Special Diabetes Program for Indians FY 2016 Tribal Leaders Diabetes Committee September 24, 2015

SDPI “3.0” 1.0: FY 1998 –First year of SDPI 2.0: FY 2004 –First competitive grant application process –Start of SDPI DP/HH Demonstration Projects –Changes to funding distribution and formula FY 2010 –New FOA, but no changes to SDPI 3.0: FY 2016 –New FOA, several changes to SDPI

SDPI Funding History: SDPI Funding FYLegislation and Amount Balanced Budget Act (BAA), P.L , signed Aug 1997: authorized $30m annually for 5 years; authorized grants for providing services for the prevention and treatment of diabetes in AI/ANs 2001 – 2003 Consolidated Appropriations Act (CAA) of 2000, P.L , signed Dec 2000: authorized additional $70 m for FY 2001; additional $70 m for FY 2002, and $100 m for FY – 2008 Reauthorization of SDPI, P.L. 107–360, signed Dec 2002: extended SDPI for 5 years (FY 2004 to FY 2008) and authorized $150 m per year for each of the 5 years 2009S.B SCHIP Extension Ac, signed Dec 2007: extended SDPI for one year (FY 2009) and authorized $150m for FY Medicare Improvements for Patients & Providers Act of 2008, P.L. 110 – 275, signed July 2008: extended SDPI for two years (FY 2010 and FY 2011) and authorized $150m for each year Medicare and Medicaid Extenders Act of 2010, H.R. 4994, signed Dec 2010: extended SDPI for two years (FY 2012 and FY 2013) and authorized $150m for each year 2014American Taxpayer Relief Act of 2012, P.L , signed Jan 2013: extended SDPI for one year (FY 2014) and authorized $150m 2015Protecting Access to Medicare Act of 2014, PL ; H.R : extended SDPI for one year (FY 2015) and authorized $150m Medicare Access and CHIP Reauthorization Act of 2015 : extended SDPI for two years (FY 2016 and FY 2017) and authorized $150m for each year TOTAL$2,490,000,000

SDPI FY 2016 In FY 2016, SDPI will enter it’s 19 th year Congress passed legislation in April 2015 –2-year SDPI authorization at $150 million (m) per year National Tribal Consultation/Confer –Dear Tribal Leader and Urban Indian Organization Leader Letters sent by IHS Acting Director on March 19 and May 3, 2015, respectively –Input received from across the country –Tribal Leaders Diabetes Committee (TLDC) meeting held May 14, 2015 Letters to Tribal and Urban Leaders with IHS Acting Director’s decisions: June 29, 2015

SDPI Changes for FY National Funding Distribution a. Area Allocation 2.SDPI DP/HH Final Year & Close-out a. Toolkits 3.Competitive Application Process 4.Single Calendar Year Budget Cycle 5.New Diabetes Best Practices

SDPI FY 2016 Funding Distribution

FY 2015 SDPI Funding Distribution- $150 million Community-Directed grant program $108.9 m Includes $4.1m for program support Diabetes Prevention/Healthy Heart $27.4 m Initiatives Includes $4.1m for program support Set Asides: – Urban Indian Health Programs $7.5 m – Data Infrastructure Improvement $5.2 m – CDC Native Diabetes Wellness Program $1.0 m Note: CDC funds for FY 2014 & FY 2015 were reassigned to diabetes-specific data projects

IHS Acting Director’s Decisions on SDPI FY SDPI set-aside funds ($1m) formerly assigned to CDC will now be assigned to the Community-Directed (C-D) grant program 2.New and competing continuation Funding Opportunity Announcement (FOA) 3.No changes to the national funding formula --User population 30%, diabetes burden 57.5%, Tribal size adjustment 12.5% 4.More recent data (FY 2012) will be used in the funding formula (user population, diabetes prevalence) 5.SDPI Diabetes Prevention and Healthy Heart (DP/HH) Initiative program will be merged into the SDPI C-D program

FY 2016 Funding Distribution Community-Directed Grants $130.2m Urban C-D Grants $8.5m SDPI Program Support $6.1m Data Infrastructure Support $5.2m $150.0m

SDPI Program Support Had been $8.2m –$4.1m each from C-D and DP/HH Will be reduced to $6.1m in FY 2016 These funds will be used for: –DDTP contract staff –DGM staff for SDPI –ADC support funds –DDTP online catalog clearinghouse –IAA for GrantSolutions, ARMS

Data Infrastructure Improvement: $5.2m National IHS Office of Information Technology $2.6 m –RPMS-based Electronic Health Record, Diabetes Management System, iCare Application –Web-based Diabetes Care and Outcomes Audit process –Web conferencing platform for virtual meetings, webinars and conferences IHS Area Office OIT $2.0 m –Supports locally determined data infrastructure improvements within each IHS Area DDTP $0.6 m –Biostatistician and data activities Organizes Audit and provides analysis on Audit outcomes Calculates AI/AN health statistics including diabetes prevalence

