that system access the farmers?. € Elaine Johannes of K-State Research and Extension for Farm Stress said not only does there need to be more telehealth options, but quality therapists who understand the unique stressors of rural America and farming. €œWe need to how many diflucan for yeast talk about telehealth,” she said. €œWe need top talent.

We need to have people understand that therapies can be done online, they can even be done through a cell phone. Now, that doesn’t replace the human and the interaction between folks how many diflucan for yeast . But again, we need to understand what’s going on with mental health care in the United States and especially in rural areas, so we could be allies with it.” Schools are typically reliable locations with stable internet in rural areas, meaning it could be possible to have students take telehealth counseling from the building. Chambers-Arway said her district has started how many diflucan for yeast a program like this. €œ(Telehealth therapy) would be an ideal situation.

It’s just, I feel like sometimes the insurance hoops are harder to get through than the parents and students agreeing to the support,” Chambers-Arway said. Insurance hoops how many diflucan for yeast were a barrier to students even when the school had an in-person therapist. This program, through Northwest Behavioral Health, designated a therapist to split time between Gallatin, Polo and Hamilton school districts each week. Chambers-Arway said the program was successful and generated a lot of interest, but because it was free to the school and paid for by a student’s insurance, the enrollment paperwork was immense. It sounds like a small inconvenience to fill out the forms and meet with the therapist, but Chambers-Arway said it meant a day off from work and a how many diflucan for yeast lot of parents in Polo couldn’t afford that time.

€œAs soon as we got that going we had students coming in, and parents, to us and asking, ‘Okay, can we get ours set up with her?. €™â€ Chambers-Arway said. When the how many diflucan for yeast therapist left Northwest Behavioral, Gallatin and Polo were without a replacement, but a well-established need. Chambers-Arway said she tried to get a different person to come to the school, but said it never reached fruition. €œIn my opinion, that’s the only way we’ll be able to secure some mental health support, outside of what I can do as a (school) counselor,” how many diflucan for yeast Chambers-Arway said.

€œI can’t do some of that deep-seeded counseling in a school setting.” Jennifer Kline, program manager at Northwest Behavioral, said all of the school outreach programs like this have ended because of a shortage in behavioral health providers. €œIt’s challenging for us to fill vacancies and meet the demand even in urban areas across the board,” Kline said. €œIt’s just how many diflucan for yeast not enough people to go around and fill all of the positions.” Providers in rural areas, and especially those working in schools, require specialized knowledge in aiding those populations, making their roles especially difficult to fill. Few and Far Between Local behavioral and mental health facilities like Northwest and North Central Missouri Mental Health are stretched thin, serving four and nine counties, respectively, with outreach offices. Even with these local offices, that leaves a lot unreached or with a significant drive to reach care.

A map by the University of Missouri how many diflucan for yeast Extension shows all of the mental health facilities in the state. Many counties are left with just one facility and others are completely barren. Mental Health Support in Missouri A map by the University of Missouri Extension shows that the vast majority of counties in the state (shaded in gray) are experiencing a shortage of mental health professionals. (Courtesy | University of Missouri Extension) May said she sees transportation as a how many diflucan for yeast major issue to clients seeking mental health care. “Transportation is a huge barrier for our clients,” May said.

€œWe do have how many diflucan for yeast a lot of satellite offices. However, for prescribers and therapists, they may not be able to get to all the offices. So the clients have to travel to a certain office location to get to our services.” Getting care is important, but Medows said for many farmers who work with the daylight, an hour and half trip can be too much time away. €œDouble that drive time and whatever time that you’re there and that’s all time that is lost in whatever else how many diflucan for yeast you want to do, working a job, spending time with the family,” Medows said. His passion for mental health awareness led Medows to create his podcast, “Ag State of Mind.” For Medows, it’s important to have farmers and ranchers talking about mental health so others struggling with the same problems know they’re not alone.

€œThere needs to be more real people talking about it. More people sharing their own experience with it and not having the fear of ridicule,” how many diflucan for yeast Medows said. By “real people” Medows means the people living with feelings of independence and isolation often associated with rural life. €œPeople who are residents of the rural community. People like me who live how many diflucan for yeast in the rural community and share their certain experience in the challenges and are relatable.

