Money Follows the Person Rebalancing Demonstration

For more than a decade, States have been asking for the tools to modernize their Medicaid programs.

With the enactment of the Deficit Reduction Act (DRA) of 2005, States now have new options to rebalance their long-term support programs to allow their Medicaid programs to be more sustainable while
helping individuals achieve independence.

The Money Follows the Person (MFP) Rebalancing Demonstration (MFP Demo), created by section 6071 of the Deficit Reduction Act of 2005 (P.L.

109-171), supports State efforts to "rebalance" their long-term support systems by offering $1.75 billion over 5 years in competitive grants to States.

Specifically, the demonstration will support State efforts to:"Rebalance their long-term support system so that individuals have a choice of where they live and receive services." Transition individuals from institutions who want to live in the community.

Promote a strategic approach to implement a system that provides person centered services and a quality management strategy that ensures the provision of, and improvement of such services in both home and community-based settings and institutions.

The demonstration provides for enhanced federal medical assistance percentage (FMAP) for 12 months for qualified home and community-based services for each person transitioned from an institution to the community during the demonstration period.

Eligibility for transition is dependent upon residence in a qualified institution.

The State may establish the minimum timeframe for residence between 6 months and two years as required by Section 6071(b)(2)(A) of the DRA.

The State must continue to provide community-based services after the 12 month period for as long as the person needs community services and is Medicaid eligible.

Demonstration grants will be awarded to States from January 1, 2007 through September 30, 2011.

CMS will accept one proposal from each State interested in participating in the demonstration program.

The Single State Medicaid Agency must be the lead applicant.

States must propose a demonstration period of no less than two consecutive fiscal years but no greater than five years.

The State will indicate in its application the targeted group(s) and number of individuals it intends to transition.

In making awards, CMS will give preference to States if they include multiple target groups including older individuals, and if they propose to deliver self-directed services.

The number of demonstration projects approved by CMS depends largely on the scope (i.e., proposed enrollment and breadth of services) and quality of the proposed projects.

Under the demonstration project, the State must propose a system of Medicaid home and community-based care that will be sustained after the demonstration period and is deemed qualified by the Secretary.

Specifically, the program must be conducted in conjunction with a "qualified HCBS program" which is a program that is in operation (or approved) in the State for such individuals in a manner that assures continuity of Medicaid coverage of services in the qualified HCBS program for eligible individuals.

States may also propose to enhance the services they will provide during the demonstration period to achieve greater success with transition.

States will be required to participate in a national qualitative and quantitative evaluation conducted by CMS.

Data collected on a national level will help evaluate the core objectives of the statute that are listed below.

Examples of Funded Projects

Awards have not been made for this demonstration.

Deadline for application is November 1, 2006.


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

This is a new demonstration grant opportunity. First year awards were made available after January 1, 2007.

Uses and Use Restrictions

Indirect Costs: The provisions of the OMB Circular A-87 govern reimbursement of indirect costs under this solicitation.

A copy of OMB Circular A-87 is available online at: http://www.whitehouse.gov/omb/circulars/a087/a087.html.



Eligibility Requirements

Applicant Eligibility

Applicants must be any single State Medicaid Agency, State Mental Heath Agency, or instrumentality of the State may apply for this Demonstration Grant.

Only one application can be submitted for a given State.

By "State" we refer to the definition provided under 45 CFR 74.2 as "any of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State exclusive of local governments." By "territory or possession" we mean Guam, the U.

S.

Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands.

Beneficiary Eligibility

As defined in Section 6071(b)(2) of the DRA, the term "eligible individual" means, with respect to an MFP demonstration project of a State, an individual in the State who, immediately before beginning participation in the MFP demonstration project: (i) resides (and has resided, for a period of not less than 6 months or for such longer minimum period, not to exceed 2 years, as may be specified by the State) in an inpatient facility; (ii) is receiving Medicaid benefits for inpatient services furnished by such inpatient facility; and (iii) with respect to whom a determination has been made that, but for the provision of home and community-based long- term care services, the individual would continue to require the level of care provided in an inpatient facility and, in any case in which the State applies a more stringent level of care standard as a result of implementing the State plan option permitted under section 1915 (i) of the Social Security Act, the individual must continue to require at least the level of care which had resulted in admission to the institution.

Credentials/Documentation

Applications can only be submitted by the single State Medicaid agency. A cover letter must accompany the application. The cover letter must be signed by the State Medicaid Director, and must indicate the title of the project, the principal contact person, the amount of funding requested, and the names of the major partners actively collaborating in the project.

Aplication and Award Process

Preapplication Coordination

Applicants are encouraged to submit a non-binding Notice of Intent to Apply.

Notices of Intent to Apply are not required and their submission or failure to submit a notice has no bearing on the scoring of proposals received.

But receipt of such notices enables CMS to better plan for the application review process.

This program is excluded from coverage under E.O.

12372.

