ACA State Innovation Models: Funding for Model Design and Model Testing Assistance

The Center for Medicare and Medicaid Innovation (Innovation Center) announces the State Innovation Models (SIM) initiative.

The purpose of the State Innovation Models (SIM) initiative is to test whether new payment and service delivery models will produce greater results when implemented in the
context of a state-sponsored State Health Care Innovation Plan.

These Plans must improve health, improve health care and lower costs for a state s citizens through a sustainable model of multi-payer payment and delivery reform, and must be dedicated to delivering the right care at the right time in the right setting.

The Innovation Center has created the SIM initiative for states that are prepared for or committed to planning, designing, testing, and supporting evaluation of new payment and service delivery models in the context of larger health system transformation.



This initiative is based on the premise that Governor-supported multi-payer models that have broad stakeholder input and engagement will achieve sustainable delivery system transformation that significantly improves health system performance.

Because of the unique powers of state governments, Governors and their executive agencies working together with and key public and private stakeholders and the Centers for Medicare & Medicaid Services (CMS) can accelerate community-based health system improvements, with greater sustainability and effect, to produce better results for Medicare, Medicaid, and CHIP beneficiaries.


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.



Program Accomplishments

Not Applicable.

Uses and Use Restrictions

This FOA provides two different funding opportunities; states can apply for a Model Design award or a Model Testing award but not both.

States can receive only one Model Testing award.

States that submit a proposal in round one and are not selected for a Model Testing cooperative agreement may submit a proposal in an expected round two, whether or not they have received a pre-testing assistance award.

States may also submit a Model Testing proposal without having received a Model Design cooperative agreement.



• Model Design awards will support states that need financial and technical support to engage stakeholders and complete a State Health Care Innovation Plan.

A Comprehensive Plan must provide a broad vision of health system transformation and payment reform.

The Plan shall describe the state s broad strategy for delivery system evolution into community-integrated health care.

Based on the State Health Care Innovation Plan, the state should develop a health system model design that includes the participation of multiple payers as part of a new payment and delivery system model.

States receiving these awards must complete their Plan and Model Design and submit a Model Testing proposal in the second round Model Testing opportunity expected in the spring of 2013; however, Model Testing funding is not guaranteed.



Funding for Model Design will support the required work.

We expect states to: 1) bring a broad range of stakeholders into the design process; 2) create multi-payer payment and service delivery models that include Medicare, Medicaid, CHIP, and other payers; 3) utilize the full range of their executive and legislative authority to facilitate and support new health care delivery models; and 4) design models that complement and coordinate with other initiatives sponsored by the CMS and Department of Health and Human Services (HHS), including the new Administration for Community Living.



Model Testing awards will provide funds for the state to implement the State Health Care Innovation Plan and to test and evaluate the proposed service delivery and payment models.

CMS expects to offer two separate opportunities for states to apply for Model Testing Awards.

This FOA presents the first of these FOA opportunities.

Testing new payment and service delivery models in the context of the broader State Health Care Innovation Plan is the central feature of the SIM initiative.

Some states may find that new payment and service delivery models that are currently available through CMS, such as the Medicare Shared Savings Program or Innovation Center initiatives, are appropriate to achieve their goals.

States may also seek to build upon the new flexibility that CMS, through State Medicaid Director letters and other mechanisms, has provided to states to utilize new payment and service delivery models for the Medicaid population.

Model testing proposals based on such established approaches will require less time for CMS to approve.

However, we also recognize that in some limited instances, it may be appropriate for a state as part of its SIM proposal to request approval to pursue payment and service delivery models that differ from established CMS pathways.

The approval process for such requests could take significantly more time.



