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healthcare-associated infections (HAI) program

Request for Application 22-10924

California Nursing Home and Long-Term Care
Infrastructure and Preparedness 

Purpose:

A total of $29.3 million, made available through the American Rescue Plan Act of 2021, P.L. 117-2, was awarded to CDPH through the Centers for Disease Control and Prevention (CDC) Epidemiology and Laboratory Capacity (ELC) Cooperative Agreement under CK19-1904 to support a ‘Nursing Home & Long-term Care Facility Strike Team and Infrastructure Project.’  The intention of this funding is to assist recipients with supporting long-term care facilities during their response to SARS-CoV-2 infections, and to build and maintain the infection prevention infrastructure necessary to support resident, visitor, and facility healthcare personnel safety.  Nursing homes (skilled nursing facilities and long-term care facilities) are the primary target for these funds. Other infectious diseases and conditions may be reasonably addressed to the extent they are in support of or related to work to control the spread of SARS-CoV-2.     

CDPH is providing local assistance funding of $21.5 million to external organizations/entities to support California skilled nursing and other long-term care facilities. CDPH requests applications from eligible organizations/entities to receive funds to conduct activities relevant to the intended purpose, henceforth referred to as ‘California Nursing Home & Long-term Care Facility Infrastructure and Preparedness Project. Because Los Angeles County Department of Public Health received separate ‘Nursing Home & Long-term Care Facility Strike Team and Infrastructure Project’ funding from CDC, proposed activities may not involve facilities located in Los Angeles County. 

Eligible organization: 

The following organizations/entities may apply:
  • IRS recognized 501(c)3 not for profit organizations
  • Community Based Organizations 
  • Health Systems (i.e. health centers, hospitals)
  • Businesses providing services in California
  • Academic Institutions
  • Local health departments
Individuals are not eligible to apply.

Allowable Costs: 

Applicants should consider requesting the following when developing their ‘California Nursing Home & Long-term Infrastructure and Preparedness Project’ budgets:
  1. Personnel (term, temporary, students, contract staff, etc.).  This includes, but is not limited to, health department staff; facility non-clinical staff (e.g., to assist with Activities of Daily Living); and/or facility clinical staff (e.g., nurses, doctors) necessary to achieve activities in this guidance. 
  2. Laboratory equipment used for COVID-19 testing and necessary maintenance contracts.
  3. Collection supplies, test kits, reagents, consumables, and other necessary supplies for existing or new screening testing or onboarding new platforms to support testing. 
  4. Personal Protective Equipment (PPE) (e.g., respirators, eye protection, gloves, gowns) for those collecting samples and/or conducting testing.  
  5. Courier services (new or expansion of existing agreements). 
  6. Provision of end-to-end services (e.g., hoteling, food, laundry, mental health services, etc.) for those family members, visitors, etc. who have been exposed at the nursing home or long-term care facility and test positive for COVID-19. 
  7. Hardware and software necessary for reporting to public health and communication and coordination of follow up on any positive cases detected.  
  8. Tools that assist in the rapid identification, electronic reporting, monitoring, analysis, and evaluation of control measures to reduce the spread of COVID-19, that may be translatable to other diseases (e.g., GIS software, visualization dashboards, cloud services).
  9. Awards to academic institutions, private laboratories, other non-commercial healthcare entities, and/or commercial entities in furtherance of allowable activities under this award.  
  10. Additional costs associated with isolating those who test positive from the rest of the community and providing the necessary additional care. 
  11. Expenses associated with outreach and technical assistance (e.g., support provided through education leaders, community-based organizations). 
The above list covers the anticipated, most relevant costs associated with achieving the activities in this guidance. This list does not represent a full list of allowable costs under this award. In determining if costs are allowable, consideration must be given to applicable regulations; the overall underlying cooperative agreement with CDC (CK19-1904); be considered necessary and reasonable; and be considered allocable (see: 45 CFR 75.403). Any questions about specific budget items should be directed to the HAIProgram@cdph.ca.gov.

