ACA-Transforming Clinical Practice Initiative: Support and Alignment Networks (SANs)

The Transforming Clinical Practice Initiative (TCPI) model will test whether a three-pronged approach to national technical assistance will enable large scale transformation of thousands of clinician practices to deliver better care and result in better health outcomes at lower costs.


/> • Support Alignment Networks (SANs) formed by group practices, health care systems, and others that join together to serve as trusted partners to provide clinician practices with quality improvement (QI) expertise, best practices, coaching and help as they prepare and begin clinical and operational practice transformation.

These organizations will collaboratively lead clinicians and practices through the TCPI phases of transformation, achieve the TCPI goals, and through adaptive redesign position these clinicians and their practices to be sustainable components of the changing care delivery system.

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 - None.

Grants Management Officer
Centers for Medicare & Medicaid Services
Office of Acquisitions and Grants Management
Phone: 410-786-5239.


Program Accomplishments

Not Applicable.

Uses and Use Restrictions

The funds shall be used to implement, manage toward results, and evaluate models that support system transformation toward higher quality care at lower costs.

Award dollars cannot be used for specific components, devices, equipment, or personnel that are not integrated into the entire service delivery model proposal.

Funds shall not be used to build or purchase health information technology or other information technology that exceed more than 10% of total costs of the applicant s proposed budget.

CMS will not fund proposals that replicate models that CMS is currently testing in other initiatives.

Eligibility Requirements

Applicant Eligibility

CMS anticipates that SANs will include but not be limited to organizations like:
• Public Nonprofit Institution/Organization
• Specialized group
• Profit Organization
• Private Nonprofit Institution/Organization
• Quasi-public Nonprofit Institution/Organization
• Other private institution/organization

*Clinicians receiving other CMMI support (e.g.

CPCI) and those already participating in alternate payment programs (e.g.

Medicare Shared Savings Program) are not eligible for participation in TCPI.

Beneficiary Eligibility

The Beneficiary eligibility includes the list as noted above with the exception of:
• Federal, Interstate
• Intrastate
• Student/Trainee and Graduate Students
• Artist/Humanist
• Engineer/Architect, Builder/Contractor/Developer
• Farmer/Rancher/Agriculture Producer
• Industrialist/Business Person
• Small Business Person
• Homeowner
• Property Owner
• Anyone/General Public.

Credentials/Documentation

No Credentials or documentation are required. This program is excluded from coverage under OMB Circular No. A-87.

Aplication and Award Process

Preapplication Coordination

Preapplication coordination is required.

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.

Award Procedures

Successful applicants will receive a Notice of Award (NoA) signed and dated by the CMS Grants Management Officer that will set forth the amount of the award and other pertinent information. The award will also include standard Terms and Conditions, and may also include additional specific cooperative agreement terms and conditions. Potential applicants should be aware that special requirements could apply to cooperative agreement awards based on the particular circumstances of the effort to be supported and/or deficiencies identified in the application by the review panel.

The NoA is the legal document issued to notify the awardee that an award has been made and that funds may be requested from the HHS payment system. The NoA will be sent electronically to the awardee organization as listed on its SF 424. Any communication between CMS and awardees prior to issuance of the NoA is not an authorization to begin performance of a project.

Unsuccessful applicants will be notified by letter, sent through electronically to the applicant organization as listed on its SF 424.

Deadlines

Oct 23, 2014 to Jan 06, 2015 The application for this FOA is due on grants.gov by January 6, 2015. Applicants are highly encouraged to submit a Letter of Intent by November 20, 2014.

Authorization

Section 1115A of the Social Security Act (the Act), as added by § 3021 of the Affordable Care Act, which authorizes the Center for Medicare & Medicaid Innovation (CMMI or the Innovation Center) to test innovative payment and service delivery models to reduce spending under Medicare, Medicaid, or CHIP, while preserving or enhancing the quality of care furnished to beneficiaries under those programs. The TCPI is a service delivery model that tests whether providing technical assistance in a specific complex adaptive manner will enable clinicians and their practices to rapidly transform the way they deliver care to patients, resulting in improved health outcomes and reduced costs.
The authority for the TCPI model is section 1115A of the Social Security Act (the Act). Under section 1115A(d)(1) of the Act, the Secretary of Health and Human Services may waive such requirements of Titles XI and XVIII and of sections 1902(a)(1), 1902(a)(13), and 1903(m)(2)(A)(iii) as may be necessary solely for purposes of carrying out section 1115A with respect to testing models described in section 1115A(b). For this model and consistent with this standard, the Secretary may consider issuing waivers of certain fraud and abuse provisions in sections 1128A, 1128B, and 1877 of the Act. Waivers are not being issued in this document; waivers, if any, would be set forth in separately issued documentation. Thus, notwithstanding any other provision of this Funding Opportunity Announcement, awardees and subawardees must comply with all applicable laws and regulations, except as explicitly provided in any such separately documented waiver issued pursuant to section 1115A(d)(1) specifically for the TCPI model. Any such waiver would apply solely to the TCPI model and could differ in scope or design from waivers granted for other programs or models.

