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Questions and Answers—Health Care Access, Quality, and Insurance for Low-Income Children

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Regarding: RFA HS-99-005, published in the NIH Guide on January 20, 1999

Agency for Health Care Policy and Research

Letter of Intent Receipt Date: February 25, 1999
Application Receipt Date: April 22, 1999

Many potential applicants have addressed questions to AHCPR regarding RFA HS-99-005, "Health Care Access, Quality, and Insurance for Low-Income Children." Questions and answers applicable to all potential applicants follow; more questions may be submitted by E-mail to If AHCPR receives further inquiries relevant to all potential applicants, this list will be updated.

Posted April 15, 1999

Question: Will there be any extension of the April 22nd deadline for submission of applications?
Answer: No.

Question: What time do applications have arrive by?
Answer: By 5 pm eastern daylight savings time.

Question: What phone number should I use for Dawn French if I'm sending my application to AHCPR by courier or express mail?
Answer: Ms. French's number is (301) 594-6768.

Posted March 29, 1999

Question: In applications involving a consortium of organizations, is it required that the principal investigator (PI) be a staff member of the applicant organization?
Answer: No, the PI does not have to be a staff member of the grantee organization.

Question: Can a proposal be submitted if the PI is unwilling to travel to the Coordinating Committee meetings and designates a representative authorized to speak on the PI's behalf, or will the proposal be disqualified as unresponsive to the RFA?
Answer: The proposal would not be disqualified as unresponsive to the RFA. However, the review criteria include "the applicant's ability to participate fully and constructively in cooperative activities." The lack of PI involvement would most likely weigh against the applicant in the peer review, and could affect the funding decision as well.

Question: Can some one who is a PI on one proposal serve as a consultant or co-investigator on another proposal? Can one person be a co-investigator on two proposals?
Answer: Yes, to both questions.

Question: Can funds be used to expand an existing project?
Answer: Yes, but the proposal must clearly delineate what the existing project is funded to do, and what the AHCPR/Packard funds are being requested for.

Question: Is a proposal that plans to compare a fee-for-service delivery system to a managed care system responsive to the RFA?
Answer: Research that concludes that there a difference in the care delivered by these systems, but cannot explain which features of the systems are responsible for the effect observed is not responsive to the RFA. The RFA calls for studies of features of U.S. insurance programs and the organization of the healthcare delivery systems associated with these programs affect access to services and quality of care received by low-income children. For more about what is meant by features, please see the answers to earlier questions, posted below.

Question: Where can the new RFA label that applicants should use when they send in their applications be found?
Answer: The sample RFA label, which encourages applicants to indicate the RFA number on the label, can be found in PDF format at:

Question: I heard that AHCPR and the Packard Foundation held a meeting last summer on the subject of research on the Children's Health Insurance Program. How do potential RFA applicants find out about that meeting?
Answer: "Learning From SCHIP II: Critical Issues in Research Across States Meeting Summary," summarizes the meeting held on June 12th by AHCPR, the Packard Foundation, ASPE, HRSA, and HCFA. Select for an online brief description of the meeting. Copies of the summary without appendices can be obtained through AHCPR's InstantFAX (special publication #995015). Copies of the full summary, including appendices, are available through AHCPR's Publications Clearinghouse (1-800-358-9295).

Posted March 8, 1999

Question: Can I submit an application without having submitted a letter of intent?
Answer: Yes, letters of intent are optional. However, we urge all prospective applicants to submit a letter of intent.

Question: Even though the deadline has passed, should I still submit a letter of intent?
Answer: Yes, having a letter of intent, even after the deadline, will be useful to AHCPR and the Packard Foundation in planning for the review of proposals.

Question: What should go in a letter of intent?
Answer: There are no guidelines for the content or format for letters of intent. The most important information for you to include is who will be members of the research team, including subcontractors. Please list the names and organizational affiliation of your key personnel. You should also include the title of the proposed research, and the name, address, phone number and E-mail address of the Principal Investigator(s). A one- or two-paragraph description of the project would also be useful information to AHCPR and the Packard Foundation, but the letter of intent should not be long or detailed.

