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Frequently Asked Questions

Please continue to check this FAQ page where responses will be posted as questions are received. Please check questions similar to ones you submitted, since not all questions will be posted verbatim and responses may be combined.

Click on the FAQ topic headings below to view an expanded list of questions and responses.

General
Purpose/Overview
Funding and Budget

Application Process
Performance Measures
Recipient Activities: Basic Component
Recipient Activities: Enhanced Component
Surveillance and Epidemiology Activities

General


Can state health departments collaborate with Prevention Research Centers on activities, such as evaluation, even though this is a non-research FOA?

Yes. States are encouraged to link and collaborate with Prevention Research Centers, or PRCs, and other partners as appropriate in order to tap into existing expertise in areas such as evaluation. Many state health departments already have relationships with PRCs. For more information about PRC locations and their work, please visit www.cdc.gov/prc.

Is addressing control of high blood pressure among patients with diabetes adequate or should we be addressing the broader population with high blood pressure?

Interventions should address all patients with high blood pressure, not just those who have diabetes.

Will there be a Funding Opportunity Announcement for Wisewoman? If so, when is it anticipated to be released?

CDC anticipates releasing a funding opportunity announcement for WISEWOMAN in 2013. Future funding will be dependent on the availability of funds.

Will there be a Funding Opportunity Announcement for sodium reduction? If so, when is it anticipated to be released?

CDC anticipates releasing a funding opportunity announcement to address sodium reduction in 2013. Future funding will be dependent on the availability of funds.

Can you clarify the expectations for allocating funds to school health activities in the basic and enhanced components?

For the basic components, awardees are expected to achieve all of the basic accomplishments, including for school health activities, and make progress toward outcomes depicted on the logic model. In the enhanced component, awardees are expected to demonstrate progress toward the outcomes depicted on the logic model. School health activity strategies are specifically noted in Domain 2 (Environmental Approaches to promote health and support and reinforce healthful behaviors) and Domain 4 (Community clinical linkages to support CVD and diabetes prevention and control efforts). In Domain 2, applicants must select at least one intervention for ALL strategies. In Domain 4, applicants must select at least one intervention for at least two strategies. Selections must include Strategy #1 or Strategy #2 and may include both of these.

Is direct assistance (DA) for personnel available through this FOA?

Yes. If an applicant’s request for personnel is approved as a part of their award, CDC may reduce the amount of funding provided to the organization as a part of their award. The amount by which the award is reduced to provide DA shall be deemed as part of the award and shall be deemed to have been to the organization, the awardee.

Is an evaluation plan required for this FOA?

Applicants must provide an evaluation plan in the narrative. A more detailed 35-page evaluation plan will be developed after the award.

If an applicant is awarded the enhanced component, will they lose the basic component?

No. All applicants that submit a technically acceptable application will be funded for the basic component.

Are there minimum requirements for professional development for school health strategies?

This FOA does not have minimum requirements for professional development (ex: # of hours that constitutes a professional development event) for school health strategies. States are encouraged to include minimum requirements already in place or that they would like to achieve through this FOA.

In my state, all Memorandum of Understanding (MOU)/Memorandum of Agreement (MOA) are legally binding. Is there flexibility submit a letter instead of an MOU/MOA?

No. Applicants will need to submit an MOU/MOA to comply with the FOA.

How this FOA will be impacted by the sequester?

In accordance with the Budget Control Act of 2011, sequestration will cancel approximately $85 billion in budgetary resources across the Federal government for the remainder of the Federal fiscal year. CDC is following the guidance of the Office of Management and Budget (OMB) and the Department of Health and Human Services (HHS) to develop plans for making the required budget reductions. As CDC develops plans for the specific budget cuts that are required, CDC is doing everything we can to minimize the impact on public health. CDC staff are working together to develop plans to implement the requirements of sequestration. At this time, final decisions have not been made.

The FOA says the new grant will begin on July 1. According to the notices of award, our obesity and heart disease/stroke grants both end on June 29. While June 30th (the unfunded day) is a Sunday this year, we are concerned about possible consequences of a gap between grants. Is there any plan to extend the obesity and heart disease grants through June 30?

The project period starting date for DP 13-1305 will be moved to June 30, 2013 instead of July 1st. (REVISED)

In the FOA, the “negotiated agreement” is referenced as the predecessor of this new approach. Can CDC provide "lessons learned" or other information from these negotiated agreement states to help applicants in this FOA?

CDC is working with the negotiated agreement states to produce a final report that will include case studies, success stories, recommendations and lessons learned. The report will be available later this year.

Since incentive programs already exist for meaningful use of EHRs, what is our expected role in this FOA? Are states expected to encourage providers to participate in meaningful use and to select the blood pressure measures for Medicare and Medicaid providers?

States may encourage providers to participate in meaningful use and to select the blood pressure measures for Medicare and Medicaid providers as one activity related to this strategy. However, this strategy is intended to be broader than just Medicare and Medicaid. Opportunities may include collaboration with Regional Extension Centers (RECs) to help increase health information technology (HIT)-enabled tools such as clinical decision supports and patient reminders, for quality improvement around control of high blood pressure. They can also explore the capacity of health information exchanges (HIEs) to provide information about action taken (e.g., patient follow-up) to improve control of high blood pressure.

We are combining staff from 4 programs for the basic component. How can expect to achieve significant programmatic reach if more of the budget is used for staff?

The FOA provides states with the flexibility to determine their own staffing needs and how best to organize in order to meet the goals of the FOA. Regardless of how a state chooses to organize, they are expected to achieve all of the Basic accomplishments (page 8-9) and make progress toward outcomes depicted in the logic model (page 7) and listed on page 9 of the FOA. For the Basic Component, any program staff paid with CDC funds will be responsible for working with appropriate partners to achieve progress on the performance measures listed on the Basic Component Table (page 13), many of which do monitor reach.

The standard logic model in CDC's Introduction to Evaluation for Public Health Programs includes outputs after activities, whereas the FOA logic model does not include outputs. In the basic component state logic model, are basic accomplishments and outputs interchangeable? Is there a meaningful difference between the basic accomplishments and short-term outcomes?

ANSWER: Basic accomplishments must be included in the state’s logic model. Additional outputs or outcomes may be added at the state’s discretion, but the main objective of the basic component is to show progress on the basic accomplishments. There is some overlap between the basic accomplishments and the short-term outcomes. Where this is the case, the main difference is in the scope and intensity of the measures. The expectations on scale and reach for these measures will be significantly higher if a state receives enhanced funding.

Will awardees be assigned one project officer for the grant?

There will be one lead project officer assigned to each award. The lead project officer will draw from a team of subject matter experts from the divisions involved in the grant to meet the technical assistance needs of the grantee.

For Strategy #2 in Domain 2, though we can propose working in more than one priority setting (as stated in another FAQ), the enhanced work plan template does not allow more than one setting to be chosen for this strategy.

Select the one setting that you plan to report performance measures.

Please provide information for the WISEWOMAN FOA contact at CDC.

The WISEWOMAN FOA is available via Grants.gov (CDC-RFA-DP13-1302). Please see page 41 of the FOA for agency contacts. Please also see
http://www.cdc.gov/wisewoman/foa.htm for additional information about the FOA.

Please provide resources for using quality improvement learning collaboratives as a means for implementing the ECE-related strategies.

Please see quality improvement learning collaboratives to implement ECE-related strategies [PDF-32Kb]

How is the term “health care provider” defined as referenced in the FOA, especially for Strategy #2 performance measure in Domain 4, “proportion of participants in CDC-recognized lifestyle change programs referred by a health care provider.” Referral forms use this term differently and it is therefore hard to aggregate.

For Domain 4, Strategy #2, a health care provider is defined as a physician, physician extender (nurse practitioner, physician’s assistant), or allied health professional (RN, RD, PharmD, CDE, etc.) providing curative, preventive, or rehabilitative services in a health care system setting (private practice, FQHC/RHC, HMO, etc.) in a systematic way to individuals, families, or communities. As stated in the FOA, CDC will work with states after the awards are made to operationalize the performance measures.

The USDA has released national nutrition standards (including sodium) for school meals and a proposed rule for all other foods sold in schools, including competitive foods, which also includes sodium. State agencies that administer national school lunch and breakfast receive funds to implement and train on these standards. Please clarify the expected role of the state health departments within the FOA to implement nutrition standards in schools and provide professional development and training to school food personnel. How do we outline roles and responsibilities in the MOU to appropriately partner with state education agencies, avoid duplication of effort and confusing information to schools about compliance authority and regulation?

The activities outlined in the CDC FOA related to the school nutrition environment are intended to complement activities that State Agencies are already, or will be, engaged in related to the new USDA meal patterns for the National School Lunch and School Breakfast Programs as well as the proposed standards for competitive foods in schools. For example, while the proposed standards for competitive foods apply to all foods sold during the school day, the CDC FOA seeks to address all competitive foods, not just those that are sold (e.g., food provided at classroom parties, or for student rewards for good behavior or academic success are not sold). Additionally, training and technical assistance could focus on promoting access to drinking water throughout the school campus, not just during the lunch meal period as required by the Healthy, Hunger-Free Kids Act of 2010. This FOA does not require the State Health Department to regulate or monitor schools’ compliance with USDA regulations.

The purpose of the MOU between State Health Departments and State Education Agencies is to ensure communication across state agencies, minimize duplication of efforts, and leverage resources between state agencies to be able to reach more districts and address multiple aspects of the school nutrition environment beyond what State Agencies are already required to engage in by USDA. The performance measures outlined in the FOA are designed to enhance the implementation of USDA requirements and focus recipient activities on aspects of the school nutrition environment beyond USDA requirements.

Does the funding for this grant fall under the Affordable Care Act?

Prevention and Public Health Fund (PPHF) dollars, which were authorized by the Affordable Care Act, will fund a portion of the nutrition/physical activity and obesity activities in the enhanced component of this FOA. The Basic Component and all other activities of the Enhanced Component are funded by the fiscal year 2013 Continuing Resolution. Funded activities will be tracked by categorical budget lines.

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Purpose/Overview


What does the term “health systems” mean in the FOA?

The health systems referenced in the FOA are health care delivery organizations and may include health maintenance organizations (HMOs), Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) and other clinical groups operating within the state.

Provide examples of “EHR appropriate for treating people with high blood pressure” and “EHR appropriate for treating patients with diabetes.”

Examples include EHRs with clinical decision supports, patient lists, and patient reminders to improve control of high blood pressure and diabetes.

Cholesterol control is not specifically mentioned in the FOA. Will it count against an applicant if they include interventions related to cholesterol as long as they address the required strategies?

With funding through this FOA, applicants are asked to focus on population efforts to significantly increase control of high blood pressure. It is acceptable to include cholesterol efforts as long as they align with efforts to control high blood pressure (e.g., clinical decision supports, patient reminders, etc.).

Define community health worker (CHW)

CHWs are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community/population being served.

Define ECE (early child care and education) and the age group.

The ECE setting is defined as a setting that provides care for children aged 0 to 5 years including child care centers, day care homes (also known as family child care), Head Start, pre-school, and pre-kindergarten programs.

Define “policy” as referenced in the FOA.

In general, CDC defines "policy" as a law, regulation, procedure, administrative action, incentive, or voluntary practice of governments and other institutions. This FOA includes support for policy approaches that promote health and support and report and reinforce healthful behaviors (e.g. statewide in schools, worksites and communities). Funded applicants should work with state agencies or organizations such as state Departments of Education, Medicaid, and Transportation, which have broad systems, organizational and environmental influence across the state. Awardees may not use federal funds for any kind of impermissible lobbying activity designed to influence proposed or pending legislation, appropriations, regulations, administrative actions, or Executive Orders (“legislation and other orders”). These restrictions include grass- roots lobbying efforts and direct lobbying. Certain activities within the normal and recognized executive-legislative relationships within the executive branch of that government are permissible. Please refer to Additional Requirement (AR) 12 referenced in the FOA for further guidance on this prohibition.

What previously funded CDC programs are replaced with this FOA?

Four chronic disease prevention programs (Diabetes; Heart Disease and Stroke Prevention; Nutrition, Physical Activity, and Obesity; and School Health) are included in this FOA. Collectively, these programs represent activities and intervention strategies that draw from each of the four chronic disease domains.

Are categorical programs (e.g. Diabetes Prevention and Control Programs) being dissolved at the state level?

CDC is committed to supporting chronic disease risk factor and disease specific subject matter expertise (SME) in state health departments, including diabetes SME. As part of efforts to coordinate work across multiple programs to implement evidence-based strategies for diabetes, heart disease and stroke, nutrition, physical activity, and obesity, and school health, CDC is giving states flexibility in how they access the expertise needed to implement the strategies and activities to achieve FOA-specific outcomes. The approach we are suggesting is one that is more synergistic and complementary across programs. States will need to decide how they will organize themselves to accomplish the outcomes outlined in this new FOA.

Where can applicants find a list of type 2 diabetes prevention programs that are recognized by the Diabetes Prevention Recognition Program (DPRP)?

