Foa_Content_of_CDC-RFA-DP-24-0048.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH

PROMOTION

State Promotion of Strategies to Advance Oral Health

CDC-RFA-DP-24-0048

05/28/2024

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA-DP- 24-0048. 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) / Agency for Toxic Substances and Disease Registry (ATSDR)

B. Notice of Funding Opportunity (NOFO) Title:

State Promotion of Strategies to Advance Oral Health

C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For purposes of this NOFO, research is defined as set forth in 45 CFR 75.2 and, for further clarity, as set forth in 42 CFR 52.2 (see eCFR :: 45 CFR 75.2 -- Definitions and https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR- 2007-title42-vol1-sec52-2.pdf. In addition, for purposes of research involving human subjects and available exceptions for public health activities, please see 45 CFR 46.102(l) (https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section- 46.102#p-46.102(l)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP-24-0048

https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l)

E. Assistance Listings Number:

93.366

F. Dates:

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

04/12/2024

2. Due Date for Applications:

05/28/2024 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

Date: Friday, April 5, 2024

Time: 1:30 pm - 2:30 pm (EST)

Conference Call Number: +1 646 828 7666 US

Passcode: 40059189

Webinar link:

https://cdc.zoomgov.com/j/1607302339?pwd=MS8zSkkrRU5seTV1NUVKWnJTV3MyQT09

Webinar ID: 160 730 2339

Passcode: Py5%sME3

Email address: StateOHE0048@cdc.gov

G. Executive Summary:

1. Summary Paragraph This three-year cooperative agreement addresses oral health disparities by supporting state-wide interventions and practices to address oral disease in populations of focus. Interventions include community water fluoridation, delivery of evidence-based preventive services to school-aged children, and infection prevention and control activities. This Notice of Funding Opportunity (NOFO) prioritizes using secondary data analysis to inform the future integration of medical and dental services for individuals with diabetes who have risk factors for negative health outcomes.

Diabetes affects over 28.7 million people and is the seventh leading cause of death in the United States, and dental visits are an important part of diabetes self-care management. Yet, about 60% of US adults with diabetes had a medical visit in the past year but no dental visit. Information is needed to understand medical services used by persons with diabetes and the opportunities missed for persons with diabetes to have both medical and dental visits within the past year.

Expected outcomes from this NOFO include increasing: 1) access to optimally fluoridated water and receipt of Evidence-based Preventive Dental Services, 2) adherence to Infection Prevention and Control recommendations, 3) access to data to build evidence for public health practice, and

4) access to care and untreated decay, and 5) foundational information supporting integrated medical and dental services for adults with Type 2 diabetes.

a. Funding Instrument Type:

https://www.grants.gov/ mailto:StateOHE0048@cdc.gov

CA (Cooperative Agreement)

b. Approximate Number of Awards

c. Total Period of Performance Funding:

$17,136,000

d. Average One Year Award Amount:

$380,800

e. Total Period of Performance Length:

3 year(s)

f. Estimated Award Date:

July 31, 2024

g. Cost Sharing and / or Matching Requirements:

No Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

Examples include complementary private foundation funding, other U.S. government funding sources, including programs supported by the Department of Health and Human Services, and other agencies such as the Department of Education, Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, the Department of Agriculture, and other funding sources. Applicants must coordinate with multiple sectors, such as public health, education, infection control programs, drinking water associations, health care delivery, community health centers, (e.g., FQHCs), faith-based organizations, correctional facilities, and other community-level resources.

Part II. Full Text

A. Funding Opportunity Description

1. Background

a. Overview Cavities (also known as tooth decay or caries) are a common chronic disease that can cause pain or suffering and diminish one’s quality of life. Cavities can affect essential aspects of daily living, eating, and speaking. In 2008, 92.4 million school and work hours were lost among school children and adults due to urgent dental care needs, with children losing over 34 million hours of school.

This new NOFO seeks to address the burden of oral disease, such as untreated cavities, among populations of focus with evidence-based interventions and practices.

Community water fluoridation (CWF) and evidence-based preventive dental services (EBPDS) delivered in schools, dental and medical offices, and other settings can prevent cavities, save money, and improve quality of life across the lifespan. Data show that 57 percent of adolescents in the United States ages 12–19 years have experienced cavities and 17 percent need treatment https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772383/ https://doi.org/10.14485/HBPR.5.2.7 https://doi.org/10.14485/HBPR.5.2.7 https://www.thecommunityguide.org/pages/task-force-findings-oral-health.html https://www.cdc.gov/oralhealth/publications/OHSR-2019-dental-caries-permanent-teeth.html%22%20/t%20%22_blank on at least one decayed tooth. Among adolescents stratified by race/ethnicity (R/E), the prevalence of untreated cavities for non-Hispanic Blacks and Mexican Americans is about 30% higher than for non-Hispanic White adolescents.

CDC’s 2019 Oral Health Surveillance Report highlights that sealant prevalence among adolescents aged 12–19 years increased from 38% during 1999–2004 to 48% during 2011–2016.

