[Federal Register Volume 59, Number 66 (Wednesday, April 6, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-8174]
[[Page Unknown]]
[Federal Register: April 6, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[Announcement Number 424]
RIN 0905-ZA36
State-Based Programs to Reduce the Burden of Diabetes: A Health
Systems Approach; Notice of Availability of Funds for Fiscal Year 1994
Introduction
The Centers for Disease Control and Prevention (CDC), announces the
availability of fiscal year (FY) 1994 funds for new applications for
cooperative agreements to develop, implement, and evaluate State-based
diabetes control programs (DCPs). The program is designed to establish
the DCP as a key component of an evolving health care environment. The
conceptual framework within which successful applicants should operate
is characterized by four areas of program activity: (1) Defining the
nature, extent, distribution, and causes of the burden of diabetes; (2)
Developing new, effective approaches for reducing the diabetes burden
which complement emerging health care systems; (3) Implementing
specific measures to ensure the widespread application of accepted
standards, policies, and protocols to reduce the burden of diabetes;
and (4) Coordinating the diabetes-related efforts of the public health
system with private health care providers and payers, as well as with
all appropriate governmental, voluntary, professional, and academic
institutions.
This announcement addresses two distinct levels of program support,
both of which are consistent with the conceptual framework described
above. The first is a Core Capacity Program, which defines basic
diabetes prevention and control activities to be carried out through
existing and evolving health care systems. The second is an Enhanced
Program, which is intended to introduce additional, innovative elements
to a State's diabetes prevention and control efforts, and is also
carried out through existing and evolving health care systems.
The Public Health Service (PHS) is committed to achieving the
health promotion and disease prevention objectives of Healthy People
2000, a PHS-led, national activity to reduce morbidity and mortality
and improve the quality of life. This announcement is primarily related
to Priority Area 17, Diabetes and Chronic Disabling Conditions--with
particular attention to populations at disproportionate risk of
developing diabetes, including minorities and the elderly. However, it
also is relevant to other priority areas, including Physical Activity
and Fitness, Nutrition, Tobacco, Educational and Community-Based
Programs, Maternal and Infant Health, Heart Disease and Stroke,
Clinical Preventive Services, and Surveillance and Data Systems. (To
order a copy of Healthy People 2000, see the section WHERE TO OBTAIN
ADDITIONAL INFORMATION.)
Authority
This program is authorized under sections 301(a) and 317(k)(3) [42
U.S.C. 241(a) and 247b (k) (3)] of the Public Health Service Act.
Applicable program regulations are found in 45 CFR part 92.
Smoke-Free Workplace
The Public Health Service strongly encourages all grant recipients
to provide a smoke-free workplace and promote the non-use of all
tobacco products. This is consistent with the PHS mission to protect
and advance the physical and mental health of the American people.
Eligible Applicants
Eligible applicants are the official public health agencies of
States or their bona fide agents or instrumentalities. This includes
the District of Columbia, American Samoa, the Commonwealth of Puerto
Rico, the U. S. Virgin Islands, the Federated States of Micronesia,
Guam, Northern Mariana Islands, the Republic of the Marshall Islands,
and the Republic of Palau.
Availability of Funds
Approximately $9,750,000 is available in FY 1994 to fund
approximately 42 awards in two categories (Core Capacity Programs and
Enhanced Programs).
A. Core Capacity Program to Reduce the Burden of Diabetes
Approximately $8,750,000 is available to fund approximately 40
awards for Core Capacity Programs. It is expected that the average
award will be $230,000, ranging from $150,000 to $350,000.
B. Enhanced Program to Reduce the Burden of Diabetes
Approximately $1,000,000 is available to fund approximately 2
awards for Enhanced Programs. It is expected that the average award
will be $500,000, ranging from $300,000 to $700,000. Enhanced Program
awards will only be considered for those applicants who compete
successfully and are funded for Core Capacity Program awards.
It is expected that awards will begin on or about July 1, 1994, and
will be made for a 12-month budget period within a project period of up
to 5 years. Funding estimates may vary and are subject to change.
Continuation awards within the project period will be made on the
basis of satisfactory progress and availability of funds.
At the request of the applicant, Federal personnel may be assigned
to a project in lieu of a portion of the financial assistance.
Purpose
The purpose of this program is to provide financial and
programmatic assistance to States and territories for integrating
diabetes prevention and control activities within existing and evolving
health care systems.
Program Requirements
The program described in this announcement reflects a significant
shift by the DCP from the direct provision of personal health services
to a responsibility for leadership and coordination of overall efforts
of the health system to reduce the burden of diabetes. Both a Core
Capacity Program and an Enhanced Program are conceptualized by the four
categories of program activity described under INTRODUCTION in this
announcement. The central objective of a Core Capacity Program is to
assist the State to establish the basic public health framework for
leading and coordinating the efforts of the health care system and
other public and private resources to reduce the burden of diabetes. A
Core Capacity Program must address all four categories of program
activity.