Applicants should check the Diabetes Prevention Recognition Program (DPRP) website to identify organizations that have achieved pending recognition and reach out to them, as appropriate, relative to efforts to increase program participation. The registry of recognized programs is currently updated on a bi-weekly basis; daily updates will occur in the future once the website is fully automated.

In the work plan template, Appendix A, Population of Focus, Geography, how are rural and frontier defined? Is it based on counties or the entire state?

Applicants should define target populations based on the U.S. Census Bureau’s definitions of urbanized areas, urban clusters and rural. Frontier counties and frontier states should be identified in accordance with Title X, Part III, Subtitle C, Section 10324 of the Affordable Care Act. States can pick more than one population of focus per strategy.

What was intended by the Enhanced Component’s Domain 3, strategy 1: Increase implementation of quality improvement processes in health systems?

Domain 3, Strategy #1 is about leveraging emerging opportunities involving health systems’ use of health information technology to promote quality improvement and population reporting of quality improvement data. To support the strategy, states may want to explore partnering with state information exchanges, health plans, the Medicare Quality Improvement Organization, Accountable Care Organizations, and Medicaid.

What is the definition of a local education agency? Is this inclusive of schools or school districts?

A Local Education Agency (LEA) can refer to a public school district or in rural areas, a body that oversees multiple schools.

Please define health equity as it relates to this FOA.

Health equity is attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. (source: http://minorityhealth.hhs.gov/npa/templates/browse.aspx?lvl=1&lvlid=34 ). Health equity as it relates to this FOA requires a strategy combining population-wide and high-risk approaches (dual action). The application should promote integrated approaches, evidence-based programs and best practices to reduce these disparities.

CDC still maintains disease-specific staff. Is there an expectation of how states should be organized?

CDC is committed to preserving subject matter experts (SME) in categorical divisions. States should determine how to organize based on their unique needs.

Are the terms used in the logic model the same as terms used in the FOA?

All terms used in the logic model correspond to the FOA and are used and explained throughout the FOA description (approach and program strategy sections), the Domain Tables on pages 13-20 of the FOA, and the work plan template on the website. If there is a particular term that is not clear, please follow up with a separate question.

How do we create synergy between Domain 2 with Domain 3 and 4? Domain 3 and 4 are very different from Domain 2.

A cohesive and synergistic approach would include selecting complementary interventions from each of the 3 domains to target a particular population or public health goal. The desired outcomes are much more likely if supported by efforts in all domains. For example, as environmental supports are increased (domain 2), this strengthens likelihood for sustaining changes essential to control chronic conditions (domains 3 and 4). This also means populations have access to strategies across the three domains.

Will there continue to be strong partnerships with states on evaluation activities and how will this be coordinated through this funding opportunity?

Yes, CDC will work closely with states on all aspects of evaluation including operationalizing the performance measures, developing state-level evaluation plans, and conducting the national evaluation. CDC will also be providing ongoing evaluation technical assistance. CDC is developing organizational supports and standard operating procedures that will be applicable to evaluating the basic component and work in all three domains.

Why does the FOA logic model show a bi-directional arrow between short-term outcomes and basic accomplishments, but no arrow between enhanced strategies and basic accomplishments?

For purposes of the application, a separate logic model should be submitted for both the basic and enhanced components. The bi-directional arrow between basic accomplishments and short-term outcomes is to acknowledge that there is a link between the basic accomplishments that will be funded and measured in the basic component and the short-term outcomes that will be funded and measured in the enhanced component. Success in achieving the basic accomplishments should lead to the short-term outcomes. Both basic and enhanced awardees will be working toward those short-term outcomes, but the expectation is for a larger measurable impact on those outcomes from awardees who receive enhanced funding.

What are considered “health care systems” as referenced in the FOA? Can a state government be considered a health care system if supporting public health hospitals?

The health care systems referenced in the FOA are health care delivery organizations and may include health maintenance organizations (HMOs), Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and other clinical groups operating within the state. In instances where the state government is responsible for providing clinical care, these settings could be included.

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Eligibility


Who is eligible to apply for funding?

All 50 states and the District of Columbia Health Departments or their bona fide agent are eligible to apply for funding.

Are counties or non-governmental organizations eligible to apply and qualify for funding in this particular FOA?

No. Eligibility is limited to state health departments or their bona fide agent.

Are the territories and freely associated states eligible to apply for funding?

American Samoa, Guam, Micronesia, Marshall Islands Ministry, Northern Mariana Islands, Republic of Palau, Puerto Rico and the Virgin Islands will continue to receive funds under Collaborative Chronic Disease, Health Promotion, and Surveillance Program Announcement: Healthy Communities, Tobacco Control, Diabetes Prevention and Control, and Behavioral Risk Factor Surveillance System (CDC RFA-DP09-901 or CDC RFA DP09-902) until March 2014. CDC is in the process of developing a new funding opportunity announcement for these areas that we anticipate releasing next year. This new funding opportunity announcement will be aligned with the unique needs of the territories and freely associated states. Future funding will be dependent on the availability of funds.

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Funding and Budget


Are the minimum and maximum anticipated funding amounts listed in the FOA for Year 1 of the project period?

Yes, the minimum and maximum anticipated funding amounts listed are for Year 1 of the project period.

Is a match of 25% required?

A match is strongly encouraged, but not required.

The basic component budget narrative guidance states that “Applicants may request additional funding to administer the questions that are included as part of the optional BRFSS diabetes and pre-diabetes modules as part of their budget.” Does this mean that states may request funding at a level that is greater than the anticipated basic component funding to cover that cost?

The administration of the BRFSS diabetes and pre-diabetes modules is a required activity in the basic component and funds may be budgeted as necessary to meet this requirement. If state chronic disease programs require funds to administer the optional BRFSS diabetes and pre-diabetes modules, the funds must be requested in the budget for the basic component. The award ceiling for basic component will not be increased for this activity. (Note: not all state chronic disease programs are required to contribute funds to the administration of these modules.)

Can states request funding that is greater than the anticipated basic component funding and/or the maximum for the competitive enhanced component?

States are not allowed to exceed the ceiling awards specified in the FOA for either the basic or enhanced components.

Can funds in this FOA be used to purchase: 1) video-conferencing equipment, recording and streaming equipment and other interactive learning tools that can be used for community education and outreach on chronic disease, and; 2) telemedicine equipment that can be utilized in the community and in schools to provide patient counseling and guidance on chronic disease prevention and management?

According to 2CFR225, Appendix A and Appendix B, Selected Items of Cost, items 11 and 15, the acquisition costs of “special purpose equipment” (see definition below) are allowable as direct charges if it is determined to be necessary for the CDC project. However, in this instance, video conferencing and telemedicine equipment do not align with or support the population-based approach described in the FOA, and therefore would not be approved for purchase with CDC funds. Grantees may work with partners to pursue other sources of funding for this equipment if desired.

“Special purpose equipment” means equipment which is used only for research, medical, scientific, or other technical activities. Examples of special purpose equipment include microscopes, x-ray machines, surgical instruments, and spectrometers.

For the enhanced component, is it required to include budget percentages for activities by focus, or are they guidelines? If budget percentages are required, how is the allocation documented? If they are not required, can a state allocate less or more to an activity area?

We request you follow the budget percentages as a guide to allocate fiscal resources to best demonstrate impact toward achievement of the FOA outcomes. The guidelines were established to facilitate tracking of expenditures by strategy back to categorical funding lines. There are also other mechanisms in place to facilitate tracking of resources by categorical funding lines.

Is the allocation of 10% of funding for evaluation encouraged for both the basic and enhanced components?

The 10% allocation of funding for evaluation applies to both the basic and the enhanced components.

Can the cost of SAS be included in the budget as Direct Assistance? If so, what is the current cost of a SAS license?

Yes. For 2013, the cost is $1,235 per SAS license. The per license cost will change from year to year. If an organization’s request for direct assistance is approved as a part of their award, CDC may reduce the amount of funding provided to the organization as a part of their award. The amount by which the award is reduced to provide DA shall be deemed as part of the award and shall be deemed to have been to the organization, the awardee.

Should travel costs for required meetings be included in the budget?

Yes, travel costs for required meetings should be included in the budget.

Should alignment of the percentages for each domain be shown in the budget?

Applicants should prepare a budget for the basic component and enhanced component and describe percentages for each domain in the work plan. Applicants do not need to include percentages line by line in the budget. We will work with awardees to clarify categorical lines.

Are there are instructions on allocating funds across the strategies for the basic component?

No. Applicants may use resources where they are needed.

How should funding in this FOA be addressed for staff working during the three-month overlap to closeout the current Coordinated Chronic Disease Prevention and Health Promotion (CCDP) FOA?

There is no expectation that all staff currently funded will be funded under the new FOA. Each state will need to assess and make determinations on the specific staff skills and subject-matter expertise that will be needed to carry out the strategies and interventions described in the FOA.

Is the budget included as part of the total page limit for applications? Is there a page limit specific to the budget narrative?

The budget is not a part of the total page limit and there is no page limit for the budget narrative.

Can funds be used toward staff salaries for Leaders of the Stanford Chronic Disease Self-Management workshops?

CDC funds should not be used for the direct delivery of education programs; this includes hiring staff to lead/deliver chronic disease self-management workshops directly to participants. The intent of Strategy #4, Domain 4, is to develop an infrastructure that expands the access, availability, and use of Chronic Disease Self-Management Programs (CDSMPs) throughout the state. This involves spreading CDSMPs to multi-site delivery systems that are able to embed the program into their routine operations in order to maintain sustainability and expand reach, and implementing strategies to increase participation and eliminate barriers to participation among people with diabetes.

Can funds be used to support implementation of a school based health center that extends services to adjacent communities?

No. Funds are not intended to support direct delivery of health care services through school-based health centers.

Do the basic and enhanced components get entered on separate lines on the Standard (SF) Form 424a?

Yes, the basic and enhanced are on separate lines.

About 50% of the performance measures are related to school health, but only 20% of the budget is allocated for school health activities. How do states handle this?

It is not expected that the school health performance measures are a direct alignment with the amount of funds committed for strategy implementation and measurement in Domain 2. We expect states to use the funding amount in each Domain to demonstrate impact using the measures rather than relying on a specific dollar amount to achieve outcomes.

The guidance for budget ratios in the enhanced component is to allocate 80% of the Domain 2 budget on nutrition, physical activity, obesity-focused activities. Can a portion of this funding be used for school-related activities, since the performance measures include youth?

No. 20% of the domain 2 budget relates to activities (Strategies #3 and #6) that are specific to schools and have aligned performance measures. While other strategies mention youth, they are not in a school setting.

What is the amount of funding available in the enhanced component for obesity prevention activities and programs?

Reference the funding tables on pages 31-33 of the FOA. Also, please refer to the Enhanced Template for guidance related to funding. For example, Domain 2 work should align with approximately 33% of your total budget. School-focused activities should account for approximately 20% of dollars allocated for Domain 2 work. All other Nutrition, Physical Activity, Obesity-focused activities should account for 80% of Domain 2 work.

What percentage of the budget should we allocate for each Domain in the enhanced component?

Refer to the Enhanced Template for guidance related to funding.
Domain 2 work should align with approximately 33% of your total budget.

  • School-focused activities should account for approximately 20% of funding allocated for Domain 2 work.
  • All other Nutrition, Physical Activity, Obesity-focused activities should account for 80% of Domain 2 work.

Domain 3 work should align with approximately 33% of your total budget.

  • Heart Disease and Stroke Prevention-focused activities should account for approximately 77% of dollars allocated for Domain 3 work.
  • Diabetes-focused activities should account for approximately 23% of dollars allocated for Domain 3 work.

Domain 4 work should align with approximately 34% of your total budget.

  • Diabetes-focused activities should account for approximately 65% of dollars allocated for Domain 4 work.
  • Heart Disease and Stroke Prevention-focused activities should account for approximately 25% of dollars allocated for Domain 4 work.
  • School-focused activities should account for approximately 10% of dollars allocated for Domain 4 work.

Since funding for Coordinated Chronic Disease Prevention and Health Promotion Program (CCDP) is ending, we assume it should be folded into this FOA. If transferring positions, should it be for less than 12 months given the funding overlap?

There is no expectation that CCDP positions would automatically be funded with this FOA. States should examine their needs based on their proposed activities. In the event of any funding overlap, states should avoid double-encumbering positions.

Can we put the same staff person at 100% in both the basic and enhanced budget? Then, if we are funded for both we can adjust our plans to cover that staff's work in another manner through either another staff person or contractors?

The applicant needs to propose a vacant position to be hired in either the basic or the enhanced component budget, as applicable, using the best estimate of the salary/fringe benefits costs for the staff to be hired. Including the same person in both budgets could complicate award processes. Full disclosure of the condition for the current staffing ready for work will help expedite the budget review processes.

Can funds from the enhanced component be used for additional staff? If so, does their time need to be divided among domains to determine total cost per domain?