Increases were observed across all socio-demographic characteristics, such as R/E and income.

Drinking fluoridated water keeps teeth strong and reduces cavities by up to 25% in children and adults. Increasing access to optimally fluoridated water is the most efficient and cost-effective way to deliver this oral health benefit to everyone in a community. Among adults who self-report they have diabetes, sixty percent have some form of periodontitis which can lead to tooth loss.

Treating periodontal disease significantly improves blood sugar level (glycemic control) among adults with diabetes compared to no treatment or routine care.

This funding opportunity will incorporate lessons learned from NOFO CDC-RFA-DP18-1810 and four prior program announcements. Recipients funded by prior programs progressed towards program goals, but the COVID-19 pandemic slowed efforts, especially school sealant initiatives.

This funding also prioritizes strategies for infection prevention and control (IPC), secondary data analysis to inform the future integration of medical and dental services for individuals with diabetes, and evaluation. Although improvements have been made with preventive measures, recipients continue to face challenges post-COVID-19. This funding will further enhance recipient efforts to advance oral health across their states.

b. Statutory Authorities The State Promotion of Strategies to Advance Oral Health is authorized under the Public Health Service Act, 42 U.S.C. §§ Sections 317M(d) and 301(a) of the Public Health Service Act, 42 U.S.C. 247b-14(d) and 241(a).

c. Healthy People 2030 NOFO strategies address the following Healthy People 2030 topics:

• Oral Conditions — General

• Adolescents

• Health Care Access and Quality

• Health Policy

• Nutrition and Healthy Eating

• Older Adults

• Preventive Care

• Public Health Infrastructure

d. Other National Public Health Priorities and Strategies This program supports strategies to increase and improve the quality of oral health outcomes, community-clinical linkages, and preventive services, which align with the following national plans, frameworks, and reports:

• The Guide to Community Preventive Services

• Health and Human Services - Equity Action Plan

• Health and Human Services - Strategic Plan FY 2022-2026 https://www.cdc.gov/oralhealth/publications/OHSR-2019-index.html https://www.grants.gov/search-results-detail/301195 https://health.gov/healthypeople/objectives-and-data/browse-objectives/oral-conditions https://www.thecommunityguide.org/ https://www.hhs.gov/sites/default/files/hhs-equity-action-plan.pdf https://www.hhs.gov/about/strategic-plan/2022-2026/overview/index.html

• Health Resources and Services Administration - Strategic Plan FY 2024

• Centers for Medicare and Medicaid Services - Framework for Health Equity 2022-2032

• National Institute of Health - Oral Health in America: Advances and Challenges

e. Relevant Work This NOFO follows past programmatic efforts to build oral health program capacity to promote and implement oral health prevention programs as outlined in CDC-RFA-DP18-1810. In addition, this NOFO supports the promotion and adherence to CDC infection prevention and control guidelines to improve the quality of care in settings where oral health care is provided.

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

CDC-RFA-24-0048 Logic Model: State Promotion of Strategies to Advance Oral Health

Strategies and Activities

Short-Term Outcomes Intermediate Outcomes

Long-Term Outcomes

Community Water Fluoridation

Provide financial and technical support for quality control and management of fluoridated water systems, especially in water systems serving 10,000 or fewer people

Collect, provide, and analyze water system fluoridation data, to identify disparities in access to optimally fluoridated water, especially for water systems serving 10,000 or fewer people

Improved access to water fluoridation equipment, especially in communities with water systems serving 10,000 or fewer people

Increased receipt of fluoridation data, from systems state-wide, especially among water systems

Increased analysis and use of fluoridation data to identify disparities and prioritize populations for CWF expansion

Reduced disparities in access to optimally fluoridated water

Increased access to water from optimally fluoridated water systems state-wide, especially among water systems

Decreased untreated decay, especially in communities with water systems serving 10,000 or fewer people and among populations who disproportionately lack access to optimally fluoridated water systems

Data Analysis to Support Medical

Improved capacity of state oral health

Increased dissemination of

Increased access to integrated medical https://www.hrsa.gov/about/strategic-plan https://www.cms.gov/files/document/cms-framework-health-equity-2022.pdf https://www.nidcr.nih.gov/research/oralhealthinamerica https://www.grants.gov/search-results-detail/301195

Dental Integration and EBPDS

Analyze, interpret, and disseminate secondary data about relationships between the oral health of adults with Type 2 diabetes, and their overall health, as well as their use and access to medical and dental care

Build and expand partnerships that will use the data analyses to raise awareness about evidence-based strategies to integrate medical and dental services that adults with Type 2 diabetes need

Analyze, interpret, and disseminate secondary oral health data about EBPDS to identify disparities in use and access among populations of focus

Build and expand partnerships that will use the data analyses to increase equitable access to EBPDS programs to monitor and describe relationships between the oral health of adults with Type 2 diabetes, and their overall health, as well as their use and access to medical and dental care

Improved EBPDS delivery and surveillance systems that monitor use and access trends and characteristics of community-clinical linkages for adults with Type 2 diabetes analyzed secondary data about relationships between the oral health of adults with Type 2 diabetes, their overall health, as well as their use of and access to medical and dental care

Increased use of secondary data to promote evidence-based strategies to integrate medical and dental services that adults with Type 2 diabetes need

Increased use of secondary data to inform equitable access to EBPDS and dental services among adults with Type 2 diabetes.

