[Federal Register Volume 59, Number 66 (Wednesday, April 6, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-8174]


[[Page Unknown]]

[Federal Register: April 6, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[Announcement Number 424]
RIN 0905-ZA36

 

State-Based Programs to Reduce the Burden of Diabetes: A Health 
Systems Approach; Notice of Availability of Funds for Fiscal Year 1994

Introduction

    The Centers for Disease Control and Prevention (CDC), announces the 
availability of fiscal year (FY) 1994 funds for new applications for 
cooperative agreements to develop, implement, and evaluate State-based 
diabetes control programs (DCPs). The program is designed to establish 
the DCP as a key component of an evolving health care environment. The 
conceptual framework within which successful applicants should operate 
is characterized by four areas of program activity: (1) Defining the 
nature, extent, distribution, and causes of the burden of diabetes; (2) 
Developing new, effective approaches for reducing the diabetes burden 
which complement emerging health care systems; (3) Implementing 
specific measures to ensure the widespread application of accepted 
standards, policies, and protocols to reduce the burden of diabetes; 
and (4) Coordinating the diabetes-related efforts of the public health 
system with private health care providers and payers, as well as with 
all appropriate governmental, voluntary, professional, and academic 
institutions.
    This announcement addresses two distinct levels of program support, 
both of which are consistent with the conceptual framework described 
above. The first is a Core Capacity Program, which defines basic 
diabetes prevention and control activities to be carried out through 
existing and evolving health care systems. The second is an Enhanced 
Program, which is intended to introduce additional, innovative elements 
to a State's diabetes prevention and control efforts, and is also 
carried out through existing and evolving health care systems.
    The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of Healthy People 
2000, a PHS-led, national activity to reduce morbidity and mortality 
and improve the quality of life. This announcement is primarily related 
to Priority Area 17, Diabetes and Chronic Disabling Conditions--with 
particular attention to populations at disproportionate risk of 
developing diabetes, including minorities and the elderly. However, it 
also is relevant to other priority areas, including Physical Activity 
and Fitness, Nutrition, Tobacco, Educational and Community-Based 
Programs, Maternal and Infant Health, Heart Disease and Stroke, 
Clinical Preventive Services, and Surveillance and Data Systems. (To 
order a copy of Healthy People 2000, see the section WHERE TO OBTAIN 
ADDITIONAL INFORMATION.)

Authority

    This program is authorized under sections 301(a) and 317(k)(3) [42 
U.S.C. 241(a) and 247b (k) (3)] of the Public Health Service Act. 
Applicable program regulations are found in 45 CFR part 92.

Smoke-Free Workplace

    The Public Health Service strongly encourages all grant recipients 
to provide a smoke-free workplace and promote the non-use of all 
tobacco products. This is consistent with the PHS mission to protect 
and advance the physical and mental health of the American people.

Eligible Applicants

    Eligible applicants are the official public health agencies of 
States or their bona fide agents or instrumentalities. This includes 
the District of Columbia, American Samoa, the Commonwealth of Puerto 
Rico, the U. S. Virgin Islands, the Federated States of Micronesia, 
Guam, Northern Mariana Islands, the Republic of the Marshall Islands, 
and the Republic of Palau.

Availability of Funds

    Approximately $9,750,000 is available in FY 1994 to fund 
approximately 42 awards in two categories (Core Capacity Programs and 
Enhanced Programs).

A. Core Capacity Program to Reduce the Burden of Diabetes

    Approximately $8,750,000 is available to fund approximately 40 
awards for Core Capacity Programs. It is expected that the average 
award will be $230,000, ranging from $150,000 to $350,000.

B. Enhanced Program to Reduce the Burden of Diabetes

    Approximately $1,000,000 is available to fund approximately 2 
awards for Enhanced Programs. It is expected that the average award 
will be $500,000, ranging from $300,000 to $700,000. Enhanced Program 
awards will only be considered for those applicants who compete 
successfully and are funded for Core Capacity Program awards.
    It is expected that awards will begin on or about July 1, 1994, and 
will be made for a 12-month budget period within a project period of up 
to 5 years. Funding estimates may vary and are subject to change.
    Continuation awards within the project period will be made on the 
basis of satisfactory progress and availability of funds.
    At the request of the applicant, Federal personnel may be assigned 
to a project in lieu of a portion of the financial assistance.

Purpose

    The purpose of this program is to provide financial and 
programmatic assistance to States and territories for integrating 
diabetes prevention and control activities within existing and evolving 
health care systems.

