[Federal Register Volume 66, Number 104 (Wednesday, May 30, 2001)]
[Notices]
[Pages 29330-29336]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-13498]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Program Announcement 01038]


Cooperative Agreement for 2001 National Breast and Cervical 
Cancer Early Detection Program; Notice of Availability of Funds

A. Purpose

    The Centers for Disease Control and Prevention (CDC) announces the 
availability of fiscal year (FY) 2001 funds for a cooperative agreement 
program for the National Breast and Cervical Cancer Early Detection 
Program (NBCCEDP). This program addresses the ``Healthy People 2010'' 
priority area related to cancer.
    The purpose of the NBCCEDP is to apply a State, territorial, or 
tribal public health approach to increase access to and use of 
screening services. The NBCCEDP was established through the Breast and 
Cervical Cancer Mortality Prevention Act of 1990 (Public Law 101-354) 
and provides screening services for low income women. Funded programs 
will establish a comprehensive breast and cervical cancer early 
detection screening program that includes the following program 
components: Breast and cervical cancer screening, tracking, follow-up 
and case management; public education and outreach; professional 
education; quality assurance and improvement; surveillance and 
evaluation; coalitions and partnerships; and management, hereafter 
referred to as the NBCCEDP program components.
    The President has committed the nation to an ambitious goal: By the 
year 2010, to eliminate the disparities in health status experienced by 
racial and ethnic minority populations. The NBCCEDP has been 
established to move closer to this goal by addressing the deficits in 
breast and cervical cancer screening and management among these women.

B. Eligible Applicants

    Assistance will be provided only to the official health departments 
of States and territories (including the Federated States of Micronesia 
and the Republic of the Marshall Islands) or their bona fide agents or 
instrumentalities, including the District of Columbia, the Commonwealth 
of Puerto Rico, the Virgin Islands, the Commonwealth of the Northern 
Mariana Islands, the Republic of Palau, and federally recognized Indian 
Tribal governments (including Indian Tribes, Tribal organizations, 
Alaska Natives and Urban Indian organizations and inter-tribal 
consortia, hereafter referred to as Tribes).
    An inter-tribal consortium or American Indian/Alaskan Native (AI/
AN) organization is only eligible for funding if its primary purpose 
for incorporation is to improve AI/AN health, and it is representative 
of the Tribes, Alaska Native villages, or Urban Indian communities in 
which it is located. Tribes are encouraged to collaborate with other 
Tribes to expand the potential screening population.
    States and Tribes currently receiving CDC funds under Program 
Announcement 96023, entitled 1996 National Breast and Cervical Cancer 
Early Detection Program, are eligible to apply for funding under this 
announcement.
    1. The following States and Territories are not eligible to apply:
    a. American Samoa, California, Colorado, Maryland, Michigan, 
Minnesota, Missouri, Nebraska, New Mexico, North Carolina, South 
Carolina, Texas, and West Virginia, which are funded under Program 
Announcement 718 entitled National Breast and Cervical Cancer Early 
Detection Program.
    b. Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, 
Illinois, Iowa, Kansas, Louisiana, Maine, Massachusetts, New Jersey, 
New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhodes Island, Utah, 
Vermont, Washington, Wisconsin, Puerto Rico, and Guam, which are funded 
under Program Announcement 99052 entitled National Breast and Cervical 
Cancer Early Detection Program.
    2. The following Tribes are not eligible to apply:
    a. Consolidated Tribal Health Project, Inc. (CA) and Southeast 
Regional Health Consortium (AK), which are funded under Program 
Announcement 718 entitled National Breast and Cervical Cancer Early 
Detection Program.
    b. Arctic Slope Native Association (AK), Cherokee Nation (OK), 
Cheyenne River Sioux Tribe (OK), Poarch Band of Creek Indians (AL), 
South Central Foundation (AK), and South Puget Intertribal Planning 
Agency (WA), which are funded under Program announcement 99052 entitled 
National

[[Page 29331]]

Breast & Cervical Cancer Early Detection Program.

C. Availability of Funds

1. Funds Available for States

    Approximately $22,421,667 is available in FY 2001 to fund 
approximately 15 States and the District of Columbia. It is expected 
that awards will range from $600,000 to $4,000,000.

2. Funds Available for Territories and Tribes

    Approximately $5,400,000 is available in FY 2001 to fund 
approximately nine Territories or Tribes. It is expected that awards 
will range from $200,000 to $1,000,000.
    It is expected that awards will begin on September 30, 2001, and 
will be made for a 12-month budget period within a project period of up 
to five years. Funding estimates may change.
    Continuation awards for funded projects within an approved project 
period will be made on the basis of disease burden, performance, and 
the availability of funds.

