Enhancing STI and Sexual Health Clinic Infrastructure NOFO FAQs – CDC-RFA-PS-23-0011

Eligibility

Q1: We are a local health department that's receiving Ending the HIV Epidemic funding (PS20-2010 Component C). Would we be eligible to apply for this grant?

A: If your EHE-funded activities do not include the activities specified in this NOFO, you can apply. But if activities you are currently funded to conduct overlap with the activities that are recommended in this NOFO, you should not apply. If you currently receive PS20-2010 Component C funding and want to apply for this NOFO, make it clear in your application that there is no overlap between your currently funded activities and what you’re proposing for this NOFO.

Q2: If we receive EHE funding from CDC, HRSA or SAMHSA, are we eligible to apply for this NOFO?

Q3: If our agency receives Ryan White grant funds are we eligible to apply for this opportunity?

A: Yes, you are still eligible to apply if activities you are currently funded to conduct using Ryan White grant funds do not overlap, but complement, the activities that are recommended in this NOFO.

Q4: Was the guidance for EHE recipients to NOT pursue this NOFO? What if we have EHE funding as a subrecipient - not a direct recipient?

Q5: If we receive CDC EHE funding in one jurisdiction, can we submit an application for a jurisdiction where we do not receive EHE funding?

A: Yes.

Q6: During today's webinar, CDC staff stated that organizations funded under other CDC Ending the HIV Epidemic programs would not be eligible for ESSHCI funding. We have two questions related to this: Would nonprofit organizations funded under CDC-RFA-PS21-2102 Comprehensive High-Impact HIV Prevention Programs for Community-Based Organizations be eligible for ESSHCI funding?

A: You are eligible to apply if the activities you propose in your application do not overlap with services provided under other CDC grants or cooperative agreements.

Q7: Would nonprofit organizations that receive other CDC Ending the HIV Epidemic program funding from pass-through entities be eligible for ESSHCI funding?

A: You are eligible to apply if the activities you propose in your application do not overlap with the EHE-funded activities you are conduct.

Q8: We’ve received some conflicting info about whether Comp C recipients are eligible to apply for the ESSHCI NOFO. This also came up on Monday’s webinar. Would you be able to let us know if/when there is resolution on this question?

A: You are eligible to apply if the activities you propose in your application do not overlap with services provided under other CDC grants or cooperative agreements.

Q9: Dallas County Health and Human Services (DCHHS) is in the process of applying for Enhancing STI and Sexual Health Clinic Infrastructure grant (Opportunity number CDC-RFA-PS-23-0011). DCHHS is also a recipient of Ending the HIV Epidemic Component C and DCHHS Sexual Health Clinic is a EHE Component C Clinic.

A: You are eligible to apply if the activities you propose in your application do not overlap with services provided under other CDC grants or cooperative agreements.

Q10: The IMG Team is inquiring about the eligibly requirement of this grant. Can profits and/or Nonprofits that have a 501(c)(3) status apply. How long must the Non-profit be in existence?

A: Non-profits are eligible for the funding. There is not a minimum amount of time in existence to be eligible for application.

Q11: We receive federal funding through the state in the form of the Expanded Partner Services (ExPS) grant. Will this make us ineligible? The funding is for completely different services, it is my understanding if we make this known, we will still be eligible. Also, the funding we receive technically is provided by NYS, so would we still need to report this funding?

A: No, you are eligible to apply if the activities you propose in your application do not overlap with services provided under other CDC grants or cooperative agreements. Providing this information in your application will help provide context for what you are applying for.

Q12: Our organization receives funding indirectly via the County of San Diego that originates with “Ending the HIV Epidemic” funds. Could you please clarify whether our organization would be eligible to apply for the CDC-RFA-PS-23-0011 - Mechanism?

A: You are eligible to apply if the activities you propose in your application do not overlap with services provided under other CDC grants or cooperative agreements.

Q13: Five Horizons is in the third year of a CDC EHE grant received from the Alabama Department of Public Health. This project is for the Tuscaloosa catchment area only. Five Horizons now includes a clinic in Starkville, MS and Montgomery, AL. Are we eligible to apply for the Starkville and Montgomery clinics?