An established Core Capacity Program is the foundation on which an
Enhanced Program is built. The central objective of an Enhanced Program
is to move the State program vigorously into a position from which it
can take the lead in ensuring that diabetes-specific, community
preventive health services are an integral part of a reformed health
system. An Enhanced Program must involve the addition of innovative
approaches not employed in the Core Capacity Program to reduce the
burden of diabetes. Simple expansion of Core Capacity Program
activities does not constitute an Enhanced Program.
A recipient of an award for an Enhanced Program may choose to focus
its initial enhancement efforts on fewer than all four of the basic
categories of program activity. However, at a minimum, the recipient
must indicate that activities will be undertaken in the first budget
year related to (1) defining the burden of diabetes and (2)
coordinating the overall effort to reduce the diabetes burden. It is
expected that each Enhanced Program will be fully operational,
including all four categories, within four years of the State's initial
Enhanced Program award.
In conducting activities to achieve the purpose of this program,
the recipient shall be responsible for the activities described under
A., below, and CDC shall be responsible for carrying out the activities
described under B., below.
A. Recipient Activities
1. Define and monitor the burden of diabetes through the
establishment and maintenance of a State-based surveillance system
which focuses on diabetes as a public health problem.
2. Develop new approaches to reduce the burden of diabetes through
the development or adaptation of specific interventions to be applied
within the existing and evolving health care system.
3. Implement specific measures to reduce the burden of diabetes by
ensuring the widespread application of accepted standards, policies,
and protocols developed for that purpose. These should include
protocols designed to prevent or postpone the occurrence of the major
complications of diabetes, as well as diabetes-related cardiovascular
disease. In addition, they should include protocols to ensure that
persons with diabetes improve their efforts to achieve levels of
glycemic control consistent with the results of the Diabetes Control
and Complications Trial (DCCT).
4. Coordinate overall program efforts of the health system to
reduce the burden of diabetes through the establishment of appropriate
linkages with other governmental agencies; private health care
providers; academic institutions; community-based organizations;
voluntary agencies; health care reimbursement organizations; national
organizations representing populations disproportionately burdened by
diabetes, such as minorities and the elderly; and others.
B. CDC Activities
1. Define and monitor the burden of diabetes by providing technical
assistance in the development of surveillance and other data systems to
measure and characterize the burden of diabetes and its complications.
2. Develop new approaches for reducing the burden of diabetes
through the provision of program guidelines for, and technical
assistance in, the development or adaptation of specific interventions
to be applied within the existing and evolving health care system.
3. Implement specific measures to reduce the burden of diabetes
through the provision of program guidelines for, and by collaborating
in the implementation of, accepted standards, policies, and protocols
within the existing and evolving health care system.
4. Coordinate overall program efforts of the health care system to
reduce the burden of diabetes through the provision of program
guidelines, and by facilitating communication among DCPs and with other
governmental agencies, private health care providers, academic
institutions, community-based organizations, voluntary agencies, health
care reimbursement organizations, and others, to assist them in
ensuring optimal coordination among all components of the public health
and health care systems to address the burden of diabetes.
Evaluation Criteria (Total 100 Points for Core Capacity Program and
100 Points for Enhanced Program)
Applications for Core Capacity Program support will be reviewed and
evaluated according to the following criteria:
A. Background and Need for the Core Capacity Program
The extent to which the need is demonstrated, including adequate
documentation of the barriers to diabetes care and education and the
degree of experience the applicant has in each of the four areas of
program activity (Define, Develop, Implement, and Coordinate). (20
points)
B. Core Capacity Program Work Plan
For each of the four areas of program activity, the Core Capacity
Work Plan will be evaluated in terms of the following items (80
points):
1. Objectives. The extent to which work plan objectives are
measurable, feasible, appropriate, and specific, and are identified for
all four areas of program activity (Define, Develop, Implement, and
Coordinate). (25 points)
2. Methods. The feasibility, appropriateness, and specificity of
the proposed methods for achieving the stated objectives and are
related to the four areas of program activity (Define, Develop,
Implement, Coordinate). (25 points)
3. Evaluation Plan. The feasibility and appropriateness of the
proposed plan for evaluating progress toward attainment of the stated
objectives and are related to the four areas of program activity
(Define, Develop, Implement, Coordinate). (25 points)
4. ``Milestones to Completion'' Chart. The completeness of the
chart describing the timeline and milestones leading to attainment of
the stated objectives for each of the four areas of program activity
(Define, Develop, Implement, Coordinate). (5 points)
C. Core Capacity Program Budget
The extent to which this budget is adequately justified,
reasonable, and consistent with this program purpose and objectives.
