cdc-rfa-ip15-1502pphf15 07 28 15 final.pdf

Centers for Disease Control and Prevention

National Center for Immunization and Respiratory Diseases

Increasing Awareness and Implementation of the Standards for Adult Immunization Practice Through Partnerships With State and Local Immunization Programs - Financed Solely by PPHF 2015 Prevention and

Public Health Funds.

CDC-RFA-IP15-1502PPHF15

Application Due Date: 07/30/2015

Increasing Awareness and Implementation of the Standards for Adult Immunization Practice Through Partnerships With State and Local Immunization Programs - Financed Solely by PPHF 2015 Prevention and

Public Health Funds.

CDC-RFA-IP15-1502PPHF15

TABLE OF CONTENTS

Part I. Overview Information

Federal Agency NameA.

Funding Opportunity TitleB.

Announcement TypeC.

Agency Funding Opportunity NumberD.

Catalog of Federal Domestic Assistance (CFDA) NumberE.

Dates F.

Executive Summary G.

Part II. Full Text

Funding Opportunity Description A.

Award Information B.

Eligibility Information C.

Required Registrations D.

Review and Selection Process E.

Award Administration Information F.

Agency Contacts G.

Other Information H.

Glossary I.

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-IP15-1502PPHF15. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) B. Funding Opportunity Title:

Increasing Awareness and Implementation of the Standards for Adult Immunization Practice Through Partnerships With State and Local Immunization Programs - Financed Solely by PPHF 2015 Prevention and Public Health Funds.

C. Announcement Type: New - Type 1 This announcement is only for non-research domestic activities supported by CDC. If research is proposed, the application will not be considered Research for this purpose is defined at http://www.cdc. gov/od/ science/ integrity/ docs/cdc- policy- distinguishing- public- health- research-nonresearch. pdf.

non-research only

D. Agency Funding Opportunity Number:

CDC-RFA-IP15-1502PPHF15

E. Catalog of Federal Domestic Assistance (CFDA) Number:

93.733 F. Dates:

1. Due Date for Letter of Intent (LOI):

2. Due Date for Applications:

[Insert 10 days from date of publication] 07/30/2015, 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Date for Informational Conference Call: N/A

G. Executive Summary:

1. Summary Paragraph:

This FOA is intended to support state and local immunization programs to collaborate with 1. community health centers, 2. pharmacies/ pharmacists, and 3. either clinical practice groups or large healthcare systems and organizations to improve and expand the implementation of the Adult Immunization Standards (aka "the Standards"), specifically to:

1. increase the routine clinical practice of healthcare providers (HCP) assessing immunizations needs among all of their adult patients,

2. improve and expand HCP recommendation to their adult patients to get all Advisory Committee on Immunization Practices (ACIP) recommended immunizations,

3. improve the ability and process for HCP to either provide the ACIP recommended adult immunizations in their practice settings or refer their adult patients to other HCP who can provide these recommended adult immunizations, and

4. document administration of adult immunizations in immunization information systems for all of their adult patients.

This FOA is also intended to support state and local immunization programs to develop and implement processes to best utilize Section 317 vaccine purchase funds to increase delivery of all ACIP adult recommended immunizations to uninsured adults.

a. Eligible Applicants: Limited

b. FOA Type: Cooperative Agreement

c. Approximate Number of Awards: 10

d. Total Project Period Funding: $10,000,000

e. Average One Year Award Amount: $1,000,000

f. Number of Years of Award: 2

g. Estimated Award Date: 09/01/2015

h. Cost Sharing and / or Matching Requirements: N

Part II. Full Text A. Funding Opportunity Description

1. Background

a. Overview http://foa.grantsolutions.gov/announcementmodule/www.grants.gov http://foa.grantsolutions.gov/announcementmodule/www.grants.gov http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf http://www.grants.gov

1. Background

a. Overview

Adult vaccination rates are well below the national Healthy People 2020 goals and racial and ethnic disparities in vaccination coverage rates among adults are substantial. Barriers that exist for improving vaccination rates in adults include limited patient awareness of the need for vaccines as an adult, shortcomings in terms of incorporation of adult immunizations into routine patient care structure, and record keeping and documentation of adult immunizations, including limited use of immunization information systems (IIS) by adult vaccine providers.

The purpose of this cooperative agreement is to develop and implement programs designed to increase adult immunization rates and reduce immunization rate disparities among adults, drawing on the principles of the Community Guide to Preventive Services for what works to improve immunization rate and the Standards for Adult Immunization Practice(aka “ the Standards”).

Awardees are expected to demonstrate measurable progress in addressing the following objectives with the goal of improving vaccination rates, through:

Collaboration with community health centers (CHC), pharmacies/ pharmacists, and clinical practice groups or large healthcare organizations/ systems to improve and expand the implementation of the Adult Immunization Standards (aka “Standards”), in the four key components of the Standards:

1.