3. Direct Assistance

    Applicants may request Federal personnel as direct assistance, in 
lieu of a portion of financial assistance.

4. Requirements Related To Use of Funds

    a. 60/40 Requirement: Not less than 60 percent of cooperative 
agreement funds must be expended for screening, tracking, follow-up and 
the provision of appropriate support services such as case management. 
Cooperative agreement funds supporting public education and outreach, 
professional education, quality assurance and improvement, surveillance 
and program evaluation, coalitions and partnerships, and management may 
not exceed 40 percent of the approved budget. [Section 1503(a)(1) and 
(4) of the PHS Act, as amended] Further information about the 60/40 
distribution is provided in the NBCCEDP Policies and Procedure Manual, 
Section II, beginning on page 10. The NBCCEDP Policies and Procedures 
Manual can be accessed through the Internet at http://www.cdc.gov/cancer/nbccedp or the program technical assistant contact listed in 
Section M, ``Where to Obtain Additional Information.''
    b. Inpatient Hospital Services: Cooperative agreement funds must 
not be expended to provide inpatient hospital or treatment \1\ services 
[Section 1504(g) of the PHS Act, as amended]. Refer to the NBCCEDP 
Policies and Procedures Manual, Section IV, ``Reimbursement Policies 
for Screening and Diagnostic Services,'' beginning on page 1, for 
additional information about allowable screening and diagnostic 
services.
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    \1\ Treatment is defined as any medical or surgical intervention 
recommended by a clinician, and provided for the management of a 
diagnosed condition.
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    c. Administrative Expenses: Not more than 10 percent of the total 
funds awarded may be expended annually for administrative expenses. 
These administrative expenses are in lieu of and replace indirect 
costs. [Section 1504(f) of the PHS Act, as amended.] Administrative 
expenses are considered a portion of the 40 percent component of the 
budget.

D. Recipient Financial Participation Requirement

    Recipient financial participation is required for this program in 
accordance with the authorizing legislation. Section 1502(a) and 
(b)(1), (2), and (3) of the PHS Act, as amended, requires matching 
funds from non-Federal sources in an amount not less than $1 for each 
$3 of Federal funds awarded under this program. However, Title 48 of 
the U.S. Code 1469a(d) requires DHHS to waive matching fund 
requirements for Guam, U.S. Virgin Islands, American Samoa and the 
Commonwealth of the Northern Mariana Islands up to $200,000.
    Matching funds may be cash or equivalent in-kind or donated 
services, including equipment, fairly evaluated. Contributions may be 
made directly or through donations from public or private entities. 
Public Law 93-638 authorizes tribal organizations contracting under the 
authority of Title I and compacting under the authority of Title III to 
use funds received under the Indian Self-Determination Act as matching 
funds.
    Applicants may also designate as State, Territory, or Tribe 
matching funds any non-Federal amounts expended pursuant to Title XIX 
of the Social Security Act for the screening, tracking, follow-up and 
case management of women for breast and cervical cancers.
    Matching funds may not include: (1) Payment for treatment services 
or the donation of treatment services; (2) services assisted or 
subsidized by the Federal government; or (3) the indirect or overhead 
costs of an organization.
    In determining the matching fund contribution, applicants should 
calculate the average amount of non-Federal contributions toward breast 
and cervical cancer programs and activities for the two year period 
preceding the first Federal fiscal year of funding for NBCCEDP. This 
amount is referred to as Maintenance of Effort (MOE). Only those non-
Federal contributions in excess of the MOE amount may be considered as 
matching funds. Supplanting existing program efforts with Federal or 
non-Federal sources is not allowable.
    Costs used to satisfy the matching requirements are subject to the 
same prior approval requirements and rules of allowability as those 
which govern project costs supported by Federal funds. All costs used 
to satisfy the matching requirements must be documented by the 
applicant and will be subject to audit. Specific rules and regulations 
governing the matching fund requirement are included in the OMB 
Circular A-87 ``Cost Principles for State, Local and Indian Tribal 
Governments'' and PHS Grants Policy Statement, Section 6.
    For further information about the matching fund requirement, see 
the NBCCEDP Policies and Procedures Manual, Section II, pages 19-21 and 
page 35.

