DP20-2002: Questions and Answers Part 4
We are planning to include a part-time patient navigator as part of our CRCCP staff (for example, in addition to the Program Director and Data Manager), as we have done in the past (2009 to 2015). Is there any reason why this approach would not fall within CDC guidelines for the current NOFO?
Patient navigators may be used to help patients overcome barriers and support adherence to screening completion (such as ensuring return of FITs), follow-up testing (colonoscopy), initiation of cancer treatment if needed, and to support implementation of required clinic-based evidence-based interventions. Use of patient navigators is not a programmatic requirement.
Should the funding amount for the anticipated (small) number of potential free colonoscopies for patients at the two partner clinics be included in the budget?
Recipients may use limited funds with CDC approval to pay for follow-up colonoscopies for asymptomatic uninsured or underinsured adults age 50 to 75 who are screened for colorectal cancer by their partner clinics. Funds may not be used to pay for colonoscopies to evaluate or diagnose symptomatic patients. Follow-up colonoscopies are not a programmatic requirement.
We are drafting our budget for the application and would like clarification on restricted items. Can we purchase computer equipment (laptop or desktop) for project staff? Can funds be used to purchase items for the office workspace (such as a desk or chair)? We were unsure due to the listed funding restrictions in bullet 4.
Applicants can propose reasonable costs. However, the intent is for awarded funds to be used to carry out program implementation requirements, not build capacity or infrastructure. Funded recipients will receive additional guidance and technical assistance.
Within the current NOFO, would it be appropriate to designate a small part of the budget to ongoing work with our existing partner clinics (in other words, continuing to fund an initiative related to the use of navigation to address barriers within those clinics) with whom we partnered for the 2015 to 2020 Colorectal Cancer Control Program?
Applicants may determine which activities and interventions to implement that will fit their target population(s) best as well as which partners can serve that population best.
Does this award operate similar to National Breast and Cervical Cancer Early Detection Program requiring minimum data elements submissions? Page 9 of the Notice of Funding Opportunity identifies a clinic-level data requirement. Will DP20-2002 require patient-level or clinic-level data to be reported?
Clinic level data must be reported as described in the Notice of Funding Opportunity. Patient-level data will not be reported, but recipients may need to use such data for program implementation. Funded recipients will be provided additional guidance related to reporting requirements.
The published Informational conference call on page 23 of the Notice of Funding Opportunity does not indicate if there is a playback for interested parties that were unable to be on the original call. Is this available?
The calls were not recorded. Question and answer documents have been posted to the DP20-2002 website.
Can CDC furnish the Medicare reimbursement rate that will be allowed? Are both the professional component for the surgeon and anesthesiologist or anesthetist allowable? Is a facility fee allowable?
Applicants should provide their best guess based on prevailing Medicare fees for all costs related to obtaining a colonoscopy. Additional guidance will be provided to funded recipients.
In rural areas that do not have a hospital with a qualified gastroenterology provider to perform colonoscopies, low-income and uninsured patients who have to travel significant distances for colonoscopy services may be concerned about the side effects of the bowel prep. As part of travel expense, could a single night stay at a hotel be provided so the patient can perform the bowel prep at a site close to the hospital where the colonoscopy will be performed, so they will not spend a long time in a vehicle without access to bathroom facilities following prep?
Applicants can propose reasonable costs. Funded recipients will receive additional guidance and technical assistance.
For the CDC-RFA-DP20-2002 grant submission, can you clarify what are “CDC Assurances and Certifications” and “Report on Programmatic, Budgetary and Commitment Overlap”?