Increasing the routine clinical practice of assessing which vaccines are needed for adult patients Improving and expanding healthcare providers’ recommendation for needed adult vaccines among their adult patients Improving the ability and process to provide recommended adult vaccinations on-site in clinical practice or the ability and process to refer adult patients to other provider sites which can provide the recommended adult vaccines Improving and expanding the ability and practice of adult healthcare providers to routinely and accurately document delivery of adult vaccinations among their adult patients, specifically through increased use of the immunization information systems (aka 'registries');

and

Developing and implementing strategies to best utilize available Section 317 vaccine purchase funds to expand access to all Advisory Committee on Immunization Practices (ACIP) recommended adult vaccines to uninsured adults. Such strategies could include working with community health centers (CHC) and possibly other community groups that serve uninsured adults to increase delivery of immunization services to uninsured adults and reduce disparities in adult vaccination coverage.

2.

Applicants will propose a technical package of activities directed towards the above objectives. Proposed activities should be supported by evidenced based strategies as described in the Community Guide to Preventive Health Services.

b. Statutory Authorities

This project is authorized under the Patient Protection and Affordable Care Act (PL111-148), Title IV, Section 4002 (Prevention and Public Health Fund)and section 317 of the Public Health Service Act (42 U.S.C. 247b).

c. Healthy People 2020

[CU1]This FOA doesn’t specifically address this issue. Recommend deleting

Measureable outcomes of the program will be in alignment with Healthy People 2020 goals for immunization and infectious disease. These include but are not limited to specific objectives:

(IID-1) Reduce, eliminate, or maintain elimination of cases of vaccine-preventable diseases Influenza Vaccination Goals for Adults IID-12.12Increase the percentage of adults aged 18 and older who are vaccinated annually against seasonal influenza IID-12.14(Developmental) Increase the percentage of pregnant women who are vaccinated annually against seasonal influenza Hepatitis B Vaccination Goals for Adults IID-15 (Developmental) Increase hepatitis B vaccine coverage among high-risk populations IID-15.1 (Developmental) Increase hepatitis B vaccine coverage among long-term hemodialysis patients IID-15.2 (Developmental) Increase hepatitis B vaccine coverage among men who have sex with men IID-15.3 Increase hepatitis B vaccine coverage among health care personnel IID-15.4(Developmental) Increase hepatitis B vaccine coverage among injection drug users Pneumococcal Vaccination Goals for Adults IID-13 Increase the percentage of adults who are vaccinated against pneumococcal disease IID-13.1 Increase the percentage of noninstitutionalized adults aged 65 years and older who are vaccinated against pneumococcal disease IID-13.2 Increase the percentage of noninstitutionalized high-risk adults aged 18 to 64 years who are vaccinated against pneumococcal disease IID-13.3 Increase the percentage of institutionalized adults (persons aged 18 years and older in long-term or nursing homes) who are vaccinated against pneumococcal disease Zoster Vaccination Goals for Adults IID-14Increase the percentage of adults who are vaccinated against zoster (shingles) In addition, HP2020’s Health Communication and Health Information Technology objectives point to importance of using the internet and social media. These include: (HC/HIT-8) Increase the proportion of quality, health-related websites and (HC/HIT-13) (Developmental) increase social marketing in health promotion and disease prevention.

Source: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=23

d. Other National Public Health Priorities and Strategies file://cdc.gov/private/M131/igc6/Adult%20Immun/FOA%20Imz%20Pgam%20Adult%20Draft%20December%2022%202014_sbg.docx#_msoanchor_1

Adult vaccination rates are well below the national Healthy People 2020 goals and racial and ethnic disparities in vaccination coverage rates among adults are substantial. Barriers that exist for improving vaccination rates in adults include limited patient awareness of the need for vaccines as an adult, shortcomings in terms of incorporation of adult immunizations into routine patient care structure, and record keeping and documentation of adult immunizations, including limited use of immunization information systems (IIS) by adult vaccine providers.

The purpose of this cooperative agreement is to develop and implement programs designed to increase adult immunization rates and reduce immunization rate disparities among adults, drawing on the principles of the Community Guide to Preventive Services for what works to improve immunization rate and the Standards for Adult Immunization Practice(aka “ the Standards”).

Awardees are expected to demonstrate measurable progress in addressing the following objectives with the goal of improving vaccination rates, through:

Collaboration with community health centers (CHC), pharmacies/ pharmacists, and clinical practice groups or large healthcare organizations/ systems to improve and expand the implementation of the Adult Immunization Standards (aka “Standards”), in the four key components of the Standards:

1.

Increasing the routine clinical practice of assessing which vaccines are needed for adult patients Improving and expanding healthcare providers’ recommendation for needed adult vaccines among their adult patients Improving the ability and process to provide recommended adult vaccinations on-site in clinical practice or the ability and process to refer adult patients to other provider sites which can provide the recommended adult vaccines Improving and expanding the ability and practice of adult healthcare providers to routinely and accurately document delivery of adult vaccinations among their adult patients, specifically through increased use of the immunization information systems (aka 'registries');

and

Developing and implementing strategies to best utilize available Section 317 vaccine purchase funds to expand access to all Advisory Committee on Immunization Practices (ACIP) recommended adult vaccines to uninsured adults. Such strategies could include working with community health centers (CHC) and possibly other community groups that serve uninsured adults to increase delivery of immunization services to uninsured adults and reduce disparities in adult vaccination coverage.