Program Requirements

    The program described in this announcement reflects a significant 
shift by the DCP from the direct provision of personal health services 
to a responsibility for leadership and coordination of overall efforts 
of the health system to reduce the burden of diabetes. Both a Core 
Capacity Program and an Enhanced Program are conceptualized by the four 
categories of program activity described under INTRODUCTION in this 
announcement. The central objective of a Core Capacity Program is to 
assist the State to establish the basic public health framework for 
leading and coordinating the efforts of the health care system and 
other public and private resources to reduce the burden of diabetes. A 
Core Capacity Program must address all four categories of program 
activity.
    An established Core Capacity Program is the foundation on which an 
Enhanced Program is built. The central objective of an Enhanced Program 
is to move the State program vigorously into a position from which it 
can take the lead in ensuring that diabetes-specific, community 
preventive health services are an integral part of a reformed health 
system. An Enhanced Program must involve the addition of innovative 
approaches not employed in the Core Capacity Program to reduce the 
burden of diabetes. Simple expansion of Core Capacity Program 
activities does not constitute an Enhanced Program.
    A recipient of an award for an Enhanced Program may choose to focus 
its initial enhancement efforts on fewer than all four of the basic 
categories of program activity. However, at a minimum, the recipient 
must indicate that activities will be undertaken in the first budget 
year related to (1) defining the burden of diabetes and (2) 
coordinating the overall effort to reduce the diabetes burden. It is 
expected that each Enhanced Program will be fully operational, 
including all four categories, within four years of the State's initial 
Enhanced Program award.
    In conducting activities to achieve the purpose of this program, 
the recipient shall be responsible for the activities described under 
A., below, and CDC shall be responsible for carrying out the activities 
described under B., below.

A. Recipient Activities

    1. Define and monitor the burden of diabetes through the 
establishment and maintenance of a State-based surveillance system 
which focuses on diabetes as a public health problem.
    2. Develop new approaches to reduce the burden of diabetes through 
the development or adaptation of specific interventions to be applied 
within the existing and evolving health care system.
    3. Implement specific measures to reduce the burden of diabetes by 
ensuring the widespread application of accepted standards, policies, 
and protocols developed for that purpose. These should include 
protocols designed to prevent or postpone the occurrence of the major 
complications of diabetes, as well as diabetes-related cardiovascular 
disease. In addition, they should include protocols to ensure that 
persons with diabetes improve their efforts to achieve levels of 
glycemic control consistent with the results of the Diabetes Control 
and Complications Trial (DCCT).
    4. Coordinate overall program efforts of the health system to 
reduce the burden of diabetes through the establishment of appropriate 
linkages with other governmental agencies; private health care 
providers; academic institutions; community-based organizations; 
voluntary agencies; health care reimbursement organizations; national 
organizations representing populations disproportionately burdened by 
diabetes, such as minorities and the elderly; and others.

B. CDC Activities

    1. Define and monitor the burden of diabetes by providing technical 
assistance in the development of surveillance and other data systems to 
measure and characterize the burden of diabetes and its complications.
    2. Develop new approaches for reducing the burden of diabetes 
through the provision of program guidelines for, and technical 
assistance in, the development or adaptation of specific interventions 
to be applied within the existing and evolving health care system.
    3. Implement specific measures to reduce the burden of diabetes 
through the provision of program guidelines for, and by collaborating 
in the implementation of, accepted standards, policies, and protocols 
within the existing and evolving health care system.
    4. Coordinate overall program efforts of the health care system to 
reduce the burden of diabetes through the provision of program 
guidelines, and by facilitating communication among DCPs and with other 
governmental agencies, private health care providers, academic 
institutions, community-based organizations, voluntary agencies, health 
care reimbursement organizations, and others, to assist them in 
ensuring optimal coordination among all components of the public health 
and health care systems to address the burden of diabetes.
    Evaluation Criteria (Total 100 Points for Core Capacity Program and 
100 Points for Enhanced Program)
    Applications for Core Capacity Program support will be reviewed and 
evaluated according to the following criteria:

A. Background and Need for the Core Capacity Program

    The extent to which the need is demonstrated, including adequate 
documentation of the barriers to diabetes care and education and the 
degree of experience the applicant has in each of the four areas of 
program activity (Define, Develop, Implement, and Coordinate). (20 
points)

B. Core Capacity Program Work Plan

    For each of the four areas of program activity, the Core Capacity 
Work Plan will be evaluated in terms of the following items (80 
points):
    1. Objectives. The extent to which work plan objectives are 
measurable, feasible, appropriate, and specific, and are identified for 
all four areas of program activity (Define, Develop, Implement, and 
Coordinate). (25 points)
    2. Methods. The feasibility, appropriateness, and specificity of 
the proposed methods for achieving the stated objectives and are 
related to the four areas of program activity (Define, Develop, 
Implement, Coordinate). (25 points)
    3. Evaluation Plan. The feasibility and appropriateness of the 
proposed plan for evaluating progress toward attainment of the stated 
objectives and are related to the four areas of program activity 
(Define, Develop, Implement, Coordinate). (25 points)
    4. ``Milestones to Completion'' Chart. The completeness of the 
chart describing the timeline and milestones leading to attainment of 
the stated objectives for each of the four areas of program activity 
(Define, Develop, Implement, Coordinate). (5 points)

