Affordable Care Act Implementation Support for State Demonstrations to Integrate Care for Medicare-M

Through this Funding Opportunity, Centers for Medicare & Medicaid Services (CMS) seeks to fund activities necessary to implement the demonstrations to integrate care for Medicare-Medicaid enrollees, especially those that promote beneficiary engagement and protection of beneficiary rights.

The
purpose of the cooperative agreement is to provide funding over a two-year period to states that previously had design contracts and also have a signed Memorandum of Understanding (MOU) with CMS to implement a CMS-approved demonstration.

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.

All programmatic questions about the Implementation Support for State Demonstrations to Integrate Care for Medicare-Medicaid Enrollees (ISSD) may be directed to the program email address: FCHCOStateDemosProgram@cms.hhs.gov.

Interested parties may also contact:

Yelile Saca
Centers for Medicare & Medicaid Services
Medicare-Medicaid Coordination Office
Phone: 410-786-4954.


Program Accomplishments

Fiscal Year 2012: N/A. Fiscal Year 2013: It is anticipated that up to 17 applications will be received and up to 17 awards will be granted in fiscal year 2013. Fiscal Year 2014: No Current Data Available

Uses and Use Restrictions

Awardees will implement the Cooperative Agreement following CMS direction.

CMS seeks to fund activities necessary to implement the demonstrations to integrate care for Medicare-Medicaid enrollees, especially those that promote beneficiary engagement and protection of beneficiary rights.

Implementation tasks will vary, but could include:
• Beneficiary and provider outreach and education;
• Participant ombudsmen activities to support individual advocacy and independent systematic oversight with a focus on compliance with principles of community integration, independent living, and person-centered care in the home and community based care context;
• Independent enrollment broker and information and assistance for beneficiaries;
• Stakeholder engagement;
• Provider training;
• Ongoing monitoring of health plans, care coordination entities, and providers, including network adequacy;
• Improvement to and execution of grievances and appeals;
• Ongoing processes to confirm network adequacy;
• Tracking claims and quality data;
• Actuarial analysis and rate-setting;
• State-level IT systems modifications to support beneficiary enrollment and data collection and reporting; and
• Evaluation activities that do not duplicate those performed by the CMS independent evaluator for the demonstration.
Awardees will develop and submit implementation plans that describe how the awardee will manage the project.

Awardees must submit regular progress reports to summarize progress against milestones identified in the implementation plans.

The following standard requirements apply to applications and awards under the ISSD funding opportunity announcement:
• Specific administrative and policy requirements of Grantees as outlines in 45 CFR 92,2 CFR Part 225(previously OMB Circular A-87) and OMB Circulars A-102 and A-133 apply to this cooperative agreement opportunity.


• 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,
• Hill-Burton Community Service nondiscrimination provisions, and
• Title II Subtitle A of the Americans with Disabilities Act of 1990,
• All equipment, staff, other budgeted resources, and expenses must be used exclusively for the project identified in the awardee s original cooperative agreement application or agreed upon subsequently with HHS, and may not be used for any prohibited uses.
Prohibited Uses of Cooperative Agreement Funds
• To match any other federal funds.
• To provide services, equipment, or supports that are the legal responsibility of another party under federal or state law (e.g., vocational rehabilitation or education services) 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 state, local, or private funding of infrastructure or services, such as staff salaries, etc.
• To be used by local entities to satisfy state matching requirements.
• To provide infrastructure for which federal Medicaid matching funds are available at the 90 / 10 matching rate, such as certain information systems projects.
• To pay for the use of specific components, devices, equipment, or personnel that are not integrated into the application.


• Construction or alteration and renovation of real property (A&R).


• Any equipment, (including information technology equipment), over $5,000 must be approved by CMS.

Eligibility Requirements

Applicant Eligibility

Funding under this opportunity is only available to states that were previously awarded a State Demonstration to Integrate Care for Dual Eligible Individuals - Design Contract in 2011 and associated state designated entities (i.e., those entities designated by those state Medicaid agencies) that are authorized by law to administer cooperative agreements, grants, and contracts in support of state programs.

Funding is only available once the state has signed a Memorandum of Understanding with CMS to implement their demonstration design.

Beneficiary Eligibility

Under this funding opportunity, interventions shall primarily target individuals enrolled in both Medicare and Medicaid.

Credentials/Documentation

Applicants must be states that were previously awarded a State Demonstration to Integrate Care for Dual Eligible Individuals - Design Contract in 2011 and associated state designated entities that are authorized by law to administer cooperative agreements, grants, and contracts in support of state programs. These States may submit applications, but funding is only available once the state has signed a Memorandum of Understanding with CMS to implement their demonstration design.

Applications must include a cover letter expressing support from the state Medicaid director. If applicable, this letter shall express support for the state designated entity to apply and administer the cooperative agreement.