E. Requirements of the Breast and Cervical Cancer Mortality 
Prevention Act of 1990 (Public Law 101-354) and Related Amendments

1. Required Screening Services

    Programs must ensure that screening and rescreening procedures are 
available for both breast and cervical cancers and include a clinical 
breast exam, mammography, pelvic exam and Pap test. [Section 
1503(a)(2)(A) and (B).]

2. Screening Procedures

    If a new or improved, and superior, screening procedure becomes 
widely available and is recommended for use, this superior procedure 
will be utilized in the program. [Section 1503(b) of the PHS Act, as 
amended.]

3. Priority for Low-income Women

    Eligibility for screening services under the NBCCEDP is limited to 
uninsured or under insured \2\ women at

[[Page 29332]]

or below 250 percent of the Federal poverty line. The official poverty 
line is established by the Director of the Office of Management and 
Budget (OMB) and revised by the Secretary of DHHS in accordance with 
Section 673(2) of the Omnibus Budget Reconciliation Act of 1991 
[Section 1504(a) of the PHS Act, as amended]. Policies related to 
eligibility for screening are detailed in the NBCCEDP Policies and 
Procedures Manual, Section IV.
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    \2\ CDC, through its delegation from the Secretary, is tasked 
with implementing its programs. Therefore, when questions regarding 
the programs and the statutes behind them arise, CDC may provide 
definitions or explanations of what the statute as a whole, or terms 
contained therein, mean, in order to ensure proper implementation of 
its programs. CDC is entitled to deference in its interpretation of 
such statutes. CDC interprets ``low income women'' to include those 
that are ``uninsured'' and ``underinsured.'' For the NBCCEDP, CDC 
defines an uninsured woman as one who has no health insurance and an 
underinsured women as one who meets at least one of the following 
criteria: (1) a woman who has health insurance but whose coverage 
does not, to any extent, reimburse for the allowable screening or 
diagnostic procedure; (2) a woman who cannot afford her insurance 
provider's deductible or required co-payment for the allowable 
screening or diagnostic procedure; (3) a woman whose insurance 
supports the allowable screening and diagnostic procedure but at 
intervals greater than those recommended by the NBCCEDP; and (4) a 
woman who does not have reasonable access to a provider included 
under her insurance coverage.
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4. Medical Referrals

    Programs are required to provide appropriate referrals for medical 
treatment of women screened in the Program and to ensure, to the extent 
practicable, the provision of appropriate, affordable\3\ and timely 
diagnostic and treatment services [Section 1501(a)(2) of the PHS Act, 
as amended.] The Breast and Cervical Cancer Treatment and Prevention 
Act (BCCTPA) of 2000 (Public Law 106-354) amends Title XIX of the 
Social Security Act to give States the option to provide Medicaid 
coverage to women who have been screened under the NBCCEDP and found to 
have breast or cervical pre-cancerous conditions or cancer. Additional 
information about this law can be obtained from the following web site: 
http://www.cdc.gov/cancer/nbccedp.
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    \3\ CDC, through its delegation from the Secretary, is tasked 
with implementing its programs. Therefore, when questions regarding 
the programs and the statutes behind them arise, CDC may provide 
definitions or explanations of what the statute as a whole, or terms 
contained therein, mean, in order to ensure proper implementation of 
its programs. CDC is entitled to deference in its interpretation of 
such statutes. Because the NBCCEDP gives priority to serving low-
income women, CDC interprets ``appropriate referrals'' to also mean 
``affordable referrals.''
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5. Service Delivery Area

    Programs are required to establish breast and cervical cancer 
screening services throughout the State, Territory, or Tribe. [Section 
1504(c)(1) of the PHS Act, as amended.] Funds may not be awarded under 
this announcement unless the State, Territory, or Tribe involved agrees 
that services and activities will be made available throughout the 
State, Territory, or Tribe, including availability to members of any 
Indian Tribe or tribal organization (as such terms are defined in 
section 4 of the Indian Self-Determination and Education Assistance 
Act). CDC may waive [Section 1504 (c)(2) of the PHS Act, as amended] 
this requirement if it is determined that compliance by the State, 
Territory, or Tribe would result in an inefficient allocation of 
resources with respect to carrying out a comprehensive breast and 
cervical cancer early detection program [as described in Section 
1501(a)]. A request from the recipient outlining appropriate and 
detailed justification would be required before the waiver is approved.

6. Payer of Last Resort

    Funds may not be awarded under this announcement unless the State, 
Territory, or Tribe involved agrees that funds will not be expended to 
make payment for any item or service that will be paid or can 
reasonably be expected to be paid by:
    a. Any State, Territory, or Tribe compensation program, insurance 
policy, or Federal or State, Territory, or Tribe health benefits 
program.
    b. An entity that provides health services on a prepaid basis. 
[Section 1504(d)(1) and (2) of the PHS Act, as amended.]