C. Core Capacity Program Budget

    The extent to which this budget is adequately justified, 
reasonable, and consistent with this program purpose and objectives. 
(Not Weighted)
    Applications for Enhanced Program support will be reviewed and 
evaluated according to the following criteria:

A. Background and Need for the Enhanced Program

    The extent to which the need is demonstrated, including adequate 
documentation of the barriers to diabetes care and education and the 
degree of experience the applicant has in each of the four areas of 
program activity (Define, Develop, Implement, and Coordinate). (20 
points)

B. Enhanced Program Work Plan

    For each of the four areas of program activity, the Enhanced 
Program Work Plan will be evaluated in terms of the following items (80 
points):
    1. Objectives. The extent to which work plan objectives are 
measurable, feasible, appropriate, and specific, and are identified for 
all four areas of program activity (Define, Develop, Implement, and 
Coordinate). (25 points)
    2. Methods. The feasibility, appropriateness, and specificity of 
the proposed methods for achieving the stated objectives and are 
related to the four areas of program activity (Define, Develop, 
Implement, Coordinate). (25 points)
    3. Evaluation Plan. The feasibility and appropriateness of the 
proposed plan for evaluating progress toward attainment of the stated 
objectives and are related to the four areas of program activity 
(Define, Develop, Implement, Coordinate). (25 points)
    4. ``Milestones to Completion'' Chart. The completeness of the 
chart describing the timeline and milestones leading to attainment of 
the stated objectives for each of the four areas of program activity 
(Define, Develop, Implement, Coordinate). (5 points)

C. Enhanced Program Budget

    The extent to which this budget is adequately justified, 
reasonable, and consistent with this program purpose and objectives. 
(Not Weighted)

Funding Priority

    Priority will be given to applications directed to those providers 
and systems which serve population groups disproportionately impacted 
by diabetes and its complications. These populations include certain 
racial and ethnic minorities (African Americans, Hispanic Americans, 
American Indians, and Asian-Pacific Islanders), the elderly, and the 
economically disadvantaged.
    Public comments are not being solicited regarding the funding 
priority because time does not permit solicitation and review prior to 
the funding date.

Executive Order 12372 Review

    Applications are subject to Intergovernmental Review of Federal 
Programs as governed by Executive Order (E.O.) 12372. E.O. 12372 sets 
up a system for State and local government review of proposed Federal 
assistance applications. The applicant should contact its State Single 
Point of Contact (SPOC) as early as possible to alert it to the 
prospective applications and receive any necessary instructions on the 
State process. For proposed projects serving more than one State, the 
applicant is advised to contact the SPOC for each affected State. A 
current list of SPOCs is included in the application kit. If SPOCs have 
any State process recommendations on applications submitted to CDC, 
they should forward them to Elizabeth M. Taylor, Grants Management 
Officer, Grants Management Branch, Procurement and Grants Office, 
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry 
Road, NE., room 305, Mailstop E-16, Atlanta, GA 30305, no later than 60 
days after the application deadline. The granting agency does not 
guarantee to ``accommodate or explain'' State process recommendations 
it receives after that date.

Public Health System Reporting Requirements

    This program is not subject to the Public Health System Reporting 
Requirements.

Catalog of Federal Domestic Assistance Number

    The Catalog of Federal Domestic Assistance number is 93.988.

Other Requirements

Paperwork Reduction Act

    Projects that involve the collection of information from 10 or more 
individuals and funded by the cooperative agreement will be subject to 
review by the Office of Management and Budget (OMB) under the Paperwork 
Reduction Act.

Application Submission and Deadline

    The program announcement and application kit were sent to all 
eligible applicants in February 1994.

Where To Obtain Additional Information

    Business management technical assistance including information on 
application procedure and copies of application forms may be obtained 
from Bernice A. Moore, Grants Management Specialist, Grants Management 
Branch, Procurement and Grants Office, Centers for Disease Control and 
Prevention (CDC), 255 East Paces Ferry Road, NE., room 305, Mailstop E-
16, Atlanta, GA 30305, telephone (404) 842-6802.
    Programmatic technical assistance may be obtained from Stephen 
DePaul, Program Services Branch, Division of Diabetes Translation, 
National Center for Chronic Disease Prevention and Health Promotion, 
Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, 
NE., Mailstop K-10, Atlanta, GA 30341, telephone (404) 488-5046.
    Please refer to Announcement Number 424 when requesting information 
and submitting an application.
    Potential applicants may obtain a copy of Healthy People 2000 (Full 
Report: Stock No. 017-001-00474-0) or Healthy People 2000 (Summary 
Report: Stock No. 017-001-00473-1) referenced in the INTRODUCTION 
through the Superintendent of Documents, Government Printing Office, 
Washington, DC 20402-9325, telephone (202) 783-3238.

    Dated: March 31, 1994.
Robert L. Foster,
Acting Associate Director for Management and Operations, Centers for 
Disease Control and Prevention (CDC).
[FR Doc. 94-8174 Filed 4-5-94; 8:45 am]
BILLING CODE 4163-18-P