Range of Approval/Disapproval Time

The anticipated date of awards for Transforming Clinical Practice Initiative is April 2015.

Appeals

Not Applicable.

Renewals

Not Applicable.

Assistance Considerations

Formula and Matching Requirements

Statutory formulas are not applicable to this program.
This program has no matching requirements.
This program has MOE requirements, see funding agency for further details.

Length and Time Phasing of Assistance

N/A. Method of awarding/releasing assistance: quarterly.

Post Assistance Requirements

Reports

CMS plans to continuously monitor SANs awardees for this model test through monthly, quarterly and annual reporting requirements in order to ensure that milestones that they are responsible for achieving are met, and to ensure that technical assistance and recruitment activities are being conducted in a manner that is effective, as well as equitable toward and inclusive of CMS beneficiaries and the medically underserved.

This will include quarterly monitoring trends in a SAN s recruited clinician s and their practice s characteristics, as well as utilization patterns for populations served by SANs participants.

We will be requiring regular aggregate reporting of practice population characteristics, attrition and accretion, and utilization stratified by the payer categories: Medicare, Medicaid, CHIP, commercial, and other, in order to monitor equity in both composition and impact of services.

Doing so will also allow us to estimate cost savings by payer category.

These data would be reported by the SANs on a monthly basis, and will also be used to assess savings impacts for the model over time.

In addition, we will use existing CMS data (Medicare fee for service claims data) and reporting systems (physician quality reporting and meaningful use program data) as part of our monitoring efforts, in order to minimize the reporting burden on practices participating in SANs.

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.

Grantees 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.

The quarterly reporting due dates are as follows: 4/30, 7/30, 10/30, 1/30.

A Quick Reference Guide for completing the FFR in PMS is at: www.dpm.psc.gov/grant_recipient/guides_forms/ffr_quick_reference.aspx.



In addition to submitting the quarterly FFR to PMS, Grantees must also provide, on an annual basis, a report to be uploaded into GrantSolutions 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 uploaded in GrantSolutions within 90 calendar days of the project period end date.

More details will be outlined in the Notice of Award.

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.

In the implementation of TCPI, applicants will receive qualitative and quantitative data from their recruited practices.

Applicants selected as SANs will submit reports 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.

Awardees must also agree to respond to requests that are necessary for the evaluation of the TCPI model and provide data on key elements of model performance and on results from the cooperative agreement activities.

No expenditure reports are required.

CMS will enlist a third party entity to assist CMS 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 networks, 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, and population health monitoring and review network performance to ensure requirements are met; tracking performance across awardees and providing for rapid cycle evaluation and early detection of performance problems; developing a system to collect, store, and analyze data to assess health care cost and utilization, quality performance, and population health improvements and assisting with awardee implementation, including coordination between awardees and CMS and its other contractors.

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

TCPI participants are required to keep records for a minimum of 30 days after the conclusion of the TCPI program.

Financial Information

Account Identification

75-0522-0-1-551.

Obigations

(Cooperative Agreements) FY 13 $0; FY 14 est $0; and FY 15 est $4,915,983

Range and Average of Financial Assistance

This will be a new service delivery model. Therefore, no funds ($0) have been requested for past or current fiscal years.

Regulations, Guidelines, and Literature

Not Applicable.

Information Contacts

Regional or Local Office

None. Grants Management Officer
Centers for Medicare & Medicaid Services
Office of Acquisitions and Grants Management
Phone: 410-786-5239.

Headquarters Office

Fred Butler, Jr. 7500 Security Boulevard, Baltimore, Maryland 21244 Email: fred.butler@cms.hhs.gov Phone: 4107865239

Criteria for Selecting Proposals

See Section V of the FOA.



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