7. Medicare Limit for Reimbursement of Services

    The amount paid by a State, Territory, or Tribe for a screening 
procedure may not exceed the amount that would be paid under part B of 
Title XVIII of the Social Security Act (Medicare)[Section 1501(b)(3) of 
the PHS Act, as amended].

8. Limitation on Imposition of Fees for Services

    Funds may not be awarded under this announcement unless the State, 
Territory, or Tribe involved agrees that if charges are to be imposed 
on clients for the provision of services or program activities, such 
fees/charges for allowable screening and diagnostic evaluation will be:
    a. Assessed according to a schedule of fees made available to the 
public [Section 1504(b)(1) of the PHS Act, amended];
    b. Adjusted to reflect the income of the woman screened [Section 
1504(b)(2) of the PHS Act, as amended.]; and
    c. Totally waived for any woman with an income of less than 100 
percent of the Federal poverty line [Section 1504(b)(3) of the PHS Act, 
as amended].Additionally, the schedule of fees/charges should not 
exceed the maximum allowable charges established by the Medicare 
Program administered by the Health Care Financing Administration 
(HCFA). Fee/charge schedules should be developed in accordance with 
guidelines described in the interim final rule (42 CFR Parts 405 and 
534) which implements section 4163 of the Omnibus Budget Reconciliation 
Act of 1990 (Public Law 101-508) which provides limited coverage for 
screening mammography services.

9. Quality Assurance Requirements

    Cooperative agreement funds may not be awarded [under Section 
1501(a)(5) of the PHS Act, as amended] unless the State, Territory, or 
Tribe involved agrees to assure, in accordance with the applicable law, 
the quality of screening procedures provided.
    a. All facilities conducting mammography screening procedures 
funded by the Program must be MQSA certified (Mammography Quality 
Standards Act of 1992). [Section 1503 (c) of the PHS Act, as amended]. 
Additional information about quality assurance is included in the 
NBCCEDP Policies and Procedures Manual, Section II, page 14.
    b. All facilities conducting cervical screening procedures funded 
by the Program must be CLIA certified (Clinical Laboratory Improvement 
Amendments of 1988). Pathologists participating in the Program must 
record their findings using the Bethesda System. [Section 1503(d) of 
the PHS Act, as amended] Additional information about quality assurance 
is included in the NBCCEDP Policies and Procedures Manual, Section II, 
page 14.

10. Grantee Contracting

    If a non-profit private entity and a private entity that is not a 
non-profit entity both submit applications to a State/Tribe/Territory, 
the State/Tribe/Territory may give priority, based on a competitive 
review process, to the application submitted by the non-profit private 
entity in any case in which the State/Tribe/Territory determines that 
the quality of such application is equivalent to the quality of the 
application submitted by the other private entity [Section 1501(b) of 
the PHS Act, as amended].

F. Program Requirements

    In conducting activities to achieve the purpose of this program, 
the recipient will be responsible for the activities under 1. 
(Recipient Activities), and CDC will be responsible for the activities 
listed under 2. (CDC Activities).

1. Recipient Activities

    a. Implement a comprehensive breast and cervical cancer early 
detection screening program that includes the NBCCEDP program 
components delineated in the Purpose, Section A [Section 1501(a)(1-6)]. 
Descriptions of

[[Page 29333]]

the NBCCEDP program components, including each component's minimum core 
expectations, are provided in Attachment 1.
    b. Attend and participate in sponsored events: Attendance at 
sponsored training, meetings, site visits, reverse site visits, and 
conferences is required. Funds may be included in the budget request 
for this purpose.

2. CDC Activities

    Provide technical assistance to Grantees to support their planning, 
implementation and evaluation of each NBCCEDP program component. 
Technical assistance from CDC may address:
    a. Practical application of Public Law 101-354, including 
amendments to the law;
    b. Design and implementation of program components;
    c. Interpretation of current scientific literature related to the 
early detection of breast and cervical cancer;
    d. Interpretation of program outcome, screening and surveillance 
data;
    e. Overall operational planning and program management.

3. Assist With Training on Selected Topics.

4. Conduct Site Visits

    Program Consultants may conduct site visits or coordinate reverse 
site visits to assess program progress and/or mutually resolve 
problems.