A: Yes, you are eligible to apply for the Starkville and Montgomery clinics.

Clinical Services Required

Q14: What type of clinical services are not authorized?

A: Clinical services not authorized include services that are not listed in Table 1, page 11 of the NOFO or any clinical services not authorized by state law.

Q15: Are clinics that already provide all basic and specialty services outlined in Table 1 of the NOFO eligible to apply?

A: Yes, if you are planning to expand on those services or increase the number of patients served. In other words, funding should not be utilized to supplant existing services or personnel.

Q16: If a clinic is unable to provide some of the services listed but can refer, is this sufficient for the requirements of this NOFO? Are we eligible or not? There are a few services that we would have difficulty offering due to the political climate in our area.

A: The expectation for eligibility is providing all basic services and some STD Specialty Clinic services, if authorized by state law. If those services can be provided by working with partners, this would allow you to meet eligibility and should be clearly detailed in your application.

Q17: Other than condom provision, is any other provision of contraception required? Does the inability to provide emergency contraception make us ineligible?

A: On page 12 of the NOFO, Table 1’s column of basic STI services lists emergency contraception as a prevention service that should be provided, unless not authorized by state law.

Q18: I work with an existing clinic, and I was wondering if existing clinics were responsible for implementing all the specialty services in Table 1, or just specific ones. And if we are supposed to implement each of the specialty activities, is there a timeline for when we're supposed to do that?

A: You are expected to offer all the basic services and some of the STI specialty services. The timeline is outlined in the NOFO on pages 10-14. The more specialty services the better. These are the items that define STD Specialty Care.

Q19: Are there specific STD specialty services that are required in an application? EX: Would including emergency contraception or POC testing be required in our clinic services? Are certain enhancements weighted heavier than others?

Q20: Are the clinical services outlined in pg. 11-12 a MUST in order to qualify? Or are these examples of the qualifying services?

A: Yes, all basic services are required as authorized by state law. There is not a minimum number of specialty STD services to be added later in the cooperative agreement period of performance.

Q21: When the NOFO states expanding STI services, can that include increasing volume of patients, or does it have to be new services than what we were doing previously?

A: That can include increasing volume of patients (if already providing services) and/or new services if not providing them already.

Q22: When stating a clinical service "should be" provided, would an application be ineligible without it?

A: You would be considered ineligible if you don’t provide all basic services, except for those that are not authorized by state law. You are expected to offer some of the STI specialty services, but here is not a minimum number of specialty STD services to be added later in the cooperative agreement period.

Q23: There is a point to the “Basic STD services” but no specification on whether all or some would need to be included. In addition, the need to adopt specialty services later in the grant period, any that we would like to include even if one/two? Depending on the population addressed, some of these STD services to me seem less valuable and it does make it more difficult to implement a new clinic with all services. For example, if we are aiming to reach MSM there seems to be less need for EC? Are we able to use objectives of the clinical service, or must we adopt all “Basic STD services”? (Reference page 11-13)?

A: Yes, all basic services are required as authorized by state law. There is not a minimum number of specialty STD services to be added later in the cooperative agreement period.

Q24: The NOFO states the clinic “should” offer basic services, but it does not say if we would be ineligible if we do not offer them. Will we be ineligible if we do not offer all basic services?

A: Yes, you would be considered ineligible if you don’t provide all basic services, except for those that are not authorized by state law.

Other

Q25: Will these slides be available to attendees?

A: Yes, we will distribute a PDF of the slides with webinar attendees via email. We will also add a link to the webinar recording on DSTDP’s Funding Opportunities page.

Q26: Who should be signing the letter from the clinical provider: the clinician providing services or our Chief Medical Officer overseeing the project?

A: The letter should be signed by the Chief Medical Officer or supervising physician. If you are proposing to create a new clinic, it will need to have medical oversight, so the person responsible for that oversight should sign the letter.