2.

Applicants will propose a technical package of activities directed towards the above objectives. Proposed activities should be supported by evidenced based strategies as described in the Community Guide to Preventive Health Services.

b. Statutory Authorities

This project is authorized under the Patient Protection and Affordable Care Act (PL111-148), Title IV, Section 4002 (Prevention and Public Health Fund)and section 317 of the Public Health Service Act (42 U.S.C. 247b).

c. Healthy People 2020

[CU1]This FOA doesn’t specifically address this issue. Recommend deleting

d. Other National Public Health Priorities and Strategies file://cdc.gov/private/M131/igc6/Adult%20Immun/FOA%20Imz%20Pgam%20Adult%20Draft%20December%2022%202014_sbg.docx#_msoanchor_1

This FOA aligns and supports other relevant national strategies:

Standards for Adult Immunization Practice:

This FOA aims to develop models for implementation of the National Vaccine Advisory Committee’s Standards for Adult Immunization Practice which were published in February 2014.

Community Preventive Services Task Force This FOA directs applicants to propose evidence-based interventions, drawing on the Community Preventive Services Task Force findings and the systematic reviews. Relevant evidence-based intervention identified in the Community Guide include but are not limited to reminder-recall, standing orders, provider assessment and feedback, use of IIS, use of health systems interventions, and multi-component interventions rather than stand-alone unilateral activities.

Source: http://www.thecommunityguide.org/vaccines/vpd-jphpm-recs-IIS.pdf HHS Action Plan to Reduce Racial and Ethnic Health Disparities This plan calls on HHS agencies to work to promote integrated approaches, evidence-based programs and best practices to reduce health disparities. A number of adult immunization disparities persist and may be worsening. This project aims to develop small models on the practice or community level to address disparate immunization rates among adults. Source: http://www.minorityhealth.hhs.gov/npa/templates /content.aspx?lvl=1&;lvlid=33&;ID=285 National Adult and Influenza Immunization Summit The National Adult and Influenza Immunization Summit (NAIIS) is dedicated to addressing and resolving adult and influenza immunization issues. A key priority for the Summit is the implementation of the Standards of Adult Immunization Practice . For more information please see: http://www.izsummitpartners.org/about/.

e. Relevant Work

From 2011-2013, ten immunization programs were funded to improve adult immunization infrastructure. The emphasis of this current FOA reflects the experience gained with the first FOA and those aspects of the first FOA which were the most productive for most awardees. For more information please see prior FOA: http://api.ning.com/files/b23b7QCf*lPWJhMksgbE5WHZIPaGYPK2440lGjLkpPL60G8544hqmc1yPXiAtfIN EkUE*tTnXd51mmDctsB61AsTu3zpC5AB/IP111107PPHF11FOAFinal3.29.11amend42611.pdf

2. CDC Project Description

a. Approach

Activities of Immunization

Programs

Short term Outcomes (must complete within project period)

Intermediate Outcomes (must completed within project period)

Long-term Outcomes

Collaborate with:1.

a. Community Health Centers

(CHC)

b. Pharmacies/ pharmacists, and

c. Clinical Practice Groups or Large Healthcare Systems/ Organizations To implement the Adult Immunization Standards (aka “Standards”) among healthcare providers (HCP) by:

- Improving the frequency and quality of how HCP assess which vaccines are needed among their adult patients

- Strengthening the delivery of HCP recommendation to their adult patients to get ACIP recommended adult immunizations

- Improving the frequency and process of how clinical practices deliver adult immunizations or refer their adult patients to other provider sites which can

1. Identified and engaged collaborators noted in activity 1 to:

-Inform providers about adult immunization recommendations, coverage rates, and the Standards.

-Assess barriers to implementing the Standards -Identify strategies to implement potential approaches such as expanding effective reminder/recall or standing orders, or other Evidence Based methods as described in the Community Guide to Prevention -Developed methods to track progress for implementation of these strategies for each group

2.Assessed current use of 317 funds available for purchase of adult vaccines -Identified potential methods to better utilize 317 funds for vaccinations for uninsured adults.

1. Strategies to implement Standards have begun and tracked:

a. Pharmacy Outcomes Measures-change in the number and proportion of pharmacist who:

-routinely assess adult patient vaccination needs -are trained in using the vaccine registry

- entering doses into registry, and -Change in the number of doses administered by pharmacists entered into registry

b. CHC Outcomes Measures- change in the number and proportion of CHC:

- offering adult vaccines -entering adult vaccinations into the IIS.

-providing adult vaccines by vaccine type -using standing orders and/or reminder/ recalls systems to offer adult vaccines

The vaccination assessment becomes a routine part of adult HCP practice.

Providers improve their delivery of immunization services or improve referral protocols for providers who do offer recommended adult vaccines

More adult vaccinations are documented in vaccine registries.

A greater degree of collaboration among multiple healthcare providers is achieved, especially through the use of IIS.