Reduced disparities in receipt of EBPDS across sociodemographic characteristics

Decreased untreated decay in populations of focus

Evidence-Based Preventive Dental Services (EBPDS)

Use secondary data analyses and program implementation data to expand access to EBPDS in populations of focus

Build or use existing partnerships to increase EBPDS participation in populations and communities that disproportionately experience barriers to oral health care or elevated risk for cavities

Increased opportunities to identify EBPDS needs and establish EBPDS programs

Increased opportunities for decision makers, parents, educators, and school administrators to receive information about the benefit of adopting EBPDS

Increased availability of and access to local/small area and state program data, EBPDS programs, and information about Medicaid/CHIP-enrolled children receiving EBPDS within a state

Infection Prevention and Control

Promote dental IPC resources by establishing new (or using existing) partnerships with state HAI programs and organizations with oral health IPC expertise

Implement activities that promote use of dental IPC resources

Increased awareness and use of dental IPC recommendations and resources state-wide, especially among EBPDS school programs, and other dental programs or facilities serving communities with oral health disparities

Increased capacity of programs that serve populations experiencing large health disparities to adhere to CDC IPC guidelines

Increased adherence to IPC Standard Precautions and other infection prevention recommendations across traditional and non-traditional settings

i. Purpose This non–research NOFO will help DOH-funded recipients to prioritize populations of focus defined as groups experiencing persistent health disparities and inequities. Recipients will increase access to evidence-based preventive dental services; increase access to optimal community water fluoridation; improve oral health and chronic disease surveillance using secondary data sources to describe oral health trends; and increase awareness of infection prevention and control guidelines in traditional (private practice) and non-traditional settings (clinics, mobile units, school sealant programs).

ii. Outcomes All applicants must address the outcomes (in bold) in the logic model for each core topical area and the associated strategies: Community Water Fluoridation, Data Analysis to Support Medical- Dental Integration and EBPDS, and Infection Prevention and Control. The required, bolded logic model outcomes are:

COMMUNITY WATER FLUORIDATION (CWF):

• Increased receipt of fluoridation data from systems state-wide, especially among water systems serving 10,000 or fewer people

• Increased access to water from optimally fluoridated water systems state-wide, especially among water systems serving 10,000 or fewer people

DATA ANALYSIS TO SUPPORT MEDICAL DENTAL INTEGRATION AND

EVIDENCE-BASED PREVENTIVE DENTAL SERVICES (EBPDS)

• Increased dissemination of information about 1) relationships between oral health and overall health among adults with diabetes, and 2) use and access to medical and dental care among adults with diabetes.

EVIDENCE-BASED PREVENTIVE DENTAL SERVICES (EBPDS):

• Increased availability of and access to local/small area and state program data, EBPDS programs and information about Medicaid/CHIP-enrolled children receiving EBPDS within a state.

INFECTION PREVENTION AND CONTROL (IPC):

• Increased awareness and use of dental IPC recommendations and resources state-wide, especially among EBPDS school programs, and other dental programs or facilities serving communities with oral health disparities.

iii. Strategies and Activities Applicants must propose specific, measurable, attainable, relevant, and time-based (SMART) objectives or strategies. Applicants are encouraged to focus SMART strategies on being inclusive and equitable (SMARTIE) and relevant to applicant’s and DOH’s populations of focus (see Populations of Focus section below). For an example of SMARTIE strategies, see this link.

Applicants are required to address all the below strategies and activities to reach NOFO outcomes. Applicants must describe their approach to implementing the strategies and activities.

COMMUNITY WATER FLUORIDATION (CWF)

Recipients will provide support to enhance quality control and management of fluoridated water systems throughout the state. Recipients will also collect CWF data from public systems across https://www.cdc.gov/cancer/nbccedp/pdf/smartie-objectives-508.pdf the state and use analyses to identify, report and disseminate data to address disparities in access to optimally fluoridated water.

Provide financial and technical support for quality control and management of fluoridated water systems throughout the state, especially in water systems serving 10,000 or fewer people

Recipients will:

• Increase access to water fluoridation equipment.

o Fund or leverage funds through mini-grants to provide new or replacement fluoridation equipment in community water systems. (Community applicants for equipment funds must provide a specific justification that includes plans for maintenance, training on use of equipment, and number of persons being served by the new or repaired equipment.)

o Educate water systems administration on how to secure funding and equipment.

o Prioritize water systems serving 10,000 or fewer people.

Collect, provide, and analyze water system fluoridation data, to identify disparities in access to optimally fluoridated water within a state

Recipients will:

• Increase data available to address water fluoridation maintenance and expansion state-wide.