People who just as easily could be their neighbor, people who people could see being their neighbor.” Marissa Plescia is a Dow Jones summer intern at Kansas City PBS. Vicky Diaz-Camacho covers community affairs for Kansas City how many diflucan for yeast PBS. Cami Koons covers rural affairs for Kansas City PBS in cooperation with Report for America. Like what you are reading?. Discover more unheard stories about how many diflucan for yeast Kansas City, every Thursday.

Thank you for subscribing!. Check your inbox, you should see something from us. Your support lets our boots-on-the-ground journalists produce stories like this one. If you believe in local journalism, please donate today. Related Stories.

Today, the how can i get diflucan over the counter U.S. Department of Health and Human Services (HHS) awarded $10.7 million from the American Rescue Plan (ARP) to expand pediatric mental health care access by integrating telehealth services into pediatric care. The awards were made through the Health Resources and Services Administration (HRSA)."I'm proud to announce nearly $11 million in grants to expand access to pediatric mental health care through telehealth, made possible by President Biden's American Rescue Plan," said HHS how can i get diflucan over the counter Secretary Xavier Becerra. "The antifungal medication diflucan has taken a toll on all of us, especially children.

This critical funding will not only improve the livelihoods of children and their families, but also secure the future of our country. We will how can i get diflucan over the counter continue to make investments that ensure our youngest Americans grow up strong and healthy." The Pediatric Mental Health Care Access Program supports state and regional networks of pediatric mental health care teams. These teams provide tele-consultation, training, technical assistance, and care coordination for pediatric primary care and other providers to diagnose, treat, and refer children and youth with mental health conditions and substance use disorders. The expansion announced today broadens the program's reach from 21 awards in 21 states to 45 awards in 40 states, as well as the District of Columbia, the U.S.

Virgin Islands, how can i get diflucan over the counter and the Republic of Palau. It also provides support to two Tribal areas – the Chickasaw Nation and the Red Lake Band of the Chippewa Indians. Currently, nearly 22 percent of children ages 3 how can i get diflucan over the counter to 17 in the United States are affected by a mental, emotional, developmental, or behavioral condition. Only about 20 percent of children with mental, emotional, or behavioral disorders, however, receive care from a specialized provider.

"Primary care providers strive to address the many mental health challenges children and families are experiencing due to the diflucan, but they need more support," said HRSA Acting Administrator Diana Espinosa. "Expanding the Pediatric Mental Health Care Access how can i get diflucan over the counter program offers new opportunities for providers to offer families the mental and behavioral health services they need but that often aren't easily accessible." To learn more about HRSA's Pediatric Mental Health Care Access program, visit. Https://mchb.hrsa.gov/training/pgm-pmhca.asp. For a list of awards, visit.

Https://mchb.hrsa.gov/maternal-child-health-initiatives/mental-behavioral-health/arp-pediatric-mental-health.Share this story Published how can i get diflucan over the counter August 25th, 2021 at 6:00 AM Above image credit. Jason and Keri Medows during a recording for Illinois Farm Bureau Women in Ag. Jason launched the "Ag State of Mind" podcast to discuss mental health issues in rural America. (Contributed | Jason Medows) A couple of years ago, Jason Medows, a farmer and pharmacist who works in Rolla, Missouri, was desperate how can i get diflucan over the counter for mental health care.

Finding that care was nearly impossible. €œI called not one, not how can i get diflucan over the counter two, not three providers in Rolla, but four and was not able to be seen,” he said. Two of the lines he called were even disconnected. €œI’m a health care worker.

I understand (the system) how can i get diflucan over the counter and I was frustrated,” he said. €œSo I could not imagine what it would be like for someone who is not in my shoes, who doesn’t have an understanding of the system, how they would be discouraged.” Ask someone in rural America what the biggest challenge is to mental health care and they’ll most likely say “access.” Not only is there a lack of mental health professionals in rural communities, experts say, but people often have to travel long distances to find those professionals. Even then, there are issues with getting it covered by insurance. According to the University of Missouri Extension, all of the 99 rural counties in Missouri have a how can i get diflucan over the counter shortage of mental health professionals.