Agreement Term and Funding Availability:

  1. Funding Term 
    • This CDC funding was awarded to CDPH in the ELC Budget Period 3   (BP3) under CK19-1904. Applicants should note that this supplemental funding is available for up to one year beyond the end of the public health emergency or through the CDC ELC BP5 that ends on July 31, 2024, whichever comes first.  
    • The resulting Agreement will be in no force until signed by both parties and approved by CDPH. The Awardee is cautioned not to commence performance until all approvals are obtained. Should performance commence before all approvals are obtained, said services may be considered to have been volunteered without State reimbursement.  

    • CDPH/CDOC reserve the right to modify the term of the resulting Agreement via a formal amendment process to modify the SOW or budget based on changes to further the implementation of the state’s cancer plan objectives and strategies.

  2. Funding Amount
    • The total amount to be distributed among all Awardees is anticipated to be $21,500,000. The maximum to be distributed to each Awardee is anticipated to be between $50,000 to $750,000, depending on the nature and scope of the proposed activity.  Contractors will be reimbursed for implementation and satisfactory completion of the Scope of Work activities in their resulting contract. CDPH reserves the right to initiate amendments as necessary to redistribute funds between fiscal years to meet the needs of the project’s success; however, Awardees should not anticipate that unspent funds will be rolled forward from one fiscal year to the next.  

Timeline:

  1. RFA application deadline: February 24, 2023 by 5pm Pacific Standard Time. Applications should be emailed to HAIProgram@cdph.ca.gov subject line Application - CDPH RFA 22-10924.  Applications received after the due date/time will not be accepted.  

Key Action
Date
(All times are in Pacific Standard Time)
RFA Release Date
12/23/2023​
Last Day to Submit Written Questions
1/13/2023​
​​Responses to Written Questions Posted

Responses now posted 
See "Attachments" section below


1/27/2023

Applications Due

​2/24/2023
​Awards Posted
Awards now posted
See "Attachments" section below

​3/20/2023

Applicant Questions and Reporting of Errors in the RFA:

CDPH will accept questions and reporting of errors related to this RFA.  Questions may include, but are not limited to, clarification of eligibility, or about instructions, requirements or RFA materials.  All applicants must follow the process below to submit a questions. 
  1. How to submit Questions or Report and Error in the RFA
    • Submit questions or errors by email to HAIProgram@cdph.ca.gov with the subject line Nursing Home Preparedness RFA.  Verbal questions will not be accepted.  
    • CDPH will send an email confirmation receipt of written questions.  If confirmation is not received, Applicants may call (510) 412-6060 prior to the stated deadline for submission of written questions to confirm receipt of questions.
    • Submit written questions by the due date specified in the Timeline section of this RFA. 
    • Errors in the RFA or its instructions may be reported up to the application due date.
  2. What to Include in an Inquiry
    • Name of inquirer, name of the organization represented, mailing address, phone number, and email address.  
    • A description of the subject, concern, or issue in question or the RFA discrepancy found.
    • RFA section, page number or other information useful in identifying the specific problem, concern, or issue in question.
    • Proposed remedy sought or suggested, if any.
  3. Response by CDPH
    • CDPH reserves the right to seek clarification of any inquiry received and to answer only questions considered relevant to this RFA.  At its discretion, CDPH may consolidate and/or paraphrase similar or related inquiries.  
    • Questions and answered will be published on the CDPH website on the date identified in the timeline.
    • CDPH may issue an addendum to address errors in the RFA up until the application submission deadline. Addendums, if needed, will be posted on the CDPH website.

Application Format:

The following items must be submitted in the Application: 
  1. Applicant Information (Attachment A) must be completed and returned as the cover page of the application. 
  2. Application Narrative (Attachment B) must be no longer than three pages (single-sided, single-spaced) with a 12pt. font size and 1-inch margins on all sides.
    The Application Narrative must address the following:  
    • Problem and needs
    • Target audience and the geographic area(s) in which the intervention will be implemented
    • Description of specific activities, collaborations, and outcomes 
    • Evaluation
    • Organizational Capacity
    • Amount of request
  3. Work Plan (Attachment C) must clearly indicate the specific intervention(s) being proposed.  Refer to the list of Allowable Activities in this RFA. 
  4. Budget (Attachment D)  

Application Review Process:

Stage One: Administrative and Completeness Screening (Pass/Fail)
Applications will be reviewed for on-time submission and compliance with the Application Format requirements.  Applicants will receive a pass/fail grade for Stage One.  Applicants who do not receive a pass grade in Stage One will not move on to Stage Two.  
Stage Two: Application Scoring (0–85 points)
Each application will be evaluated and scored according to the scoring criteria by a review committee on a scale of zero to 85 points. The review committee may include representatives of CDPH, other state agencies, and non-scoring subject matter experts (non-scoring experts shall have no influence on application scores). To be eligible for funding, an application must receive a score of 70 points or more. However, scoring 70 or more does not guarantee funding or funding at the level requested. CDPH reserves the right to not fund any of the applications received for this RFA. Funding decisions may also be made to ensure:
  • No duplication or overlap of efforts with existing CTCP-funded projects.
  • Adequate representation of the indicators addressed.
  • Balanced representation of the types of organizations funded.
The table below describes the maximum point value for each RFA scoring criteria.
​Scoring Criteria
​Points Possible
​1.  Numbers and geographic distribution of facilities.
​10
​2.  Describes how the activity will support underserved or disproportionately impacted facilities and communities. 
​15
​3. Addresses a current gap or activity that is anticipated to expire.
10​
​4.  Describes anticipated impact to reduce morbidity/mortality.
​15
​5.  Demonstrates proposer’s ability to conduct activity.
​5
​6.  Addresses SARS-CoV-2 or an emerging infectious disease most likely to occur and impact skilled nursing and other long term care facilities.
​10
​7.  Clearly outlines appropriate plans for measuring and evaluating accomplishments.
​10
​8. Budget follows funding restriction guidance and is complete with reasonable and justified costs.
​10
​Total Points Possible
​85

Stage Three: Appeals
An applicant who has submitted an application and was not funded may file an appeal with CDPH HAI.  Appeals must state the reason, law, rule, regulation, or practice that the applicant believes has been improperly applied in regard to the evaluation or selection process.  There is no dispute process for applications that are submitted late or are incomplete.  Appeals shall be limited to the following grounds:
  1. The CDPH HAI failed to correctly apply the application review process, the format requirements or evaluating the applications as specified in the RFA.
  2. The CDPH HAI failed to follow the methods for evaluating and scoring the applications as specified in the RFA.
Appeals must be sent by email to HAIProgram@cdph.ca.gov and received within five (5) business days from the date you received notification that your grant application was denied. The CDPH HAI Chief, or designee, will then come to a decision based on the written appeal letter.  The decision of the CDPH HAI Chief, or designee, shall be the final remedy.  Appellants will be notified by email with 15 days of the consideration of the written appeal letter.  CDPH HAI reserves the right to award the agreement when it believes all appeals have been resolved, withdrawn, or responded to, to the satisfaction of the CDPH HAI.

Allowable Activities: 

Infection Prevention and Control Training, Assessment and Support 

Activities in this category relate to infection prevention and control training, assessment and support strategies.  All interventions must align with the following strategies:
  • Local health department applications to expand their own infection prevention capacity or collaborate with local partners (e.g., academic centers, professional organizations) to provide infection prevention education, training, and support to skilled nursing and other long-term care facilities in their jurisdiction. Strong applications will include active outreach and ongoing engagement of facility leadership, and provision of on-site infection prevention program assessments and support outside the context of active outbreak response (e.g., “pre-emptive” assessments in facilities at high risk of outbreaks, or to ensure gaps addressed following an outbreak).   
  • Applications from academic centers or professional organizations with expertise in care for persons with dementia and other behavioral conditions (e.g., substance abuse disorder, brain injury) to develop and evaluate training and implementation of strategies to improve infection control practices for individuals with dementia and other behavioral conditions in congregate living to prevent transmission of SARS-CoV-2. Strong applications would include description of evidence-based practices and metrics for successful training and implementation.  

Testing to Detect Pathogens and Guide Infection Prevention and Control Activities

Activities in this category relate to testing to detect pathogens and guide infection prevention and control strategies. All interventions must align with the following strategies: 
  • Applications to engage facility leadership and infection preventionists to provide initial and refresher training of facility staff and caregivers on how to conduct and interpret point of care antigen tests for COVID-19 and influenza A/B. Training should include how to appropriately collect anterior nasal specimens, how to conduct the test, and how to read the results. The training could also include how to set up onsite staff and visitor testing, when to send a confirmatory molecular test, and how to use and interpret antigen tests during response testing. 