Illustrative List of Allowable Model Design Costs Allowable costs associated with state Model Design work could include:
• State staff costs to engage in model design
• Staff participation and travel to relevant learning collaboratives and workshops and other relevant learning and diffusion opportunities
• Investments in State data collection and analysis capacity and cost and utilization pattern analysis
• Consumer and provider engagement and focus group costs
• Actuarial modeling
• Performance measure development and evidence-based improvement research
• Business process analysis and requirement system analysis
• Policy, legal, and regulatory research to address legislative and legal frameworks for models
• Planning and convening for creating a statewide all-payer data bases
• Planning work relating to public health programs including the state s Healthy People 2020 plan, and meeting goals for the National Quality and/or National Prevention Strategy
• Model Design costs, including: model scope development, theory of action development, target population research, setting performance targets, financial analysis and analysis of health care trend impacts, budget planning, and travel to SIM workshop and conferences

llustrative List of Allowable Model Testing Costs Allowable costs associated with state Model Testing work could include:
• Technical resources to implement new model
• Model performance data collection, analysis, reporting cost
• Data center costs, and system information processing associated with the model testing
• Provider costs for data collection
• Coordination with Innovation Center rapid cycle evaluation, and costs for collecting and preparing data for Innovation Center evaluator and/or state evaluator
• Staff resources associated with model management and project management, including travel to SIM workshops and conferences
• Simulation and modeling cost
• Provider and beneficiary tracking system cost
• Health information exchange cost associated with the model
• Infrastructure costs to build or expand telemedicine system
• Model beneficiary assignment or reconciliation cost
• Web and internet collaborative learning and communication cost
• Project management and reporting cost
• Business operation associated with the model
• Model contract management and administration
• Building a statewide all-payer database
• Completing work relating to public health programs including the state s Healthy people 2020 plan, and meeting goals for the National Quality and/or the National Prevention Strategy
• Impact model evaluation data collection, reporting, beneficiary and provider survey data, and other costs associated with final model evaluation
• In addition, on a limited, case-by-case, basis CMS may consider funding provider payments for performance-based shared savings.
• Other activities necessary to implement the overall State Health Care Innovation Plan that will further the testing of payment and service delivery models and improve outcomes for CMS beneficiaries.



Administrative and National Policy Requirements: The following standard requirements apply to applications and awards under this FOA:
• Specific cost principles and administrative requirements, as outlined in 2 CFR Part 225 and 45 CFR Part 92, apply to cooperative agreements awarded under this announcement.


• All awardees under this project must comply with all applicable Federal statutes relating to nondiscrimination including, but not limited to: Title VI of the Civil Rights Act of 1964: Section 504 of the Rehabilitation Act of 1973: The Age Discrimination Act of 1975; and Title II Subtitle A of the Americans with Disabilities Act of 1990,

Terms and Conditions: Cooperative agreements issued under this FOA are subject to the Health and Human Services Grants Policy Statement (HHS GPS) at http://www.hhs.gov/grantsnet/adminis/gpd/.

Standard terms and special terms of award will accompany the Notice of Award.

Potential awardees should be aware that special requirements could apply to awards based on the particular circumstances of the effort to be supported and/or deficiencies identified in the application by the HHS review panel.

The General Terms and Conditions that are outlined in Section II of the HHS GPS will apply as indicated unless there are statutory, regulatory, or award-specific requirements to the contrary (as specified in the Notice of Award).

CMS will not fund proposals that duplicate models for populations that are already being funded and tested as part of CMS or HHS initiatives.

For example, if the state receives a Strong Start for Mothers and Newborns cooperative agreement, SIM funding will only be used in a coordinated manner and not to supplant funding for Strong Start for Mothers and Newborns.

States may propose the use of SIM testing funds to support additional costs associated with or created by testing a SIM model.



Indirect Costs
If requesting indirect costs, an Indirect Cost Rate Agreement will be required.

For this Cooperative Agreement funding opportunity indirect costs are limited to 10%.

The provisions of 2 CFR Part 225 (previously OMB Circular A-87) govern reimbursement of indirect costs under this solicitation.

A copy of these cost principles is available online at: http://www.whitehouse.gov/sites/default/files/omb/fedreg/2005/083105_a87.pdf

Direct Services
Cooperative Agreement funds may not be used to provide individuals with services that are already funded through Medicare, Medicaid, and/or CHIP

Reimbursement of Pre-Award Costs
No cooperative agreement funds awarded under this solicitation may be used to reimburse pre-award costs.