G. Application Content

    Use the information in the Requirements (Section E), Recipient 
Activities (Section F and related attachments), and Evaluation Criteria 
(Section G) sections to develop the application content. Applications 
will be evaluated on the criteria listed in Section G. Because this is 
a competitive program announcement, CDC requires Applicants to submit 
certain data and performance indicators in order that it be considered 
in making funding decisions. The application, including budget, 
justification and appendices, should be no more than 125 double-spaced 
unbound pages, printed on one side of 8\1/2\  x  11'' paper, suitable 
for photocopying, with one inch margins and 12 point font. Applicants 
should number each page and include a header with the Applicant's 
program name. Please interpret the maximum page limits as a ceiling, 
rather than a goal.

1. Executive Summary (Maximum 4 Pages)

    The applicant should provide a clear, concise summary to include 
the: (1) need for the program; (2) number and characteristics of women 
to be screened; (3) requested amount of Federal funding; and (4) past 
performance indicating the applicant's capability to implement the 
program.

2. Background and Need (Maximum 6 Pages, Including Matrix)

    The applicant should describe:
    a. The State, Territory, or Tribal breast and cervical cancer age-
adjusted mortality rates averaged over five years and ranked nationally 
(States should use SEER or State Cancer Registry data for the period 
1993-1997);
    b. The State, Territory, or tribal incidence rates for breast and 
cervical cancer by age, race, and ethnicity (where available) (States 
should use data from their Cancer Registries for 1998 or the most 
recent year available);
    c. The number of women who are at or below 250 percent of the 
Federal poverty level and uninsured, by age (18-39; 40-49; 50-64; 65+) 
and racial/ethnic distribution (if possible, use 1990 Census data, 
unless 2000 Census data is available); and
    d. The unmet screening and rescreening needs of uninsured and 
under-insured women (where available).
    Applicants are encouraged to present these data (a-d above) using 
the Background and Need matrix, Attachment 2.
    e. The priority populations for screening, including supporting 
data and/or justification for their selection. Broadly, priority 
populations can be described as women who are racial, ethnic and/or 
cultural \4\ minorities, such as American Indians, Alaska Natives, 
African-Americans, Hispanics, Asian and Pacific Islanders, lesbians, 
women with disabilities, and women who live in geographically or 
culturally isolated communities in urban and rural areas. The term 
priority populations, as defined above, will be used throughout this 
document.
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    \4\ Cultural minorities are defined as communities which, in 
order to preserve or protect cultural or religious beliefs or 
practices, limit contact with other people or the larger community.
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    Breast and cervical cancer death rates vary by race and ethnicity; 
therefore, applicants must review related state and local morbidity and 
mortality rates to identify specific priority populations in need of 
breast and cervical cancer screening in their geographic area. Programs 
should aim to eliminate racial health disparities by prioritizing 
populations that are under screened and/or disproportionately affected 
by breast and/or cervical cancer for recruitment and enrollment.
    Regardless of the geographic area, priority for breast cancer 
screening should be given to women age 50 to 64 years of age. Priority 
for cervical cancer screening should be given to rarely \5\ or never 
screened women.
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    \5\ Rarely screened is defined by the NBCCEDP as a woman who has 
not received a Pap test during the past five years.
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    f. The specific barriers to screening services that impede women in 
the priority populations from participating in breast and cervical 
cancer screening and diagnostic services.

3. Capability for Program Implementation (Maximum 10 Pages, Not 
Including Letters of Commitment)

    a. Applicants should address their capability to implement the 
proposed activities as measured by their accomplishments as part of an 
existing or past NBCCEDP program or relevant past experiences funded by 
other sources.
    (1) States, Territories, or Tribes currently receiving NBCCEDP 
funds should detail their accomplishments in operating a comprehensive 
breast and cervical cancer early detection program. Applicants should 
address accomplishments in program and fiscal management, 
infrastructure development, and service delivery by summarizing 
progress in meeting NBCCEDP fiscal year 2001 Program Progress 
Indicators.\6\ These program progress indicators are listed in the 
NBCCEDP Policies and Procedures Manual, Section III, beginning on page 
3. Applicants should use the most recent data available to summarize 
these indicators.
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    \6\ Program Progress Indicators have been developed to provide a 
systematic approach for rapid assessment of program progress. 
Program progress indicators are defined as performance measures used 
to track critical processes over time to signify progress toward a 
particular goal or outcome of the program.
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    (2) Territories and Tribes not currently receiving CDC NBCCEDP 
funds should address relevant past experiences in conducting any of the 
NBCCEDP program components for cancer control, chronic disease control 
or other relevant areas.
    b. Letters of Commitment: Applicants should include letters of 
commitment (dated within the last three months) from key partners, 
participants, and community leaders that detail their commitment to and 
participation in the proposed program. If the applicant is a Tribe, 
also include either of the following documentation, as appropriate: (1) 
A signed and dated tribal resolution supporting the application from 
the Indian Tribe served by the project. If the applicant includes more 
than one Indian Tribe, resolutions from all Tribes to be served must be