• Track and analyze local and state CWF data.

• Assess the implications of supply shortages for continued operations and possible expansion state-wide.

• Collect, analyze, and report on the proportion of the state population served by community water systems who receive optimally fluoridated water: % of population on community water systems receiving optimally fluoridated water; % of population on small community water systems receiving optimally fluoridated water; and % of water systems reporting fluoridation data to WFRS.

• Summarize and disseminate water fluoridation data.

• Ensure that all public water system information in the CDC Water Fluoridation

Reporting System (WFRS) is current and accurate, and that all discrepancy reports provided by CDC on WFRS are addressed according to established timeline.

DATA ANALYSIS TO SUPPORT MEDICAL DENTAL INTEGRATION AND EBPDS

Recipients will 1)analyze secondary state-wide and community-level data to improve their capacity to describe relationships between the oral health of adults with diabetes (e.g., tooth loss), and their overall health (e.g., risk factors for diabetes-related complications), as well as factors that can influence access to and use of medical and dental care among people with diabetes, 2) build and expand partnerships that will use the data analyses to raise awareness about evidence-based strategies to integrate medical and dental services that adults with diabetes need, and 3) identify disparities in use of and access to EBPDS.

Specifically, recipients will analyze state-wide EBPDS data to 1) identify priority schools/communities based on the percentage of Medicaid/CHIP-enrolled children receiving EBPDS at the local and community-levels, 2) monitor EBPDS delivery in the priority communities/schools, and 3) assess oral health outcomes (e.g., untreated decay) their risk factors, and community-clinical linkage gaps among populations with limited access to

EBPDS.

Analyze, interpret, and disseminate secondary data about relationships between the oral health of adults with Type 2 diabetes, their overall health, as well as their use and access to medical and dental care

Recipients will:

• Develop/maintain an oral health surveillance system that includes the following elements: surveillance plan, surveillance indicators and data sources, community level (associated with small area estimates [e.g., county-level]) factors such as social determinants of health (SDOH) affecting oral health, timely data dissemination to monitor burden of oral disease overall and among populations of focus and other populations with a large burden of health disparities (e.g., populations that have limited access to oral care), and inform program and policy decisions at the state and community level.

• Submit surveillance plan to CDC in the first-year annual performance report. The surveillance plan must include the following components: goals and objectives, logic model, and identification of indicators and their data sources to assess state and community level need. Plan must include information about integrating diabetes indicators into their surveillance plan and systems.

• Analyze, interpret, and disseminate data from surveillance indicators to public health partners, officials, and other interested parties.

o Secondary data sources include but are not limited to Centers for Medicare & Medicaid Services (CMS), existing Basic Screening Survey (BSS) data, the Behavioral Risk Factor Surveillance System (BRFSS), the Pregnancy Risk Assessment Monitoring System (PRAMS), the National Survey of Children’s Health (NSCH), and cancer registries.

o Surveillance indicators may include, but are not limited to, those recommended by the Council of State and Territorial Epidemiologists (CSTE) for state oral health systems and those included in the CMS Child Health Care Quality Measures set. Indicators may also include additional social determinants of health (see glossary section for definition) or comorbidities.

Build and expand partnerships that will use the data analyses to raise awareness about evidence-based strategies to integrate medical and dental services that adults with Type 2 diabetes need, and inform oral health equity programs and policies

Recipients will:

• Develop and publicly disseminate at least one data related product per year (e.g., report, fact sheet, data brief, infographics, web-based content, presentations at state-wide or national meetings, or peer-reviewed publications). The products must summarize an analysis of secondary oral health data. In the case a data analysis is not complete by the end of Year 1, the dissemination goal will be met if the surveillance plan is 1) publicly available and 2) presents secondary data to justify state-specific oral health surveillance and program gaps.

o Data products must

▪ assess relationships between the oral health of adults with Type 2 diabetes, their overall health, as well as their use and access to medical and dental care.

▪ include recommendations for public health practice related to how patient-provider interaction, workforce development and operations, health information exchange, or payment mechanisms could be improved to provide care to adults with Type 2 diabetes.

▪ be prepared in collaboration with another public health program or partner.

▪ be posted on a state oral health website and/or partner website.

• In Years 2 to meet the requirement of producing at least one data related product per year, recipients must:

o Create and deliver one or more presentations from the analysis of secondary data that describe the oral health of adults with Type 2 with diabetes, their overall health, as well as their use and access to medical and dental care.

o Create and disseminate two or more data briefs that summarize analyses of secondary data.

▪ To increase awareness among the public and providers about the connection between overall health and oral health, in Year 2,

▪ Data Brief #1 must assess diabetes status and select health characteristics by sociodemographic characteristics (e.g., income, race and ethnicity).

▪ Data Brief #2 must quantify the number of people in a state who had a medical visit but no dental visit, dental visit but no medical visit, and no medical visit and no dental visit.