Q27: Regarding the ESSHCI, how will the roster of pre-identified/pre-approved clinics be created? Who is on the list (all applicants, only those who are invited to submit an application after submitting an LOI, only awardees)? Does this mean funding for the ESSHCI program has not been allocated? Can you elaborate on how funding for the Approved-But-Unfunded list of recipients works?

A: Approved but unfunded refers to applications recommended for approval during the objective review process; however, they were not recommended for funding by the program office and/or the grants management office.

Q28: For the table required for existing clinics (page 17 of NOFO), is it only the information related to STI visits requested or ALL visit types if we see more than just STIs?

A: The table should summarize data from all visit types.

Q29: What is meant by “increased identification of new STIs by clinics” (page 7 under Outcomes)? Is this new, emerging STIs? Or an STI that is not currently being screened for at the applicant's site? Is that STIs that are newly diagnosed by the organization or new to our populations, like mpox, for example?

A: This refers to STIs that will be diagnosed due to increased screening as part of new STI care access. These are the infections that are currently going undiagnosed due to lack of access to care.

Q30: What is a CLIA Waiver (page 10)?

A: Some point of care tests and other laboratory tests on site require a Clinical Laboratory Improvement Amendments (CLIA) waiver. It is a laboratory regulation.

Q31: On page 11, POC testing is mentioned, along with a training plan should applicants aim to provide such testing. Can you please clarify what point of care testing is being referenced here? All POC testing? Or specific examples of POC testing?

A: On page 12, in the right-hand column under STI Specialty Services, POC tests listed include microscopy (wet mount and gram stain), rapid HIV test, rapid syphilis test, urinalysis with microscopy, and other point of care tests.

Q32: On page 24, there is a performance evaluation rubric that should be submitted per period of performance. What length is this performance period? Every year?

A: Page 24 includes a sample work plan format. For applicants who choose to use this format for their application, the table should be completed for each Year 1 outcome. The period of performance for the Year 1 detailed work plan is the first 12 months of the award.

Q33: We have a nonprofit that has agencies across the US, and we were wondering if we could write multiple grants for these locations. Can we just write one to cover all locations, or can we only write just for one agency?

A: An agency that has multiple sites should only apply with one application (that includes each proposed location) if your agency only has one identifier. If each location has a unique identifier, you can submit separate applications. Please note that the average award is per application not number of locations in each application.

Follow-up Q: Our agency also has one unique identifier, and each facility (in different New York City boroughs) has their unique identifier. Does that mean that they can apply? We can apply separately or together as a system?

A: You may submit separate applications if you have unique identifiers for each location. Please note that the average award is per application not number of locations in each application.

Q34: Please clarify #13 on page 27? What is meant by no DA available?

A: No direct assistance is available under this NOFO. Direct Assistance is a financial assistance mechanism, which must be specifically authorized by statute, whereby goods or services are provided to recipients in lieu of cash. DA generally involves the assignment of federal personnel or the provision of equipment or supplies, such as vaccines. DA is primarily used to support payroll and travel expenses of CDC employees assigned to state, tribal, local, and territorial (STLT) health agencies that are recipients of grants and cooperative agreements. Most legislative authorities that provide financial assistance to STLT health agencies allow for the use of DA. https://www.cdc.gov/grants/additionalrequirements/index.html.

Q35: What is the % we can budget for regarding indirect costs?

A: For this NOFO, you must have a current indirect cost rate agreement with the federal government. If you don’t have one, the most you’ll be able to claim is maybe a 10% minimum rate. So you do have to have a current federal indirect cost rate from the federal government.

Follow-up Q: Our agency does have indirect cost rate agreed with federal government. Can we go as high as it is stated? Is there a no cap on that?

A: If it’s an approved federal indirect cost rate agreement, we will review it and accept it if it’s valid.

Q36: Does the “Sexual Health Services” definition include gender services?

A: Gender services can be included as part of sexual health services if they are authorized by state law. However, they are not required as part of this NOFO. The required services are the ones listed in Strategy B on pages 9-14.

Q37: If we're an STD clinic that is fully grant-funded by the state, and this would be a grant to expand our services, should the initial grant come from our original funders?