Prohibited Uses of Cooperative Agreement Funds
• To match any other Federal funds.


• To provide services, equipment, or support that are the legal responsibility of another party under Federal or state law (e.g., vocational rehabilitation, criminal justice, or foster care) or under any civil rights laws.

Such legal responsibilities include, but are not limited to, modifications of a workplace or other reasonable accommodations that are a specific obligation of the employer or other party.


• To supplant existing Federal, state, local, or private funding of infrastructure or services.


• To be used by local entities to satisfy state matching requirements.


• To pay for the use of specific components, devices, equipment, or personnel that are not integrated into the entire service delivery and payment model proposal.
• To lobby or advocate for changes in Federal and/or state law.



Eligibility Requirements

Applicant Eligibility

CMS invites the 50 state Governor s Offices, United States Territories Governor s Offices ( American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the Virgin islands), and the Mayor s Office of the District of Columbia to apply.

Only one application from a Governor per state is permitted for Model Design requests, and one application for each round of Model Testing awards (assuming the state applied and was not selected for funding under the first round of Model Testing awards).

A state cannot receive multiple Model Design, pre-testing assistance, or Model Testing awards.

Each application must include a letter from the Governor (or the Mayor, if from the District of Columbia) officially endorsing the application for a Model Design award or for a Model Testing award.

All states, the District of Columbia, and U.S.

Territories may submit applications for Model Design and Model Testing funding through this FOA.



Foreign, international, and faith-based organizations are not eligible to apply.

Beneficiary Eligibility

The emphasis is on targeting Medicare, Medicaid, and CHIP populations.

The proposal describes the target populations, geographic areas, or communities that will be the focus of service delivery and payment model testing, the current quality and beneficiary experience outcomes including current health population status, and the specific improvement targets expected from the model.

Credentials/Documentation

Employer Identification Number: All applicants must have a valid Employer Identification Number (EIN) assigned by the Internal Revenue Service.

Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS number): All applicants must have a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number in order to apply. The DUNS number is a nine-digit identification number that uniquely identifies business entities. Obtaining a DUNS number is free. To obtain a DUNS number, access the following website: www.dunandbradstreet.com or call 1-866-705-5711. See Section IV, Application and Submission Information, for more information on obtaining a DUNS number.

Central Contractor Registration (CCR) Requirement: All awardees must provide DUNS and EIN numbers in order to be able to register in the Central Contractor Registration (CCR) database at www.ccr.gov. Applicants must successfully register with CCR prior to submitting an application or registering in the Federal Funding Accountability and Transparency Act Subaward Reporting System (FSRS) as a prime awardee user. See Section IV, Application and Submission Information, for more guidance on CCR registration. Prime awardees must maintain a current registration with the CCR database, and may make subawards only to entities that have DUNS numbers. Organizations must report executive compensation as part of the registration profile at www.ccr.gov by the end of the month following the month in which this award is made, and annually thereafter (based on the reporting requirements of the Federal Funding Accountability and Transparency Act (FFATA) of 2006 (Pub. L. 109-282), as amended by section 6202 of Public Law 110-252 and implemented by 2 CFR Part 170)). See Section VI, Award Administration Information, for more information on FFATA. 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

OMB Circular No. A-102 applies to this program. This program is excluded from coverage under OMB Circular No. A-110. Letter of Intent to Apply: No letter of intent is required.

Application Materials: Application materials will be available for download at http://www.grants.gov. Please note that HHS requires applications for all announcements to be submitted electronically through http://www.grants.gov. For assistance with grants.gov, contact support@grants.gov or call 1-800-518-4726. The Funding Opportunity Announcement can also be viewed on the Innovation Center website at http://innovations.cms.gov. Specific instructions for the format and content of applications are included in the FOA.

Standard Forms: The following standard forms must be completed with an electronic signature and enclosed as part of the proposal:
a. SF 424: Official Application for Federal Assistance
b. SF 424A: Budget Information Non-Construction
c. SF 424B: Assurances-Non-Construction Programs
d. SF LLL: Disclosure of Lobbying Activities
e. Project Site Location Forms(s)
f. Project Abstract Summary

In order to receive a cooperative agreement for either Model Design or for Model Testing, States must submit an application in the required format, no later than the established deadline date and time. Applications that do not meet all the technical requirements will not be reviewed. If an applicant fails to submit all of the required documents or does not address each of the topics described below, the applicant risks not being awarded a cooperative agreement.