A greater degree of Section 317 funds are used to assist in providing ACIP recommended vaccines for uninsured adults and racial/ethnic disparity is http://www.thecommunityguide.org/about/aboutTF.html http://www.thecommunityguide.org/vaccines/vpd-jphpm-recs-IIS.pdf http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=285 http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=285 http://www.izsummitpartners.org/about/ http://api.ning.com/files/b23b7QCf*lPWJhMksgbE5WHZIPaGYPK2440lGjLkpPL60G8544hqmc1yPXiAtfINEkUE*tTnXd51mmDctsB61AsTu3zpC5AB/IP111107PPHF11FOAFinal3.29.11amend42611.pdf http://api.ning.com/files/b23b7QCf*lPWJhMksgbE5WHZIPaGYPK2440lGjLkpPL60G8544hqmc1yPXiAtfINEkUE*tTnXd51mmDctsB61AsTu3zpC5AB/IP111107PPHF11FOAFinal3.29.11amend42611.pdf

e. Relevant Work

From 2011-2013, ten immunization programs were funded to improve adult immunization infrastructure. The emphasis of this current FOA reflects the experience gained with the first FOA and those aspects of the first FOA which were the most productive for most awardees. For more information please see prior FOA: http://api.ning.com/files/b23b7QCf*lPWJhMksgbE5WHZIPaGYPK2440lGjLkpPL60G8544hqmc1yPXiAtfIN EkUE*tTnXd51mmDctsB61AsTu3zpC5AB/IP111107PPHF11FOAFinal3.29.11amend42611.pdf

2. CDC Project Description

a. Approach http://api.ning.com/files/b23b7QCf*lPWJhMksgbE5WHZIPaGYPK2440lGjLkpPL60G8544hqmc1yPXiAtfINEkUE*tTnXd51mmDctsB61AsTu3zpC5AB/IP111107PPHF11FOAFinal3.29.11amend42611.pdf http://api.ning.com/files/b23b7QCf*lPWJhMksgbE5WHZIPaGYPK2440lGjLkpPL60G8544hqmc1yPXiAtfINEkUE*tTnXd51mmDctsB61AsTu3zpC5AB/IP111107PPHF11FOAFinal3.29.11amend42611.pdf other provider sites which can provide the recommended adult vaccines

- Improve HCP documentation of adult immunizations in their jurisdiction's immunization information systems (aka registry)

2. Develop strategies to best utilize available Section 317 vaccine purchase funds to expand access to all ACIP recommended adult vaccines to uninsured adults.

adult vaccines

c. Provider and/or Health Systems groups Outcomes Measures- change in number of medical provider offices or systems -engaged with annually to assist with implementation Standards, and

- change in numbers and types of systems-level interventions initiated in practices

2. Implemented strategic plan to better utilize 317 funds for uninsured adults

- Track progress of implementation: using these outcome measures:

- change in numbers of vaccines by vaccine type designated for uninsured adults in Section 317 funds

- types of changes in program approach to reach uninsured adults and racial/ethnic disparity is reduced.

i. Purpose

This FOA is intended to support state and local immunization programs to collaborate with partners to implement the Adult Immunization Standards in clinical practice in their communinities to promote increased adult immunization coverage and reduce racial and ethnic immunization and disease disparities.

ii. Outcomes

1. Immunization programs and collaborators (community health centers, pharmacies/pharmacies, and either large healthcare organizations or medical practice groups) implement improved strategies to reach and vaccinate uninsured adults, as documented in the Adult Immunization Standards.

Awardees will track progress of implementation through use of the measures listed below:

a. Pharmacy Outcomes Measures

- Change in the number and proportion of pharmacists who routinely assess adult patient vaccination needs

- Change in proportion and number of pharmacists trained in using the state immunization information system (IIS = registry)

- Change in the proportion and number of pharmacies or pharmacist entering doses into registry

- Change in the number of doses administered by pharmacists entered into registry

b. CHC Outcomes Measures

- Change in the number and proportion of CHC offering adult vaccines

- Change in the number and proportion of CHC entering adult vaccinations into the IIS.

- Change in the number and proportion of community health centers providing adult vaccines by vaccine type

- Change in the number and proportion of community health centers using standing order and/or reminder/ recalls systems to offer adult vaccines

c. Provider and/or Health Systems groups Outcomes Measures

- Change in the number of medical provider offices or health systems the awardee has engaged with annually to assist with implementation of one or more parts of the Standards

- Change in numbers and types of systems-level interventions initiated in provider or health systems to implement adult immunizations (e.g.

reminder-recall, standing orders programs, etc.)

- Change in number of state and/or local chapters of provider groups that the awardee has engaged with to educate providers and/or the public about vaccine recommendations and low vaccination rates for adults

2. Implement strategic plan to better utilize 317 funds for uninsured adults

- Awardee will track progress using these outcome measures:

- change in numbers of vaccines by vaccine type designated for uninsured adults in Section 317 funds

i. Purpose

This FOA is intended to support state and local immunization programs to collaborate with partners to implement the Adult Immunization Standards in clinical practice in their communinities to promote increased adult immunization coverage and reduce racial and ethnic immunization and disease disparities.

ii. Outcomes

1. Immunization programs and collaborators (community health centers, pharmacies/pharmacies, and either large healthcare organizations or medical practice groups) implement improved strategies to reach and vaccinate uninsured adults, as documented in the Adult Immunization Standards.