A: This is an open NOFO, so anybody can apply if you meet the criteria. This is not a grant, this is a cooperative agreement, and there is a difference between the two. If your agency is not able to meet the financial management systems requirements described on 45 CFR 75, this might not be the ideal cooperative agreement or NOFO for you. These requirements include, but are not limited to:

Records that identify adequately the source and application of funds for federally funded activities.
Effective control over, and accountability for, all funds, property, and other assets. Comparison of expenditures with budget amounts for each Federal award.
Written procedures to implement payment requirements.
Written procedures for determining cost allowability.
Written procedures for financial reporting and monitoring.

Follow-up Q: Could you explain what the difference is between a cooperative agreement and a grant?

A: The NOFO includes a Glossary on pages 54-59 that include the definition of a grant and a cooperative agreement. A Cooperative Agreement is a financial assistance award with the same kind of interagency relationship as a grant except that it provides for substantial involvement by the federal agency funding the award. Substantial involvement means that the recipient can expect federal programmatic collaboration or participation in carrying out the effort under the award.

Q38: Can grant funding be used to hire additional staff to support activities?

A: Yes.

Q39: In the NOFO, many places where text is blue and underlined, indicating it is a hyperlink, there is no actual hyperlink or there is a broken hyperlink. Can you provide those missing hyperlinks?

A: Hyperlinks below:

https://www.cdc.gov/nchhstp/atlas/index.htm
https://www.fsd.gov/gsafsd_sp
https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html
https://www.hhs.gov/civil-rights/for-providers/laws-regulations-guidance/laws/index.html
https://www.cdc.gov/std/statistics/2021/default.htm
https://www.gsa.gov/
https://sam.gov/
https://www.cdc.gov/grants/additional-requirements/ar-12.html
https://www.cdc.gov/os/integrity/reducepublicburden/index.htm

Q40: In the NOFO (page 4), it states that “ESSHCI is intended to establish a roster of pre-identified and pre-approved clinics for rapid funding to perform activities set forth by this funding opportunity. This NOFO will establish an Approved-But-Unfunded (ABU) list of recipients used to respond to programmatic and community needs as funds become available.” When will this roster be published and how can it be found?

A: This won’t be determined until after the objective review. Applicants will be notified if their application was approved but not funded. So, it’s to be determined as to whether it will be publicly available.

Q41: For mobile units could the funds be used for capital costs such as purchase of a mobile van or only operating costs?

A: Funds can be used for purchase of a mobile van. A mobile clinic van would be considered equipment, as it is over $5,000. There is no limit, but the cost should be reasonable.

Q42: Is there a preference on the clinic type? Can we apply for HIV primary care clinics, or women's health clinics? Or does it have to be primary care?

A: There is no preference.

Q43: I saw on the application that it was recommended that we partner with local, like for instance, county departments of public health. I'm assuming that's what's meant by jurisdiction if that could be clarified.

A: Yes, that is correct.

Q44: I know that partnerships, other collaborations, and partnerships are also encouraged. And I was wondering if you could speak more to that in terms of, you know, what you would look forward to seeing and what kind of partnerships you'd hope applicants are building.

A: Please refer to the NOFO for examples. They are included on pages 15 and 16.

Q45: Can we propose to provide telehealth services in other states if we don't have a standing agency in that state? For instance, if my main office in Las Vegas, Nevada, but I want to provide services to Arizona via telehealth, is that something we can do with this funding?

A: This is regulated by state licensure issues. If physicians are licensed in the other state, yes. Otherwise, you would need to check state licensure rules. Applicants must describe the population they are proposing to reach through telehealth services, and how individuals receiving services will access laboratory services.

Q46: Do we need to propose 3 activities for strategy C (1 for each activity listed under strategy C)?

A: No, it’s optional as to which activities under Strategy C that you propose activities for.

Q47: I'm interested in how strategies A and B relate. It seems that community needs and input should drive much of what is offered (or how its offered) in strategy B, but we won't necessarily know what those are until we have undertaken strategy A. Should we outline examples of what we think may come up during strategy A and how this would then impact strategy B?Q47: I'm interested in how strategies A and B relate. It seems that community needs and input should drive much of what is offered (or how its offered) in strategy B, but we won't necessarily know what those are until we have undertaken strategy A. Should we outline examples of what we think may come up during strategy A and how this would then impact strategy B?

