Block Grant Guidance.Title and TOC.Jan_2015_REVISED

TITLE V MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT TO STATES PROGRAM

GUIDANCE AND FORMS

FOR THE

TITLE V APPLICATION/ANNUAL REPORT

OMB NO: 0915-0172

EXPIRES: 12/31/2017

U.S. Department of Health and Human Services

Health Resources and Services Administration

Maternal and Child Health Bureau

Division of State and Community Health

Room 5C-26

5600 Fishers Lane, Rockville, MD 20857

(Phone 301-443-2204 FAX 301-443-9354)

Public Burden Statement:  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  The OMB control number for this project is 0915-0172.  Public reporting burden for this collection of information is estimated to average 145.1 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10C-03I, Rockville, Maryland, 20857.

TITLE V MATERNAL AND CHILD HEALTH (MCH) SERVICES BLOCK GRANT TO STATES PROGRAM APPLICATION/ANNUAL REPORT GUIDANCE

SEVENTH EDITION

The Maternal and Child Health (MCH) Block Grant is a formula grant under which funds are awarded to 59 states and jurisdictions upon their submission of an acceptable plan that addresses the health services needs within a state for the target population of mothers, infants and children, which includes children with special health care needs (CSHCN), and their families. Through this process, each state and jurisdiction supports and promotes the development and coordination of systems of care for the MCH population, which are family-centered, community-based and culturally appropriate.

The Application/Annual Report Guidance is used annually by the 50 States and nine jurisdictions in applying for Block Grants under Title V of the Social Security Act and in preparing the required Annual Report. States/jurisdictions report annually on national and state outcome/performance measures, which document their progress towards the achievement of established performance targets, ensure accountability for the ongoing monitoring of health status in women and children and lend support to the delivery of an effective public health system for the nation’s MCH population. Complementary to the reporting of outcome and performance measure data is the state/jurisdictional narrative Title V story, which discusses program impact within the State and at the national level.

This edition of the MCH Block Grant Application/Annual Report Guidance builds on the performance partnership approach that exists between the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) and the State Title V agencies. In developing this Guidance, the MCHB engaged with the State Title V leadership and other national MCH leaders and stakeholders to develop and refine a common vision for transforming the MCH Block Grant to States Program. Changes to this edition are intended to facilitate the increased alignment of State/jurisdictional Title V program efforts with other MCHB investments and to demonstrate the vital leadership role of the State Title V programs in assuring and advancing public health systems that can readily respond to changing MCH population needs. The seventh edition of the Title V MCH Block Grant to States Application/Annual Report Guidance consists of two documents: 1) Instructions to the States on completing the required Application/Annual Report and Reporting Forms; and 2) Appendix of Supporting Documents, which includes background program information and other technical resources.

As with previous editions, this Guidance adheres to the specific statutory requirements outlined in Sections 501 and 503-509 of the Title V legislation and promotes the use of evidence-based public health practices by states/jurisdictions in developing a Five-year Action Plan that addresses identified MCH priority needs. The revised Guidance also reaffirms the mission of Title V as “to improve the health and well-being of all of America’s mothers, children, and families.”

This edition of the MCH Block Grant to States Program Guidance is the fifth to be released since the introduction of a Web-based Application/Annual Report. The use of this online method for completing and submitting a yearly Application/Annual Report continues to be a requirement for the receipt of Federal Title V program funds. Since its development in 2002, the Title V Information System (TVIS) has contributed to numerous efficiencies in the Application/Annual Report submission process. Administered by HRSA’s MCHB, the TVIS consists of two components: 1) Title V Block Grant Application/Annual Report Data Entry (used by state/jurisdictional Title V Block grantees to submit their financial, program, and performance data; and 2) TVIS Reports (a Web-based interface that allows public users to generate reports from Title V data.) The substantive changes made to the seventh edition of the MCH Block Grant Application/Annual Report Guidance mandated the development of a new electronic Title V data collection and web reports system, beginning with the submission of the fiscal year (FY) 2016 Applications/FY 2014 Annual Reports.

Questions and comments regarding this edition of the Application/Annual Report Guidance may be addressed to:

Michele H. Lawler, M.S., R.D.

Acting Director

Division of State and Community Health

Maternal and Child Health Bureau

Health Resources and Services Administration

Room 5C-26, Parklawn Building

5600 Fishers Lane

Rockville, Maryland 20857

Telephone: (301) 443-2204

Fax: (301) 443-9354

[email protected]

TABLE of CONTENTS

PART ONE: BACKGROUND AND ADMINISTRATIVE INFORMATION

1. Purpose of the MCH Block Grant Program 1

2. Background and Brief History 1

3. MCH Transformation and Revision of MCH Block Grant 2 Application/Annual Report Guidance

   1. Vision and Mission 2

   2. National Performance Measure Framework 4

   3. Changes to the Application/Annual Report Guidance 6

4. Legislative Requirements 9

   1. Who Can Apply for Funds 9

   2. Use of Allotment Funds 9

   3. Application for Block Grant Funds 9

   4. Annual Report 11

   5. Administration of Federal and State Programs 12

PART TWO: APPLICATION/ANNUAL REPORT INSTRUCTIONS 13

1. General Requirements 13

   1. Letter of Transmittal 13

   2. Face Sheet 13

   3. Assurances and Certifications 13

   4. Table of Contents 13

   5. Application/Annual Report Executive Summary 13

2. Components of the Application/Annual Report 14

   1. Overview of the State 15

   2. Five-Year Needs Assessment Summary 16

      1. Process 19

      2. Findings 19

         1. MCH Population Needs 20

         2. Title V Program Capacity 21

1. Organizational Structure 21

2. Agency Capacity 22

3. MCH Workforce Development and Capacity 22

3. Partnerships, Collaboration, and Coordination 23

1. State Selected Priorities 26

2. Linkage of State Selected Priorities with National Performance 26 and Outcome Measures

3. Linkage of State Selected Priorities with State Performance 27 and Outcome Measures

4. Five-Year State Action Plan 28

   1. State Action Plan and Strategies by MCH Population 28

      1. Five-year State Action Plan Table 30

      2. State Action Plan 31

9. Plan for the Application Year and Annual Report 32

35. Other Programmatic Activities 32

1. MCH Workforce Development and Capacity 33

3. Family Consumer Partnership 33

4. Health Reform 34

5. Emerging Issues 34

6. Public Input 34

7. Technical Assistance 35

3. Budget Narrative 35

   1. Expenditures 35

   2. Budget 36

PART THREE: REPORTING FORMS 37