Applicants may budget for additional staff under the enhanced component, if needed. As part of Organizational Capacity under the enhanced component, applicants must demonstrate that they have sufficient leadership within the state health department for program planning and development, which includes the identification, hiring, or reassignment of staff, contractors, and/or consultants sufficient in number and subject matter expertise to plan and implement strategies across the domains.

If staff time will be spread across the domains, it will be necessary to estimate the percentage of time and corresponding salary costs allocated for each domain in order to arrive at the total amount budgeted for each domain. CDC will need to see the domain totals only.

In Strategy #2, Domain 3, for the intervention "increase use of self-measured blood pressure monitoring tied with clinical support," can we use funds to purchase the consumer-version digital blood pressure monitors (bulk, reduced price) to be distributed by primary care staff to patients with hypertension and served by patient-centered medical homes?

These funds are not to be used for direct services, including purchase of blood pressure equipment. Instead, applicants should focus on systems changes, such as collaborating with state chapters of provider organizations, the state primary care organization, and other relevant associations and quality improvement organizations to promote the role of self-measured blood pressure monitoring (SMBP) in the clinical management of hypertension. Applicants could also work with payers and purchasers to encourage coverage of SMBP and additional support. For more information on potential state activities to support this intervention, please review the resource guide Self-Measured Blood Pressure Monitoring [PDF-1MB] available from Domain 3 FOA web page.

Can funds be used to develop an infrastructure to expand access and availability of the National Diabetes Prevention Program? Specifically, would it be appropriate to utilize funds to send lifestyle coaches to Atlanta to be trained or to arrange for and fund the Diabetes Training and Technical Assistance Center to conduct a training in our state for multiple partners?

No, CDC funding should not be used to pay for lifestyle coach training.

Are applicants allowed to provide mini-grants to local communities to implement activities in Domain 2, with resources, training and technical assistance provided by the state?

The primary purpose of this FOA (page 8) is to support state-level and/or statewide implementation of cross-cutting approaches to promote health, and prevent and control chronic diseases and their risk factors. In order to focus on support of state-level and/or statewide approaches, it is expected that the majority of resources provided by this FOA support the State Health Department and other state agencies. Funding support to local communities is acceptable if provided along with training, technical assistance and monitoring to ensure that the funded communities are implementing activities that support the specific FOA strategies.

Will the purchase of EBT machines for farmers markets be an allowable expense for a proposed budget? If so, would it be considered equipment or supply in the budget narrative? If the machines are rented then would they be considered an equipment or supply purchase?

If EBT machines for farmers markets are determined to be necessary for the project by CDC, the costs will be allowable. If not necessary, the costs are not allowable per 2CFR225, Appendix A. If the costs are allowable, the classification of the EBT machines purchase costs as equipment or supplies is based on the applicant’s accounting policy. In the absence of capitalization threshold in the accounting policy, the $5,000.00 threshold per the cost principles is used for capitalization of the costs as either equipment or supplies. If the costs are allowable, the applicant has to perform a cost analysis of lease vs. purchase for economical choice as required in 45CFR92.36. If the lease (rental) is advantageous over purchase, the applicant should follow the 2CFR225, Appendix B, selected items 11, 15 & 37 to save the money.

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Application Process


Trouble using the Work Plan Templates?

Microsoft Word 2007 or newer is required to effectively work with the Basic Work Plan and Enhanced Work Plan templates. If you have an earlier version of Microsoft Word, you can download the free Microsoft Office Compatibility Pack to open, edit, and save these files in your older version of Microsoft Word.

If applying for the enhanced component, do separate applications need to be submitted for both the basic component and enhanced component?

(Revised). Applicants should submit a single application response for DP13-1305 containing two separate project and budgets narratives for each of the two components so that they can be reviewed separately. A single SF424A should be submitted, with Section A showing each component budget in a separate row and the two component budgets summarized in the last column of row 5 (Totals); the two components should also be listed separately by column in Section B and combined totals summarized in the last column of row K (TOTALS).

Does the 18-page limit for the Project Narrative does include the work plan or the evaluation plan, or are they separate attachments on www.grants.gov?

The 18-page limit for the project narrative should include the logic model and a description of the evaluation plan; the work plan is a separate attachment with a 25-page limit. The work plan is not included in the page count of the project narrative.

Is the Background section required as part of Project Narrative and scored?
The Background section is required as part of the Project Narrative and is not scored.

The project narrative does not include a section for burden information. Does the FOA only require burden information for specific target populations?

Applicants should include data used to identify target populations as part of the program strategy description in the project narrative.

How should states identify and apportion activities associated with the basic component separately from those associated with the enhanced component?

If applying for both components, applicants should submit separate, self-standing project narratives, work plans, and budget narratives for basic and enhanced components.

What are the bolded headers that should be included in the section 10 project narrative (pg. 35)?

The project narrative must include all bolded headers noted in section 10 Project Narrative, including the headers Background, Approach, Outcomes, Program Strategy, Work Plan, Organizational Capacity, Project Management, Evaluation, and Performance Measurement, and the sub-headings such as target population, inclusion, collaboration, MOUs, etc.

For the work plan portion of the project narrative, is a brief summary of the work plan with direction to the separate work plan document acceptable?

Yes, a brief summary of the work plan portion for the project narrative is acceptable. It is expected that the details of the work plan be delineated in the accompanying Work Plan Template.

For project management, can applicants upload both CVs and organizational charts in www.grants.gov?

Yes, both CVs and organizational charts need to be uploaded.

Maryland currently has a statute that governs the relationship between the state department of education and the department of health regarding school health. Is this a sufficient legal relationship in lieu of an MOU/MOA?

You will need an MOU/MOA to comply with the FOA.

Are applicants able to provide a staff position through this FOA that could be split with the state education agency in terms of location and reporting? Would applicants also need to provide fiscal support, or is either acceptable? Is there a need to transfer funds between the state health and education agencies?

A Memorandum of Understanding (MOU)/Memorandum of Agreement (MOA) between the state health department and state department of education is required for the enhanced component of the FOA. It is up to the applicant to work with the state education agency to determine what to include in the MOU/MOA. Applicants can determine how to handle staffing or fiscal support. There is no specific requirement that the MOU/MOA include staffing support or transfer of funds.

Can states delete unnecessary text from the work plan templates to save space (ex: remove settings not applicable to a given intervention)?

Yes, applicants may delete unnecessary text from the work plan templates to save space.

How should states identify and apportion activities associated with the basic component separately from those associated with the enhanced component?

Since applications for the basic and enhanced components are stand-alone documents, States should identify activities separately.

Is the state-specific logic model included in the project narrative or can it be an attachment?

Yes, the applicant logic model should be included in the 18-page project narrative.

Can applicants include supporting materials in addition to those listed in the FOA as attachments? Is there a page limit for attachments?

Only attachments identified in "Other Information" may be included (Section H, page 52). There is no size limit for the acceptable attachments.

Should programmatic experience be included in the Background section of our application?

Programmatic experience should be included in the Program Strategy's Organizational Capacity section of the Project Narrative as part of a "clear and concise description of their readiness to implement the required evidence-based strategies" (page 36).

Is there a copy of the Logic Model that states can work with to complete the application?

The logic model has been posted to the website under the "General Information" section.

Do work plans need to include activities from the six cross-cutting public health activities (page 12) for each of the strategies addressed?

Applicants should describe their work on the cross-cutting, core public health functions (described on page 12 of the FOA) in support of accomplishing the required strategies in the work plan. The “Activities” section of the work plan should be used for this purpose. It is not necessary to have an activity addressing each of these core public health functions for every strategy listed in the work plan template. Applicants should use their best judgment on where to place and align cross-cutting public health activities in support of their work on the strategies.

We are not able to select more than one intervention under a strategy on the enhanced work plan template. For example, we can select only one intervention for Strategy #7 in Domain 2. How should we indicate that we want to work on two interventions in the one strategy?

Under Domain 2, Strategy #7, there are 3 lines provided to select interventions from the drop down list. If you would like to work on two interventions, select the first in line 1 and the second in line 2.

Can states also send the FOA epidemiologist to the two grantee meetings planned during the 5-year project period (March 2014 and other TBD), in addition to the participants listed in the FOA?

Yes, states can send the FOA epidemiologist to the two grantee meetings.

Both the basic and enhanced work plan templates include a column for a “Key Contributing Partner Assigned.” Can we list more than one partner?

Applicants may enter more than one partner, but should limit their entries to “key” partners.

Do we select “African American or Black” or “Other Populations: Other (specify immigrant)” for a program reaching immigrants and/or refugees from Africa?

Either is acceptable.

How many days/nights should we plan for attending the required orientation meeting in March 2014? Are there registration fees for the orientation?

Plan for 4 days/3 nights in Atlanta, GA (this is subject to change). There will be no registration fees.

Is there a limit on the number of activities that should/can be listed in the work plan?

There is no limit on the number of activities that can be included in the work plan; however, applicants should be succinct in describing a limited number of key activities they will do during Year 1 to accomplish the performance measures for each intervention, and provide a brief narrative description of activities proposed in Years 2-5. Activities should be limited to a reasonable number to provide enough detail about the work being proposed without exceeding the 25-page work plan limit.

Can applicants determine their own target timelines for the basic and enhanced work plans, to coincide with state strategic plans or existing initiatives? Or should all target timelines be one year?

Yes, timelines are individually determined. States will report progress on measures annually.

Do we include “Organizational Capacity of Awardees to Execute Approach” in the project narrative or in separate attachments of CVs and organizational charts?

“Organizational Capacity of Awardees to Execute Approach” should be described in the 18-page project narrative. Supporting documentation, specifically CVs/resumes and organizational charts should be attachments.

The Assurances document does not have a signature line. Do we need to add one?

Yes. All applicants are required to sign and submit CDC Assurances and Certifications that can be found on the CDC Web site at the following Internet address: http://www.cdc.gov/od/pgo/funding/grants/foamain.shtm. Applicants must name this file ‘Assurances and Certifications” and upload as a PDF on www.grants.gov.

In the work plan template, Timeframe for Activities column, if the "Start Quarter" is July 2013 through September 2013, should we also assume this is “Quarter 1” since it is the start of the project period?

Yes.

Is it acceptable to include footnote citations in the required one inch margins of the project narratives?

Yes.

Do we need to use Calibri 12-point font for the state-specific logic model, as is required for the project narrative?

No. (revised 03/29/13)

For the work plans that are required for both the Basic and Enhanced Applications, (page 37) in the FOA it says that “applicants must provide a detailed work plan that covers the first year of the project period and a high level plan for subsequent years.” What components are required in the high level plan, as these are not shown or described in the template?

Year 2-5 Work Plan Summary: Applicants should submit a general narrative summary of key activities to be completed in Years 2-5. The Year 2-5 summary should also address plans for identifying and accessing data for any performance measures for which data are currently unavailable.

Are descriptions of the “target populations, inclusion, and collaborations” required in both the basic and the enhanced project narratives? In the FOA outline (page 36) it appears that these descriptions are required only in the enhanced project narrative.

The Project Narratives for both the Basic and the Enhanced components should address target populations, inclusion, and collaboration. Please refer to page 10 of the FOA for additional information related to target populations, inclusion and collaborations.

A logic model is required for both the basic and enhanced applications. How should the logic model a state creates for the enhanced component show the activities covered by the logic model for the basic component?

Since the applications for the basic and enhanced components need to stand alone, each should contain a logic model. Overlap between the two logic models is expected for the application process. Once awards are made, we will work with states who receive enhanced funding to combine the two logic models into one comprehensive logic model for the entire award.

Can headings for performance measures be altered?

Applicants are not allowed to alter headings for performance measures.

Are applicants required to submit position descriptions for vacant positions as part of the CV/Resume file?

No. The instructions provided in the FOA (see page 51, "Other Information") do not require position descriptions as attachments.

Do applicants need to submit a detailed description and plan for carrying out year 1 activities? When listing activities in the template, do we also include details about how each activity will be accomplished?

A detailed description of how each activity will be carried out during Year 1 is not required. The Activity section of the Work Plan Template is intended to capture succinct descriptions of a limited number of “key “activities applicants will do during Year 1 to accomplish the performance measures for each intervention, and a brief narrative description of activities proposed in Years 2-5. Activities should be limited to a reasonable number to provide enough detail about the work being proposed without exceeding the 25-page work plan limit. Information on how the applicant plans to address the required program strategies to achieve outcomes, identify target populations, achieve synergy across the domains, and collaborate with partners should be included in the “Approach” section of the project narrative. Information on the applicant’s ability to manage the day-to-day responsibilities of the project (project monitoring, staffing, report preparation, etc.) should be described under the heading of Project Management in the “Organizational Capacity” section of the project narrative.

Are we required to include a description of the work plan in the project narrative? Or can we indicate that reviewers see the attached work plan document? Will the work plan be scored based on information in the project narrative or based on the actual work plan document?