Applicants can find full information on CDC Assurances and Certificates at CDC’s Grant Assurances Homepage. Applicants should refer to “Duplication of Efforts” on pages 24 and 25. Applicants are responsible for reporting if this application will result in programmatic, budgetary, or commitment overlap with another application or award (grant, cooperative agreement, or contract) submitted to another funding source in the same fiscal year. Programmatic overlap occurs when substantially the same project is proposed in more than one application or is submitted to two or more funding sources for review and funding consideration, or a specific objective and the project design for accomplishing the objective are the same or closely related in two or more applications or awards, regardless of the funding source. Budgetary overlap occurs when duplicate or equivalent budgetary items (such as equipment or salaries) are requested in an application but already are provided by another source. Commitment overlap occurs when an individual’s time commitment exceeds 100 percent, whether or not salary support is requested in the application. Overlap, whether programmatic, budgetary, or commitment of an individual’s effort greater than 100 percent, is not permitted. Any overlap will be resolved by the CDC with the applicant and the program director or principal investigator prior to award. Report submission: The applicant must upload the report in Grants.gov under “Other Attachment Forms.” The document should be labeled “Report on Programmatic, Budgetary, and Commitment Overlap.”
The guidance allows optional attachments. Do we include these in the “other attachments” form, which is not automatically checked but looks like it’s available? Are there any page limits for the attachments?
There is no page limit for attachments, but applicants should limit their upload to required attachments such as the risk assessment questionnaire, letters of support, and the optional attachments listed under Section H. Other Information (page 45 and 46). These documents may be uploaded under “Other Attachments” with a naming convention that easily identifies them.
Are you accepting applications for this from non-profit healthcare networks as the primary awardee?
CDC-RFA-DP20-2002 Public Health and Health Systems Partnerships to Increase Colorectal Cancer Screening in Clinical Settings is full, open competition.
To whom should we address the letters of support?
The LOS can simply be addressed to CDC (see page 25) as there are no published guidelines.
In the Notice of Funding Opportunity (NOFO) the ceiling is $900,000, is this in direct costs or does this ceiling also include indirect costs? Also, the principal investigator is proposing use of some of the funds to issue mini grants to service providers for activities such as increased screening participation, data collection, and clinical capacity evaluation. Are mini grants allowable under this NOFO?
The ceiling includes both direct and indirect costs. Mini grants are not allowable. However, partnerships and contracting with external organizations are allowable under this NOFO.
May we use National Institutes of Health bio-sketches for key personnel? Or should they be full CVs?
Either the NIH biosketches or full CVs are acceptable.
Is there a limit to the number of partnerships with health systems or clinics? For example, on page 11 we are instructed to provide letters of support from at least two primary clinics or one health system. Can we plan to work with 3 health systems?
At a minimum, applicants should propose to partner with at least 2 separate primary care clinics that provide services to adults, or one health care system with at least 2 primary care clinic sites that provide services to adults. Applicants can propose to work with additional partners.
If awarded, can health system partners be added later in the award, for example in year 2, that were not identified in the application?
Working with CDC, funded recipients could decide to work with different partners in subsequent years of program implementation.
Is the expectation that the evidence-based interventions (EBIs) are implemented concurrently, or can we take a phased approach to planning EBI implementation? For example, in phase one of the project, focus on improving data quality and implementing provider assessment and feedback, and in phase two focus on implementing provider reminders?
The programmatic expectation is that funded recipients will implement at least 2 of the 4 recommended EBIs. However, implementation of additional interventions could occur over the course of the 5-year project period. If needed, funded recipients will receive guidance and technical assistance related to program implementation timelines.
Is a logic model required in the Evaluation and Performance Measurement Plan section of the application? Or would it be developed and included in the plan submitted 6 months after the award date?
The logic model is due within six months of award.
Does the 12-point font requirement also apply to the workplan, or could that section be reduced to a 10-point font? Can the workplan be formatted for landscape orientation?
The format requirements do not apply to the template. However, applicants are cautioned that making the margins too small may affect printing, and making the font too small may make it difficult for reviewers when reading. Landscape orientation is acceptable.
Under 2. Additional Eligibility, it states that the award ceiling for this NOFO is $900,000 and any request above that will be non-responsive. So, are we to conclude that we are completing the SF424a budget with ONLY the FIRST year’s budget amounts? We are not putting the whole 5-year period funding totals. Correct?
Correct. Please enter the information for the first budget period into form SF-424A.
The amount in SF424a Budget form Section A, line one “Federal e” should only be the total of year one or the five-year total?
Enter the total for the first budget period.
Is the only place we are able to put subsequent year funding amounts in the SF424a budget in Section E- Budget estimates of federal funds needed for Balance of the project? Please confirm.
