SDPI FY 2021 Funding Distribution Consultation with Tribal Leaders
Outline of SDPI funding history, upcoming grant cycle, consultation details, and key questions for Tribal and UIO community leaders to consider in reallocating funds for diabetes treatment and prevention programs.
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Presentation Transcript
SDPI FY 2021 Funding Distribution Tribal Portland Area Consultation Hosted by the Confederated Tribes of the Umatilla Indian Reservation Pendleton, OR October 23, 2019
SDPI Funding Background SDPI has been funding diabetes treatment and prevention activities in I/T/U programs since FY 1998. Congress has reauthorized the Special Diabetes Program for Indians (SDPI) for 1-3 year periods from 2002 to 2019 Current renewal of SDPI expires on November 21, 2019 (Continuing Appropriations Act of 2020, H.R. 4378). SDPI funding has been at $150 million since 2004 and does not include medical inflation. Current SDPI funding is in the 4thyear of a 5-year grant cycle (FY 2016- FY 2020). Next SDPI grant cycle will be from FY 2021- FY 2025)
IHS DTLL- SDPI FY 2021 Funding Distribution IHS initiated Tribal Consultation on October 2, 2019. The DTLL included a detailed SDPI FY 2019 budget for review. Each IHS Area Director will coordinate an Area consultation on the SDPI FY 2021 funding distribution. COMMENTS DUE: December 2, 2019.
Purpose Tribal leaders and Tribal Health Directors need to deliberate and answer the consultation questions provided by IHS. We cannot assume that we will get what we need above $150 million. We need to discuss the budget to shift the funds to best effectively make the SDPI a tribally-run program for our people. Additionally, we must figure out where to come up with at least $5 million per year if we would like to include new SDPI grantees and discuss the budget to shift funds.
IHS SDPI FY 2021 Funding Distribution Questions 1. Currently, the SDPi funding distribution is as follows: Tribal and IHS Community-Directed grant programs $130.2 million UIO Community-Directed grant programs $8.5 million SDPI Support $6.1 million Data Infrastructure Improvement $5.2 million a. If SDPI is funded at $150M, should there be changes in the funding distribution? If so, what changes should be made? b. If the SDPI receives an increase in funding above the current $150M, how should those funds be utilized? (Possible considerations could include funding Tribes and UIOs not current funded, providing an increase for existing programs, etc.)
IHS SDPI FY 2021 Funding Distribution Questions Cont d 2. The last change to the SDPI national funding formula was for the FY 2004 funding cycle. Based on recommendations from Tribal Consultation, the following national funding formula has been used to determine allocation to each IHS Area for the SDPI Tribal and IHS Community-Directed grant program: User Population= 30% Tribal Size Adjustment (TSA) = 12.5% (adjustment given for small Tribes) Disease Burden = 7.5% (diabetes prevalence)
IHS SDPI FY 2021 Funding Distribution Questions Cont d User population and diabetes prevalence data from 2012 have been used in the national funding formula. a. Should there be changes to the national funding formula? b. Should more recent user population and diabetes prevalence data be used? If so, how would the resultant changes in the Area funding distribution be addressed?
Tribal and IHS Grant Awards ($130.2M) Community-Directed Tribal and IHS Grants Tribal Grants (232) IHS Grants (15) $130.2M $114,124,998 + $13,549,765 As decided by SDPI Tribal and IHS grantees in each Area SDPI Data Technical Assistance Services Contracts Portland (NPAIHB) Contract Alaska (ANTHC) Contract Funds Transfers Albuquerque Bemidji California Great Plains Navajo $346,628 $465,701 $82,925 $107,000 $350,000 $200,000 $850,000 $122,970 Oklahoma City
Urban Community-Directed Grants ($8.5M) Urban Community-Directed Grants $8.5M $8.4M Urban Grants (29) SDPI Data Technical Assistance Services As decided by SDPI Urban grantees $100,000 Cooperative Agreement (UIHI)
Data Infrastructure Support National OIT ($2.6M) $9,600 Adobe Connect License- Enables communication and training between the DDTP and SDPI grantees $137,649 Quality Measures and Clinical Care tools- Development and maintenance of quality measures that enable RPMS users to run quality reports, submit data to Congress, and report to HRSA to maintain grants. Reminders to assist providers in providing care to patients with diabetes and gestational diabetes. Measure and decision support logic is made available to external programs to promote unified reporting $384,000 Diabetes Management System Updated the RPMS application that maintains the Diabetes Audit logic and reporting functionality. $237,287 User support- Training and user support for diabetes related questions, problems, and issues related to RPMS or other OIT functions.