Question: Will any feedback be provided on letters of intent?
Answer: AHCPR and the Packard Foundation will not provide responses to letters of intent. However, if prospective applicants would like feedback on the responsiveness of their planned proposals to the RFA, a one- or two-page concept letter can be sent to Cindy Brach, AHCPR Project Officer ( For other inquiries, please see the RFA's Inquiries section.

Question: Are for-profit companies eligible to apply?
Answer: No. Grantee institutions may be domestic or foreign, public or private nonprofit organizations, including universities, clinics, units of State and local governments, and other nonprofit organizations and foundations. For-profit organizations are not eligible as applicants, but may participate as members of consortia or as subcontractors. Organizations described in section 501(c)4 of the Internal Revenue Code engage in lobbying are not eligible to receive cooperative agreement awards.

Question: Can non-profit health care delivery systems apply?
Answer: Yes, the fact that they deliver services does not make them ineligible.

Question: Can more than one application per State be submitted?
Answer: Yes. However we encourage collaboration among researchers, both within and across States.

Question: Are applications restricted to certain communities?
Answer: No. Any State or community in the United States, including Puerto Rico, can be the subject of study under the RFA. However, the RFA asks applicants to focus their attention on communities where a high proportion of the families are low-income, as well as communities with relatively large numbers of children with special health care needs and minority children, and communities whose health care systems have not been studied extensively.

Question: Can State and local government applicants use form PHS 398, or must they use PHS 5161-1?
Answer: State and local governments can use either the PHS 398 or the PHS 5161-1.

Question: If several institutions are involved in a proposal, does a certain percentage of the work have to be performed by the grantee institution as compared to the other members of the consortia or subcontractors?
Answer: There is no set percentage of work that a grantee institution must perform. Grantee institutions must have a substantial role in the project and may not serve as a pass through for directing money to other organizations. For example, a grantee institution that receives only 25 percent of grant funds but provides a central oversight and coordination function is permissible; a grantee institution that receives 55 percent of grant funds but makes no substantial contribution to the project is not permissible.

Question: Are there any minimum qualifications for the Principal Investigator?
Answer: There are no minimum qualifications for the Principal Investigator. However, AHCPR Principal Investigators usually have an advanced degree (Ph.D. or M.D.). The overall adequacy of the research team, including the qualifications and experience of the Principal Investigator, will be assessed by reviewers. The Principal Investigator must be able to demonstrate control of the project, as evidenced by organizational lines, written agreements, or other structural arrangements, and by commitment of time. The Principal Investigator must possess enough expertise to participate constructively in the Coordinating Committee.

Question: Can there be more than one Principal Investigator?
Answer: No, one person must be responsible for the direction of the project. The concept of co-Principal Investigators is not formally recognized.

Question: Can an applicant submit two applications to AHCPR at the same time, one under the RFA and the other an unsolicited application responding to a Program Announcement?
Answer: No, an applicant may not submit two applications that essentially deal with the same research questions at the same time. If a prospective applicant has already submitted a proposal to AHCPR, she or he may withdraw the application in order to submit an application under the RFA. (Letters of withdrawal should be sent from the grantee institution's business office to Pat Thompson, AHCPR, 2101 E. Jefferson Street, Suite 400, Rockville, MD, 20852, with a copy sent to the Principal Investigator.) However, RFA applicants who are not awarded cooperative agreements under the RFA may submit revised applications in response to other AHCPR or Packard funding opportunities.

Question: Can an applicant submit an application under the RFA if she or he already has funding from AHCPR?
Answer: Yes, as long as the proposal is clearly distinguished from currently funded work.

Question: What should applicants do if they do not have an Institutional Review Board?
Answer: Applicants must have Institutional Review Board (IRB) certification if they conduct activities with human subjects that are not exempt from Federal regulations. IRB certification is not required at the time of submission of an application, but must be submitted to the Scientific Review Administrator within 60 days of submission. Contact the Office for Protection from Research Risks (OPRR) at the National Institutes of Health (NIH) at (301) 496-7041 for more information. Information is also available on the NIH Web site.

Question: Can grant funds be used to support the delivery of health services?
Answer: No, grant funds can only be used to support research, not the development or delivery of any health service.