• In Year 3, to meet the requirement of producing at least one data related product per year, recipients must:

o Create and deliver one or more presentations from the analysis of secondary data that describe the oral health of adults with Type 2 diabetes, their overall health, as well as their use and access to medical and dental care.

o Create and disseminate two or more data briefs that summarize analyses of secondary data.

▪ To increase awareness among partners and the oral health community, one of the two data briefs in Year 3 must assess associations between diabetes status and community-clinical linkages.

Analyze secondary data about EBPDS (e.g., Medicaid claims and other data, if complementary) to identify 1) disparities in use and access (i.e., delivery in clinical and community programs) and 2) populations of focus

Recipients will:

• Prioritize geographic communities and populations within communities for EBPDS programs and collaborate with partners to implement the programs.

• Work with other state agencies and programs (e.g., state Medicaid office, Department of Education, school-based health center medical programs) to identify and monitor number of schools and number of children in the populations of focus served by EBPDS programs.

• Document data agreements (e.g., Memorandum of Agreements [MOAs], Data Use Agreements [DUAs]) other equivalent documents with other partners e.g., state- Medicaid office, community health centers) that have community-level data about the receipt of EBPDS.

• Work with partners to use the analysis of community-level Medicaid EBPDS measures and other data (e.g., existing BSS data, Health Center Program data, social determinants of health, Dental Health Professional Shortage Areas) to address EBPDS related community-clinical linkage gaps among populations of focus.

• In Year 2 and Year 3, create and deliver one or more presentations focusing on the use of local/community-level data to inform EBPDS program planning and evaluation.

EVIDENCE-BASED PREVENTIVE DENTAL SERVICES (EBPDS):

Recipients will identify schools and non-school settings (e.g., FQHCs) with the highest need for EBPDS to increase use and access to preventive services by establishing and maintaining relationships with entities that can assist with reaching populations of focus. In addition, the recipients will collect and use secondary data to inform efforts for and improve equitable access to EBPDS delivery programs in populations of focus and other populations with a large burden of health disparities (e.g., communities that are disproportionately experiencing barriers to oral health care or elevated risk for cavities). This approach aims to enhance state-wide program delivery across populations of focus and communities disproportionately experiencing barriers to oral health care or having an elevated risk of caries.

Use secondary data analyses and program implementation data to expand access to EBPDS in populations of focus

Recipients will:

• Conduct community-level data analyses that include disparities by race/ethnicity and location of high-need schools.

• Prioritize schools for EBPDS delivery programs based on relative community need, and resources and implement or support implementation of EBPDS in priority schools.

• Evaluate impact of school EBPDS delivery programs on increasing access to EBPDS and reducing oral health disparities, such as untreated cavities among students attending prioritized schools.

• Use oral health surveillance and evaluation data to monitor the progress in increasing access to EBPDS in priority schools. This includes assessing changes in service use rates, oral health outcomes (e.g., decrease in untreated cavities), and the implementation of evidence-based interventions.

Build or use existing partnerships to increase EBPDS participation in populations and communities that disproportionately experience barriers to oral health care or elevated risk for cavities.

Recipients will:

• Identify and develop partnerships with public and private organizations at the state and community-level whose missions align with promoting oral health equity and who may assist with reaching populations of focus.

o Share data with and develop collaborative efforts with community health centers, school-based health centers or school-linked staff, including community health workers, school nurses, and other traditional and non-traditional providers, to expand access to evidence-based dental services and improve oral health outcomes in populations of focus.

o Share data with and collaborate with partners inside and outside the state health department, such as statewide and local coalitions, and other state agencies (e.g., obesity prevention and management of school programs, Department of Education).

o Engage with Medicaid and Children Health Insurance Program (CHIP) dental administrators, as well as private dental insurers, and community health care centers to facilitate a dental home referral process for children without one.

This collaborative effort can significantly enhance access to comprehensive dental care and improve the oral health outcomes of children in need.

o Create opportunities for enhancing partnerships such as: communication campaigns and summits to promote oral health, commitments to promote oral health, collaboration on policy change, and in-kind or other support for oral health activities.

• Provide evidence of formalized partnerships that foster collaboration, resource sharing, and coordinated efforts in addressing community-level or public health priorities that may support oral health promotion in populations of focus. Examples include (MOU)/(MOA), signed letter of commitment, or equivalent documentation (e.g., data-sharing agreement, collaborative research agreement, inter-agency agreement, draft

MOU/MOA).

• Develop an EBPDS implementation plan for the state with key partners to enhance access to EBPDS in schools. The plan must include strategies to increase participation of high-need schools and students, especially racial and ethnic minority students who may experience health disparities.

• Include in the implementation plan medical-dental integration activities to expand the reach of EBPDS strategies in settings outside of schools (e.g., medical clinics, community settings serving the relevant populations of focus).

• Collect, analyze, and report school sealant programs’ cost of resources, quality assurance (sealant retention rate) and program impact using CDC’s SEALS system or other CDC sponsored application when EBPDS activities are conducted. In the 3-year project period, recipients must submit data using CDC’s SEALS system or other CDC sponsored application for one complete school year.