SDPI Undisbursed Funds Background Special Diabetes Program for Indians (SDPI) funds are x-year (available until expended) 2019 is SDPI s 22ndyear SDPI grants are on a calendar year budget cycle (January 1-December 31) Challenges for grantees related to carryover of undispersed funds Majority of carryover balances are from accumulated salary savings due to difficulties with recruitment/retention of staff It can be difficult to spend carryover balances e.g., additional activities proposed may not align with approved grant scope of work, can t hire additional staff with carryover alone, etc. The Payment Management System (PMS) contains Tribal and Urban grant funds Funds for IHS grantees are transferred to Areas In the past, the IHS Division of Grants Management (DGM) was not able to estimate Tribal/Urban grantee undisbursed balances from the PMS, but DGM recently determined a way to do this.
SDPI Undisbursed Funds Estimates Headquarters (as of September 2019) DGM* $0.1M $0.03M Comments Current Year Prior Year Due to grants with difficulties so funds not awarded. $1.2M $1.6M Tribal/Urban/IHS Grants ------ $4.25M Office of Information Technology (OIT)** SDPI is subject to a 2% ($3M) sequestration, which occurred in 2013, 2014, and 2017 prior year funds were used to protect grants then and would be used if occurs again. $0.98M $5.66M SDPI Admin Total $2.28M $13.82M
SDPI Undisbursed Funds Estimates Current Year Prior Year Areas (Total) (as of September 2019) Comments $3.8M $8.9M Range of prior year Support funds by Area: $0.12M-$1.8M Funds to Support Area SDPI Activities: Total of Area Diabetes Consultant Support, Data Technical Assistance, and Data Infrastructure Improvement IHS Grants SDPI budget period is Jan- Dec 2019 $7.4M $12.7M One Area has $6.8M in prior year grant funds, another has $3.4M A balance is expected as the SDPI budget period is Jan-Dec 2019
SDPI Undisbursed Funds Estimates Tribal/Urban Grantees (as of April 2019) Current Year Prior Year Comments $99M $91M DGM notes the overall carryover balance corresponds with a grant program of this size and duration Estimated from PMS A balance is expected as the SDPI budget period is Jan- Dec 2019 Of the 43 grants that had >$1M in undispersed funds, 25 had at least a full year of undispersed prior year grant funds. 1/3 of prior year belongs to 7 grantees, to 18 grantees: One had $12.7M in prior year funds o DGM did an offset for that grant in 2016 3 grantees had $3-4M, another 2 had $2-3M 12 grantees had $1-2M
SDPI Undisbursed Funds: IHS Plans for Addressing Balances Ensure grantees know they can request changes/expansions to their grant scope of work Offsets An offset is when the awarding agency utilizes reported, available, unobligated funds as part of an authorized grant award. If SDPI does not receive full funding for FY 2020 ahead of the time the 2020 Notices of Grant Awards (NOAs) have to be awarded in December, DGM will limit offsets this year. Will need Tribal input to develop a plan for the use of offset funds.
Data Infrastructure Support National OIT ($2.6M) $1,375,000 HealthShare License- Enables RPMS and other EHR users to aggregate patient data to improve patient care (provides clinicians with information from multiple EHRs or sites. Provides a diabetes related dashboard to focus on needs of the population as well as the individual patient. $12,250 National Data Warehouse Enable RPMS and non-RPMS programs to better submit medical record data to the National Data Warehouse and to develop and maintain new quality measures to assess diabetes care for AI/ANs. $390,000 First Data Bank contract- Pharmacy medication and medication education handout databased use by RPMS.