[[Page 29334]]

included; or (2) A letter of support for the application from the Board 
of Directors of an Urban Indian organization(s) or Indian Health 
organization(s), signed by the Board Chairman.
    c. Other Accomplishments: Applicants should include information 
about any other accomplishments that reflect capability and capacity 
for implementing a breast and cervical cancer early detection program.

4. Work Plan (Maximum 30 Pages)

    The applicant should develop a detailed work plan that, for each 
NBCCEDP program component, describes: proposed goals; measures of 
success related to goals; specific, measurable, attainable, realistic 
and time-phased objectives; and activities to attain the objectives. 
The minimum core expectations for each program component should be 
addressed in the work plan. Be reminded that descriptions of the 
NBCCEDP program components are included as Attachment 1.
    The work plan should include a time table for program 
implementation that specifies dates for the accomplishment of all 
proposed activities. Applicants are encouraged to use the NBCCEDP work 
plan template available through the Internet at http://www.cdc.gov/cancer/nbccedp/training/index.htm. This template is included in the 30-
page limit but may be single spaced.
    Applicants should include an attachment to the work plan with 
realistic screening projections for fiscal year 2001-2002 that are 
based on past screening performance. Screening projections should be 
provided with the following detail: the number of women to be screened 
by the program by age, race, ethnicity and other identified priority 
populations (applicant's cultural minorities identified in the 
Background and Need section as priority populations). In addition, the 
applicant should include a projection of the number of rarely and never 
screened women to receive a Pap test. Projected screening levels for 
racial and ethnic populations should be based on population estimates 
of the number of women in the Program area who meet NBCCEDP age and 
income eligibility guidelines, as well as past screening performance. 
Applicants are encouraged to present the screening projections using 
the Screening Projections matrix, Attachment 3. Applicants with current 
NBCCEDP funding from CDC should provide a brief narrative justification 
that includes recent screening data supporting the projections.
    If the applicant has submitted a request to the HCFA and received 
approval to provide Medicaid coverage for treatment to women screened 
under the NBCCEDP with breast or cervical cancer, or pre-cancerous 
conditions of the breast or cervix, complete Attachment 4, the Breast 
and Cervical Cancer Prevention and Treatment Act Form.

5. Organizational Structure (Maximum 15 Pages)

    The applicant should provide the following supporting documents 
related to organizational structure:
    a. An organizational chart (can be single spaced) indicating the 
placement of the proposed Program in the department or organization and 
the structure of the proposed breast and cervical cancer early 
detection program management and staffing;
    b. Documentation of available resources in the State, Territory, or 
Tribe for the payment or reimbursement of breast and cervical cancer 
screening, including the Medicaid program;
    c. The proposed schedule of fees and charges for breast and 
cervical cancer screening and diagnostic services, consistent with 
maximum Medicare reimbursement rates, if fees will be imposed (single 
line spacing is acceptable). Include a description of the use of the 
proposed schedule of fees and charges in the Program. In States, 
Territories, or Tribes where there are multiple Medicare rates and a 
single reimbursement rate is being proposed, the applicant must provide 
justification for approval.
    d. Documentation of how the State, Territory, or Tribe will assure 
that funds will be used in a cost-effective manner.
    e. A description of how the State, Territory, or Tribe will 
establish or enhance linkages with their State Cancer Registry program 
if the Applicant has a State Registry with the North American 
Association of Central Cancer Registries (NAACCR) certification. For 
more information about Cancer Registries see http://www.cdc.gov/cancer/npcr, http://www-seer.ims.nci.nih.gov, and for NAACCR certification see 
http://www.NAACCR.org.

6. Source Data for Matching Requirement (Maximum 5 Pages)

    a. Maintenance of Effort: The applicant should detail the average 
amount of non-Federal dollars expended for breast and cervical cancer 
programs and activities made by a State, Territory, or Tribe for the 
two year period preceding the first Federal fiscal year of NBCCEDP 
funding. This amount will be used to establish the maintenance of 
effort baseline for current and future match requirements.
    b. Sources of Match: The applicant should detail the State, 
Territory, or tribal allowable sources of matching funds for the 
Program and the estimated amounts from each. The applicant should 
document the procedures for determining the value of non-cash matching 
funds. Further information about the Matching Funds Requirement can be 
found in the NBCCEDP Policies and Procedures Manual, section II, pages 
19-21 and page 35.
    c. Documentation of Match Received: The applicant should describe 
procedures for documenting the actual amount of match received.