In 57 of those counties there are no mental health professionals. This isn’t just a rural problem, either. Less than 6% of mental health how can i get diflucan over the counter needs are met in Missouri, according to a 2021 report by the Bureau of Health Workforce, Health Resources and Services Administration and the U.S. Department of Health &.

Human Services how can i get diflucan over the counter. That’s less than any other state. In Kansas, about 32% of needs are met. Changing a Rural Mindset Garret Hawkins, president of the Missouri Farm Bureau, said the first obstacle to mental health care for farmers is acknowledging its how can i get diflucan over the counter need.

As a farmer himself, Hawkins said he knows the physically demanding lifestyle of a farmer or rancher encourages a do-it-yourself mentality. And not in a Pinterest, make-your-own-coffee-table type of way, but in a way that stigmatizes asking for help. €œWe’re known for how can i get diflucan over the counter being tough and resilient, yet at the same time, we’re not always the best about asking for help when we need it,” Hawkins said. €œAnd so one of the roles that we have taken on as the state’s largest farm organization is to work with others to tear down the stigma, to let our members know it’s okay to not be okay.” Garrett Hawkins, president of the Missouri Farm Bureau.

(Courtesy | Missouri Farm Bureau) Hawkins said Missouri Farm Bureau has been working with the University of Missouri and other partners to normalize conversations around mental health amongst its members. While others might be how can i get diflucan over the counter able to admit they need help, they might feel a social stigma around entering a mental health care facility or trying to seek help. Kansas Farm Bureau (KFB) and K-State Research and Extension for Farm Stress are also working on bringing more mental health awareness in rural Kansas. Erin Petersilie, assistant how can i get diflucan over the counter director of health plans at KFB, said in a town where common knowledge travels fast it can be uncomfortable to seek care.

€œWe also need to think about the fact that there is still very much a stigma surrounding mental health and it is very hard in those small towns when we think about how everybody knows everybody,” Petersilie said. €œSo the last thing people want to have happen is to have a vehicle parked in front of a mental health office, because they are going to get talked about.” KFB and K-State Research and Extension have teamed up to provide more education on mental health warning signs and different numbers and hotlines people can call if they need help. Amy May, clinical director at North Central Missouri Mental Health, said her rural how can i get diflucan over the counter offices have typically only dealt with severe mental health illnesses like schizophrenia or bipolar disorder. But in the past year or so she’s seen more patients dealing with suicide and depression.

Despite the increase in patients, May said many still feel uncomfortable in seeking mental health care. €œI still feel like how can i get diflucan over the counter there is this stigma of we still just don’t want to talk about it. Or we don’t want people to know we’re getting services, especially here,” May said. “I feel like our offices are kind of in outlying locations and yet I still have clients … they’ll drive to another office just because they don’t want, and they flat out said, ‘I don’t want people to see my car in your parking lot.’ ” Even at the school level, Polo R-VII school counselor Rebecca Chambers-Arway said the invisible illness can be hard for her students to take seriously.

She worked with a student for a while how can i get diflucan over the counter who said her friends would make jokes about her counseling sessions. Chambers-Arway’s advice was to remind them that mental well-being is a serious health issue even though it’s not always visible. Someone goes to the doctor how can i get diflucan over the counter for a broken bone, Chambers-Arway noted. How is it any different to seek help for a broken spirit?.

“It’s hard because I still think kids think that a mental illness is a weakness, but so many of us deal with it on a daily basis,” Chambers-Arway said. €œIt’s just (that) it’s hidden how can i get diflucan over the counter. You can’t see it.” Chambers-Arway said she works to simplify complex emotions, like anxiety, and instead helps children to recognize the things they are worried about. Those simplified conversations can evolve as the students age to better understand the way they are feeling.

€œI think so many times those feelings aren’t normalized when they’re little, how can i get diflucan over the counter so that’s what they grow up learning,” Chambers-Arway said. It’s not an issue that can be solved or normalized overnight. Chambers-Arway said she hopes to see more involvement with mental health first aid training both at school and in the community. These sessions can help instructors and parents to recognize signs of mental health issues and know how to intervene, but she said the response in how can i get diflucan over the counter Polo hasn’t been huge.