Yes, enter estimates for the remaining budget periods in Section E.
Budget justification: Do we need to address the FIRST year funding activity only? Do we need a total project dollar amount if we propose a 5-year project at the end as well?
Provide the narrative for the first budget period. Subsequent narratives will be required with continuation applications each budget period.
On the SF424 Application form Section 17, should we enter FIVE-YEAR PROJECT PERIOD such as: 7-1-20 to 6-30-2025? Or just a ONE-year project period even though we are planning for 5?
Enter the start and end dates for the entire project period, which is 5 years: 6/30/2020 to 6/29/2025.
On the SF424 Application form Section 18, should the amount in “g Total” equal the amount listed in SF424a in Section B – k. Totals?
Yes. Both sections should indicate the total budget year 1 funding.
We are a tribal organization that is planning to implement program activities in community primary care clinics with several partner tribal organizations (which include more than one tribe, since every community is a tribe in our state). As we read this, we are concerned that reviewers scoring our application will award us 0 out of 10 points because of the planned structure of our program, even though this is similar to a university working with several health systems and their associated primary care clinics. We want to make sure we are eligible and compliant with all the review selection criteria and do not lose points. Could you please confirm whether this planned structure would be responsive to the NOFO? And if so, is there a way we should state it such that reviewers do not accidentally consider us non-responsive to this criterion?
If the defined target population is served by the health systems or clinics your organization plans to partner with, and those health systems or clinics also provide services to other tribes, that is fine. Your organization may partner with other tribes that have overlapping target populations. Your organization shouldn’t partner with other tribes with the specific intent of expanding the target population.
What “follow-up colonoscopy” billing codes are acceptable for provider reimbursement with DP20-2002 funds?
Funded recipients will receive additional program guidance. Applicants should use their best estimate, keeping in mind that reimbursement for colonoscopy may not exceed the Medicare rate and that program funds must be used as the payment of last resort.
Are high-risk patients (those with a first degree relative with colorectal cancer) eligible for “follow-up colonoscopy” per the CDC definition?
Ideally, colorectal cancer screening protocols in partner clinics should follow national guidelines or recommendations from the U.S. Preventive Services Task Force, the American Cancer Society, or the National Comprehensive Cancer Network. People at increased or high risk are generally recommended to have a colonoscopy as the initial screening test. If the provider determines, per national guidelines or recommendations, that any recommended screening test is acceptable, and the screening test is positive or abnormal, then CDC funds may be used to pay for a follow-up colonoscopy.
What is the operational definition for the intermediate outcome, “number of cancers prevented?”
One measure of “number of cancers prevented” is the number of patients with adenomatous polyps removed. DP20-2002 only requires that awardees report, via CDC’s clinic data, the number of patients receiving follow-up colonoscopies using CDC funds with a result of adenomatous polyps. We recognize that this would only represent a subset of patients at CRCCP clinics since other patients would likely receive colonoscopies paid for with non-CDC resources. CDC does not require awardees to provide any other measure for this outcome.
Is it necessary to include a recipient logic model within the application? Or will the recipient be required to submit a logic model with its evaluation plan 6 months post-award?
The logic model is due within six months of the award.
Are applicants to propose performance measures or indicate readiness to comply with CDC provided or required performance metrics?
The work plan “integrates and delineates more specifically how the recipients plans to carry out achieving the period of performance outcomes, strategies and activities, evaluation and performance measurement” (page 28). Applicants should address the activities as described in the NOFO and program outcomes as indicated in the logic model on page 4. Applicants may choose to provide additional outcomes to illustrate how proposed activities will lead to the primary program outcome.
Can you confirm that formal agreements with partners are not needed for application submission?
Applicants are required to submit letters of support from proposed partners.
Strategy 3: page 6 indicates CDC will review readiness assessment results prior to the implementation of evidence-based interventions (EBIs). Can you describe for what purpose, to what end, implications, timeframe estimation for this? Will EBI implementation take place in the first year?
CDC expects that implementation of EBIs will start within the first year. Additional guidance regarding processes and timelines for the submission and review of clinic readiness assessments will be provided to recipients after funds are awarded.