A brief summary of the work plan should be included in the project narrative; however, it is expected that the details of the work plan be delineated in the accompanying Work Plan Template. The 25 points allocated for the work plan in the Enhanced Component Review Criteria are based on the contents of the actual work plan delineated in the accompanying work plan template (page 44).

What is the penalty for using a smaller [than 12 point Calibri] font on the logic model?

There is no penalty in this FOA for using smaller font on the logic model.

Can the font for the state logic model be reconsidered at a smaller font?

CDC will accept a smaller font size on the state logic model.

The work plan template provided by CDC is set up to use 9-point Book Antiqua font (for Basic work plan template) or 10-point Times New Roman font (for Enhanced work plan template). The funding announcement says on page 37 that the work plan should be in 12-point Calibri font. If we choose to use the provided template, is it OK to use the default 9- or 10-point font instead of 12-point font?

You may use the default font provided in the work plan templates. Work plans may not exceed the 25-page limit.

If the MOU between our state health department and state education department includes logos for both state agencies in the header and is signed by senior management in each agency, does this qualify as "being on state education department letterhead with an original signature?" Or do we need to also include a cover letter on state education department letterhead and with an original signature?

The FOA requires the MOU/MOA to be on official letter head and with original signatures but does not specify which agency’s letterhead. If the MOU/MOA is on the letterhead of one of the two agencies, it should qualify if the other minimal elements on page 29 of the FOA are included.

Are the attachments listed on page 52 of the FOA synonymous with “appendices?” Is it acceptable to attach additional documents in an appendix? For example, we would like attach our recently completed state chronic disease plan and related documents?

Attachments are synonymous with appendices. Applicants may only attach documents from the list on page 52 of the FOA. Chronic disease plans are not on the list and therefore should not be attached.

For the project narratives, including the target population, inclusion and collaboration subheadings and content for each strategy seems to add duplication and takes space, making it hard to meet the 18-page limit on the narratives, especially for the enhanced component. Instead, can applicants do a target population for each strategy (since this is quite different for each), but include one summary for inclusion and collaboration within each application? If yes, where would the summaries of inclusion and collaboration need to be positioned in the narrative?

Applicants should summarize information on key target populations and plans for inclusion and collaboration under the “Approach” section of the Project Narrative for both the basic and enhanced components of the application. Applicants may use the basic and enhanced work plan templates to provide more specific information on scope, setting, populations of focus, and contributing partners for each individual strategy.

Is documentation of matching funds required? If so, what kind of documentation?

Matching funds and/or in-kind support are strongly encouraged in the amount of not less than $1 for each $4 of federal funds awarded for both the basic and enhanced components. The match should be from non-federal sources and can be all cash, in-kind, or a combination of both. The amount and source of the match should be included in the budget narrative and justification section of the application. Applicants may include documentation of the match as an attachment to their application. See pages 30 and 52 for additional information.

Please provide the contact information that Letters of Support (LOS) should be addressed to.

The letters of support should be addressed to a designated person at the State Health Department. Note: Letters of Support are strongly encouraged for key collaborations for the basiccomponent. They are required for the enhancedcomponent and will be a criterion used in evaluating the application. Applicants should provide MOUs/MOAs/LOSs and name the file “MOUsMOAsLOSs.name of state” and upload as a PDF file on www.grants.gov.

Do applicants need to make any modifications to the font type, size, or color on the work plan templates, or can they be used as is?
The text fields in the templates can be used as is. Applicants are not required to make any modifications to font type, size, or color, unless desired.

Do we include references in the 18-page project narrative? Or can we add these as an attachment or appendix?

If an applicant chooses to include references they would be part of the 18-page limit in the project narrative. The FOA does not ask for applicants to include references. Applicants should only include attachments from the acceptable list on page 52 of the FOA, which does not include a reference attachment.

Can an acronym list be included in the Table of Contents for the Entire Submission Attachment?

Yes, applicants may include a list of acronyms in their Table of Contents. In addition, applicants should spell out each acronym the first time it is used in the Basic Component and the Enhanced Component of the application.

The Enhanced work-plan template, without instructional pages, is 22 pages before any information is added to the document. Simply selecting the necessary performance measures, before even adding activities, makes the document longer than 25 pages. How are applicants expected to meet the 25-page limit?

It is not necessary to select all of the interventions and performance measures on the Enhanced template. For example, under Domain 2, applicants are asked to choose at least one intervention for each strategy and only select those performance measures that align with the chosen intervention(s). The remaining performance measures may be deleted to save space. Similarly, any options under "Scope", "Setting", or "Population of Focus" that are not selected may also be deleted. Activities should be limited to a reasonable number to provide enough detail about the work being proposed without exceeding the 25-page work plan limit. See page 14 of the FOA for additional information on the required number of interventions per domain.

Is there a word or character limit for the 2-paragraph Project Abstract Summary?

There is not a word/character limit for the Project Abstract summary. Applicants should provide a separate Project Abstract Summary for the Basic and Enhanced Components.

On page 37 of the FOA: "Applicants should name this file “CVs.Resumes.name of state” or “Organizations Charts.name of state” and upload to www.grants.gov." Should there be just one combined file for each of these for the basic and enhanced? If not, how do we label the file to show that one is for the basic application and the other is for the enhanced application?

Combined files for the Basic and Enhanced components may be uploaded back-to-back as long as each package is clearly labeled as “Basic Component” or “Enhanced Component.” If applicants prefer, attachments supporting the Basic and Enhanced components may also be submitted through the “Optional Documents for Submission” box in Grants.gov. Each document should be clearly labeled following the naming conventions provided in the FOA.

Should applicants applying for both the Basic and Enhanced components prepare one combined project abstract summary and table of contents or two, one for each component?

Two; one for each component is preferred.

We are including tables and graphs in our project narrative. Can the font be smaller than 12 pt? This is not referencing the logic model or the work plan tables.

Yes; font for tables and graphs can be smaller than 12 point.

Should the abstract of the grants.gov application package template, for the basic application and the enhanced application, be the same? Or, can the one in the abstract portion of grants.gov application package template be a combination of the basic abstract that is an attachment in the basic application and the enhanced abstract that is an attachment in the enhanced application?

Applicants can use one project abstract document and have two sections; an abstract summary for the basic and an abstract summary for the enhanced.

Since both the basic and enhanced components are considered stand alone applications, can the Basic Budget be submitted without any 100% full-time staff? In other words, can percentages of staff time be split between Basic and Enhanced when submitting the budgets?

Yes; percentages of staff time can be split between basic and enhanced applications.

For the Project Abstract Summary, the section "Federal and Non-Federal Share Requested (for each year)" does not allow for segregation of Basic & Enhanced Components funds requesting. Since the form is a fillable PDF form, do we combine the totals for both components in this section, as we do for the SF 424, #18: Estimated Funding? We have been instructed by our PGO to submit only (1) SF 424 and to combine the totals in this section, and to make sure both component budgets are entered in separate columns on SF 424A.

Yes, you can combine the federal share for the Basic and Enhanced components. At the applicant’s option, segregated federal share information can be inserted in the “Project Abstract Summary” narrative box.

If we are applying for both the basic and enhanced components, are we allowed two (2) paragraphs for each component, or two (2) paragraphs summarizing both components?

Applicants can use one project abstract document and have two sections; an abstract summary for the basic and an abstract summary for the enhanced.

Are there page limits for the application, other than the page limits for the project narrative and work plan? Specifically, are there any limitations to the number of letters of support?

No; There are not limitations to the number of letters of support, but they should be from key partners.

In outlining the expectations for our partnership with the Department of Education for both the Basic and Enhanced components of this funding opportunity, the Public Health Division will submit a document on official letterhead with original signatures. The document outlines senior organizational leaders from both agencies that will provide leadership support and implementation oversight. Included are details of resources (including fiscal) to be provided by the Public Health Division to the Department of Education for implementation of program activities including support of staff positions at the education agency, and also the liaisons within both agencies that will serve as technical experts and coordinators of cross-agency activities. However, the state Contracts/Procurement office that handles such agreements for the Department of Education insists on titling this document as an legally binding "Interagency Agreement" rather than and MOU or MOA, despite our joint agency requests that we call it an MOU/A for the purposes of this funding opportunity. If this agreement ends up being titled as an "Interagency Agreement" but still has the effect of an MOU, will it suffice for the purposes of our Basic and Enhanced proposals?

Based on the description provided, this "Interagency Agreement" document does include the required components for a MOU/MOA as outlined in the FOA, and is appropriate to title as an Interagency Agreement When saving this document in grants.gov, be sure to name the file as if it were a MOU/MOA using the naming conventions in the FOA guidance.

If we have different LOS for the basic and enhanced components, can these be uploaded separately labeled as "MOUsMOAsLOSs.BasicComponent.state" and "MOUsMOAsLOSs.EnhancedComponent.state"?

Combined files for the Basic and Enhanced components may be uploaded back-to-back as long as each package is clearly labeled as “Basic Component” or “Enhanced Component.” If applicants prefer, attachments supporting the Basic and Enhanced components may also be submitted through the “Optional Documents for Submission” box in Grants.gov. Each document should be clearly labeled following the naming conventions provided in the FOA.

If we have different CVs for the basic and enhanced component, can these be uploaded separately and labeled “CVs.Resumes.BasicComponent.state" and "CVs.Resumes.EnhancedComponent.state"?

Combined files for the Basic and Enhanced components may be uploaded back-to-back as long as each package is clearly labeled as “Basic Component” or “Enhanced Component.” If applicants prefer, attachments supporting the Basic and Enhanced components may also be submitted through the “Optional Documents for Submission” box in Grants.gov. Each document should be clearly labeled following the naming conventions provided in the FOA.

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Review Process


If applying for both basic and enhanced components, will the application components be separated for review by different reviewers, or will they be reviewed together by the same reviewers? If some information would be the same in each application (e.g. some information on organizational capacity) can one application just refer to the information in the other application, or should the information be repeated?

Applications should be stand-alone documents. The basic component will be reviewed using a Systematic Technical Acceptability Review (STAR) process involving program staff from all four programs represented in this FOA. The enhanced component will be objectively reviewed by a panel consisting of CDC staff.

Is the Background section required as part of Project Narrative and scored?

The Background section is required as part of the Project Narrative and is not scored.

Will the basic and enhanced component applications be separated for review, or will they be reviewed together? For information that is the same for both applications, (ex: organizational capacity) can one application refer to the information in the other application, or should it be stated in each?

Applications should be stand-alone documents. The basic component will be reviewed using a Systematic Technical Acceptability Review (STAR) process involving program staff from all four programs represented in this FOA. The enhanced component will be objectively reviewed by a panel consisting of CDC staff.

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Performance Measures


Will there be any flexibility for states to develop alternate performance measures that better reflect progress in a particular strategy area? For example, if a state has already achieved a required process measure, can an intermediate outcome measure be substituted?

In order to analyze data across all states, it is necessary for states to report the same measures. If a state has already achieved a required short-term measure, they may report an intermediate or long-term measure in addition to the short-term measure to better demonstrate progress. At this time, alternate measures cannot be substituted for the required measures.

While the ultimate goal over the five year period is to have all states reporting consistently on the measures to report national impact of the FOA dollars, we will be looking at the possibility of operationalizing the indicators in more than one way in the short term to increase states’ ability to report progress using available data sources. We will be working with all states to operationalize the measures in ways that maximize CDC’s ability to provide Agency and Department management, Congress, and national partners with evidence of substantial movement on the outcomes specified in the FOA. Therefore, if a state currently has a data source and method of collecting and reporting data that broadly addresses the performance measure but may differ slightly, they may describe that in the work plan related to that measure and we will consider that during the operationalization process. States are allowed to report additional measures, but again, these cannot be substituted for the required measures.

Are states required to report on all performance measures listed in the FOA for the strategies/interventions or can additional performance measure be added?

States funded for the basic component are required to report on all performance measures noted in the table. States funded for the enhanced component are required to report on the performance measures associated with their selected interventions. CDC also recognizes that some measures will be challenging for states to report and we will work with awardees to select appropriate performance measures, define and operationalize performance measures, and identify available and feasible data sources. There may be particular challenges reporting long-term measures, and for Domain 2, states are encouraged, but not required, to report on as many of the long-term measures associated with their funded interventions as is feasible. States also may report on additional measures that demonstrate progress on the selected interventions, but these cannot be substituted for the required measures.

Can the intermediate and long-term measures in the FOA be modified or must they be strictly followed? For example, Domain 3, Strategy 2 has two intermediate performance measures. Can applicants address one of those measures rather than both of them?

For the application, states should describe plans to address all of the measures in the table that correlate to their selected interventions. The measures will be further defined and operationalized by CDC and through working with the states.

What should be the denominator when measuring the proportion of health care systems reporting on a specific NQF measure (#18 and #59)? For example, if our program were working to promote PCMH initiatives in community health centers (FQHCs), private practices, Medicaid and Medicare, would these be considered four health care systems, with the measure as the proportion of those health care systems, with a denominator = 4? Or would the measure be the proportion of entities within each health care system, with denominators differing by health care systems?