Question: Under the cooperative agreement mechanism, how much will applicants be expected to change their research project from what they proposed.
Answer: Drastic changes will not be required. However, awardees may be asked to fine tune their data collection strategies, instruments used, etc. to further the cooperative goals. Decisions to undertake such changes will not be imposed unilaterally by the Project Officers, but will be part of a group process of the Coordinating Committee in which all Principal Investigators participate along with the Project Officers.

Question: How are children with special health care needs (CSHCNs) defined?
Answer: CSHCNs are defined in the RFA as those who have or are at increased risk for a chronic physical, development, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. This is intended to be a broad definition, encompassing both children who have been diagnosed with specific conditions (e.g., asthma, cerebral palsy) and who are members of risk groups (e.g., children in foster care).

Question: Does the research have to address the Children's Health Insurance Program (SCHIP)?
Answer: No. SCHIP presents many opportunities for conducting research under the RFA, and SCHIP should benefit from the results of the research conducted, but SCHIP does not have to be the subject of the research.

Question: Can commercial or privately-sponsored health plans be studied?
Answer: The RFA calls for studies of features of public insurance programs and delivery systems. This includes Medicaid, Children's Health Insurance Program (SCHIP), and State- or locally- subsidized health insurance. Commercial/private populations can be examined as part of such as study, such as when they are used as a comparison group. However, the focus of the study should be the public insurance program.

Question: Must the measures, instruments, and databases listed in the Methods section of the RFA be used?
Answer: No, these are measures, instruments, and data bases that have been developed by the Department of Health and Human Services and applicants are encouraged to consider using them, but investigators should select the measures, instruments, and data bases best suited to their studies. For example, if an investigator is planning to measure consumer satisfaction, we urge her or him to consider using the Consumer Assessment of Health Plans (CAHPS®) instrument. However, the investigator might select an instrument that has been widely tested and used in the particular ethnic community that the investigator has chosen to study.

Question: What is a feature of health insurance or health care delivery systems?
Answer: Health insurance features pertain to how the insurance program is structured. Examples of health insurance features given in the RFA include the scope of the benefits package and premium- and cost-sharing requirements. Health care delivery system features pertain to how the delivery of care is organized. Examples of health care delivery system features given in the RFA include the organizational form of the entity that is responsible for the delivery of care, the network of providers, provider compensation arrangements, gatekeeper arrangements, procedures to access pediatric specialists, provisions for culturally competent care, and mechanisms to coordinate care and/or link to social services.

Question: Does a particular feature of health insurance or delivery systems have to be studied, or can an entire program be evaluated?
Answer: The RFA is not intended to fund program evaluations as such. AHCPR and Packard seek to fund research that will provide some specific answers to the question of what works for low-income children, and in particular, what works for low-income minority children or children with special health care needs. The proposed research should be able to answer such questions as: Which features of insurance programs and delivery systems increase the probability that children receive appropriate health services? Which features improve satisfaction? Which features improve health outcomes? Which features improve child and parental well-being? While more than one feature can be examined, a proposal to evaluate a program that does not delve inside the black box to learn what about that program is responsible for the results observed would not be responsive to the RFA.

Question: Can the research study adults as well as children?
Answer: The RFA solicits studies on low-income children. Children are almost always situated in families and can be studied in the context of their families. However, studies that seek to examine the impact of health insurance and delivery system features on both children and adults (as distinct from the impact on families with children) should find another source of funding for the adult component and apply for funds under this RFA for the child component only.

Question: Is primary data collection required?
Answer: There are no requirements regarding data collection. Applicants will use process and outcome measures to examine the impact of insurance and delivery system features on low-income children's access to services and quality of care. The best method of data collection must be determined by the applicant.

Question: If I decide my research is not responsive to the RFA, can I still apply to AHCPR for research funds?
Answer: Yes. Proposals for grants can be submitted. Grant applications are reviewed for scientific and technical merit by a peer review group with appropriate expertise. Funding decisions are based on the quality of the proposed project, availability of funds, and program balance among research areas. Proposals submitted in April 1999 will be considered for fiscal year 2000 funding. For application instructions and to see AHCPR priority interests in research, demonstration, dissemination, and evaluation projects, select AHCPR Health Services Research—Program Announcement.

Potential applicants are invited to submit questions by E-mail to

Current as of April 15, 1999


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