7. Budget With Justification (Maximum 7 Pages)

    a. Provide a detailed line item-budget (can be single spaced) with 
a separate narrative justification (for both Federal and non-Federal 
funds) of all proposed operating expenses consistent with the program 
activities described in this announcement. The budget may include line 
items for personnel, fringe benefits, travel, contractors, consultants, 
equipment, administrative, and other expenses. Not less than 60 percent 
of Federal funds will be expended for screening, tracking, follow-up 
and other support services such as case management. Not more than 10 
percent of Federal funds will be expended for administrative expenses. 
The following information is required for all contracts: (1) name of 
contractor; (2) method of selection; (3) period of performance; (4) 
scope of work; (5) method of accountability; and (6) itemized budget 
with justification for each contract.
    b. A detailed line-item breakdown of the 60/40 distribution should 
be provided. A sample 60/40 budget breakdown is included in the NBCCEDP 
Policies and Procedures Manual, section II, page 38. For further 
information about the 60/40 requirement, please refer to the NBCCEDP 
Policies and Procedures Manual, section II, page 10.
    c. The applicant should submit a completed Screening and Diagnostic 
Worksheet which is used to estimate the amount of funding needed to 
reimburse providers for allowable clinical services provided to 
eligible women served in your program. Further information about the 
Screening and Diagnostic Worksheet is provided in the NBCCEDP Policies 
and Procedures Manual, Section IV, pages 21-25. An electronic version 
of the Screening and Diagnostic Worksheet, an EXCEL spreadsheet, may be 
obtained through the program technical assistance contact listed in

[[Page 29335]]

Section L, Where To Obtain Additional Information.
    d. To request Federal, direct-assistance assignees, include:
    (1) number of assignees requested;
    (2) description of the position and proposed duties;
    (3) ability or inability to hire locally with financial assistance;
    (4) justification for request;
    (5) organizational chart and name of intended supervisor;
    (6) opportunities for training, education, and work experiences for 
assignees; and
    (7) description of assignee's access to computer equipment for 
communication with CDC (e.g., personal computer at home, personal 
computer at workstation, shared computer at workstation on site, shared 
computer at a central office).

H. Submission and Deadline

    Submit the original and two copies of PHS 5161-1 (OMB Number 0937-
0189). Forms are available in the application kit and at the following 
Internet address: www.cdc.gov/od/pgo/forminfo.htm
    On or before June 27, 2001 submit the application to the Grants 
Management Specialist identified in the ``Where To Obtain Additional 
Information'' section of this announcement.

I. Evaluation Criteria (100 Points)

    Applications will be evaluated individually against the criteria 
below which reflect an emphasis on disease burden and program quality. 
Funding for Tribes and Territories will be competitive based on review 
by a panel of independent reviewers. All applicants representing States 
will be funded. State applications will undergo technical acceptability 
reviews by independent reviewers.

1. Background and Need (20 Points)

    The extent and clarity with which the applicant describes the 
disease burden, size of potentially eligible population, unmet 
screening needs, size, selection and characteristics of the priority 
populations and extent to which the applicant has identified barriers 
to care that can be addressed through program activities.

2. Capability for Program Implementation (10 Points)

    The extent to which the applicant appears likely to be successful 
in implementing the proposed activities as measured by:
    a. Prior performance reflected by the NBCCEDP program progress 
indicators or, for applicants not currently receiving NBCCEDP funds, 
their success as measured by relevant past experiences in conducting a 
similar program(s).
    b. Letters of commitment from key partners, participants, and 
community leaders that detail their commitment to and participation in 
the proposed program. If the applicant is a Tribe, the inclusion of a 
tribal resolution(s) or letter of support from the Board of Directors 
is required.
    c. Other accomplishments that reflect the capability of the 
applicant to implement a breast and cervical cancer screening program.

3. Work Plan (60 Points)

    The degree of comprehensiveness and quality of the work plan 
represented by the goals, measures of success related to goals, 
objectives and activities to attain the objectives for each of the 
NBCCEDP program components and a time table for program implementation. 
The degree of comprehensiveness in addressing the minimum core 
expectations for each NBCCEDP program component within the work plan as 
detailed in the descriptions included as Attachment 1. The extent to 
which realistic screening projections are provided based on the 
applicant's past screening history (if applicable) and detailed 
separately for Pap tests and mammograms by the number of women to be 
screened for the 2001-2002 program year by age, race, ethnicity, and 
other priority populations identified by the applicant in the 
Background and Need section. In addition, the extent to which realistic 
screening projections are provided for Pap tests among rarely and never 
screened women.