As indicated in Section IV, Application and Submission Information, all State applicants for Model Design awards must submit the following:
1) Standard forms
2) Letter of Endorsement from Governor
3) Project abstract
4) Model design strategy
5) Description of stakeholder engagement
6) Evidence of public and private payer participation
7) Project organization information
8) Provider Engagement
9) Project plan and timeline
10) Budget narrative and itemized expenditure plan
11) Financial Analysis demonstrating net savings
12) Letters of support and participation from major stakeholders

All State applicants for Model Testing awards must submit the following:
1) Standard forms
2) Letter of Endorsement from Governor
3) Project abstract
4) State Health Care Innovation Plan
5) Description of the model testing strategy
6) Description of expected engagement and transformation of major provider entities within the State
7) Description of roles of other payers and stakeholders participating in the model
8) Description of multi-stakeholder engagement and commitment
9) Budget Narrative and expenditure plan
10) Financial Analysis demonstrating net savings
11) Plan for performance reporting, continuous improvement, and evaluation support
12) Model Testing project plan and timeline with milestones
13) Letters of support and participation from major stakeholders including key provider groups, and payers committing to transforming their clinical and business models in support of the Model objectives.


Award Procedures

Successful applicants will receive a Notice of Award (NoA) signed and dated by the CMS Grants Management Officer. The NoA is the document authorizing the cooperative agreement award and will be sent through electronic mail to the applicant organization as listed on the SF424. Any communication between CMS and applicants prior to issuance of the NoA is not an authorization to begin performance of a project. Unsuccessful applicants are notified within 30 days of the final funding decision for each cooperative agreement and will receive a disapproval letter via the U.S. Postal Service and/or electronic mail.

Deadlines

Jul 19, 2012 to Sep 17, 2012: Please see "Other Deadline Information". Electronic Cooperative Agreement Application Due Dates:

Model Design Applications: Due September 17, 2012, by 5 p.m., EDT

Round One Model Testing Applications: Due September 17, 2012, by 5 p.m., EDT.

Authorization

Section 1115A of the Social Security Act (Added by Section 3021 of the Affordable Care Act).

Range of Approval/Disapproval Time

Anticipated Notice of Cooperative Agreement Award Dates:

Model Design Phase: Award Date: November 15, 2012

Round One Model Testing: Award Date: November 15, 2012.

Appeals

CMS reserves the right to approve or deny any or all proposals for funding. Note that section 1115A of the Social Security Act states that there is no administrative or judicial review of the selection of organizations, sites, or participants to test models.

Renewals

N/A.

Assistance Considerations

Formula and Matching Requirements

Statutory formulas are not applicable to this program.
Matching requirements are not applicable to this program.
MOE requirements are not applicable to this program.

Length and Time Phasing of Assistance

Anticipated Period of Performance
States receiving Model Design awards and pre-testing assistance awards have from announcement of award until May 14, 2013 to complete their State Health Care Innovation Plans and Model Designs. The period of performance and budget period for Model Design and Model Pre-Testing assistance awards will be six months.

States receiving Model Testing awards will be placed on one of two tracks: Ready-to-go states and New Model States. Ready-to-go Model Testing awards are for 42 months and will be divided into four budget periods. The first budget period will be six months followed by three budget periods of 12 months each. Also note, the period of performance and budget period for States receiving pre-testing assistance awards is six months. The period of performance for New Model Testing awards is 48 months and will be divided into five budget periods. The first budget period will be approximately six months for waiver/plan review followed by six months for implementation and then by three budget periods of 12 months each. Also note, the period of performance and budget period for States receiving pre-testing assistance awards is six months.

Cooperative Agreement Anticipated Period of Performance:

Model Design:
-From award date through May 14, 2013.