SDPI FY 2016 Area Funding Allocation

SDPI DP/HH Initiatives Final Year and Close-out

SDPI Diabetes Prevention and Healthy Heart Initiatives DP/HH funds will be merged into the SDPI Community- Directed (C-D) grant program –Current DP/HH grantees are funded through September 29, 2016 –Can then request no-cost extensions up to September 2017 –3-month grant close-out period (up to December 2017) C-D programs that want to implement activities/services similar to those done as part of the DP/HH Initiatives can do so DP/HH Toolkits –DP toolkit will be available within about a month –HH toolkit in about 4-5 months

SDPI FY 2016 Competitive Application Process

SDPI Community-Directed Grant Program Funding Opportunity Announcement (FOA) –Posted on Federal Register on August 4, 2015 –Application deadline date: October 7, 2015 –5-year project period (contingent on funds availability) Funds will be awarded to all applicants who successfully meet application criteria –Competition is to achieve a fundable score on the objective application review (not against each other) Applications must be complete, good quality, and submitted on time –Grant regulations do not allow revisions after the application deadline date. –Applications which are incomplete, of insufficient quality, and/or late will not be awarded SDPI funds.

C-D Grant Amounts Won’t know final C-D grant amounts until December 2015 –FY 2016 applicants applying for same amount as in FY 2015 Steps to determine FY 2016 grant amounts: –Need to know which sites successfully applied –Areas will reach consensus with grantee programs on: Area funding formula Which data to use in Area formula Any Area set-asides –Areas will then calculate the grant amounts for each grantee, then notify DDTP/DGM for NOAs –Grantees who will receive more than they applied for will then submit supplemental budget and program information

DDTP Application Training DDTP is providing as much training and assistance as possible, available to all applicants –Assistance to Individual applicants is not allowed DDTP working to ensure that as many eligible applicants submit fundable applications as possible –DDTP website has extensive information for applicants –DDTP has been providing 1-3 training and Q&A webinars per week Started with FY 2016 SDPI C-D Kick-off webinar on July 15 Since then, have provided 18 webinar trainings and Q&As as of 9/23 –DDTP partnered with DGM to provide several important trainings Four more webinars scheduled up to the October 7 application deadline All webinars are recorded and made available on DDTP website for applicants not able to attend the live sessions

SDPI FY 2016 Single Calendar Year Budget Cycle

Budget Period for FY 2016 Since beginning of SDPI there have been 4 budget cycles: starting October 1, January 1, April 1, June 1 One budget cycle starting in FY 2016 – January 1 to December 31, 2016 How this affects current C-D grantees for their FY 2015 budget cycle: –Cycle 1: No cost extensions and, when needed, supplemental funding to cover Oct-Dec 2015 –Cycle 2: No change –Cycle 3: Overlap 3 months with FY 2015 –Cycle 4: Overlap 5 months with FY 2015

FY 2016 SDPI New Diabetes Best Practices

SDPI Diabetes Best Practices Congress directed that SDPI funds be used to implement best practice approaches for diabetes prevention and treatment Best Practices (BP) for SDPI grant programs started in 2001 –BPs have gone through several versions over the years –BPs continue to evolve: now unveiling the next generation Why BPs are changing for FY 2016: –Used to be long documents –Need data to demonstrate effectiveness of SDPI –Expanding scope of best practice work Grantees will decide how to improve their Required Key Measure (RKM) –BP will no longer dictate how, with whom, or where

SDPI Diabetes Best Practices Focused areas for improvement of diabetes prevention and treatment activities/outcomes in communities and clinics FY 2016: 18 SDPI Diabetes Best Practices –Every current BP aligns with a new BP Only exception: Community Advocacy (can still do as part of other activities) –Different emphases: Screening, education, clinical services, clinical outcomes –One short webpage each—no longer long pdf’s Each Best Practice includes: –Importance Statement –One Required Key Measure (RKM) –Target Group Guidance –Helpful resources

SDPI Diabetes Best Practice Overview Applicants must select one of the new SDPI Diabetes Best Practices –Best Practices encompass both clinical and community activities/services Emphasis is on providing data to show that improvements are being made –Required Key Measures (RKM) are tied to the Diabetes Audit –Applicants will select a target group to work intensively with during the budget period Will report baseline and year-end RKM data on this group DDTP will be able to combine RKM data from sites who have chosen same BP –to show how SDPI C-D funds have directly improved important data Applicants may propose using some of their SDPI funds for diabetes- related activities outside of their selected Best Practice Current Cycles 3 & 4 must continue their FY 2015 BP work through the end of their project periods

Same BP/Different Activities & Target Groups! Applicants choosing the same Best Practice may propose different activities/services with different Target Groups.

Draft DP Toolkit

Thank you