4. Organizational Structure (10 Points)

    The appropriateness of the applicant's organizational structure; 
documentation of the applicant's available resources for the payment or 
reimbursement of breast and cervical cancer screening, including the 
Medicaid program; the proposed schedule of fees consistent with 
Medicare reimbursement rates, if applicable; the assurance that funds 
will be used in a cost effective manner; and the description of 
linkages between the proposed program and the State Cancer Registry, if 
applicable.

5. Source Data for Matching Requirement (Not Weighted)

    The extent to which the applicant provides clear evidence of 
maintenance of effort, sources of match, and a means to document actual 
match received.

6. Budget With Justification (Not Weighted)

    The extent to which the proposed budget is reasonable, justified, 
consistent, and in compliance with this program announcement.

7. Human Subjects (Not Weighted)

    The extent to which the application adequately addresses the 
requirement of 45 CFR Part 46 for the protection of human subjects. An 
application will be disapproved if the research risks are sufficiently 
serious and protection against risks is so inadequate as to make the 
entire application unacceptable.

J. Technical Reporting Requirements

    Provide CDC with the original plus two copies of:
    1. Semiannual progress reports, to be submitted no later than 90 
days after each semiannual reporting period. All manuscripts published 
as a result of the work supported in part or whole by the cooperative 
agreement must be submitted with the progress reports.
    2. Financial status report (FSR), no more than 90 days after the 
end of each budget period.
    3. Final financial report and performance report, no more than 90 
days after the end of the project period.
    Send all reports to the Grants Management Specialist identified in 
the ``Where to Obtain Additional Information'' section of this 
announcement.
    The following additional requirements are applicable to this 
program. For descriptions of each, see the Appendix.

AR-1  Human Subjects Requirement
AR-2  Requirements for Inclusion of Women and Racial and Ethnic 
Minorities in Research
AR-7  Executive Order 12372 Review
AR-9  Paperwork Reduction Act Requirements
AR-10  Smoke-Free Workplace Requirements
AR-11  Healthy People 2010
AR-12  Lobbying Restrictions

K. Authority and Catalog of Federal Domestic Assistance Number

    This program is authorized under sections 1501, 1502, 1507 and 1509 
[42 U.S.C. 300k, 42 U.S.C. 300l, and 42 U.S.C. 300n-3] of the Public 
Health Service Act, as amended. The Catalog of Federal Domestic 
Assistance number is 93.919.

L. Where To Obtain Additional Information

    This and other CDC announcements can be found on the CDC home page 
Internet address--http://www.cdc.gov. Click on ``Funding'' then 
``Grants and Cooperative Agreements.''
    Should you have questions after reviewing the contents of all the

[[Page 29336]]

documents, business management technical assistance may be obtained 
from: Glynnis Taylor, Grants Management Specialist, Grants Management 
Branch, Procurement and Grants Office, Program Announcement 01038.
    Centers for Disease Control and Prevention (CDC), 2920 Brandywine 
Road, Room 3000, Atlanta, GA 30341-4146, Telephone number: (770) 488-
2752, Email address: <a href="/cdn-cgi/l/email-protection#1f78737b2e5f7c7b7c31787069"><span class="__cf_email__" data-cfemail="60070c0451200304034e070f16">[email protected]</span></a>.
    For program technical assistance, contact: Amy DeGroff, Program 
Services Branch, Division of Cancer Prevention and Control, National 
Center for Chronic Disease Prevention and Health Promotion, Centers for 
Disease Control and Prevention (CDC), 4770 Buford Highway, NE., 
Mailstop K-57, Atlanta, GA 30341-3724, Telephone number: (770) 488-
4248, Email address: <a href="/cdn-cgi/l/email-protection#e4859780d5a4878087ca838b92"><span class="__cf_email__" data-cfemail="ceafbdaaff8eadaaade0a9a1b8">[email protected]</span></a>.

    Dated: May 22, 2001.
Henry S. Cassell III,
Acting Director, Procurement and Grants Office, Centers for Disease 
Control and Prevention (CDC).
[FR Doc. 01-13498 Filed 5-29-01; 8:45 am]
BILLING CODE 4163-18-P


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