INFECTION PREVENTION AND CONTROL (IPC):

Recipients will support and promote IPC in dental settings throughout the state by establishing IPC partnerships, completing IPC training courses, and promoting the use of IPC trainings, guidelines and other infection prevention resources. Recipients must specifically promote the use of these trainings and resources among oral health programs serving EBPDS school programs, and other dental programs or facilities serving communities with oral health disparities. Recipients will expand their state-wide capacity for IPC in dental settings by establishing partnerships with organizations with this expertise and a shared mission to promote IPC, especially with state healthcare associated infection (HAI) programs. To improve their ability to provide technical assistance, recipients must also complete IPC training courses.

Promote dental IPC resources by establishing new (or using existing) partnerships with state HAI programs and organizations with oral health IPC expertise.

Recipients will:

• Foster and sustain partnerships with infection control organizations, dental health personnel and organizations, state dental boards, and others whose mission aligns with promoting infection prevention and control in dental settings. In addition, where appropriate, leverage this expertise to expand distribution and use of IPC resources.

• Establish or create a MOU/MOA, signed letter of commitment, or equivalent documentation with state health departments’ HAI program to demonstrate collaboration of state infection control activities across medical settings with a dental component.

Implement activities that promote use of dental IPC resources.

Recipients will:

• Require funded recipient staff and recommend that state HAI personnel complete CDC training courses for infection prevention control in dental settings, including but not limited to, CDC’s Foundations: Building the Safest Dental Visit training.

• Provide financial support for one funded recipient program staff member to attend the Organization for Safety, Asepsis and Prevention (OSAP) Dental Infection Control Boot Camp annually.

• Promote CDC and non-CDC IPC training courses and resources to oral health programs in community and public health settings (school sealant programs, FQHCs, community health centers, correction facilities, etc.). Funded recipients must promote the following CDC resources: CDC’s Summary of Infection Prevention Practices in Dental Settings, Dental Check and Foundations: Building the Safest Dental Visit.

1. Collaborations https://www.cdc.gov/oralhealth/infectioncontrol/foundations-building-the-safest-dental-visit.html https://www.osap.org/about https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/index.html https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/index.html https://www.cdc.gov/oralhealth/infectioncontrol/dentalcheck.html https://www.cdc.gov/oralhealth/infectioncontrol/foundations-building-the-safest-dental-visit.html

a. With other CDC projects and CDC-funded organizations:

To ensure program success and to achieve NOFO outcomes, recipients must identify and leverage opportunities with other programs that enhance their work state-wide addressing health equity, school health, environmental health, chronic diseases, or underlying risk factors within the relevant programs and organizations. Opportunities include cost sharing to support a shared position (for example, chronic disease epidemiologist, health communication specialist, program evaluator, or policy analyst) to collaborate on activities across work units within the recipient organization. Other options include, but are not limited to, joint planning and leadership activities, joint funding of aligned program strategies, establishing or maintaining coalition alliances, joint health education efforts, communication activities, data acquisition, analysis and communication, and combined development and implementation of policy, systems, and environmental approaches, community interventions and other cost-sharing activities that align program strategies and performance measures. Recipients will be required to provide information on collaborations with CDC projects and CDC-funded organizations, including leveraged approaches to meeting NOFO outcomes and in their Annual Performance Report (APR) (e.g., collaborations with programs funded by CDC Healthy Schools). Examples of CDC projects and CDC-funded organizations can be found in the below links.

• Population Health o Good Health and Wellness in Indian Country o Adolescent and School Health o Healthy Schools o Supporting Communities to Address Social Determinants of Health

• Disability and Health Program: Improving the Health of People with Mobility Limitation and Intellectual Disabilities through State-based Public Health Programs

• Racial and Ethnic Approaches to Community Health

• Community Health Workers for COVID Response and Resilient Communities

• Healthcare-associated Infections and Antimicrobial Resistance Program

• National Institute For Occupational Safety And Health

• Safe Water Program

• Prevention and Control of Chronic Disease and Associated Risk Factors in the U.S.

Affiliated Pacific Islands, U.S. Virgin Islands, and Puerto Rico

• Nutrition, Physical Activity, and Obesity

• Additional National Center for Chronic Disease Prevention and Health Promotion divisions and Offices

• Recipient(s) of Partner Promotion of Strategies to Advance Oral Health Equity (CDC-