There are many different ways that the indicators could be operationalized. Our goal is to work with states to operationalize the measures in a consistent way in order to facilitate the reporting of national impact. In general, since we are looking for statewide or state-level reach, we would prefer that the denominator be the total number of entities, not just the number of types of systems. For your application, please propose a feasible method of operationalization for you, and we will work with you and the other awardees to finalize the measures in year 1.

For Strategies selected for the enhanced component, is it expected that we report on all of the short-term performance measures included? For example, Domain 2, Strategy #3 has 12 performance measures for nutrition environments in schools. Do states need to report on all 12 performance measures, or select those likely to reflect progress for the activities.

Yes, awardees will be expected to report on all of the short-term performance measures. Most of these performance measures can be obtained through the School Health Profiles survey.

The performance measure for Strategy #4 in the basic component refers to the number of systems reporting on National Quality Form (NQF) measure 18. Should state health department receive data on this measure to avoid difficulty in finding out who is sending the data to NCQA?

The purpose of this measure in the basic component is transition states toward the capacity to report measures related to blood pressure control, such as those noted in the enhanced component. So, the states should explore ways to access these data. The measures will be further defined and operationalized by CDC and through working with the states.

For Strategy #7 in the Basic Component Table, why is BRFSS not used for performance measure “Proportion of people with diabetes in targeted settings who have at least one encounter at an ADA-recognized, AADE-accredited, state accredited/certified, and/or Stanford licensed DSME program during the funding year?”

The BRFSS question “Have you ever taken a course or class in how to manage your diabetes yourself?” is very general and open to interpretation by the respondent. The goal in both the basic and enhanced components of the FOA is to increase utilization of DSME programs that adhere to national standards, are delivered with quality and fidelity, and are sustainable over the long-term, preferably through a reimbursement mechanism.

Our state does not have an existing data source for the Strategy #7 performance measure in the Basic Component Table (“Proportion of people with diabetes in targeted settings who have at least one encounter at an ADA-recognized, AADE-accredited, state accredited/certified, and/or Stanford licensed DSME program during the funding year”). Should we leave this blank?

Yes, applicants can leave this information blank on the work plan template if they do not have an existing data source, but should include a brief description of plans to access these data in their year 2-5 work plan narrative. CDC will work with states to further define and operationalize required performance measures after the awards are made.

In Domain 3, Strategy #2, does every intervention need to focus on both intermediate and long-term performance measures?

All strategies should lead to intermediate and long-term measures. We expect to see movement on all the measures over the 5 years of the program.

The Heart Disease and Stroke Prevention (HDSP) program had indicators previously. Should applicants use these in this FOA?

Most of the measures related to heart disease and stroke prevention in this FOA are based on indicators previously developed by CDC’sHDSP program. We will develop tools to help states use the indicators in their evaluation plans.

What are the expected time frames for short-term, intermediate, and long-term performance measures in the enhanced component? Are short-term measures expected within one year, intermediate measures by 5-years and long-term over ten years?

Specific time frames for each of the measures are not defined, since these will vary by state, depending on their experience in working in each of the strategies. In general, however, we expect to see movement on the short-term measures beginning in year 1. In your application, please propose time frames for the intermediate and long-term measures that are feasible for you, and CDC will work with you to refine those time frames as necessary after the award.

For Strategy #4 in the basic component, are applicants required to select from the list of optional performance measures?

The optional performance measures for Strategy #4 in the basic component are not required, but are encouraged as applicants are able to address them.

For Strategy #4 in the basic component, are applicants required to select the performance measure of "Proportion of health care systems reporting on National Quality Forum (NQF) Measure 59?”

For Strategy #4, the NQF measure 59 is optional; it is required in Domain 3 of the enhanced component.

For the basic component, how are states expected to achieve Strategy #4 performance measure, “proportion of health care systems reporting on National Quality Forum (NQF) Measure 18?”

States should promote reporting by health care systems on the percentage of patients 18–85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year.

In the basic component, Strategy #4, first optional measure, “proportion of patients in health care systems with policies or systems to encourage a multi-disciplinary team approach to blood pressure control”, “proportion of patients in health care systems with policies or systems to encourage self-monitoring of HBP” and, “proportion of patients in health care systems with electronic health records appropriate for treating patients with HBP.” Are these measures focused on patients?

All three of these measures are focused on patients. The measures before are focused on systems.

For Strategy #2 in Domain 3, the intermediate performance measure related to “proportion of patients with high blood pressure that have a self-management plan” is related only to the second intervention, “increase use of self-measured blood pressure monitoring tied with clinical support.” If we do not select the second intervention in Strategy #2, do we need to address the related self-management performance measure?

Yes, applicants will need to address that intermediate performance measure. The intermediate measures relate to all Domain 3 interventions.

In Domain 3, Strategy #2, second intervention, how are we to measure “clinical support” for “increased use of self-measured blood pressure monitoring tied with clinical support?”

ANSWER: Self-monitoring is not appropriate as a stand- alone strategy, but rather, should be connected to clinical support. For more information, please review Self-Measured Blood Pressure Monitoring Action Guide [PDF-1Mb] listed under Domain 3 in the Related Documents section of the FOA website.

Will there be definitions for “short-, intermediate, and long-term measures?”

Because capacity in states varies and states will make progress at different rates, CDC has not defined a time range to short, intermediate and long-term measures. CDC will work with states to operationalize the measures. States are required to report progress on measures annually.

For Strategy #4 in the basic component (Promote reporting of blood pressure and A1C measures; and as able, initiate activities that promote clinical innovations, team-based care and self-monitoring of blood pressure), should the state health department receive data on the NQF measure to avoid difficulty in finding out who is sending the data to NCQA?

CDC does not expect you to contact NCQA for state data. Instead, this strategy is about leveraging emerging opportunities involving health system use of health information technology to promote quality improvement and population reporting of quality improvement data. Examples of potential state-level partners include state information exchanges, health plans, the Medicare Quality Improvement Organization, Accountable Care Organizations, and Medicaid.

In the future, will CDC provide numerators and denominators for the various performance measure indicators for both the basic and enhanced components? It is difficult to determine a data source since the denominators can be interpreted in different ways for multiple performance measures.

Yes, CDC will provide definitions for the numerators and denominators for the required measures and states will fill in the actual numbers consistent with those definitions. While the ultimate goal over the five year period is to develop a single definition (method of operationalization) for each measure to permit consistent reporting at a national level, in the short term, CDC will be looking at the possibility of operationalizing (defining) the indicators in more than one way to increase states’ ability to report progress using available data sources. Therefore, if a state currently has a data source and method of collecting and reporting data that broadly addresses the performance measure, the state may describe that in the work plan related to that measure and CDC will consider that during the operationalization process.

For Strategy #4 in the basic component, there are 6 items in the first optional measure. These items appear to be 3 pairs of specific measures: health systems and patients within those health systems. Should applicants report on all 6 items, any of the 3 pairs, or any one or more of the 6 that are most appropriate for the state?

Applicants may choose any or all of the 3 pairs for the first optional measure in Strategy #4 of the basic component (Proportion of health care systems with policies or systems to encourage a multi-disciplinary team approach to blood pressure control; proportion of patients in health care systems with policies or systems to encourage a multi-disciplinary team approach to blood pressure control; proportion of health care systems with policies or systems to encourage self-monitoring of high blood pressure; proportion of patients in health care systems with policies or systems to encourage self-monitoring of high blood pressure; proportion of health care systems with electronic health records appropriate for treating patients with high blood pressure; proportion of patients in health care systems with electronic health records appropriate for treating patients with high blood pressure). For those selected, applicants should report both health care systems and patient measures.

If we do not have baseline data for performance measures, we will provide a brief description of how the data will be collected in the future, but how should we determine an achievable target if we do not have a baseline? Does CDC have specific numerical targets for performance measures (ex: percentage increase or decrease)?

After award, CDC will work with states to help them identify data sources and establish targets appropriate to the context and settings in which a state will be working. At this time, CDC has not set specific numerical targets for the performance measures; benchmarking will be part of the overall process of working with states on operationalizing the performance measures. For your application, please propose targets such as percentage increases that you believe will be feasible to achieve given the activities in your work plans.

Please clarify the short-term performance measures for Domain 2, Strategy #4 in the enhanced component: Design streets and communities for physical activity. For example, if a pedestrian plan is developed, but not adopted, can this still serve as a short-term performance measure? Or, if a transportation master plan is adopted, but is not optimal for walking and biking, can adoption of the plan be included as a short-term measure? Can the adoption of a sidewalk policy or complete streets policy serve as short-term measures?

The development of a pedestrian plan can serve as a short-term performance measure along with evidence that the grantee is working on adoption of the plan. An adopted transportation master plan is expected to include activities that increase access to physical activity to be included as a short-term measure. The adoption of a sidewalk policy or complete streets policy can serve as short-term measures.

The work plan templates have a field for reporting baseline data for all performance measures; however the FOA indicates that "CDC will work with grantees to define and operationalize the performance measures and to identify available and feasible data sources." What should be indicated in the work plan templates if we do not have baseline data for a performance measure readily available, either because the measure has not been defined and operationalized, or a data source has not been identified or is not available?

States should propose a way to report data that is feasible for their state and that broadly addresses performance measures. While our ultimate goal over the five year period is to come up with a single definition (method of operationalization) for each measure to permit consistent reporting at a national level, in the short term, we will be looking at the possibility of operationalizing the indicators in more than one way to increase states’ ability to report progress using available data sources. If states do not have an existing data source or need more time to determine a feasible way to collect the data, they can leave this information blank on the work plan template, but should include a brief description of plans to try to access data in their year 2-5 work plan narrative. States are also encouraged to incorporate specific activities into their year 1 work plans to identify feasible data sources. And as noted, CDC will work with states after the award on data sources and definitions for performance measures.

Are there specific data sources to use for Strategy #1 in Domain 3, intermediate performance measure, "Proportion of adults with high blood pressure and patients with diabetes in adherence to medication regimens?" This seems difficult to track even with access to EHR data and seems measurable only by reviewing refills.

States should propose a way to report data that is feasible for their state and that broadly addresses performance measures. While our ultimate goal over the five year period is to come up with a single definition (method of operationalization) for each measure to permit consistent reporting at a national level, in the short term, we will be looking at the possibility of operationalizing the indicators in more than one way to increase states’ ability to report progress using available data sources. If states do not have an existing data source or need more time to determine a feasible way to collect the data, they can leave this information blank on the work plan template, but should include a brief description of plans to try to access data in their year 2-5 work plan narrative. And as noted, CDC will work with states after the award on data sources and definitions for performance measures.

The short-term performance measure for Strategy #2 in Domain 4 is "number of Medicaid recipients or state/local public employees with prediabetes or at high risk for type 2 diabetes who have access to evidence-based lifestyle change programs as a covered benefit." The Diabetes Prevention Program with the YMCA currently covers Medicare recipients, not Medicaid recipients. Is this performance measure acceptable for planned activities with the YMCA Diabetes Prevention Program?

No. This performance measure is specifically intended to measure the impact of interventions aimed at obtaining the CDC-recognized National Diabetes Prevention Program Lifestyle Change Program as a covered benefit for Medicaid recipients or state/local public employees with prediabetes or at high risk for type 2 diabetes.

The performance measure for Strategy #1 in the basic component is the "number of local education agencies that received professional development and technical assistance on strategies to create a healthy food nutrition environment." Can applicants report attendance to trainings for this performance measure? Or should we use School Health Profiles?

Documenting training attendance for the Strategy #1 performance measure is acceptable; however, School Health Profiles is necessary to track other short-term measures.

For Domain 4, the Strategy #4 performance measure is the “age-adjusted hospital discharge rate for diabetes as any-listed diagnosis per 1,000 persons with diabetes.” What are the age-adjustment categories that should be used for the required measures?

At this time, we have not established specific age-adjusted categories for any of the required measures. This will be addressed during the operationalization process for performance measures that will take place in year one. For purposes of the application, please propose whatever works best for your state.

On page 20 of the FOA under the Enhanced Component Domain 4, Strategy # 3 there are three interventions. Are all the bulleted intermediate and long-term measures required to be reported for any of the three interventions selected? There are no lines identifying the measures with any particular interventions.

All of the bulleted intermediate and long-term measures listed under Enhanced Component, Domain 4, Strategy # 3 are required to be reported for any of the three interventions selected, with the exception of the following intermediate measure: “Number of participants in recognized/accredited DSME programs using CHWs in the delivery of education/services”. This particular measure aligns only with intervention #1 (Increase engagement of CHWs in the provision of self-management programs), and should be reported if that intervention is selected.

In the FOA, two of the performance measures for promoting physical education and physical activity in schools are "number of state-level multi-component physical education policies for schools developed and adopted by the state,” and “number of state-level recess policies for schools developed and adopted by the state." Our state constitution prohibits unfunded mandates and any new, expanded or modified programs or responsibilities must either be fully funded by the state or approved for funding by a vote of the local legislative body. If a state level multi-component PE or recess policy is passed, we will need to prove it is revenue neutral or funding would have to occur at the local level, thus not allowing for statewide implementation.