Model Testing:
-Ready-to-Go States - Up to 6 months for implementation readiness

-36 months for and testing after the date of award, through May 14, 2016.

-New Model States - Approximately 6 months for CMS review and up to 6 months for implementation readiness and 36 months for implementation and testing after the date of award, through November 14, 2016

States in the Ready-to-Go track are expected to implement model testing within 6 months of receiving the award. Each state s capacity and readiness to implement its proposed model within the six month period after the award will be assessed. For States in the New Model track, an additional estimated 6 months will be provided for CMS review of needed waivers.

Once the Model Testing period begins - 6 months after award for Ready-to-Go States and approximately 12 months after award for New Model States - the model will run for three consecutive years. However, should the model fail to meet its performance milestones, including savings targets, CMS may modify or terminate that agreement prior to the completion of the three-year testing period. The Model Testing cooperative agreement with the state will delineate all testing and evaluation support requirements for the model. See the following for information on how assistance is awarded/released: Anticipated date of awards for Model Design or Model Pre-Testing assistance is November 15, 2012. Anticipated date of First round awards for Model Testing is November 15, 2012. All cooperative agreement awards (Model Design, Model Pre-Testing assistance, Model Testing) will have an initial budget period of six months.

Post Assistance Requirements

Reports

Awardees must agree to cooperate with any federal evaluation of the model and performance results and provide required quarterly, semi-annual (every six months), annual and final (at the end of the cooperative agreement period) reports in a form prescribed by CMS.

Reports will be submitted electronically.

These reports will include how cooperative agreement funds were used, describe project or model progress, and describe any barriers, delays, and measurable outcomes.

CMS will provide the format for project and model reporting and technical assistance necessary to complete required report forms.

States must also agree to respond to requests that are necessary for the evaluation of the Model Design, pre-testing assistance, or Model Testing efforts and provide data on key elements of model performance and on results from the cooperative agreement activities.



Project Monitoring: CMS will enlist a third party entity to assist us in monitoring the model implementation and testing performance results and outcomes.

CMS plans to collect data elements to be part of monitoring for all of the different state models, and these monitoring and surveillance elements will feed into the evaluation.

All awardees will be required to cooperate in providing the necessary data elements to CMS or a CMS contractor.



Evaluation: The evaluation strategy for this initiative includes three parts: an overall design and data collection phase, rapid cycle evaluation of state models, and an impact evaluation.

Broadly, CMS will evaluate each design and each state model and then compare all models to identify themes related to improved care and health outcomes and reduced costs.

While states must play an active role in these evaluations, particularly in regard to Medicaid and CHIP benefits, so that these evaluation efforts continue after the model funding has ended, CMS is in charge of the evaluation process and reports.



Impact Evaluation: Towards the end of the Model Test, the evaluation contractor will conduct impact evaluations of the effectiveness of each state model on key outcomes for target Medicare, Medicaid, and CHIP beneficiaries.

Again, either difference-in-difference or time trend models, using concurrent controls, will be used to evaluate the impact of the models.



Executive Compensation: Organizations must report executive compensation as part of the registration profile at www.ccr.gov by the end of the month following the month in which this award is made, and annually thereafter (based on the reporting requirements of the Federal Funding Accountability and Transparency Act (FFATA) of 2006 (Pub.

L.

109-282), as amended by section 6202 of Public Law 110-252 and implemented by 2 CFR Part 170)).

See Section VI, Award Administration Information, for more information on FFATA.



Federal Funding Accountability and Transparency Act (FFATA) Subaward Reporting Requirement: New awards issued under this funding opportunity announcement are subject to the reporting requirements of the Federal Funding Accountability and Transparency Act of 2006 (Pub.

L.

109-282), as amended by section 6202 of Public Law 110-252 and implemented by 2 CFR Part 170.

Grant and cooperative agreement States must report information for each first-tier sub-award of $25,000 or more in Federal funds and executive total compensation for the State s and sub-recipient s five most highly compensated executives as outlined in Appendix A to 2 CFR Part 170 (available online at www.fsrs.gov).

States must submit a quarterly electronic SF-425 via the Payment Management System.