(Not Weighted)
Applications for Enhanced Program support will be reviewed and
evaluated according to the following criteria:
A. Background and Need for the Enhanced Program
The extent to which the need is demonstrated, including adequate
documentation of the barriers to diabetes care and education and the
degree of experience the applicant has in each of the four areas of
program activity (Define, Develop, Implement, and Coordinate). (20
points)
B. Enhanced Program Work Plan
For each of the four areas of program activity, the Enhanced
Program Work Plan will be evaluated in terms of the following items (80
points):
1. Objectives. The extent to which work plan objectives are
measurable, feasible, appropriate, and specific, and are identified for
all four areas of program activity (Define, Develop, Implement, and
Coordinate). (25 points)
2. Methods. The feasibility, appropriateness, and specificity of
the proposed methods for achieving the stated objectives and are
related to the four areas of program activity (Define, Develop,
Implement, Coordinate). (25 points)
3. Evaluation Plan. The feasibility and appropriateness of the
proposed plan for evaluating progress toward attainment of the stated
objectives and are related to the four areas of program activity
(Define, Develop, Implement, Coordinate). (25 points)
4. ``Milestones to Completion'' Chart. The completeness of the
chart describing the timeline and milestones leading to attainment of
the stated objectives for each of the four areas of program activity
(Define, Develop, Implement, Coordinate). (5 points)
C. Enhanced Program Budget
The extent to which this budget is adequately justified,
reasonable, and consistent with this program purpose and objectives.
(Not Weighted)
Funding Priority
Priority will be given to applications directed to those providers
and systems which serve population groups disproportionately impacted
by diabetes and its complications. These populations include certain
racial and ethnic minorities (African Americans, Hispanic Americans,
American Indians, and Asian-Pacific Islanders), the elderly, and the
economically disadvantaged.
Public comments are not being solicited regarding the funding
priority because time does not permit solicitation and review prior to
the funding date.
Executive Order 12372 Review
Applications are subject to Intergovernmental Review of Federal
Programs as governed by Executive Order (E.O.) 12372. E.O. 12372 sets
up a system for State and local government review of proposed Federal
assistance applications. The applicant should contact its State Single
Point of Contact (SPOC) as early as possible to alert it to the
prospective applications and receive any necessary instructions on the
State process. For proposed projects serving more than one State, the
applicant is advised to contact the SPOC for each affected State. A
current list of SPOCs is included in the application kit. If SPOCs have
any State process recommendations on applications submitted to CDC,
they should forward them to Elizabeth M. Taylor, Grants Management
Officer, Grants Management Branch, Procurement and Grants Office,
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry
Road, NE., room 305, Mailstop E-16, Atlanta, GA 30305, no later than 60
days after the application deadline. The granting agency does not
guarantee to ``accommodate or explain'' State process recommendations
it receives after that date.
Public Health System Reporting Requirements
This program is not subject to the Public Health System Reporting
Requirements.
Catalog of Federal Domestic Assistance Number
The Catalog of Federal Domestic Assistance number is 93.988.
Other Requirements
Paperwork Reduction Act
Projects that involve the collection of information from 10 or more
individuals and funded by the cooperative agreement will be subject to
review by the Office of Management and Budget (OMB) under the Paperwork
Reduction Act.
Application Submission and Deadline
The program announcement and application kit were sent to all
eligible applicants in February 1994.
Where To Obtain Additional Information
Business management technical assistance including information on
application procedure and copies of application forms may be obtained
from Bernice A. Moore, Grants Management Specialist, Grants Management
Branch, Procurement and Grants Office, Centers for Disease Control and
Prevention (CDC), 255 East Paces Ferry Road, NE., room 305, Mailstop E-
16, Atlanta, GA 30305, telephone (404) 842-6802.
Programmatic technical assistance may be obtained from Stephen
DePaul, Program Services Branch, Division of Diabetes Translation,
National Center for Chronic Disease Prevention and Health Promotion,
Centers for Disease Control and Prevention (CDC), 4770 Buford Highway,
NE., Mailstop K-10, Atlanta, GA 30341, telephone (404) 488-5046.
Please refer to Announcement Number 424 when requesting information
and submitting an application.
Potential applicants may obtain a copy of Healthy People 2000 (Full
Report: Stock No. 017-001-00474-0) or Healthy People 2000 (Summary
Report: Stock No. 017-001-00473-1) referenced in the INTRODUCTION
through the Superintendent of Documents, Government Printing Office,
Washington, DC 20402-9325, telephone (202) 783-3238.
Dated: March 31, 1994.
Robert L. Foster,
Acting Associate Director for Management and Operations, Centers for
Disease Control and Prevention (CDC).
[FR Doc. 94-8174 Filed 4-5-94; 8:45 am]
BILLING CODE 4163-18-P