You should clearly articulate in your application the performance measures that are a barrier and explain why. If your application is funded, CDC will work with you to identify strategies to meet the performance measures.

For Outcomes within the Approach section, should applicants restate the outcomes already specified, as performance measures (excluding those for the unselected interventions ) and adding “increase” or “decrease”? Should we limit this just to the long-term outcomes, or short-, intermediate-, and long-term? Are the baseline and target values to be included within the Outcomes section?

Please see the review criteria for the Purpose and Outcomes sections (Basic – page 42, Enhanced – page 43.) You will be evaluated on howyou are proposing to achieve the required outcomes. Specification of target populations is also required, as are your specific strategies to address synergy across and within domains. Baseline and target values are required. States will be expected to show progress on the short-term measures in Year 1. Applicants are encouraged to propose a method of operationalizing the measures that they believe is feasible for them. CDC will be looking at the possibility of operationalizing the indicators in more than one way in the short term in order to increase states’ ability to report progress; therefore, it is to states’ advantage to submit feasible definitions for consideration in this process. If states do not have an existing data source, they can leave this information blank on the work plan template, but should include a brief description of plans to access data in their year 2-5 work plan narrative.

For Domain 4, the Strategy #2 short-term performance measure is, “number of Medicaid recipients or state/local public employees with prediabetes or at high risk for type 2 diabetes who have access to evidence-based lifestyle change programs as a covered benefit.” Is the baseline and target considered "all" or "100%" if the evidence-based lifestyle change program is offered at no charge to anyone who wants to take it in the state? Please clarify “access” in this performance measure.

This performance measure is specifically intended to measure the impact of interventions aimed at obtaining the CDC-recognized National Diabetes Prevention Program (National DPP) Lifestyle Change Program as a covered benefit for Medicaid recipients (and/or state/local public employees) with prediabetes or at high risk for type 2 diabetes. If the Medicaid Program in your state does not currently include the CDC-recognized National DPP Lifestyle Change Program among its covered benefits for Medicaid recipients, your baseline for this performance measure would be zero. If the Medicaid Program approves the program as a covered benefit, all
Medicaid recipients with prediabetes or at high risk for type 2 diabetes in the state would “have access.”

If a survey is to be developed and administered as part of the evaluation process, how is that noted in the short-term measurement section of the work plan and associated data source and baseline?

If you do not have an existing data source for the measures, you can leave this information blank on the work plan template, but should include a brief description of your plans to develop the survey in your Year 2-5 work plan narrative. You should also include any key activities specific to data collection in the “Activities" section of the work plan template for Year 1.

For Domain 2, strategy #7 short-term performance measure for the first intervention, the data source is mPINC, which is administered every 2 years. Can the short-term performance measure target and time frame be set for June 30, 2016, even though it is more than 1 year out? Also, School Health Profiles data will not be available until 2015. Can we set 2015 as the time frame for short-term performance measures using Profiles data if it will not be available within one year?

Although short term measures are expected to be reported annually, we recognize that data sources may only be available on a bi-annual basis. If you do not currently have data on this short term measure or will not be able to report annually, include a brief description of your plans to report this data in your narrative for Years 2-5 and leave the appropriate field (timeframe) blank in the work plan template, if applicable. It is acceptable to set the time frame for a performance measure based on the availability of School Health Profiles data. States should propose time frames that are aligned with their strategies and activities and feasible based on available data sources.

If we do not expect intermediate and long-term performance measures to change significantly from the reported baseline in one year, is there a time frame for these measures in the enhanced work plan? Are we expected to project targets that indicate progress from the baseline measure for the intermediate and long-term performance measures in the first year? Would it be okay if we do not project a change from the baseline in Year 1 for these performance measures?

There is no expectation that progress from baseline measures for intermediate and long-term performance measures will be made in the first year. It is fine to project a change from baseline in year one if you think it is feasible, but this is not required.

Can applicants follow definitions for NQF 18 on the National Quality Forum website? Specifically, we are looking at blood pressures of < 140/90 in the numerator regardless of a diagnosis of diabetes or chronic kidney disease (with treatment goals < 130/80 according to the JNC 7)?

Yes

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Recipient Activities: Basic Component


Can Strategy #7 on the Basic Component Table also include promoting participation in a Stanford-licensed Chronic Disease Self-Management Program (CDSMP) for patients with diabetes, cardiovascular disease, prediabetes?

Strategy # 7 on the Basic Component Table is intended to increase the proportion of people with diabetes in targeted settings who have at least one encounter at an ADA-recognized, AADE-accredited, or state accredited/certified diabetes self-management education (DSME) program and/or participate in the Stanford Diabetes Self-Management Program (DSMP). This strategy does not include promoting participation in the Stanford Chronic Disease Self-Management Program (CDSMP).

For Strategy # 5 on the Basic Component Table, clarify how the performance measure of "proportion of adults in the stateaware they have high blood pressure" is an appropriate measure of strategies to promote awareness of high blood pressure among patients.

For Strategy #5 on the Basic Component Table, “among patients” is used to make clear that this strategy relates to a diagnosis of high blood pressure by a health professional or health extender rather than an intervention intended to promote public awareness, such as a media campaign. The measure does align in terms of receiving a diagnosis and will be further operationalized and defined over the next few months and through working with states.

What is meant by “Increased awareness of high blood pressure among patients?” Does this mean decreasing undiagnosed high blood pressure? Should states focus on a communication campaign for the public? Should states focus on improving diagnosis of high blood pressure by health care providers?

The strategy is expected to decrease undiagnosed high blood pressure and increase action to control it. It would be appropriate to include providers, but health care extenders or other community resources could also be involved. With the limited resources available through the basic component, we do not expect to see a communication campaign for the general population. If any communication aspect is proposed, it should closely link individuals to existing healthcare systems.

What is meant by “Increased awareness of prediabetes among people at high risk for type 2 diabetes?” Does this mean decreasing undiagnosed type 2 diabetes and undiagnosed prediabetes? Should states focus on a communication campaign for the public? Should states focus on improving diagnosis of prediabetes by health care providers?

The goal of promoting awareness of prediabetes is to increase the prevalence of people with prediabetes who are aware of their condition, as measured through the BRFSS Prediabetes Module question: “Have you ever been told by a doctor or other health professional that you have pre-diabetes or borderline diabetes?” In order to affect change in this measure at a statewide level, states should be prepared to focus on multiple strategies targeting different population groups and sectors over the five year project period; these may include, but are not limited to, people at high risk, health care systems, worksites, and community-based organizations.

For Strategy #7 in the Basic Component Table, what is the definition of “state-accredited/certified” in reference to programs?

“State-accredited/certified” refers to those DSME programs in a limited number of states where the State Health Department serves in the role of a formal accrediting body responsible for determining the programs that achieve the state-level equivalent of ADA recognition/AADE accreditation. In this role, the State Health Department is able to ensure that the state-accredited/certified programs adhere to the National Standards for Diabetes Self-Management Education and Support and qualify for reimbursement. The National Standards do allow DSME programs flexibility in selecting the specific curricula (e.g., DEEP, etc.) they will use for their programs, as long as these curricula reflect current evidence and DSME practice guidelines (see Standard # 6, National Standards for Diabetes Self-Management Education and Support: http://care.diabetesjournals.org/content/35/11/2393.full).

The key to Strategy #7 in the basic component is promoting participation in DSME programs that adhere to national standards, are delivered with quality and fidelity, and are sustainable over the long-term, preferably through a reimbursement mechanism. If your state is working with diabetes education programs that are not currently in compliance with these criteria, the enhanced component of this FOA (Domain 4, Strategy #1) offers an opportunity to be creative in planning an approach to help achieve this.

What are considered “target settings” in Strategy #7 for the basic component? To select a target setting, is it a short-term performance measure to obtain the number of people with diabetes in that target setting as the denominator?

Targeted settings, referenced in the Strategy #7 performance measure for the basic component, should be specified by each state. They are typically defined geographically or by type of setting (e.g., FQHCs). Any estimates of the target setting should reflect the state’s best knowledge of the population that could ideally be reached if the intervention were optimally delivered within budget constraints. CDC will work with awardees to further define and operationalize the required performance measures so that data may be collected and reported in a consistent way by each state; however, for this measure, we expect that the denominator would be defined by the number of people with diabetes in the specified targeted settings.

The performance measures for Strategy #2 of the basic component refer to multi-component physical education (PE) policies. Does this include some/most of the Comprehensive School Physical Activity Program (CSPAP), although it is not specifically mentioned in the basic component?

While Strategy #2 in the basic component would include some elements of a CSPAP, the multi-component state policy is not limited to CSPAP elements. A multi-component physical education policy requires schools or school districts: to teach physical education (PE) and follow national or state PE standards or guidelines, hire qualified PE teachers and require professional development, and does not allow substitutions for, or exemptions from, PE.

Will a Memorandum of Understanding (MOU)/Memorandum of Agreement (MOA) with the education department be required for the basic component?

For the basic component, an MOU/MOA between the state health agency and the corresponding state education agency is strongly encouraged. For the enhanced component, these MOUs/MOAs are required and will be a criterion used in evaluating the application.

In the basic component, Domain 1, are the core public health activities in surveillance and epidemiology primarily part of the basic component, or are they also supported in the enhanced component?

Some funding from basic component will support surveillance and epidemiology. Applicants can increase funding for these areas through the enhanced component.

For Strategy #3 in the Basic Component Table, can schools be considered a worksite to promote the adoption of physical activity by employees?

Yes, staff wellness in schools promoting the adoption of physical activity strategies is considered a worksite strategy.

Can you provide resources for the National Quality Forum measures (NQF 18 and NQF 59) referenced in Strategy #4 in the Basic Component Table?

NQF 18 - Controlling High Blood Pressure. Measure Description: The percentage of patients 18–85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year.

NQF 59 - Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%). Measure Description: The percentage of members 18-75 years of age with diabetes (type 1 and type 2) whose most recent HbA1c level during the measurement year was greater than 9.0% (poor control) or was missing a result, or if an HbA1c test was not done during the measurement year.

We recently e-mailed a guidance document (Promoting Clinical Quality--A Resource Guide for State Heart Disease and Stroke Prevention and Diabetes Prevention and Control Programs) to State Chronic Disease Directors and other program staff to help inform their work in Domain 3.

In the basic component strategies, what does the term “promote” mean? Is this more specific than media promotion?

Yes, “promotion” refers to policy, systems and environmental change strategies that result in achievement of the “Basic Accomplishments” in the logic model on page 7 of the FOA. Applicants should focus on the basic component accomplishments and what is expected at the end of the five years as they select effective strategies. Promotion activities must result in those accomplishments, as evidenced by progress on the performance measures listed in the Basic Component table on page 13 of the FOA.

For Strategy #1 in the basic component, what are the food service guidelines/nutrition standards that are referenced?

See Domain 2 Resources on the FOA website for examples of food service guidelines/nutrition standards.

For Strategy #2 in the basic component, what are the physical activity/physical education standards or guidelines referenced?

See Domain 2 Resources of the FOA website for examples of evidenced-based comprehensive school physical activity programs. For physical activity guidelines, please refer to the Division of Nutrition, Physical Activity, and Obesity's Implementation Guidance and Resources [PDF-590Kb] in Domain 2 of the FOA website.

How are state-level multi-component physical education policies different from existing state department of education regulations for a multi-component, learning standards-based, sequential physical education program for grades K-12?

A multi-component physical education policy requires schools or school districts: to teach PE and follow national or state PE standards or guidelines, hire qualified PE teachers and require professional development, and does not allow substitutions for, or exemptions from, PE.

In Strategy #5 of the basic component, is the goal to increase awareness of health risks associated with high blood pressure among those with high blood pressure? Or is the goal to increase the percentage of people who know they have high blood pressure and then control it?

The intent of Strategy #5 in the basic component is to increase the percentage of people who are aware they have high blood pressure and control it.

For Strategy #7 in the basic component, can an initial activity include obtaining a statewide umbrella DSME license and sponsoring a number of sites?

The intent of Strategy #7 in the basic component is to increase participation in ADA-recognized, AADE-accredited and/or state-accredited/certified DSME programs, and/or Stanford licensed diabetes self-management programs (DSMP). To determine how best to address this strategy, it is important that applicants assess the availability, location, and utilization patterns of existing DSME programs in their states. For example, serving as an umbrella agency for ADA recognition or AADE accreditation may be useful in some states where recognized/accredited programs are lacking, but may not be a particularly helpful approach in settings where existing programs abound but are not well attended. In the latter case, a state may wish to consider approaches for increasing referrals to existing DSME programs, or addressing barriers that impact participation (cost, accessibility, cultural relevance, etc.).