Awardees will track progress of implementation through use of the measures listed below:

a. Pharmacy Outcomes Measures

- Change in the number and proportion of pharmacists who routinely assess adult patient vaccination needs

- Change in proportion and number of pharmacists trained in using the state immunization information system (IIS = registry)

- Change in the proportion and number of pharmacies or pharmacist entering doses into registry

- Change in the number of doses administered by pharmacists entered into registry

b. CHC Outcomes Measures

- Change in the number and proportion of CHC offering adult vaccines

- Change in the number and proportion of CHC entering adult vaccinations into the IIS.

- Change in the number and proportion of community health centers providing adult vaccines by vaccine type

- Change in the number and proportion of community health centers using standing order and/or reminder/ recalls systems to offer adult vaccines

c. Provider and/or Health Systems groups Outcomes Measures

- Change in the number of medical provider offices or health systems the awardee has engaged with annually to assist with implementation of one or more parts of the Standards

- Change in numbers and types of systems-level interventions initiated in provider or health systems to implement adult immunizations (e.g.

reminder-recall, standing orders programs, etc.)

- Change in number of state and/or local chapters of provider groups that the awardee has engaged with to educate providers and/or the public about vaccine recommendations and low vaccination rates for adults

2. Implement strategic plan to better utilize 317 funds for uninsured adults

- Awardee will track progress using these outcome measures:

- types of changes in program approach to reach uninsured adults

iii. Strategies and Activities

The awardee will propose a combination of activities to address the stated objectives and to be able to collecte data on the shared outcomes.

Applicants must select evidence-based strategies the meet their needs or describe the rationale for developing and evaluating new strategies or practice-based interventions. Awardees are also encouraged to conduct outreach with other US immunization programs with experience in implementing adult vaccination programs.

In the first phase of the project, efforts will focus on building a successful outreach and relationships with provider groups, including jurisdictional organizations to help with identifying specific provider groups and health systems to work with on implementation of the standards. They will also participate in monthly individual conference calls and monthly all awardee calls with CDC.

In the second phase of the project, efforts will focus on implementing the national adult immunization standards among the collaborating provider groups, as targeted by the awardee. Monthly calls as above will continue for the duration of the project.

Applicants will be expected to come to Atlanta, GA for a 2-day cooperative agreement kick off meeting and then a reverse site visit meeting one year into the project to present interim reports and share lessons learned with other awardees.

1.Collaborations

Awardees are required to collaborate with CDC-funded programs and with organizations external to CDC below.

a. With CDC-funded programs:

Applicants are required to collaborate with CDC to improve technical assisstance, program guidance, and program evaluation efforts.

b. With organizations external to CDC:

Applicants are required to collaborate with external partners that have a role in achieving the FOA outcomes and proposed activities, including:

Community Health Centers (CHC) with adult patient populations1.

Pharmacies/ pharmacists, and 2.

Either Clinical Practice Groups (e.g. large doctor's offices with adult patients) or Large Healthcare Systems/ Organizations3.

2. Target Populations

The target population for this FOA and for work conducted by the awardees include adult patient populations who currently or may in the future seek healthcare from pharmacies, community health centers, large healthcare organizations, or large clinical practice sites, especially racial and ethnic minority groups, where applicable. Implementation of the Adult Immunization Standards may increase overall and individual immunization coverage among adult groups, especially among racial and ethnic minority groups.

a. Inclusion n/a

iv. Funding Strategy (for multi-component FOAs only)

Not applicable. One Funding Announcement Opportunity for all applicants.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

The CDC Strategy for monitoring and evaluating program and awardee performance will include several activities, spanning both process and outcome evaluation and will be consistent with the logic model and approach presented earlier. This will include at minimum awardee quarterly progress reports, annual reports, and final report. Data will be used to improve CDC technical assistance and strategies for increasing adult immunization coverage.

Process measures Intermediate Measures Long-Term Outcome Measures

-awardee has identified and engaged collaborating community health centers, pharmacies/ pharmacists, and clinical practice groups or large healthcare

-collaborators have implemented strategies to implement the Standars among collaborating healthcare provider groups, including tracking progress

The vaccination assessment becomes a routine part of adult HCP practice.

- types of changes in program approach to reach uninsured adults

iii. Strategies and Activities

1.Collaborations

Awardees are required to collaborate with CDC-funded programs and with organizations external to CDC below.

a. With CDC-funded programs:

Applicants are required to collaborate with CDC to improve technical assisstance, program guidance, and program evaluation efforts.

b. With organizations external to CDC:

Applicants are required to collaborate with external partners that have a role in achieving the FOA outcomes and proposed activities, including:

Community Health Centers (CHC) with adult patient populations1.

Pharmacies/ pharmacists, and 2.

