The Affordable Care Act Medicaid Incentives for Prevention of Chronic Disease Demonstration Project

Section 4108(a)(1)(A)The Secretary shall award grants to States to carry out initiatives to provide incentives to Medicaid beneficiaries who - (i) successfully participate in a program described in paragraph (3); and (ii) upon completion of such participation, demonstrate changes in health risk and outcomes,
including the adoption and maintenance of healthy behaviors by meeting specific targets (as described in subsection (c)(2)).

(a)(1)(B) The purpose of the initiatives under this section is to test approaches that may encourage behavior modification and determine scalable solutions.
(a)(3)(A)The Secretary shall award grants to States to carry out initiatives to provide incentives to Medicaid beneficiaries who successfully participate in a comprehensive, evidence-based, widely available, and easily accessible program, proposed by the State and approved by the Secretary, that is designed and uniquely suited to address the needs of Medicaid beneficiaries and has demonstrated success in helping individuals achieve ceasing use of tobacco, controlling their weight, lowering cholesterol, lowering blood pressure, and avoiding onset of diabetes.

(a)(3)(B) A program under this section may also address co-morbidities (including depression) that are related to any of the conditions described in subparagraph (A).



(a)(3)(C) WAIVER AUTHORITY- The Secretary may waive the requirements of section 1902(a)(1) (relating to statewideness) of the Social Security Act for a State awarded a grant to conduct an initiative under this section and shall ensure that a State makes any program described in subparagraph (A) available and accessible to Medicaid beneficiaries.
(a)(4)(D) FLEXIBILITY IN IMPLEMENTATION- A State may enter into arrangements with providers participating in Medicaid, community-based organizations, faith-based organizations, public-private partnerships, Indian tribes, or similar entities or organizations to carry out programs described in subparagraph (A).

(d)(2) A State awarded a grant to conduct an initiative under this section shall develop and implement a system to-
(1) track Medicaid beneficiary participation in the program and validate changes in health risk and outcomes with clinical data, including the adoption and maintenance of health behaviors by such beneficiaries;
(2) to the extent practicable, establish standards and health status targets for Medicaid beneficiaries participating in the program and measure the degree to which such standards and targets are met;
(3) evaluate the effectiveness of the program and provide the Secretary with such evaluations;
(4) report to the Secretary on processes that have been developed and lessons learned from the program; and
(5) report on preventive services as part of reporting on quality measures for Medicaid managed care programs.


Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.

Office - See Regional Agency Offices.

Applicants should refer to the agency contact information of the funding opportunity announcement under this CFDA program for contact information.


Program Accomplishments

Not Applicable.

Uses and Use Restrictions

Funding under this program will be used according to the ACA section 4108 statute.

States will be reimbursed for approved expenditures through the grant with 100 percent Federal funds.

Approvable expenditures will include direct cash incentives, or alternative forms of inducement such as free goods, transportation support, reduced Medicaid program fees, provision of alternative preventive services not normally reimbursable through Medicaid, or payments to family members, friends or community agencies that provide support and facilitation of a participants preventive program attendance and meeting goals of tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or improving the management of the condition.

Also reimbursement of 100 percent of approved expenditures for the administrative operation of the MIPCD Program is available through the grant.

Examples of eligible reimbursable items are: key personnel; MIPCD travel, training, outreach and marketing; IT infrastructure to accommodate the MIPCD reporting requirements; and completing the satisfaction survey requirements.

Applicants should review the individual funding opportunity announcement issued under this CFDA program for prohibited uses of grant funding.



Eligibility Requirements

Applicant Eligibility

Applicants should review the eligibility information of the individual funding opportunity announcement issued under this CFDA program.

Beneficiary Eligibility

Applicants should review the funding opportunity description of the funding opportunity announcement issued under this CFDA program for information on participant eligibility requirements.

Sec 4108(e) No Effect on Eligibility For, or Amount of, Medicaid or Other Benefits - Any incentives provided to a Medicaid beneficiary participating in a program described in subsection (a)(3) shall not be taken into account for purposes of determining the beneficiary s eligibility for, or amount of, benefits under the Medicaid program or any program funded in whole or in part with Federal funds.

Credentials/Documentation

Applicants should review the individual funding opportunity announcement issued under this CFDA program for any required proof of certifications which must be submitted prior to or simultaneous with submission of an application package. OMB Circular No. A-87 applies to this program.

Aplication and Award Process

Preapplication Coordination

Preapplication coordination is not applicable.

Environmental impact information is not required for this program.