The report identifies cash expenditures against the authorized funds for the cooperative agreement.

Failure to submit the report may result in the inability to access funds.

Awardees must agree to cooperate with any federal evaluation of the model and performance results and provide required quarterly, semi-annual (every six months), annual and final (at the end of the cooperative agreement period) reports in a form prescribed by CMS.

Reports will be submitted electronically.

These reports will include how cooperative agreement funds were used, describe project or model progress, and describe any barriers, delays, and measurable outcomes.

CMS will provide the format for project and model reporting and technical assistance necessary to complete required report forms.

States must also agree to respond to requests that are necessary for the evaluation of the Model Design, pre-testing assistance, or Model Testing efforts and provide data on key elements of model performance and on results from the cooperative agreement activities.

The Federal Financial Report (FFR or Standard Form 425) has replaced the SF-269, SF-269A, SF-272, and SF-272A financial reporting forms.

All grantees must utilize the FFR to report cash transaction data, expenditures, and any program income generated.

States must report on a quarterly basis cash transaction data via the Payment Management System (PMS) using the FFR in lieu of completing a SF-272/SF272A.

The FFR, containing cash transaction data, is due within 30 days after the end of each quarter.



In addition to submitting the quarterly FFR to PMS, states must also provide, on an annual basis, a hard copy FFR to CMS which includes their expenditures and any program income generated in lieu of completing a Financial Status Report (FSR) (SF269/269A).

Expenditures and any program income generated should only be included on the annually submitted FFR, as well as the final FFR.

Annual hard-copy FFRs should be mailed and received within 30 calendar days of the applicable year end date.

The final FFR should be mailed and received within 90 calendar days of the project period end date.

More details will be outlined in the Notice of Award.

CMS will enlist a third party entity to assist us in monitoring the model implementation and testing performance results and outcomes.

CMS plans to collect data elements to be part of monitoring for all of the different state models, and these monitoring and surveillance elements will feed into the evaluation.

All awardees will be required to cooperate in providing the necessary data elements to CMS or a CMS contractor.

The contractor would assist CMS in developing a cost, quality, beneficiary experience, and population health monitoring and review model performance to ensure model design requirements are met; tracking performance across awardees and providing for rapid cycle evaluation and early detection of model performance issues; developing a system to collect, store, and analyze data to assess health care cost and utilization, quality performance, beneficiary experience, and population health improvements and assisting with state implementation, including coordination between states and CMS and its other contractors.



Data for monitoring will include process, safety, and performance measures including beneficiary experience.

It will include, but will not be limited to, data on the background characteristics of the target population and target area, data characterizing the activities of the model testing and a battery of follow-up data describing relevant characteristics of the target population or target area and metrics at selected intervals after commencement of the delivery system and/or payment model.

This will include detailed information on participant characteristics and outcomes reported in a standard format.

Data for monitoring will be collected from awardees and/or CMS claims data, electronic health record, public health or other sources.

The model monitoring aspect of this initiative will balance the examination of the extent to which awardees demonstrate fidelity to their proposed delivery system and payment models and the potential need to make mid-course corrections that improve or optimize performance of the delivery system or payment models based on feedback from the monitoring and rapid cycle evaluation findings.

The evaluation will also assess whether there is evidence of harm or unintended consequences as a result of the models or testing methods.

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

Awardees must comply with the audit requirements of Office of Management and Budget (OMB) Circular A-133. Information on the scope, frequency, and other aspects of the audits can be found on the Internet at www.whitehouse.gov/omb/circulars.

Financial Information

Account Identification

75-0522-0-1-551 - N/A.

Obigations

(Salaries) FY 12 Not Available; FY 13 est $117,000,000; and FY 14 est $100,000,000

Range and Average of Financial Assistance

CMS may award a total of up to $50 million for up to twenty five (25) states for Model Design cooperative agreements. Any pre-testing assistance awards provided to unsuccessful applicants for Model Testing awards will be counted toward this limit of 25 Model Design cooperative agreements.) CMS may award a total of up to $270 million in funding for up to six state-sponsored Model Testing cooperative agreements, awarded in this first round. All states, the District of Columbia, and U.S. Territories may submit applications for Model Design and Model Testing funding in round one through this FOA.