In addition to this documentation, the application is expected to address how the applicant will implement the cooperative agreement program, including how the implementation activities are necessary to implement the demonstration. 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. N/A

Award Procedures

The review process will include the following:
• Applications will be screened to determine eligibility for further review using the criteria detailed in the solicitation. Applications received late or that fail to meet the eligibility requirements or do not include the required forms will not be reviewed.
• Applications must include a cover letter of support from the state Medicaid director. If not, the applicant s submission will not receive further consideration and will not be eligible for award.
• A team consisting of staff from HHS and potentially other outside experts will review all applications. The review panel will assess each application to determine the merits of the application and the extent to which the proposed program furthers the purposes of the program. CMS reserves the option to request that applicants revise or otherwise modify their applications and budget based on the recommendations of the panel.
• Applications will be scored with a total of 100 points available. The following criteria will be used to evaluate applications received in response to this solicitation. More information about each criteria can be found in the funding opportunity announcement.
o Proposed approach (40 points)
o Organizational capacity and management plan (25 points)
o Evaluation and reporting (10 points)
o Budget and budget narrative (25 points)
• The results of the objective review of the applications by qualified experts will be used to advise the approving HHS official. Final award decisions will be made by an HHS program official. In making these decisions, the HHS program official will take into consideration: recommendations of the review panel; the extent to which the requested resources directly support demonstration implementation efforts; any overlap with existing resources that support implementation; the extent to which the state is committing state resources to implementation efforts; the reasonableness of the estimated cost to the government and anticipated results; likelihood that the proposed project will result in the benefits expected; and availability of funding.
• Successful applicants will receive one cooperative agreement per application issued under this announcement, pending the signing of an MOU with CMS to implement the demonstration design.

Deadlines

Jan 28, 2012 to May 29, 2013: Applications are due January 28, 2012. A second round of applications is due April 15, 2013. A third round of applications is due May 29, 2013. Applications are due January 28, 2012. A second round of applications is due April 15, 2013. A third round of applications is due May 29, 2013. The anticipated period of performance is two years from award. The anticipated funding period for the January 28, 2013 applicants is March 15, 2013 - March 14, 2015. The anticipated funding period for the April 15, 2013 applicants is May 29, 2013 to May 28, 2015. The anticipated funding period for the May 29, 2013 applicants is July 15, 2013 to July 14, 2015.

Authorization

Patient Protection and Affordable Care Act, P.L. 111-148, section 3021.

Range of Approval/Disapproval Time

The anticipated notice of cooperative agreement dates are approximately March 15, 2013, May 29, 2013, and July 15, 2013.

Appeals

Not Applicable.

Renewals

Not Applicable.

Assistance Considerations

Formula and Matching Requirements

This program has no statutory formula.
Matching Requirements: Percent: 25.%. 25% in year two only.
This program does not have MOE requirements.

Length and Time Phasing of Assistance

The project period of performance is two years. For the first 12-month period of performance, cooperative agreement funding may cover 100% of approved implementation activities during this period.

In the second 12-month period of performance, cooperative agreement funding is available for 75% of the costs of approved implementation activities. The applicant must fund the remaining 25%. See the following for information on how assistance is awarded/released: Award will be made through cooperative agreements.

Post Assistance Requirements

Reports

• Awardees must submit semi‐annual Progress Reports that describe their activities, outcomes related to their goals, challenges and lessons learned with final copies of formal funding agreements developed during the grant period attached.

The semi-annual Progress Reports shall also detail how cooperative agreements funds were used for each six-month period.


• In the second budget period, the report shall report expenditure of the non-federal share.

This information shall be provided to CMS using the SF-424A form.

CMS will use this information to monitor operations.
• Awardees must agree to cooperate with any federal evaluation of the program and provide required quarterly, semi-annual, and final reports in a form prescribed by CMS.

Awardees must submit a semi-annual electronic SF-425 via the Payment Management System and to the CMS Office of Acquisition and Grants Management/Grants Specialist.

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 submit semi‐annual Progress Reports that describe their activities, outcomes related to their goals, challenges and lessons learned with final copies of formal funding agreements developed during the grant period attached.

The semi-annual Progress Reports shall also detail how cooperative agreements funds were used for each six-month period.


• In the second budget period, the report shall report expenditure of the non-federal share.

This information shall be provided to CMS using the SF-424A form.

CMS will use this information to monitor operations.
• Within 90 days of the end of the cooperative agreement, the awardee shall submit a final report to CMS that summarizes federal and state expenditures for implementation activities, review lessons learned, and inform CMS about implementation needs to replicate successful demonstrations in other states or make potential future Medicare and Medicaid policy changes.

Awardees shall detail how cooperative agreement funds were used for each six-month period.

This information shall be provided to CMS using the SF 424A.

Awardees will be monitored based on their progress to execute the implementation plan and achieve the outcomes developed collaboratively between CMS and the awardee during the first 25 calendar days of the cooperative agreement.

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 track data required for tracking progress in the implementation plan and for semi-annual progress reports and the final report.

Financial Information

Account Identification

75-0522-0-1-551.

Obigations

(Formula Grants (Cooperative Agreements)) FY 12 Not Available(Exp: NA); FY 13 Estimate Not Available(Exp: TBD); and FY 14 Estimate Not Available - TBD.

Range and Average of Financial Assistance

CMS expects to make awards ranging from $1,000,000 to $15,000,000 to each grantee to cover a two-year cooperative agreement period of performance, and CMS reserves the right to award less or more depending on the scope and nature of the individual applications received. Awardees may not receive the total award amount requested but may be asked to revise the work plan and reflect the funding that CMS will award.

Regulations, Guidelines, and Literature

The background provided in the funding opportunity announcement describes relevant literature.

Information Contacts

Regional or Local Office

See Regional Agency Offices. All programmatic questions about the Implementation Support for State Demonstrations to Integrate Care for Medicare-Medicaid Enrollees (ISSD) may be directed to the program email address: FCHCOStateDemosProgram@cms.hhs.gov. Interested parties may also contact:

Yelile Saca
Centers for Medicare & Medicaid Services
Medicare-Medicaid Coordination Office
Phone: 410-786-4954.

Headquarters Office

Penny Williams 7500 Security Blvd. , Baltimore, Maryland 21244 Email: Penny.Williams@cms.hhs.gov Phone: 410-786-2237

Criteria for Selecting Proposals

See Award procedures (093).



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