Identifying a target population is already a prerequisite for becoming an ADA recognized DSME site. Thus, are states required to further target settings as part of the performance measure for Strategy #7 in the basic component, “proportion of people with diabetes in targeted settings who have at least one encounter at an ADA-recognized, AADE-accredited and/or state-accredited/certified DSME programs, and/or Stanford licensed diabetes self-management programs (DSMP)?”

Targeted settings, as referenced in Strategy #7 performance measure in the basic component, should be specified by each state. They are typically defined geographically or by type of setting (e.g., FQHCs). Any estimates of the target setting should reflect the state’s best knowledge of the population that could ideally be reached if the intervention were optimally delivered within budget constraints.

Strategy #4 in the basic component is to “promote reporting of blood pressure and AIC measures; and as able, initiate activities that promote clinical innovations, team-based care, and self-monitoring of blood pressure.” Are these activities optional and based on capacity (promote clinical innovations, team-based care, and self-monitoring of blood pressure)?

Yes, promoting clinical innovations, team-based care, and self-monitoring of blood pressure are optional activities.

Should applicants choose their own strategies or are we expected to implement those listed in the domains tables? On page 9 of the FOA, it states that funded applicants are expected to implement interventions within their chosen strategies from each of the domains. However, on page 35 of the FOA it states that “as applicable, applicants should use and explicitly reference The Community Guide as a source of evidence-based program strategies whenever possible. In addition, applicants may propose additional program strategies to support the outcomes. Applicants should select existing evidence-based strategies that meet their needs, or describe the rationale for developing and evaluating new strategies or practice-based innovations.”

For the basic component, applicants should address all of the strategies listed in the domain table. For the enhanced component, applicants are required to work in each of the 3 domains. For Domain 2, applicants must select at least one intervention for each of the 7 strategies; for Domain 3, at least one intervention in each of the 2 strategy areas and; for Domain 4, at least one intervention for at least 2 of the strategy areas.

Can Indian Health Service (IHS) DSME programs be included as “ADA-recognized, AADE-accredited, state-accredited/certified, and/or Stanford licensed DSME programs” for Strategy #7 in the basic component and Strategy #1 in Domain 4 of the enhanced component?

Some Indian Health Service (IHS) and tribal diabetes self-management education programs are ADA-recognized or AADE-accredited, though not all of them are. When the IHS Division of Diabetes changed the focus of their Integrated Diabetes Education Recognition Program (IDERP) in 2010, IDERP accredited programs were given the opportunity to choose to maintain their accreditation through the ADA Diabetes Education Recognition Program or the AADE Diabetes Education Accreditation Program, and technical assistance was offered to help in the transition. Strategy #7 under the Basic Component can include promoting participation in IHS or tribal DSME programs that have ADA recognition or AADE accreditation; however, this work would require close coordination with the appropriate IHS or tribal health officials.

For the basic component, do we describe “activities” or “strategies” in the application?

For the Basic component, you are to describe how each of the required strategies will be implemented.

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Recipient Activities: Enhanced Component


In the enhanced work plan template (page ii), Domain 4 work should align with approximately 34% of the total budget, with 10% of that allocated for work in schools (Strategy #5). If a state chooses notto select Strategy #5 under Domain 4, how should the 10% of dollars that is prescribed to be allocated for that strategy be used?

In Domain 4, if an applicant chooses notto select Strategy #5 (managing chronic conditions in schools), the Domain 4 budget should be decreased by 10%. Example: If a state originally estimates a budget of $600,000 for work on all of the strategies and interventions listed in Domain 4, and then decides not to work on Strategy #5, their revised budget should be $540,000.

In Domain 3, Strategy #1, are both interventions required, or are we able to select just one of them? The interventions listed in Strategy #1 are bulleted and not separated by a line, as they are in the other strategies.

For Domain 3, Strategy #1, the two bulleted items comprise one intervention; therefore, both items should be addressed.

Domain 4 guidance includes multiple references to the Stanford Diabetes Self-Management Education programs (DSME). Do you mean to say Diabetes Self-Management Program (DSMP)?

For Domain 4, “diabetes self-management education (DSME)” encompasses the following programs:
1. ADA-recognized DSME programs
2. AADE-accredited DSME programs
3. State accredited/certified DSME programs, and/or
4. The Stanford Diabetes Self-Management Program (DSMP)

What does CDC recommend as examples of evidence-based comprehensive school physical activity programs (CSPAP)?

Refer to resources located in "Domain 2" of the FOA website for examples of evidenced-based comprehensive school physical activity programs.

Specify how states should identify underserved areas, related to farmers markets in Domain 2, Strategy #1 of the enhanced component?

Refer to the Division of Nutrition, Physical Activity and Obesity (DNPAO) Implementation Guidance and Resources for Cooperative Agreement DP-13-1305 [PDF-590Kb]. See page 4 for suggested definitions of underserved areas and page 2 for suggested data sources and definitions of underserved areas. This reference is available on the FOA website.

Is the sole focus for improving care for diabetes just on hypertension and HbA1c? Should work also focus on the other elements of quality care (immunizations, cholesterol, etc.)?

States may work on quality care improvement efforts in a holistic way, but are only required to report data on the performance measures listed on the Domain 3 Table on page 18 of the FOA.

What examples of interventions for Domain 3, Strategies #1 and #2?

Examples of interventions for Domain 3, Strategy #1 are: Collaboration with Regional Extension Centers (RECS), Medicare Quality Improvement Organizations (QIOS), Health Information Exchanges (HIEs), etc. to promote meaningful use of EHRs to better manage chronic illness. Promoting inclusion of: quality improvement data collection and exchange (e.g., through multi-payer databases); accountability measures aligned with Million Hearts™; and patient-centered medical home models of care. For examples for Strategy #2, review the resources listed on this FOA website under Domain 3. Domain 3, Strategy #1 is a two-part intervention. There are two interventions for Strategy #2 and applicants are only required to address one of these.

For Strategy #7 in the Basic Component Table, what is the definition of “state-accredited/certified” in reference to programs?

“State-accredited/certified” refers to those DSME programs in a limited number of states where the State Health Department serves in the role of a formal accrediting body responsible for determining the programs that achieve the state-level equivalent of ADA recognition/AADE accreditation. In this role, the State Health Department is able to ensure that the state-accredited/certified programs adhere to the National Standards for Diabetes Self-Management Education and Support and qualify for reimbursement. The National Standards do allow DSME programs flexibility in selecting the specific curricula (e.g., DEEP, etc.) they will use for their programs, as long as these curricula reflect current evidence and DSME practice guidelines (see Standard # 6, National Standards for Diabetes Self-Management Education and Support: http://care.diabetesjournals.org/content/35/11/2393.full).

The key to Strategy #7 in the basic component is promoting participation in DSME programs that adhere to national standards, are delivered with quality and fidelity, and are sustainable over the long-term, preferably through a reimbursement mechanism. If your state is working with diabetes education programs that are not currently in compliance with these criteria, the enhanced component of this FOA (Domain 4, Strategy #1) offers an opportunity to be creative in planning an approach to help achieve this.

In Domain 4, should applicants choose more than two strategies, or try to achieve more reach through just two strategies.

All applicants must choose at least one intervention for at least two strategies in Domain 4. Selections must include Strategy #1 or #2, or both. Achieving substantial reach is important for all strategies/interventions selected, so each state should assess their resources, skills, and abilities and determine whether they are in a position to work on more than 2 strategies in Domain 4.

What is a comprehensive school physical activity program (CSPAP) in Domain 2, Strategy #6?

A comprehensive school physical activity program (CSPAP) is a multi-component approach by which school districts and schools use all opportunities for students to be physically active, meet the nationally recommended 60 minutes of physical activity each day, and develop the knowledge, skills, and confidence to be physically active for a lifetime. A CSPAP consist of the following components: physical education, physical activity during school (e.g., recess, physical activity breaks), physical activity before and after school (e.g., walk or bike to school programs, physical activity clubs), staff involvement, and family and community engagement. A CSPAP must be well coordinated and have synergy across all of the components so that messages and lessons about physical activity are consistent. For more information and guidelines about CSPAP, see CDC’s School Health Guidelines to Promote Healthy Eating and Physical Activity, Guideline 4. For tools to implement a CSPAP, see the National Association for Sport and Physical Education (NASPE) resources.

In Domain 4, would states choose the same program if they selected Strategy #4, CDSMP, and also Strategy #2, lifestyle programs? Is CDSMP considered a lifestyle intervention because it also addresses weight loss?

The Stanford-based Chronic Disease Self-Management Program (CDSMP) and the National Diabetes Prevention Program (National DPP) lifestyle change program are two different programs designed to achieve different outcomes. CDSMP reaches people with chronic disease, helping them develop the skills needed to manage their health; it is designed to enhance regular treatment and disease-specific education.

The CDC-recognized National DPP lifestyle change program targets people with prediabetes, or at high risk for developing type 2 diabetes, to prevent the onset of type 2 diabetes in this population. The program is based on the Diabetes Prevention Program research study, led by the National Institutes of Health and supported by CDC, which reduced the risk of developing type 2 diabetes by 58% among participants at high risk for diabetes. It is currently the only program for which we have this level of evidence associated with type 2 diabetes prevention.

Can applicants choose one of the two interventions for Strategy #2, Domain 3? Instructions are to select at least one intervention per strategy?

Yes. Applicants may choose one of the two interventions for Strategy #2, Domain 3.

Is Domain 4, Strategy #4 in enhanced component, "increase access to and use of chronic disease self-management programs," meant to be exclusive to chronic disease self-management programs, or can diabetes self-management programs also be included?

Domain 4, Strategy #4 is intended to be exclusive to Stanford Chronic Disease Self-Management Programs (CDSMP). Stanford Diabetes Self-Management Programs are included under Domain 4, Strategy #1.

For the enhanced component, can states add interventions to their work plans in out years, if they later determine that they are able to focus on additional activities? For example, if a state’s year 1 work plan includes the first intervention under Strategy #1, Domain 2, and in year 3 the state determines they are able to also work on the second intervention, can they add this to the work plan at that time?

Yes, states awarded the enhanced component can later add interventions listed under in the domain strategies.

For the enhanced component, can the evidence-based program EnhanceFitness be used for Domain 4, Strategy #2, “to increase use of lifestyle intervention programs in community settings for the primary prevention of type 2 diabetes?”

Domain 4, Strategy #2 is specific to increasing referrals to, use of, and/or reimbursement for the CDC-recognized National Diabetes Prevention Program lifestyle change program. This program is based on the Diabetes Prevention Program research study, led by the National Institutes of Health and supported by CDC, which reduced the risk of developing type 2 diabetes by 58% among participants at high risk for diabetes. We do not have this same level of evidence for other lifestyle intervention programs.

In Domain 4, Strategy #5, can applicants choose to work on just one chronic condition in schools, or do they need to address all chronic conditions listed (asthma, food allergies, diabetes, and other chronic conditions related to activity, diet and weight)?

This FOA is intended to maximize CDC’s investment in the work of state departments of health as they implement a basic set of public health activities and strategies. States can choose the range of chronic conditions that they will focus on in schools. Regardless of the chronic condition(s) selected for emphasis, states should provide support for their selection(s).

In the FOA, the focus on providing quality care appears seems specific to just HBP and A1C measures. Should applicants plan to drop activities related to other aspects of diabetes care, such as foot care?

States may work on quality care improvement efforts in a holistic way, but are only required to report data on the performance measures listed in the table for Domain 3 on page 18 of the FOA.

For Strategy #5 in the basic component related to blood pressure awareness among patients, how should states measure the "proportion of adults in the state aware that they have high blood pressure?"

The BRFSS core Hypertension section is a potential data source.

Please define “farmers market” used in in Domain 2, Strategy #1. There are many non-traditional retail food access interventions that may or may not fall under "farmers markets". Would a weekly produce stand selling fruits and vegetables procured from wholesale providers (not local farmers or a local food distributer), be considered "retail" or a "farmers markets?"

A farmers market is a recurring gathering of farmers selling their food products directly to consumers. Other produce markets may include wholesalers and retailers, rather than just farmers. These markets can be: held on public or private land, in temporary or permanent structures, or may even be mobile; set up in community locations, health clinics, places of worship, schools, hospitals, and workplaces, and; include locally or regionally grown items and farm fresh produce.

For Strategy #2 in Domain 2, is there an option to select more than one of the three priority settings (ECE's, worksites, communities) or do we choose one to apply to all performance measures?

It is acceptable to propose working in more than one setting; however settings should be prioritized so that proposed work is feasible. It is expected that all performance measures will be reported on for each setting selected.

For the enhanced component, Domain 2, Strategy #1, can an intervention to provide access to healthier food retail include activities to address local retailers in communities, and also retail and vending environments in workplaces and schools?

Yes. It is acceptable to include activities that address local retailers in communities, in addition to retail and vending in workplaces and schools.

For the enhanced component, Domain 2, Strategy #7, are worksites, schools, and other clinical settings considered “facilities” in implementing supportive breastfeeding practices, in addition to birthing facilities?