Either Clinical Practice Groups (e.g. large doctor's offices with adult patients) or Large Healthcare Systems/ Organizations3.

2. Target Populations

The target population for this FOA and for work conducted by the awardees include adult patient populations who currently or may in the future seek healthcare from pharmacies, community health centers, large healthcare organizations, or large clinical practice sites, especially racial and ethnic minority groups, where applicable. Implementation of the Adult Immunization Standards may increase overall and individual immunization coverage among adult groups, especially among racial and ethnic minority groups.

a. Inclusion n/a

iv. Funding Strategy (for multi-component FOAs only)

Not applicable. One Funding Announcement Opportunity for all applicants.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy organizations to implement the Adult Immunization Practice Standards.

on a quartely basis.

-collaborators, as above, have informed providers about adult immunization recommendations, coverage rates, and the Standards

(Pharmacy Specific Measures) change in the number and proportion of pharmacist who routinely assess adult patient vaccination needs

Providers improve their delivery of immunization services or improve referral protocols for providers who do offer recommended adult vaccines

-collaborators, as above, have assessed and explained barriers to implementing the Standards

(Pharmacy Specific Measures) change in the number and proportion of pharmacist who are trained in using the immunization information sytem or 'registry'

More adult vaccinations are documented in vaccine registries.

-collaborators, as above, have identified strategies to implement potential approachs such as expanding effective reminder/ recall or standing orders, or other Evidence Based methods as described inteh Community Guide to Prevention

(Pharmacy Specific Measures) change in the number and proportion of pharmacist who are entering vaccine doses given into the registry

A greater degree of collaboration among multiple healthcare providers is achieved, especially through the use of

IIS.

-awardee has assessed current use of Section 317 funds available for purchase of adult vaccines

(Pharmacy Specific Measures) change in the number of adult vaccine doses administered by pharmacists and entered into the registry

A greater degree of Section 317 funds are used to assist in providing ACIP recommended vaccines for uninsured adults and racial/ethnic disparity is reduced.

-awardee has identified potential methods to better utilize Section 317 funds to purchase vaccinations for uninsured adults

(Community Health Center (CHC) Measures) Change in the number and proportion of CHC offering adult vaccines, by type of vaccine

(Community Health Center (CHC) Measures) Change in the number and proportion of CHC entering adult vaccinations into the registry

(Community Health Center (CHC) Measures) Change in the number and proportion of CHC using standing order and/or reminder/ recall system to offer adult vaccines

(Provider and/or Health Systems Measures) Change in the number of medical providers officer or systems engaged by the awardee to assist with implementation of the Standards

(Provider and/or Health Systems Measures) Change in the number and types of system-level interventions initiated in medical providers offices, practices or health systems

Awardee has implemented strategic plan to better utilized 317 funds for uninsured adults

Change in the number of adult vaccines by type designated for uninsured adult in Section 317 funds

Types of changes in program approach to reach uninsured adults

ii. Applicant Evaluation and Performance Measurement Plan

Applicants must provide an evaluation and performance measurement plan that is consistent with the CDC strategy. Their plan must:

Affirm their ability to collect the performance measures and respond to the evaluation questions specified in the CDC strategy.

Describe how key program partners will participate in the evaluation and performance measurement planning processes.

Describe how evaluation findings will be used for continuous program quality improvement.

c. Organizational Capacity of Awardees to Execute the Approach

Applicants should demonstrate sufficient organizational capacity and conduct a high level of program planning, program evaluation, performance monitoring, financial reporting, budget management and administration, and personnel management. Applicants must demonstrate relevant experience and capacity (management, administrative, and technical) to implement the activities, achieve the project outcomes, and implement the evaluation plan. Applicant must clearly present a staffing plan and project management structure sufficient to acheive the project outcomes and which clearly defines staff roles. Applicants must also be fully capable of managing the required procurement efforts, including the ability to write and award contracts in accordance with applicalable cooperative agreement regulations.

d. Work Plan

Applicants must identify and address the activities under this FOA in no more than 15 pages. Specific details on how the proposed strategies will achieve the outcomes should be included. CDC will provide feedback and technical assistance to recipients to finalize the workplan post award.

For each selected activity, a descriptive plan, process, and timeline with milestones/measures and responsible staff for efforts related to each short term and intermediate outcome in the logic model must be provided for the two-year project. This includes descriptions of:

staff and administrative roles and functions to support the project work plan and the outcomes. Awardees should identify and assign staff, contractors, and/or consultants, sufficient in number and expertise, to carry out the activities of this FOA;

administrative and assessment processes to ensure successful implementation, reporting and quality assurance;

organizational capacity to successfully achieve the project outcomes, including demonstrated experience leading to collective action;

capacity and plans to successfully implement sustainable practices that result in the improved immunization rates of the target population.

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and awardees, site visits, and awardee reporting (including work plans, performance, and financial reporting). Consistent with applicable grants regulations and policies, CDC expects the following to be included in post-award monitoring for grants and cooperative agreements:

Tracking awardee progress in achieving the desired outcomes.

Ensuring the adequacy of awardee systems that underlie and generate data reports.