Data Infrastructure Support DDTP Data Funds ($600,000) Cont d DDTP Data Funds $600,000 ($480,00) Multiple Services Contract (DDTP data and website staff) * Funds combined with SDPI Program Support funding $110,000 Informatics/Pharmacy Consultant $10,000 SDPI Communications, Software *MailChimp *Survey Monkey *SnagIT *Affinity Photo for Windows
Data Infrastructure Support DDTP Data Funds ($600,000) Cont d $2.0M Area IT Programs IT staffing, travel, support for documentation and reporting, maintaining hardware, software licensing, training, and enhancement, performance improvement, and access to clinical resources. Alaska $155,416 $135,416 Albuquerque $165,416 Bemidji $125,416 Billings $165,417 California $195,417 Great Plains $185,417 Nashville/USET $190,417 Navajo $245,417 Oklahoma City $185,417 Phoenix $175,417 Portland $75,417 Tucson
Data Infrastructure Support DDTP Data Funds ($600,000) Cont d $2.0M Area IT Programs IT staffing, travel, support for documentation and reporting, maintaining hardware, software licensing, training, and enhancement, performance improvement, and access to clinical resources. Alaska $155,416 $135,416 Albuquerque $165,416 Bemidji $125,416 Billings $165,417 California $195,417 Great Plains $185,417 Nashville/USET $190,417 Navajo $245,417 Oklahoma City $185,417 Phoenix $175,417 Portland $75,417 Tucson
SDPI Program Support ($6.1) $5.7M Fixed, predictable expenses Costs that are expectant from year to year that are used to run the SDPI grant program, support grantees and clinicians, provide data that shows progress , etc. Multiple Services Contract and IHS Division of Diabetes Treatment and Prevention (DDTP) Data funds --Coordinating and leading DDTP National Projects, Meetings, and Workgroups *Diabetes in Indian Country Conference *Face-to-face and/or virtual meetings for SDPI grantees, DDTP/SDPI team members, ADCs, etc. *Preparation of conferences/meetings and transcripts/summaries and other post-meeting documentation --Coordination, Programmatic Review, Evaluation of AI/AN Clinical and Public Health Programs *Assist in development of a new funding opportunity announcement (FOA) for each SDPI grant cycle *Assist in the development of an online application process and application documents for SDPI grant programs *Maintain grantee databases, distribution lists, and spreadsheets; generate requested information and reports; and distribute communication to grantees *Provide technical assistance to grantees, ADCs, DGM staff, and Project staff $2.65M ($2,593,724 +445K from DDTP Data Infrastructure funds)
SDPI Program Support ($6.1) Contd $1.02M Division of Grants Management Specialists for SDPI (salary, benefits, training, support costs) --Grants Management Specialists (4) *Oversees and manages SDPI grants *Provides technical assistance to SDPI grantees --GrantSolutions SME/Objective Review Coordinator *Serves as a technical advisor to grantees and others regarding GrantSolutions *Oversees the Objective Review process for each new funding opportunity announcement (FOA) $1.02M Area Diabetes Consultant (ADC Support) --Assists ADCs to support Area SDPI grantees Alaska ADC Support (19 grantees) Albuquerque ADC Support (29 grantees) Bemidji ADC Support (33 grantees) Billings ADC Support (12 grantees) California ADC Support (37 grantees) Great Plains ADC Support (20 grantees) Nashville ADC Support (25 grantees and sub-grantees) Navajo ADC Support (13 grantees and sub-grantees) Oklahoma City ADC Support (34 grantees) Phoenix ADC Support (36 grantees) $94,742 $123,570 $126,027 $74,828 $128,485 $97,199 $99,656 $89,828 $126,027 $128,485
SDPI Program Support ($6.1) Contd $456,723 $460,000 SDPI Grants Management Systems Total --GrantSolutions and Application Review Module (ARMS) *Electronic grants management system that tracks the financial and communication components of grants --Application Review Module (ARM) *Online grants application review process DDTP Online Catalog Clearinghouse Contract *Stores, inventories, and disseminates diabetes treatment and prevention materials to patients and professionals in AI/AN communities nationwide TLDC Support *Cooperative agreement with NIHB Communications about SDPI, outreach and education, meeting logistics (materials, TA), travel, supporting tribal leaders. SDPI/Diabetes national conference (speakers, printing) DDTP travel to TLDC, Area/SDPI meetings, conferences Objective Review Panels National DMS training for local site staff Printing materials for online catalog Shipping special catalog orders, conference materials Equipment, supplies, software Staff training Fees for contracts, funds, transfers, etc. Unplanned expenses Necessary costs that SDPI Support funds helped cover to avoid reducing grants $92,000 $300,000 $250,000 $85k $85k $60k $36k $35k $25k $15k $10k $10k Varies