“I think it’s just going to be a constant battle until people, not people, society, embraces it and recognizes that it is something that needs to be addressed,” Chambers-Arway said. In the same vein, Hawkins said the Missouri Farm Bureau how can i get diflucan over the counter is working to teach people the warning signs of mental illness. In early 2020, the bureau was part of a study noting the effect of economic changes, congressional action and severe weather conditions on the mental well-being of Missouri agriculture producers. Since then, Hawkins said the antifungal medication diflucan exacerbated mental health conditions as supply chain disruptions and increased isolation caused more stress to farmers.

€œJust knowing that family and friends are facing issues makes it even more imperative that maybe we do check-ins more frequently, just to see how folks are doing,” Hawkins how can i get diflucan over the counter said, “Just asking the question, ‘How are you doing?. €™ It’s really that simple.” Thankfully, as studies emerge about this issue, Hawkins said more resources have been made available through the University of Missouri Extension and through the USDA’s Farm and Ranch Stress Assistance Network. Telehealth Counseling Out of Reach After someone in a rural area has identified the signs of mental illness and decided to seek help, where do they turn?. Hawkins serves on his local hospital board and said the number one issue it how can i get diflucan over the counter is currently faced with, and doesn’t provide, is mental health counseling.

€œOne of the challenges that we have as a critical access hospital is how to provide all the services that are needed in our community and the outlying rural areas for our farm and ranch families,” Hawkins said. Telehealth presents itself as a golden solution to reaching rural communities, but access to strong internet connection remains an obstacle. €œIn my hometown of Appleton City, we have the technology to how can i get diflucan over the counter do telehealth, but we don’t have strong enough bandwidth to provide telehealth on a consistent basis that is adequate for the provider, as well as the patient,” Hawkins said. Because Missouri has such a shortage of mental health professionals, Hawkins said telehealth is logistically the best way to reach communities far and wide.

€œIf we have that physical shortage it only makes sense that opportunities provided with telehealth how can i get diflucan over the counter allow us to cast a wider net to try to reach more providers to improve accessibility for farm, ranch and rural families,” Hawkins said. Medows is a big proponent for telehealth counseling. After his unsuccessful search for in-person care, Medows went online, where he was finally able to get help. He now uses a virtual service called Better Health, which allows him to instant message and video how can i get diflucan over the counter conference with licensed professionals.

Medows is fortunate because he has access to high-speed internet, but that’s not the case for many in rural communities. According to the Federal Communications Commission (FCC), just one-fourth of the rural population in America has broadband access. But even this data has been criticized for how can i get diflucan over the counter not being granular enough, meaning that ratio is likely even smaller. Jason Medows, host of the “Ag State of Mind” podcast.

(Contributed | Jason Medows) “There is no such thing as affordable high speed internet out here,” Medows said. €œI mean, that’s like a unicorn, as far as I’m concerned how can i get diflucan over the counter. We’re fortunate to where we can afford it, but even what we afford isn’t very good. We pay $190 a month for internet and it’s not even that good.” Petersilie of KFB said that the bureau has some initiatives to improve how can i get diflucan over the counter broadband access and stressed the importance of making care as accessible as possible.

€œHow do farmers access this system?. € Petersilie said. €œWe also need to look at the flip how can i get diflucan over the counter side of that point. How does that system access the farmers?.

€ Elaine Johannes of K-State Research and Extension for Farm Stress said not only does there need to be more telehealth options, but quality therapists who understand the unique stressors of rural America and farming. €œWe need to talk about telehealth,” how can i get diflucan over the counter she said. €œWe need top talent. We need to have people understand that therapies can be done online, they can even be done through a cell phone.

Now, that doesn’t replace the human and the interaction between folks how can i get diflucan over the counter. But again, we need to understand what’s going on with mental health care in the United States and especially in rural areas, so we could be allies with it.” Schools are typically reliable locations with stable internet in rural areas, meaning it could be possible to have students take telehealth counseling from the building. Chambers-Arway said her district has started a program like this how can i get diflucan over the counter. €œ(Telehealth therapy) would be an ideal situation.