RFA-DP-24-0049

Applicants must submit at least one and up to three MOU/MOA/equivalent documentation with a CDC project or CDC-funded organization, clearly outlining which NOFO goal(s), strategies and activities are enabled by the collaboration(s). The MOA(s)/MOU(s)/letter of commitment(s)/equivalent document(s) must describe the scope of work and contributions from each key partner for work to be conducted. Applicants unable to submit finalized MOU(s)/MOA(s)/letter of commitment/equivalent documentation with their applications must submit a draft MOU/MOA, letter of commitment, or equivalent document from the CDC project https://www.cdc.gov/populationhealth/index.html https://www.cdc.gov/healthytribes/ghwic.htm https://www.cdc.gov/healthyyouth/index.htm https://www.cdc.gov/healthyschools/index.htm https://www.cdc.gov/populationhealth/sdoh/index.htm https://www.cdc.gov/ncbddd/disabilityandhealth/programs.html https://www.cdc.gov/ncbddd/disabilityandhealth/programs.html https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/index.htm https://www.cdc.gov/covid-community-health-workers/ccr-recipient-profiles.html https://www.cdc.gov/hai/hai-ar-programs/recipients-funding.html https://www.cdc.gov/niosh/index.htm https://www.cdc.gov/nceh/ehs/water/index.html https://taggs.hhs.gov/Detail/AwardDetail?arg_AwardNum=NU58DP006667&arg_ProgOfficeCode=120 https://taggs.hhs.gov/Detail/AwardDetail?arg_AwardNum=NU58DP006667&arg_ProgOfficeCode=120 https://www.cdc.gov/nccdphp/dnpao/index.html https://www.cdc.gov/chronicdisease/resources/publications/aag.htm https://www.cdc.gov/chronicdisease/resources/publications/aag.htm or CDC-funded organization and include the required information above, with a concise summary with a justification for being unable to submit finalized attachments and timeline for finalization. The MOU(s)/MOA(s)/letter(s) of commitment/other equivalent documentation may include language indicating they are contingent on successful awarding of this NOFO.

Applicants must name these files "MOU/MOA/letter_of_commitment/name_of other_equivalent_documentation_ApplicantPartnerName_RFA_0048_Name of Applicant" and upload them as PDF files to Grants.gov.

b. With organizations not funded by CDC:

Recipients are required to establish, enhance, or maintain collaborative relationships with external organizations that have a critical role in achieving the NOFO outcomes. Collaborations with a variety of public and private partners from multiple sectors are required to maximize resources, reach, and impact. Partners and agencies identified must serve or be able to serve the population(s) of focus. Examples of potential partners include:

• State offices of health equity or health disparities

• Education partners (e.g., Department of Education; School Board Associations; parent, teacher and student organizations; school nurses; school health coordinators)

• Water departments or associations

• Persons or groups representing population(s) of focus (e.g., Women, Infant, and Children

(WIC) programs; area agencies on aging)

• State administrators managing Medicaid/CHIP/Medicare programs and other relevant federally funded programs

• Health Resources and Services Administration (HRSA) or other applicable federally funded programs, including programs receiving Title III, V, or VII funding

• Health care provider and insurer organizations (e.g., dental, medical, behavioral health)

• Health care clinics (e.g., Federally Qualified Health Centers, community safety-net clinics, school-based health centers, Indian Health Service clinics)

• Primary care associations, primary care offices, rural health offices, regional extension centers

• American Indian or Alaska Native tribal governments or tribally designated organizations

• Representative opinion leaders, including decision-makers

• Minority-serving institutions

• Faith-based organizations

• Non-governmental organizations

• Non-profit organizations

• Foundations focused on health equity, oral health

• Other organizations that can provide data related to populations of focus, health disparities, NOFO key performance measures and strategies

Applicants must submit, at a minimum, two and up to five letters of support for key collaborations with organizations not funded by CDC. Applicants are encouraged to submit at least one letter of support demonstrating planned collaborations with an organization from the above list. Letters of support from partners must document specific contributions of the partner, including but not limited to a description of the precise nature of past and proposed collaborations, products, services, and other resources that will be provided by the partner through the proposed collaboration and any expected and mutually beneficial outcomes (e.g., Area Agency on Aging and recipient co-creating a deliverable on oral health and diabetes in older adults). Letters of support must clearly outline the NOFO goal(s), strategies, and activities that are enabled by the collaboration(s). Applicants must name these files "Letterofsupport_ApplicantPartnerName_RFA_0048_Name of Applicant" and upload them as PDF files to Grants.gov.

2. Population(s) of Focus

While oral diseases affect all segments of society, certain populations experience a disproportionate burden or risk, or lack adequate access to prevention and treatment services.

Some people or communities may not have equitable access to resources and opportunities due to unfair policies, practices, and conditions, or other factors. These factors include, but are not limited to, race and ethnicity, sexual orientation, gender identity, age, physical abilities, geographic location, educational background, economic status, and the intersectionality of these and other factors. DOH-funded recipients must seek to achieve oral health equity by using relevant data to identify populations disproportionately affected by oral diseases and selecting culturally appropriate interventions for implementation.

Populations who could benefit from this funding are people from some racial and ethnic groups, people with lower incomes, persons with disabilities, people who do not speak English or have limited English proficiency, people with limited literacy, American Indian and Alaska Native communities, people who live in rural areas and other under-resourced communities, people who identify as LGBTQIA+, and other groups with a large burden of health disparities.