Creating an environment that fosters integrity in program performance and results.

Monitoring may also include the following activities:

Ensuring that work plans are feasible based on the budget and consistent with the intent of the award.

Ensuring that awardees are performing at a sufficient level to achieve outcomes within stated timeframes.

Working with awardees on adjusting the work plan based on achievement of outcomes, evaluation results and changing budgets.

Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels.

Other activities deemed necessary to monitor the award, if applicable.

These activities may include monitoring and reporting activities that assist grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high-risk grantees.

ii. Applicant Evaluation and Performance Measurement Plan

c. Organizational Capacity of Awardees to Execute the Approach

d. Work Plan

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and awardees, site visits, and awardee reporting (including work plans, performance, and financial reporting). Consistent with applicable grants regulations and policies, CDC expects the following to be included in post-award monitoring for grants and cooperative agreements:

Tracking awardee progress in achieving the desired outcomes.

Ensuring the adequacy of awardee systems that underlie and generate data reports.

Creating an environment that fosters integrity in program performance and results.

Monitoring may also include the following activities:

Ensuring that work plans are feasible based on the budget and consistent with the intent of the award.

Ensuring that awardees are performing at a sufficient level to achieve outcomes within stated timeframes.

Working with awardees on adjusting the work plan based on achievement of outcomes, evaluation results and changing budgets.

Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels.

Other activities deemed necessary to monitor the award, if applicable.

These activities may include monitoring and reporting activities that assist grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high-risk grantees.

Awardees will be required to submit quarterly and annual progress reports. Format to be provided by CDC post-award.

(Section 220 – Prevention Fund Reporting Requirements) Prevention Public Health Fund (PPHF) Reporting Requirements:

This award requires the awardee to complete projects or activities which are funded under the Prevention and Public Health Fund (PPHF) (Section 4002 of Public Law 111-148) and to report on use of PPHF funds provided through this award. Information from these reports will be made available to the public. Awardees provided funds with a value of $25,000 or more shall produce reports on a semi-annual basis with a reporting cycle of January 1 - June 30 and July 1 - December 31; and email such reports to the CDC website (template and point of contact to be provided after award) no later than 20 calendar days after the end of each reporting period (i.e. July 20 and January 20, respectively). Awardee reports must reference the NoA number and title of the coooperative agreement, and include a summary of the activities undertaken and identify any sub-awards (including the purpose of the award and the identity of each sub-recipient).

Responsibilities for Informing Sub-recipients: Awardees agree to separately identify each sub-recipient, document the execution date sub-award, date(s) of the disbursement of funds, the Federal award number, any special CFDA number assigned for PPHF fund purposes, and the amount of PPHF funds. When an awardee awards PPHF funds for an existing program, the information furnished to sub-recipients shall distinguish the sub-awards of incremental PPHF funds from regular sub-awards under the existing program.

f. CDC Program Support to Awardees (THIS SECTION APPLIES ONLY TO COOPERATIVE AGREEMENTS)

CDC will provide technical assistance in terms of project officer and subject matter expertise in the development and implementation of program planning, comprehensive evaluation plans, and capacity building among the awardees. This will include, at a minimum, monthly calls with each awardee, monthly all awardee calls to share best practices, and any additional technical assistance, as needed by awardees. CDC will also organize reverse site visits for awardees to improve program activites and promote greater collaboration. Information will be shared with awardees, at a minimum, through conference calls, reverse sites visits, and email and telephone.

B. Award Information

1. Funding Instrument Type: Cooperative Agreement CDC's substantial involvement in this program appears in the CDC Program Support to Awardees

Section.

2. Award Mechanism: H23 - Immunizat

The award issued under this FOA is contingent upon available funds in Prevention and Public Health Fund.

3. Fiscal Year: 2015 Estimated Total Funding: $10,000,000

4. Approximate Total Fiscal Year Funding: $10,000,000

5. Approximate Project Period Funding: $10,000,000

6. Total Project Period Length: 2 year(s)

7. Expected Number of Awards: 10

8. Approximate Average Award: $1,000,000 Per Project Period

9. Award Ceiling: $1,250,000 Per Project Period

10. Award Floor: $400,000 Per Project Period

11. Estimated Award Date: 09/01/2015 Throughout the project period, CDC will continue the award based on the availability of funds, the evidence of satisfactory progress by the awardee (as documented in required reports), and the determination that continued funding is in the best interest of the federal government. The total number of years for which federal support has been approved (project period) will be shown in the “Notice of Award.” This information does not constitute a commitment by the federal government to fund the entire period. The total project period comprises the initial competitive segment and any subsequent non-competitive continuation award(s).

12. Budget Period Length: 24 month(s)

13. Direct Assistance Direct Assistance (DA) is not available through this FOA.

C. Eligibility Information

1. Eligible Applicants Eligibility Category: State governments

City or township governments Special district governments

Government Organizations:

State (includes the District of Columbia) Local governments or their bona fide agents Territorial governments or their bona fide agents in the Commonwealth of Puerto Rico, the Virgin

Awardees will be required to submit quarterly and annual progress reports. Format to be provided by CDC post-award.

