Recovery.gov - Track the Money

Centers for Disease Control and Prevention

CDC will award funding to eligible state health departments to support efforts to prevent HAIs as part of the HHS Action Plan to Prevent HAIs. Existing Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) and the Emerging Infections Programs (EIP) competitive cooperative agreement programs will be utilized to make competitive supplemental awards to eligible state health departments to carry out HAI activities as follows:

Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)
• Coordinating and reporting of state HAI prevention efforts
• Reporting progress toward reductions on two or more of the targets in the HHS Action Plan To Prevent Healthcare-Associated Infections
• Developing sustainable state HAI reporting using the NHSN and to evaluate NHSN data
• Increasing awareness among healthcare providers
• Estimating the burden of HAI
• Monitoring the impact of prevention programs and reporting using NHSN metrics for progress toward HHS HAI Prevention Targets
• Establishing prevention collaborations with healthcare facilities, healthcare professionals, state Hospital associations, and state-based Medicare Quality Improvement Organizations

Emerging Infections Programs (EIP)
• Monitoring and investigating the changing epidemiology of HAIs in populations as a result of prevention collaboratives
• Quickly expanding the EIP infrastructure to address a broader array of HAI epidemiology
• Providing additional training for EIP state staff on HAI epidemiology and surveillance
• Developing and implementing enhanced surveillance tools and methods, and add staff for targeted two year projects

Centers for Medicare and Medicaid Services
This initiative will significantly expand the awareness of proper infection control technique among ASCs and SAs, increase the extent to which infection control deficiencies are both identified and remedied, and prevent future serious infections in ASCs by:

(a) Improving SA inspection capability and frequency for onsite surveys of ASCs nationwide,
(b) Using a new infection control survey tool developed by the CDC and CMS,
(c) Improving the survey process through the use of a CMS tracer methodology, and
(d) Using multi-person teams for ASCs over a certain size or complexity.

A CMS pilot program tested the above survey process improvements in three States in 2008 and demonstrated superior results in the identification and remedy of serious infection control deficiencies. The particular focus on ASCs for this funding was chosen because the available tool was developed and tested for ASCs, because ASCs have not been surveyed with the frequency and attentiveness to infection control that is needed (about once every ten years on average nationally), and because of the likely continuing infection control deficiencies in this setting. The Recovery Act funds will enable the application of the above four-component new survey process nationwide.

CDC
CDC has established a centralized management/oversight function, the Recovery Act Coordination (RAC), at the agency level to oversee and coordinate all Recovery Act -funded activities. Quarterly reviews of Recovery Act programs will be conducted by ORAC in collaboration with CDC’s FMO and PGO, as well as HAI program managers. The roles and responsibilities for the RAC oversight function as well as the additional duties of PGO, FMO and the responsible program office are described in CDC’s Recovery Act Implementation Plan.

CDC will perform the following:

• Coordinate with the Office of Inspector General (OIG) to ensure that Recipient Capability Assessments are conducted on funded organizations that may have had performance issues in the past, or are new recipients of CDC-awarded funds;

• Ensure that ongoing technical assistance is provided to contractors and grantees that may need help in meeting the additional Recovery Act administrative and program requirements;

• Conduct additional, more vigorous post-award management and monitoring of Recovery Act activities, to include site visits of Recovery Act grantees if necessary. As resources permit, CDC-sponsored meetings for award recipients will be convened;

• Monitor the receipt of Recovery Act financial and performance reports, and will review those reports for purposes of monitoring compliance with Recovery Act’s special financial requirements; and

• Ensure the unique identification of Recovery Act funds in contractual and grant agreements, to include the use of a unique Recovery Act CFDA number for HAI grants.

• Ensure timely enforcement and other actions for any non-performing Recovery Act contractor or grantee misuse of Recovery Act funds, such as the disallowance of costs, the recovery of funds, the referral of suspected fraud to the OIG, the implementation of administrative corrective actions by the contractor or grantee, or the termination of funding

Program Specific Risk Mitigation Strategies
For EIP and ELC, funds will be specifically awarded for HAI activities only. Eligible applicants will outline a plan for reporting progress toward HHS Action Plan Prevention Targets per specified metrics compatible with NHSN. CDC will collaborate with AHRQ and work with grantees to eliminate duplication of effort, and the EIP and ELC supplemental funding opportunity announcements (FOAs) will require details on how CDC-funded work will link into existing efforts funded by AHRQ.