Technology, Staffing, Supplies to Support Vaccination 

Activities in this category relate to technology, staffing, supplies to support vaccination strategies. All interventions must align with the following strategies: 
  • Staffing and support for COVID19 vaccination teams for on-site clinics at long-term care facilities, especially adult and senior residential facilities (also commonly referred to as assisted living facilities)  
  • Support for facility staff to create and maintain facility plans on accessing vaccine resources (seasonal flu vaccine, COVID vaccine, etc.)    
  • Support for LTCFs to enroll in and use the California Immunization Registry (CAIR) to share vaccine information – please also see Technology to Enhance Surveillance and Reporting section below about general electronic health record systems.  

Technology to Enhance Surveillance and Reporting

Activities in this category relate to technological strategies to enhance surveillance and reporting. All interventions must align with the following strategy: 
  • Applications from individual, group, or corporate nursing homes and other long-term care facilities in coordination with LHDs to upgrade their electronic health records system. This would include purchasing software, encouraging interoperability, and linking with Health Information Exchanges. 

Emergency Preparedness for Personal Protective Equipment and Supplies 

Activities in this category relate to the Emergency Preparedness for Personal Protective Equipment and Supplies strategies. All interventions must align with the following strategies:  
  • Applications to engage facility leadership and infection preventionists to implement strategies for maintaining adequate Personal Protective Equipment (PPE) supply and storage. 
  • Support for facility staff to create and maintain facility emergency plans, and engagement in local jurisdiction planning efforts. 
  • Support for facility staff to create, test, and evaluate a facility-level and/or organization-level continuity of operations plan. 
  • Efficiencies for protocols, standard operating procedures and procurement efforts related to surge staffing.

Ventilation and Respiratory Protection and Healthcare Personnel Safety

Activities in this category relate to ventilation and respiratory protection strategies. All interventions must align with the following strategies: 
  • Applications from local health departments, industrial hygiene firms/professionals, academics, etc., to expand the capacity to provide train-the-trainer respiratory protection fit test training to skilled nursing facilities and other long-term care facilities in their jurisdiction. Strong applications will include active outreach and ongoing engagement of facility leadership in encouraging fully Cal/OSHA compliant respiratory protection programs within facilities. Applications from industrial hygiene firms/professionals to assist individual facilities with the establishment of Cal/OSHA compliant respiratory protection programs including written programs, training, fit testing, respirator selection, etc.  
  • Applications from Health Care Access and Information (HCAI), or academic or professional organizations, to set up a demonstration project in one or more skilled nursing facilities and LTC Facilities that demonstrate how facility engineers can add rooms and areas to temporarily and effectively isolate patients having, or suspected of having, an aerosol transmissible disease. The demonstration project would have rooms and areas that could be converted to isolation rooms to demonstrate how facility ventilation and portable ventilation devices are effectively and safely used to prevent transmission to other patients and staff outside the isolation room/area. A written document would be prepared that describes the results of the demonstration project.   
  • Applications for funding renovations from organizations representing skilled nursing facilities and LTC facilities to create permanent and temporary airborne infection isolation rooms and areas in their facilities in compliance with requirements of HCAI, including portable air cleaners or other equipment. Strong applications would build capacity for providing airborne infection isolation across the region and state. 

    Applications from qualified industrial hygiene and/or ventilation firms/professionals for onsite services to facilities to evaluate existing ventilation systems, make recommendations for ventilation-related improvements to improve indoor air quality and reduce COVID transmission risk, and guide facilities through implementation of improvements. 

Healthcare Personnel Safety

Activities in this category relate to healthcare personnel safety strategies. All interventions must align with the following strategy: 
Applications from qualified professionals (consultants, specialists) to evaluate, train, and communicate aspects and management of fatigue and support facility healthcare personnel safety. Should include elements of shift work, shift rotation, shift duration; sleep practices; dietary factors; commute times; circadian rhythms, etc. This can be a critical and integral component of effective COVID-19 risk management as it relates to addressing aspects of fatigue such as relaxation of standards of practice (such as disinfecting/cleaning); validating control measures such as proper operation and maintenance of ventilation systems; relaxation of use of proper personal protective equipment; poor decision making due to diminished alertness; absence from work due to fatigue; etc. 

Attachments

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