It’s just, I feel like sometimes the insurance hoops are harder to get through than the parents and students agreeing to the support,” Chambers-Arway said. Insurance hoops were a barrier to students even when the school had an how can i get diflucan over the counter in-person therapist. This program, through Northwest Behavioral Health, designated a therapist to split time between Gallatin, Polo and Hamilton school districts each week. Chambers-Arway said the program was successful and generated a lot of interest, but because it was free to the school and paid for by a student’s insurance, the enrollment paperwork was immense.

It sounds like a small inconvenience to fill out the forms and meet with the therapist, how can i get diflucan over the counter but Chambers-Arway said it meant a day off from work and a lot of parents in Polo couldn’t afford that time. €œAs soon as we got that going we had students coming in, and parents, to us and asking, ‘Okay, can we get ours set up with her?. €™â€ Chambers-Arway said. When the therapist left Northwest Behavioral, Gallatin and Polo were without a replacement, how can i get diflucan over the counter but a well-established need.

Chambers-Arway said she tried to get a different person to come to the school, but said it never reached fruition. €œIn my how can i get diflucan over the counter opinion, that’s the only way we’ll be able to secure some mental health support, outside of what I can do as a (school) counselor,” Chambers-Arway said. €œI can’t do some of that deep-seeded counseling in a school setting.” Jennifer Kline, program manager at Northwest Behavioral, said all of the school outreach programs like this have ended because of a shortage in behavioral health providers. €œIt’s challenging for us to fill vacancies and meet the demand even in urban areas across the board,” Kline said.

€œIt’s just not enough people to go around and fill all of the positions.” Providers in rural areas, and especially those working in schools, require specialized knowledge in aiding those populations, making their how can i get diflucan over the counter roles especially difficult to fill. Few and Far Between Local behavioral and mental health facilities like Northwest and North Central Missouri Mental Health are stretched thin, serving four and nine counties, respectively, with outreach offices. Even with these local offices, that leaves a lot unreached or with a significant drive to reach care. A map by how can i get diflucan over the counter the University of Missouri Extension shows all of the mental health facilities in the state.

Many counties are left with just one facility and others are completely barren. Mental Health Support in Missouri A map by the University of Missouri Extension shows that the vast majority of counties in the state (shaded in gray) are experiencing a shortage of mental health professionals. (Courtesy | University how can i get diflucan over the counter of Missouri Extension) May said she sees transportation as a major issue to clients seeking mental health care. “Transportation is a huge barrier for our clients,” May said.

€œWe do have a lot of satellite how can i get diflucan over the counter offices. However, for prescribers and therapists, they may not be able to get to all the offices. So the clients have to travel to a certain office location to get to our services.” Getting care is important, but Medows said for many farmers who work with the daylight, an hour and half trip can be too much time away. €œDouble that drive time and whatever time that how can i get diflucan over the counter you’re there and that’s all time that is lost in whatever else you want to do, working a job, spending time with the family,” Medows said.

His passion for mental health awareness led Medows to create his podcast, “Ag State of Mind.” For Medows, it’s important to have farmers and ranchers talking about mental health so others struggling with the same problems know they’re not alone. €œThere needs to be more real people talking about it. More people sharing their own how can i get diflucan over the counter experience with it and not having the fear of ridicule,” Medows said. By “real people” Medows means the people living with feelings of independence and isolation often associated with rural life.

€œPeople who are residents of the rural community. People like me who live in the rural community and share their certain experience in the challenges and how can i get diflucan over the counter are relatable. People who just as easily could be their neighbor, people who people could see being their neighbor.” Marissa Plescia is a Dow Jones summer intern at Kansas City PBS. Vicky Diaz-Camacho covers community affairs for how can i get diflucan over the counter Kansas City PBS.

Cami Koons covers rural affairs for Kansas City PBS in cooperation with Report for America. Like what you are reading?. Discover more unheard stories about Kansas City, every Thursday. Thank you for subscribing!.

Check your inbox, you should see something from us. Your support lets our boots-on-the-ground journalists produce stories like this one. If you believe in local journalism, please donate today. Related Stories.