HAI state applicants will identify state plans for sustaining Recovery Act impact beyond the federal funding provided and demonstrate a continued plan for progress toward meeting HHS Action Plan prevention targets as evidenced through reporting metrics outlined in the Plan.

There will be frequent communication between grant recipients and program staff, including regular conference calls addressing allowable and unallowable expenditures. Appropriate penalties for misappropriation or misuse of funds will be enforced. Tables 2A and 2B include (OMB MAX) a full presentation of the Agency specific Recovery Act Risks and Mitigations for Healthcare-Associated Infections.

Development and submission of HAI grantee plans and quarterly updates on progress towards specific economic and performance measures and targets will help minimize the risk of such abuse, serve as an evaluation of progress, and allow for early and timely risk mitigation.

The HAI proposal was shared with the Office of Inspector General (OIG), and CDC successfully responded to all questions.

CMS
CMS will: 1) obtain detailed information on the ASC infection control deficiencies; 2) analyze associated information to discern patterns and correlates; 3) and evaluate the extent to which States conduct the onsite surveys. Risk mitigation will focus primarily on issues related to addressing State-wide personnel restrictions (per State budget deficits) and obtaining the necessary data on survey re

CDC and CMS will: be transparent in all of its Recovery Act contracting and grant competitions and regulations; ensure recipient reporting per Section 1512 is made available to the public on Recovery.gov by October 10, 2009; inform recipients of reporting obligations via standard terms and conditions, grant announcements, contract solicitations, and other program guidance; provide technical assistance to grantees and contractors and fully utilize Project Officers to ensure compliance with reporting requirements, including site visits and frequent communications for costs and performance.

CDC
Healthcare facility data for National Healthcare Safety Network are confidential at the federal level, but some state public health department websites may provide access to specific facility data for facilities in their state. HAI performance measures track the number of states with a "threshold" percentage of healthcare facilities meeting the designated benchmark.

The program and project officers will use data from the quarterly reports and performance data from the grantee progress reports. CDC will appropriately aggregate and disaggregate necessary recipient performance and financial data for public access on www.cdc.gov. It will also be reported in an existing system to CDC's FMO and PGO.

CMS
CMS will publish (www.cms.hhs.gov): the public communications with States (Survey and Certification memoranda) as well as the survey Guidance and protocol documents; results from the quarterly reporting; and completed research per survey results. All grant funds will be designated to State levels per the number of ASCs in that specific State

CDC and CMS will leverage existing internal controls. Senior officials from CDC and CMS will meet regularly with senior Department officials to ensure that projects are meeting their program goals, assessing and mitigating risks, ensuring transparency, and incorporating corrective actions.” The personnel performance appraisal system will also incorporate Recovery Act program stewardship responsibilities for program and business function managers. A point of contact has been established for Recovery.gov to receive and answer public inquiries

CDC
Per CDC’s internal Program Implementation Plan, Programs will be held accountable through both the programmatic review processes and annual performance evaluations. Internal program processes will include quarterly meetings between Division Directors, senior program managers and project officers to address progress to date and discussion of grantee performance. These data will be reviewed by National and Coordinating Center leadership and RAC for discussion with HAI program leadership. Corrective actions will be identified per recipient performance or financial issues, and progress on program improvement will be tracked quarterly.

CMS
CMS will establish additional procedures and practices, as necessary, to ensure proper transparency and accountability by tracking mandatory training in the new survey process for relevant State and federal surveyors and completion of the expected ASC. CMS will incorporate the ASC-HAI performance expectations for States into CMS’ State Performance Standards System (SPSS).

CMS will: communicate to the SAs the intent, purpose, and process for the State grants consistent with Recovery Act funding and requirements; with State officials (such as State Governors) and leadership of state Departments where the State Survey Agencies are organizationally located to address any State gubernatorial or Department-level actions relevant to fulfilling the goals of this initiative. SAs progress will be monitored and the agencies will be held accountable for outcomes via the existing SPSS. CMS will determine if States have applied the Recovery Act dollars consistent with this program’s purpose. Pilot study results and progress reports will be posted on CMS’ Web site

Not Applicable