A: You are correct that Strategy A efforts will inform some of the activities included in Strategy B. It is expected that Strategy A activities will happen concurrent with Activity B1. Please refer to the NOFO for additional details, include the timeline for Strategy A and B activities (pages 10-14).

Q48: If we are an HIV primary care clinic and have an STD clinic, does the org chart we provide need to be for the entire organization or just the project staff?

A: We would suggest that you submit an org chart for your entire organization. For reviewers, it’s helpful to see the big picture. And then in terms of your staffing plan, you can just submit for your staff.

Q49: Do we need to pick one of the named populations of focus, or can we propose one?

A: We ask that you choose one of the named populations of focus. If there is an additional population not named in the NOFO that you are interested in conducting activities with, you can include that in your application.

Q50: Is this the first time this NOFO has been offered? Or are there previous awardees?

A: This is a new NOFO, so there are no previous awardees.

Q51: Given that the PS20-2010 Component C funds are ending in May 2024, and we haven't heard about how those funds will be reallocated or if there will be a new NOFO and what that NOFO would look like, do you recommend that local health departments receiving Component C funds not apply for this NOFO because there is something coming in the next few months?

A: There will be another opportunity for EHE program funding in the future, but there is no guarantee that currently funded recipients will receive funding again.

Q52: Can the 90% of funds to the "clinic" be to a clinic system? Can it be to a formal or informal consortium of clinics at different agencies/providers?

A: No, funds cannot go to a clinic system. The NOFO asks each applicant to identify the priority population(s) they plan to focus on within their proposed clinic’s catchment area.

Q53: Can you share the link to the NOFO in grants.gov?

A: https://www.grants.gov/web/grants/view-opportunity.html?oppId=342737

Q54: Are there specific types of staffing that can be supported by the award--for example clinical navigators, PHI, other--is there specifications for object classes for the support--i.e., % of the award for staffing/travel/etc.?

A: The proposed staffing plan should support meeting the strategies and activities in the NOFO and will be reviewed based on those criteria.

Q55: Can you please define "equipment" for the funding restrictions? Are laptops and tablets for staff and clients to use permissible as they are under the $5000 equipment cap?

A: Please refer to the budget preparation guidance for additional information: https://www.cdc.gov/grants/documents/Budget-Preparation-Guidance.pdf

Laptops and tablets should be placed under supplies.

Q56: Can one application include multiple sites?

A: An agency that has multiple sites should only apply with one application (that includes each proposed location) if your agency only has one unique identifier. If each location has a unique identifier, you can submit separate applications. Please note that the average award is per application not number of locations in each application.

Q57: Does the funding differ if you Apply for A and B and not C? Or if you apply for A, B and C is the funding increased?

A: Funding for Strategy C activities is contingent on available federal funding and CDC’s programmatic priorities (outlined in Strategies and Activities for Y1). For Y1, the highest scoring applicants for Strategies A & B may also be funded for Strategy C.

Q58: Also, about the required letter from our "local public health organization" -- may we choose which one to use? (ex. County Health Dept. vs. State Health Dept.)

A: The letter should come from the state, county, city, local or territorial health department.

Q59: What is the best source of information for number STI clinics/million people in area? Should this include clinics providing any STI services or only comprehensive services?

A: Reporting both would be best. 1) # of basic STI care clinics and # of STI specialty clinics in the metropolitan statistical area (MSA), and 2) reporting the population of the MSA.

Q60: Are medications for STI's an allowable expense?

A: Per the NOFO, recipients may use funds to screen, diagnose, or treat STIs in persons who are uninsured and underinsured.

Q61: What are federal plain language guidelines and Clear Communication Index?

A: Please refer to the following: Federal Plain Language Guidelines- https://www.plainlanguage.gov/guidelines/

Clear Communication Index – The CDC Clear Communication Index | The CDC Clear Communication Index | Centers for Disease Control and Prevention

Q62: Will a support letter from Department of Health and Human Services suffice for the local public health support letter?