Each applicant must propose at least one population(s) of focus using relevant state and community-level data to identify communities with significant oral health disparities and select culturally appropriate interventions for implementation. Applicants must consider the data sources/systems or tools below and may propose additional data sources to determine priority data sources and indicators used to select their population(s) of focus. Recipients must identify and begin tracking changes in oral health disparities during the NOFO cycle.

Examples of potential data sources include, but are not limited to:

• Oral Health Data o Indian Health Services Dental Portal Data Briefs by Age Group o Water Fluoridation Reporting System o Basic Screening Surveys/State Oral Health Surveys

• Additional CDC Data Resources o Social Vulnerability Index o PLACES: Local Data for Better Health o Disability and Health Data System (DHDS) | CDC o Behavioral Risk Factor Surveillance System (BRFSS) Prevalence & Trends

Data o Youth Risk Behavior Surveillance System (YRBSS) Data Portal https://www.grants.gov/ https://www.cdc.gov/oralhealthdata/index.html https://www.ihs.gov/doh/index.cfm?fuseaction=home.databriefs https://www.cdc.gov/fluoridation/data-tools/reporting-system.html https://www.astdd.org/docs/states-with-bss-oral-health-data.pdf https://www.atsdr.cdc.gov/placeandhealth/svi/index.html https://www.cdc.gov/places/ https://www.cdc.gov/ncbddd/disabilityandhealth/dhds/index.html https://www.cdc.gov/brfss https://www.cdc.gov/brfss https://data.cdc.gov/browse?category=Youth+Risk+Behaviors o Pregnancy Risk Assessment Monitoring System o Chronic Disease Interactive Data Applications and Chronic Disease Indicators

• AHRQ Social Determinants of Health Database

• Centers for Medicare & Medicaid Services (CMS) Data Resources o State Medicaid Programs o Annual Early and Periodic Screening, Diagnostic, and Treatment Reporting o Child and Adult Health Care Quality Measures

• DQA State Oral Healthcare Quality Dashboard

• Health Resources & Services Administration (HRSA) Data Resources o Health Center Program Uniform Data System (UDS) Data Overview o Health Professional Shortage Area (HPSA) Find

• National Survey of Children’s Health

• US Census Bureau Data

In addition to using relevant data to identify populations of focus, applicants must also address these populations in the relevant NOFO strategies:

• Community Water Fluoridation: Residents in communities with water systems serving 10,000 or fewer people.

• Evidence-Based Preventive Dental Services o School Sealant Program: Public elementary or middle schools located in urban areas in which at least 50% of students qualify for federal or state free or reduced meal programs. Schools in rural or frontier communities may also be prioritized based on applicant data rationale. Applicants must know, or have a plan to identify, gaps in school sealant programs in their respective jurisdictions.

o Fluoride Varnish: Communities with lower incomes and those with high rates of cavities among children. Applicants must know, or have a plan to identify, gaps in fluoride varnish programs in their respective jurisdictions.

o Eligible students: Children who are the focus of EBPDS programs in an eligible school. Eligible students should be between six and nine years old, typically between first and third grade. However, data from middle schools are acceptable (typically grades six through nine). These ages/grades were chosen based on the Centers for Medicare & Medicaid Services Oral Health Sealant for Children measure (Centers for Medicare & Medicaid Services Measure Inventory Tool ID: 830).

• Infection Prevention and Control: Evidence-Based Preventive Dental Services school programs and other dental programs or facilities serving communities with oral health disparities.

• Data Analysis to Support Medical-Dental Integration: Adults with Type 2 diabetes, especially those with limited access to services that are acceptable and affordable.

All applicants must describe how the strategies they implement will address oral health disparities in their populations of focus. Applicants are encouraged to use CDC's Preferred https://www.cdc.gov/prams/index.htm https://www.cdc.gov/chronicdisease/data/statistics.htm https://www.cdc.gov/cdi/index.html https://www.ahrq.gov/sdoh/data-analytics/sdoh-data.html https://www.medicaid.gov/state-overviews/scorecard/eligibles-who-received-preventative-dental-services/index.html https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment/index.html https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-and-child-health-care-quality-measures/index.html https://www.ada.org/resources/research/dental-quality-alliance/dqa-improvement-initiatives https://data.hrsa.gov/tools/data-reporting/program-data https://data.hrsa.gov/tools/shortage-area/hpsa-find https://www.childhealthdata.org/browse/survey https://data.census.gov/ https://www.cdc.gov/healthcommunication/Preferred_Terms.html

Terms for Select Population Groups & Communities and NCCDPHP's Equitably Addressing Social Determinants of Health and Chronic Diseases. Disparities by race and ethnicity, geography, mobility limitations and/or intellectual/developmental disability, primary language, health literacy, income, gender identity, and other relevant dimensions must be considered.

Examples of national oral health disparities may be found in Oral Health Surveillance Report:

Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999– 2004 to 2011–2016.

• For children aged 2 to 5 years, about 33% of Mexican American and 28% of non- Hispanic Black children have had cavities in their primary teeth, compared with 18% of non-Hispanic White children.