This program is excluded from coverage under E.O.

12372.

Application Procedures

This program is excluded from coverage under OMB Circular No. A-102. This program is excluded from coverage under OMB Circular No. A-110. Sec 4108(4) APPLICATION- Following the development of program criteria by the Secretary, a State may submit an application, in such manner and containing such information as the Secretary may require, that shall include a proposal for programs described in paragraph (3)(A) and a plan to make Medicaid beneficiaries and providers participating in Medicaid who reside in the State aware and informed about such programs.
The standard application form SF-424 and related forms, as furnished by CMS, must be used for this program. Applicants are encouraged to submit a non-binding Notice of Intent to Apply. Notices of Intent to Apply are not required and a state s submission or failure to submit a notice has no bearing on the scoring of proposals received. Notices of Intent to Apply are due no later than February 3, 2011. Applications are due March 1, 2011.
Applicants should review the application and submission information in the funding opportunity announcement for specific instructions to apply for this grant program.

Award Procedures

Successful applicants will receive a Notice of Award. Unsuccessful applicants will be notified by letter. Applicants should review the award administration information of the funding opportunity announcement issued under this CFDA program.

Deadlines

Contact the headquarters or regional office, as appropriate, for application deadlines.

Authorization

): Affordable Care Act (Public Law 111-148) Section 4108.

Range of Approval/Disapproval Time

Applicants should review the award information of the individual funding opportunity announcement issued under this CFDA program for applicable approval/disapproval time range.

Appeals

Not Applicable.

Renewals

Subject to approval, the grant funding will be renewed annually.

Assistance Considerations

Formula and Matching Requirements

This program has no statutory formula.
This program has no matching requirements. This program has no matching requirements.
This program does not have MOE requirements. This program has no MOE requirements.

Length and Time Phasing of Assistance

Section 4108(f) Funding- Out of any funds in the Treasury not otherwise appropriated, there are appropriated for the 5-year period beginning on January 1, 2011, $100,000,000 to the Secretary to carry out this section. The funds in this section may be obligated within the 5-year period beginning 1/1/2011. Method of awarding/releasing assistance: quarterly.

Post Assistance Requirements

Reports

Applicants should review the individual funding opportunity announcement for information on programmatic and evaluation reporting required.
Section 4108(2) STATE REPORTING- A State awarded a grant to carry out initiatives under this section shall submit reports to the Secretary, on a semi-annual basis, regarding the programs that are supported by the grant funds.

Such report shall include information, as specified by the Secretary, regarding--
(A) the specific uses of the grant funds;
(B) an assessment of program implementation and lessons learned from the programs;
(C) an assessment of quality improvements and clinical outcomes under such programs; and
(D) estimates of cost savings resulting from such programs.

Applicants should review the individual funding opportunity announcement for information on financial reporting requirements.

Applicants should review the individual funding opportunity announcement for information on programmatic and evaluation reporting requirements.

Applicants should review the individual funding opportunity announcement for information on financial reporting requirements.

Applicants should review the individual funding opportunity announcement for information on programmatic and evaluation reporting requirements.

Audits

In accordance with the provisions of OMB Circular No. A-133 (Revised, June 27, 2003), "Audits of States, Local Governments, and Non-Profit Organizations," nonfederal entities that expend financial assistance of $500,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $500,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in Circular No. A-133.

Records

Proper accounting records, identifiable by project number including all receipts and expenditures must be maintained for 3 years. Subsequent to audit, they must be maintained until all questions are resolved.

Financial Information

Account Identification

75-0516-0-1-551.

Obigations

(Salaries) FY 10 $0; FY 11 $22,000,000; FY 12 Estimate Not Available

Range and Average of Financial Assistance

FY 2011 - Estimate 8-10 states, $1.7-2.1 million/per state in annual grant money and the full 12-month obligation to be made in FY 2011.

Regulations, Guidelines, and Literature

Applicants should refer to the funding opportunity announcement for applicable regulations, guidelines and literature.

Information Contacts

Regional or Local Office

See Regional Agency Offices. Applicants should refer to the agency contact information of the funding opportunity announcement under this CFDA program for contact information.

Headquarters Office

Ed Hutton, 7500 Security Boulevard, Baltimore, Maryland 21244 Email: Grant@cms.hhs.gov Phone: (410) 786-6616.

Criteria for Selecting Proposals

Applicant should refer to the funding opportunity announcement under this CFDA program for specific criteria requirements on proposal selection.



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Edited by: Michael Saunders

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