A: The letter should come from the state, county, city, local or territorial health department.

Q63: Are STI clinics not receiving EHE Component C funding prioritized over those currently receiving funding?

A: NOFO funding is provided for clinical services and preference may be given to applicants based on the factors identified on page 43 under Phase III Review.

Q64: Page 48 describes the Recipient Evaluation and Performance Measurement Plan and says it should provide additional detail on: “How evaluation reports will be published on a publicly available website.” Does this refer to our organizational website or to the CDC website or some other website?

A: This refers to your organizational website.

Q65: Is there going to be any discussion of how to work as a team in Grants.gov? Or are those questions supposed to be directed elsewhere?

A: Grants.gov was only utilized to announce the NOFO and submit the application. Not clear what the question is regarding working as a team. If you need additional clarification, please reach out to Ted Castellanos at ipq1@cdc.gov.

Q66: We have multiple clinics in adjacent counties in one metro area, operating under one UEI. Could we include all clinics in our service region, or are we limited to multiple clinics in a single county?

Q67: Are states able to collaborate to provide services? (i.e., SD and ND coming together to provide services)

A: Yes, states can collaborate; however, there would need to be one lead state applicant for us to be able to award. Please reach out to Ted Castellanos ipq1@cdc.gov for further clarification or questions.

Q68: In terms of data sharing, what level of detail is expected to be shared, while adhering to HIPAA?

A: Recipients will be required to report aggregate patient outcome data to CDC, stratified by demographics and priority populations. See pages 19-20 of the NOFO for proposed measures.

Q69: If we are offering services in a metro area that straddles two states, and our providers are licensed in both states, do we need letters of agreement from both states or just the one where we are headquartered?

A: For the application, where headquartered should be sufficient.

Q70: Could this funding be used to help fund an upcoming Pilot STI projects (not clinical trials)?

A: NOFO funding is provided for clinical services and preference will be given to applicants who meet the factors identified on page 43 under Phase III Review. As a reminder, to be eligible for strategy C, you must apply for strategies A and B. Reach out to Ted Castellanos ipq1@cdc.gov for additional clarification. As a reminder, this is not a research NOFO.

Q71: What is the expected project period start date? If funding is announced September 2023, would it be October 2023?

A: The estimated award date is September 29, 2023. Depending on funding, project period would begin shortly thereafter. For purposes of workplan and budget development, applicants may use October 1, 2023, as start date.

Q72: Any estimation on whether this funding opportunity might be proposed for continuation/recompete after the first 5-year cycle? Obviously, budget-dependent, but ideally?

A: At this point, we can only provide what has been currently approved for release. We cannot predict future funding or initiatives that will be supported.

Q73: Many clinic H80 PCHP grants expired this year following their first 3-year cycle. That grant allowed for purchase of ARV/PrEP starter packs. This CoAg prohibits that, but is that a potential exception for discussion?

A: CDC funds cannot be used to cover the costs of antiretroviral medication, including PrEP.

Q74: In a jurisdiction where the public health department is applying for the grant, will it affect the application of a clinic?

A: NOFO funding is provided for clinical services and preference will be given to applicants who meet the factors identified on page 43 under Phase III Review. Reach out to Ted Castellanos ipq1@cdc.gov for additional clarification.

Q75: On page 4 of the NOFO states "This NOFO will establish an Approved- But-Unfunded (ABU) list of recipients used to respond to programmatic and community needs as funds become available." Are you planning to make 25 awards this cycle or will an application only get us on the ABU list?

A: The number of awards will depend on the funds available for this initiative.

Q76: Is there a CDC template for the evaluation and performance measurement plan for the ESSHCI NOFO?

A: No, use your own formatting for the submission.

Q77: Will recipients be able charge for STI services? The revenue generated by the ESSHCI program will enable us to continue to provide services after the cooperative agreement ends. Can we apply for strategies A, B, and C in our application?

A: There are no restrictions on whether you can charge for services. Yes, you can apply for all three strategies.