Is patient navigation considered part of the Reducing Structural Barriers evidence-based intervention (EBI) or separate? If separate, can you confirm that the application of patient navigators (PNs) regarding EBI implementation is an expectation for all recipients?
Patient navigators may be used to help patients overcome barriers and support adherence to screening completion (such as, ensuring return of FITs), follow-up testing (colonoscopy), initiation of cancer treatment if needed, and to support implementation of required clinic-based EBIs. Patient navigators may be used to facilitate screening and reduce barriers to colonoscopy completion regardless of the source of payment for the colonoscopy, such as educating patients about the procedure, assisting with scheduling, providing instructions for bowel preparation, providing appointment reminders, assisting with transportation or translation services, and performing other related activities.
Strategy 5: What are the eligibility requirements for patients to receive support for follow-up colonoscopies? Page 31 says funds may not be used for clinical care. Is this a required strategy and will these cases be reported in Cast?
All applicants must describe how they will facilitate linkage to follow-up colonoscopy regardless of whether the applicant intends to use awarded funds to support this activity. All applicants must describe how they will secure treatment resources for patients who are diagnosed with cancer or who need additional evaluation or treatment. Recipients may use limited funds with CDC approval to pay for follow-up colonoscopies for asymptomatic uninsured or underinsured adults age 50 to 75 who are screened for colorectal cancer by their partner clinics. Funds may not be used to pay for colonoscopies to evaluate or diagnose symptomatic patients. Recipients may use awarded funds to pay for a colonoscopy following a positive or abnormal test result if these tests were ordered or performed by a partner clinic for the purpose of screening asymptomatic adults for colorectal cancer. Colonoscopies provided by the program should meet national quality standards and reimbursement may not exceed the Medicare rate. Funded recipients will receive additional guidance related to follow-up colonoscopies as well as reporting requirements should funds be used to pay for follow-up colonoscopies.
“Applicants must provide a detailed work plan that covers the first year of the period of performance and a high-level plan for subsequent years. At a minimum, the work plan must demonstrate how the strategies, activities, and staffing/partnerships work together to achieve program outcomes. Information on performance measures, data sources, and data collection should be included. Please use the template above when describing your work plan. A sample work plan template can be found at https://www.cdc.gov/cancer/crccp/dp20-2002.htm” Does this mean we need to submit two separate work plan templates, or can we do one work plan template that covers the five grant years? If we have to do two work plans, will it count towards the 20-page limit for the narrative and work plan?
The work plan is part of the 20-page limit for the project narrative. Applicants are encouraged to use the template for the detailed work plan for year 1. However, it is up to the applicant to determine how to address the requirement for a higher-level work plan for years 2 through 5, either in the template or a narrative form, while staying within the page limit.
Is there a page limit for attachments?
While there is no page limit, applicants should limit their upload to required attachments such as the risk assessment questionnaire, letters of support and the optional attachments listed under Section H. Other Information on pages 45 and 46.
In addition to the two letters of support required from partners, are additional letters of support encouraged, for example, from other CDC-funded programs and additional collaborators? If additional letters are appropriate, would they be uploaded with the two required letters of support?
Yes, all letters of support should be uploaded per the instructions on pages 11 and 12.
Should a draft of the actual readiness tool, rather than just a description, be included?
At a minimum, applicants should describe how they will conduct implementation readiness assessments of participating health clinics.
We were unable to find the additional details about the readiness tool (on the resource webpage) using the suggested links. Can CDC provide additional information on where to find those details?
Could CDC provide additional details on the manual chart review? Given patient confidentiality concerns, can award funding be used to support partner clinic staff to do the chart review, under awardee supervision? Additionally, is a manual chart review necessary for existing partners?
Additional programmatic guidance and information will be provided to funded recipients.
Applicants will submit an initial Evaluation and Performance Measurement Plan followed by a more detailed Evaluation and Performance Measurement Plan within the first six months for awardees. Should the logic model be included with the initial Evaluation and Performance Measurement Plan, and if so, is it part of the narrative or can it be uploaded as an attachment?
Funded recipients will be required to submit their logic model within six months of award. The logic model is not required.