Model Design: State Model Design awards will be based on the budget submitted by the state to support its work to produce a Comprehensive Health Care Transformation Plan and Model Design proposal. The range for Model Design cooperative agreement awards is $1 million to $3 million. State budget proposals will be reviewed to determine the appropriateness of itemized budget expenditure estimates and the total requested amount. CMS reserves the right to request modifications to the Model Design budget and expenditure plan. Consideration will be given to the size of the Medicaid, CHIP, and Medicare population in the state as well as the overall efficiency and sustainability of the proposal.

Model Testing: Up to six Model Testing cooperative agreements will be awarded under the State Innovation Model initiative in this first round of awards. Each state s budget plan will be reviewed to determine appropriateness of the amount requested based on the model s complexity, size of the target population, spectrum of state policy activity, level of multi-payer and other stakeholder engagement, the return on investment, and the strength of the evidence base or logic model in supporting the expected impact of the Plan. CMS expects the total award for a Model Testing will range from $20 to 60 million for the implementation and testing period. This amount would include the cost of testing and evaluating the model. The Innovation Center is responsible for the evaluation for each Model Test. States must also develop their own model evaluation process, under the guidance of the Innovation Center. In general, we expect that Model Testing awards will cover only costs not normally part of a state s operational cost, data collection cost, or administrative cost.

States applying for Model Testing awards may receive pre-testing assistance ranging from $1-3 million if they do not qualify for a full Model Testing award, but meet enough of the Testing award requirements to merit further consideration. The eligibility standards, deliverables and other requirements for pre-testing awards are based on the review of the state s Model Testing application.

Regulations, Guidelines, and Literature

Cooperative agreements issued under this FOA are subject to the Health and Human Services Grants Policy Statement (HHS GPS) at http://www.hhs.gov/grantsnet/adminis/gpd/. Standard terms and special terms of award will accompany the Notice of Award. Potential awardees should be aware that special requirements could apply to awards based on the particular circumstances of the effort to be supported and/or deficiencies identified in the application by the HHS review panel. The General Terms and Conditions that are outlined in Section II of the HHS GPS will apply as indicated unless there are statutory, regulatory, or award-specific requirements to the contrary (as specified in the Notice of Award).

Information Contacts

Regional or Local Office

None.

Headquarters Office

James T. Johnston 7205 Windsor Blvd, Baltimore, Maryland 21244 Email: james.johnston@cms.hhs.gov Phone: 410-786-2817

Criteria for Selecting Proposals

Model Design Awards: States that submit Model Design applications will be reviewed and scored based on the quality of their proposals. The review criteria for Model Design applications are based on a total of 100 points allocated across the following areas:

Model Design Strategy: (30 points)
Plan for Provider Engagement: (15 Points)
Evidence of Payer and other Stakeholder Engagement: (15 points)
Organizational Capacity, Project Plan and Timeline (10 points)
Model Design Budget and Financial Analysis (30 points)

Model Testing Awards: States that submit Model Testing applications will be reviewed and scored based on the quality of their proposals. The Model Testing proposals receiving the highest scores, and meeting other criteria specified under the Review and Section Process section of this FOA, will be offered cooperative agreements to implement and test multi-payer payment and/or service delivery models. States with lower scores signifying that additional implementation work is needed, may be offered pre-testing assistance awards. Part of the review process will include an analysis of the readiness of the state to implement a model within the six months after approval of a cooperative agreement award. Applications will be scored with a total of 100 points possible. The following criteria will be used to evaluate applications received in response to this solicitation:

Model Testing Strategy: (25 points)
Evidence and Scope of Provider Engagement: (15 Points)
Participation of Other Payers: (15 points)
Organizational Capacity, Project Plan and Timeline: (5 points)
Multi-Stakeholder Commitment: (5 points)
Model Testing Operational Budget/Financial Analysis and Model Sustainability (25 points)
Performance Reporting and Rapid Cycle Evaluation and Evaluation Support: (10 points).



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