(Section 220 – Prevention Fund Reporting Requirements) Prevention Public Health Fund (PPHF) Reporting Requirements:

This award requires the awardee to complete projects or activities which are funded under the Prevention and Public Health Fund (PPHF) (Section 4002 of Public Law 111-148) and to report on use of PPHF funds provided through this award. Information from these reports will be made available to the public. Awardees provided funds with a value of $25,000 or more shall produce reports on a semi-annual basis with a reporting cycle of January 1 - June 30 and July 1 - December 31; and email such reports to the CDC website (template and point of contact to be provided after award) no later than 20 calendar days after the end of each reporting period (i.e. July 20 and January 20, respectively). Awardee reports must reference the NoA number and title of the coooperative agreement, and include a summary of the activities undertaken and identify any sub-awards (including the purpose of the award and the identity of each sub-recipient).

Responsibilities for Informing Sub-recipients: Awardees agree to separately identify each sub-recipient, document the execution date sub-award, date(s) of the disbursement of funds, the Federal award number, any special CFDA number assigned for PPHF fund purposes, and the amount of PPHF funds. When an awardee awards PPHF funds for an existing program, the information furnished to sub-recipients shall distinguish the sub-awards of incremental PPHF funds from regular sub-awards under the existing program.

f. CDC Program Support to Awardees (THIS SECTION APPLIES ONLY TO COOPERATIVE AGREEMENTS)

CDC will provide technical assistance in terms of project officer and subject matter expertise in the development and implementation of program planning, comprehensive evaluation plans, and capacity building among the awardees. This will include, at a minimum, monthly calls with each awardee, monthly all awardee calls to share best practices, and any additional technical assistance, as needed by awardees. CDC will also organize reverse site visits for awardees to improve program activites and promote greater collaboration. Information will be shared with awardees, at a minimum, through conference calls, reverse sites visits, and email and telephone.

Territorial governments or their bona fide agents in the Commonwealth of Puerto Rico, the Virgin Islands, the Commonwealth of the Northern Marianna Islands, American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

2. Additional Information on Eligibility State and local governments or their Bona Fide Agents (this includes the District of Columbia, City of New York, Philadelphia, Houston, Chicago, San Antonio, the Commonwealth of Puerto Rico, the Virgin Islands, the Commonwealth of the Northern Marianna Islands, American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau) Limited Competition Assistance will be provided only to the current 64 immunization program awardees because they have the necessary infrastructure in place to perform the activities required and have the experience needed to successfully complete the required objectives. Included among these awardees are the District of Columbia, City of New York, Philadelphia, Houston, Chicago, San Antonio, the Commonwealth of Puerto Rico, the Virgin Islands, the Commonwealth of the Northern Marianna Islands, American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. Competition is limited to the entities listed above because they have the primary responsibility for carrying out the public health assurance functions required to achieve the desired outcomes and performance goals established by CDC.

The following 10 immunization programs are not eligible because they used funding under previous PPHF supported cooperative agreement to develop adult immunization infrastructure (CDC FOA IP11-1107PPHF11): Arkansas, Chicago, Connecticut, Iowa, Massachusetts, Minnesota, Oregon, Utah, Virginia, and Washington.

The award ceiling for this FOA is $1,250,000. CDC will consider any application requesting an award higher than this amount as non-responsive and it will receive no further review. If a pre-application is required, then specify here and include it in the special eligibility requirements section. (http:// www.hhs.gov/ asfr/ ogapa/ aboutog/ hhsgps107.pdf)

3. Justification for Less than Maximum Competition

4. Cost Sharing or Matching Cost Sharing / Matching Requirement:

No

5. Maintenance of Effort

Maintenance of effort is not required for this program.

D. Required Registrations

Additional materials that may be helpful to applicants: http://www.cdc.gov/od/pgo/funding/docs/Financial ReferenceGuide.pdf.

1. Required Registrations An organization must be registered at the three following locations before it can submit an application for funding at www.grants.gov.

a. Data Universal Numbering System: All applicant organizations must obtain a Data Universal Numbering System (DUNS) number. A DUNS number is a unique nine-digit identification number provided by Dun & Bradstreet (D&B). It will be used as the Universal Identifier when applying for federal awards or cooperative agreements.

The applicant organization may request a DUNS number by telephone at 1-866-705-5711 (toll free) or Internet at http:// fedgov.dnb.com/webform/displayHomePage.do. The DUNS number will be provided at no charge.If funds are awarded to an applicant organization that includes sub-awardees, those sub-awardees must provide their DUNS numbers before accepting any funds.

b. System for Award Management (SAM): The SAM is the primary registrant database for the federal government and the repository into which an entity must submit information required to conduct business as an awardee. All applicant organizations must register with SAM, and will be assigned a SAM number. All information relevant to the SAM number must be current at all times during which the applicant has an application under consideration for funding by CDC. If an award is made, the SAM information must be maintained until a final financial report is submitted or the final payment is received, whichever is later. The SAM registration process usually requires not more than five business days, and registration must be renewed annually.