Strategies supportive of breastfeeding practices in birthing hospitals apply specifically to birthing hospitals and birthing centers. These include facilitating changes in maternity practices that are related to the Ten Steps to Successful Breastfeeding. Strategies implemented in clinical settings other than birthing facilities are in alignment with the intent of the FOA as long as they serve to support implementation of the Ten Steps to Successful Breastfeeding within the associated birthing facilities. This generally includes implementation of Step 3: Inform all pregnant women about the benefits and management of breastfeeding; and Step 10: Identify sources of national and local support for breastfeeding and ensure that mothers know how to access these prior to discharge from hospital.

Strategies supportive of breastfeeding in worksites must relate directly to assisting worksites to implement practices that are in compliance with the federal lactation accommodation law. Strategies supportive of breastfeeding in schools can only be those that relate to schools as worksites; such as strategies assisting the schools in implementing practices that are in compliance with the federal lactation accommodation law, or a state law if this one is more comprehensive. Please note that schools as worksites are exempt from the federal lactation accommodation law but: 1) can be encouraged to meet the space and time requirements of the law, or; 2) may be covered by a more comprehensive state law. Download Ten Steps to Successful Breastfeeding document and other resources at DNPAO Implementation and Resource Guidance document on the Domain 2 on the FOA website.

Strategy #1 in Domain 3 is to “increase implementation of quality improvement processes in health systems, with an intervention to increase EHR adoption and use of HIT to improve performance.” Is the intent of this intervention to see an increase in the number of health care systems that currently don't have appropriate EHR systems in obtaining appropriate EHR systems? Or is the intent to see an increase in the number of health care systems that currently have EHR systems that begin to appropriately use them to treat patients with high blood pressure and/or patients with diabetes?

It could be both.

Are farm direct programs (Farm to School, Work Cafeteria) considered farmers markets for Domain 2, Strategy #2?

Farm direct programs are not included in Domain 2 Strategy #2. For additional guidance on what is included, refer to the DNPAO Implementation Guidance and Resources [PDF-590Kb] document found under Domain 2 on the FOA website.

For Strategy #1 interventions in Domain 2, are states limited to working with "small retail venues" or can they work with large supermarket chains?

Work with large supermarket chains is acceptable under Domain 2, Sstrategy #1. For additional guidance on what is acceptable, refer to the DNPAO Implementation Guidance and Resources [PDF-590Kb] document found under Domain 2 on the FOA website.

Does the National Diabetes Education Program’s (NDEP) "Small Steps Big Rewards" curriculum qualify as an evidence-based intervention that community health centers can use when working with patients at-risk for diabetes?

No. Domain 4, Strategy #2 specifically addresses increasing referrals to, use of, and/or reimbursement for the CDC-recognized National Diabetes Prevention Program (National DPP) Lifestyle Change Program for the prevention of type 2 diabetes. More information on this program is available at http://www.cdc.gov/diabetes/prevention/index.htm.

For Domain 2, Strategy #1, “provide access to healthier food retail,” page 2 of the Division of Nutrition, Physical Activity, and Obesity's Implementation Guidance and Resources [PDF-590Kb] states that "Stores can include supermarkets, grocery stores, convenience stores, corner stores, and specialty food stores." However, the performance measures are focused on small retail venues. Are supermarkets and grocery stores included in this measure? What types of food retail are eligible?

The expectation is that work in Domain 2, Strategy #1 should focus on small retail venues (e.g. corner stores, bodegas, gas stations, drug/dollar stores, etc.) that are located in underserved areas. Limited work with supermarkets or grocery stores (e.g. data mapping to inform new store location in high need area) is acceptable. All awardees will be required to report progress on the performance measures; number of small retail venues that sell healthier food options in underserved area” and “number of adults, youth, or families that access small retail venues offering healthier food options.” Grantees should plan work that will show progress in these performance measures.

Is epilepsy, in adults and children, considered a chronic condition related to Domain 4?

This FOA is intended to maximize CDC’s investment in the work of state departments of health as they implement a basic set of public health activities and strategies targeting diabetes, heart disease and stroke prevention and their underlying risk factors. As part of Domain 4, Strategy #5, states can choose to focus on epilepsy and/or other chronic conditions in schools. States should provide support for their selection(s).

For the enhanced component, please provide an example of Year 1 activities for Domain 2, Strategy #4, intervention 2, “design streets and communities for physical activity.”

Please refer to the DNPAO Implementation Guidance and Resources document [PDF-590Kb] for Domain 2. This document provides examples of resources and activities which would be appropriate to address “Design streets and communities for physical activity.” Year 1 activities are dependent on where you are in the process of addressing state and community design for physical activity. If not already completed, planning and assessment activities are appropriate during the first year. If planning and assessment are completed, beginning implementation activities are appropriate for year 1.

In regards to Domain 4, Strategy 5 which is specific to schools, what additional chronic conditions can be referred to as “other?” Asthma, food allergies, diabetes, and other chronic conditions related to activity, diet and weight are specifically mentioned. Would mental health conditions (i.e., depression, anxiety, ADHD) also be considered as 'other'?

This FOA is intended to maximize CDC’s investment in the work of state departments of health as they implement a basic set of public health activities and strategies targeting diabetes, heart disease and stroke prevention and their underlying risk factors. As part of Domain 4, Strategy 5, states can choose to focus on mental health conditions in schools. States should provide support for their selection(s).

If we are purposing a comprehensive key activity that will impact multiple Domains (3 & 4) and also multiple Strategies and Interventions within those Domains, should we include the activity in the first Domain/Strategy which is impacted and note that it will also impact other Domains/Strategies in parentheses or do we include it as an activity under each applicable Domain/Strategy entry in the work plan?

The activity should be included under each applicable Domain/Strategy.

In Domain 3, Strategy #1, please define "increase the institutionalization and monitoring" of aggregated/standardized quality measures at the provider and systems level?

Examples of interventions for Domain 3, Strategy #1 are: Collaboration with Regional Extension Centers (RECS), Medicare Quality Improvement Organizations (QIOS), Health Information Exchanges (HIEs), etc. to promote meaningful use of EHRs to better manage chronic illness. Promoting inclusion of: quality improvement data collection and exchange (e.g., through multi-payer databases); accountability measures aligned with Million Hearts™; and patient-centered medical home models of care.

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Surveillance and Epidemiology Activities


Are states required to use YRBS and School Health Profiles?

Yes. States are required to use YRBS and School Health Profiles.

Are states required to apply for School Health Profiles even if it is difficult to get weighted data?

Yes. School Health Profiles questions are aligned with the school health performance measures in the FOA. Profiles results will be used to monitor the state’s progress in addressing school health outcomes.

What should applicants do if their state education agency applies for YRBS funding? Will there be additional funding to applicants through this FOA?

Funding for the administration of the YRBS and School Health Profiles is available through the Division of Adolescent and School Health’s funding opportunity announcement (FOA DP13-1308). Applicants should coordinate with their respective State Education Agencies to ensure that funding support for administration of these surveys is obtained through FOA DP13-1308.

Can states with a waiver to YRBS apply that waiver for this FOA?

Yes, states with a waiver to YRBS will receive the waiver in this FOA. These states will need to identify the data source they have in place to meet the reporting measure requirement.

What year is “year 1” to administer the BRFSS Prediabetes Module, which is to be administered during the 1st and 5th years of the project period?

Calendar year 2014 is “year 1” for administering the BRFSS Prediabetes Module for the FOA.

Can states ask just one question in the BRFSS Prediabetes Module (ex: Have you ever been told you have pre-diabetes?) to meet FOA requirements?

States must administer the entire BRFSS Diabetes or Prediabetes Module, without any alterations, in order for CDC to receive the data. We prefer that states do not make any changes to the module questions.

Is 2013 or 2015 considered the first odd year that the BRFSS Diabetes Module should be administered?

The BRFSS Diabetes Module should be administered in odd years, starting with calendar year 2013 if possible, but no later than calendar year 2015. The "age at diabetes diagnosis" question on the Diabetes Module should be administered annually; CDC's Division of Diabetes Translation is proposing that this question be included as part of the BRFSS Core Module in the future and will update states on the outcome of these discussions.

Can you please clarify the expectations for surveillance and epidemiology activities?

See page 12 of the FOA (basic component) which describes six cross-cutting core public health activities included in the basic component. Expectations of surveillance and epidemiology activities are found in activity #6. expectations.

Please clarify the time frame for “odd years” for BRFSS Diabetes Module data collection. Is this odd calendar years, fiscal years, or grant years?

The Diabetes Module should be administered in odd years, starting with calendar year 2013 if possible, but no later than calendar year 2015. The "age at diabetes diagnosis" question on the Diabetes Module should be administered annually; CDC's Division of Diabetes Translation is proposing that this question be included as part of the BRFSS Core Module in the future and will update states on the outcome of these discussions.

Do states need to conduct the BRFSS core and also ask the specific BRFSS questions and modules outlined in the FOA, or will these questions become part of the BRFSS core?

The Diabetes and Prediabetes Modules are optional modules that are not part of the BRFSS Core. States should budget for the cost of these optional modules following the instructions provided on page 12 (item #6) of the FOA. CDC's Division of Diabetes Translation is proposing that this question be included as part of the BRFSS Core Module in the future and will update states on the outcome of these discussions.

What questions should be administered in the Pre-Diabetes Module (year 1 & 5) and Diabetes Module (odd years)?

Use calendar year 2014 as “year 1” for administering the Prediabetes Module. The Diabetes Module should be administered in odd years, starting with calendar year 2013 if possible, but no later than calendar year 2015. The "age at diabetes diagnosis" question on the Diabetes Module should be administered annually. Visit: For information on specific questions in the BRFSS Diabetes and Prediabetes Modules [PDF-66Kb].

Appendix A in the FOA references Health Plan Employer Data and Information Set (HEDIS). Is this the same data set as the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Effectiveness Data and Information Set (also known as HEDIS)?

Yes, the HEDIS data set referenced in Appendix A is the same as AHRQ’s HEDIS and is sponsored by the National Committee for Quality Assurance. Healthcare Effectiveness Data and Information Set is the current name for this data set.

There is not a Domain 1 table in the enhanced component section of the FOA. Should Domain 1 activities (surveillance and epidemiology) be included in the work plan along with activities chosen from other Domains?

Epidemiology and surveillance activities should be described in the “Activities” section of the work plan; these activities should be conducted in support of accomplishing the required strategies under both the basic and enhanced components.

Will CDC change the content of the School Health Profiles surveys to reflect the priorities of this funding initiative?

Yes. The content of the School Health Profiles surveys is reviewed prior to each administration to ensure the questions reflect current funding priorities and selected performance measures.

If our state conducts its own version of YRBSS, is that an acceptable data source for this FOA?

Yes, this is an acceptable data source. Applicants with alternate data sources for measuring risk behaviors are strongly encouraged to apply for funding through DP13-1308 (DASH funding) to implement the School Health Profiles.

Were the PNSS and PedNSS surveillance systems, referenced in Appendix A of the basic and enhanced work plans, discontinued in 2012?

DNPAO published final 2011 state and national PedNSS and PNSS reports last year. The PedNSS/PNSS website at http://www.cdc.gov/pednss will be active thru June 2014; 2011 national PedNSS and PNSS reports with various state prevalence rates are posted on the site and may be of use to applicants.

Are there any requirements for BRFSS modules in hypertension, cholesterol, stroke and sodium in odd years?

The BRFSS core includes sections on high blood pressure and cholesterol awareness. Beyond this, as states are able, they are encouraged to utilize the Sodium and Cardiovascular Health modules during odd years.

What are specific strategies and requirements for epidemiologic and surveillance activities in Domain 1 that inform, prioritize, and monitor the delivery of the interventions in Domains 2-4?

Epidemiologic and surveillance work (Domain 1) should be included in the work plan as activities that support the accomplishment of the strategies and performance measures in Domains 2-4. Specific requirements for surveillance are described on page 12 (item #6) of the FOA.

How can applicants get state-level data from the Society for Human Resources Management (SHRM) survey about worksite lactation support programs?

The Society for Human Resources Management (SHRM) data on worksite lactation accommodation is reported on a national level only. In order to obtain state-level data, states should consider partnering with an organizations or state agency that has an existing survey of worksites, to determine if lactation accommodation questions (reasonable break time and a private, non-bathroom place for nursing mothers to express breast milk during the workday) can be added to the survey.

If we already have a waiver for YRBS in other applications, do we need to reapply for a waiver for this FOA?

Applicants do not need to reapply for a waiver for this FOA, but must document in their application that they have received a waiver. Applicants will need to identify in their application the data source their state has in place to meet the reporting measure requirement.

In order to calculate “Age-adjusted hospital discharge rate for diabetes as any-listed diagnosis per 1,000 persons with diabetes,” is the population of persons with diabetes estimated from BRFSS?

Yes, BRFSS can be used for this purpose, and we will work with states to develop a consistent method for doing this when we operationalize the measures. States may also propose an alternative data source and/or method for calculating a diabetes population estimate in their applications, and we will review that as part of the operationalization process.

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