Application Procedures

Applicants must submit their applications electronically through http://www.grants.gov. Please note when submitting your application electronically, you are required, additionally, to mail a signed SF 424 to Nicole Nicholson, Centers for Medicare and Medicaid Services, Office of Operations Management, Acquisition and Grants Group, C2-21-15 Central Building, 7500 Security Boulevard, Baltimore, MD 21244-1850. The mailed SF 424 form may be received at the Centers for Medicare and Medicaid Services within 2 business days of the application closing date.

Award Procedures

An independent review of all applications will be conducted by a panel of experts including members of the disability community, advocates, providers and staff from State and Federal agencies including CMS. The review panel will assess each application to determine the merits of the proposal and the extent to which it furthers the purposes of the demonstration program. The panel will evaluate each application for further review by CMS. CMS reserves the right to request that States revise or otherwise modify certain sections of their proposals based on the recommendations of the panel and the budget. A low score in one or two areas, even if offset by high scores in other areas, may result in a rejection of the proposal. Final approval of demonstration projects will be made by the Administrator of CMS after consideration of the comments and recommendations of the review panelists, program office recommendations, and the availability of funds. CMS reserves the right to approve or deny any or all proposals for funding. CMS seeks to achieve reasonable balance among the grants to be awarded in a particular category in terms of key factors such as geographic distribution and broad target group representation. CMS may redistribute grant funds (as detailed in the "Award Information" section of this solicitation) based upon the number and quality of applications received. (e.g., to adjust the minimum or maximum awards permitted or adjust the aggregate amount of Federal funds allotted to a particular category of grants).

Deadlines

The deadline for applications is November 1, 2009, (11:59pm Eastern Standard Time).

Authorization

Section 6071, Public Law Deficit Reduction Act of 2005, Public Law 109-171.

Range of Approval/Disapproval Time

Successful applicants will receive a Financial Assistance Award (FAA) signed and dated by the CMS Grants Management Officer. The FAA is the document authorizing the grant award and will be sent through the U.S. Postal Service to the applicant organization as listed on its SF 424. Any communication between CMS and applicants prior to issuance of the FAA is not an authorization to begin performance of a project. Unsuccessful applicants will be notified by letter, sent through the U.S. Postal Service to the applicant organization as listed on its SF 424, after December 1, 2009.

Appeals

Appeals are governed by Title 45--Public Welfare SUBTITLE A--DEPARTMENT OF HEALTH AND HUMAN SERVICES PART 16--PROCEDURES OF THE DEPARTMENTAL GRANT APPEALS BOARD.

Renewals

Any funding allocated for the Federal match for home and community-based services provided under the demonstration for the first year of this grant that remain unspent will be carried over to the next year of the Grant.

Assistance Considerations

Formula and Matching Requirements

A State receiving an award under this solicitation will receive reimbursement for home and community-based services provided under the demonstration on a quarterly basis at the following Federal Medical Assistance Percentage (FMAP) rates: Service Category Match rate for 12-month demonstration period "Qualified HCB program" services Enhanced match HCB Demonstration services Enhanced match Supplemental Demonstration services Regular FMAP rate Administrative costs will be reimbursed according to the requirements of CFR 42, 433.15.

Length and Time Phasing of Assistance

The demonstration period is five years. The project period is from January 1, 2007 through September 30, 2011. The budget period is from January 1, 2007 through September 30, 2011.

Post Assistance Requirements

Reports

Financial Status Report, form (SF-269), will be required to be submitted semi-annually.

This financial status report will account for all uses of grant monies during each reporting period.

During the pre-implementation period, CMS will work with the grantees to determine if additional reporting requirements imposed.

At the end of each demonstration grant year, States will be required to produce documentation that they have not exceeded the determined budget ceiling and meet all CMS financial requirements.

The format of this financial report will be determined during the IP phase of the Demonstration Semi-Annual Progress Reports: Web-based reports in a pre-determined format will be required to be submitted semi-annually.

The submission of the finalized IP will be due no later than 9 months after receipt of the Notice of Financial Assistance Award.

The IP will be considered the First report due under this demonstration.

Audits

Audits must be in accordance with the provisions of OMB Circular No. A-133 (Revised, June 24, 1997).

Records

Grantees are required to follow 45 CFR 74.53.

Financial Information

Account Identification

75-0516-0-1-551.

Obigations

FY 07 $45,935,063; FY 08 $350,470,000; and FY 09 est $349,270,000.

Range and Average of Financial Assistance

There is not a prescribed or predetermined maximum floor or ceiling grant award. Each State is unique in the numbers of individuals that will be projected for transition under the demonstration grant. In addition, the costs of individuals transitioning to community settings may vary, by targeted population. Applicants are advised to request a grant award that is sufficient in the amount needed to transition the projected individuals into community settings. CMS reserves the right to reduce the requested grant award, based on the number and size of additional grant awards given under this demonstration, as well as because of concerns contained within a State's application (i.e., concerns with the number or costs of individuals projected for transition by the individual State).

Regulations, Guidelines, and Literature

To promote effective outcomes from the demonstration, the statute provides waiver authority for four provisions of title XIX of the Social Security Act, to the extent necessary to enable a State initiative to meet the requirements and accomplish the purposes of the demonstration. These provisions are: 1. Statewideness (Section 1902(a)(1) of the Social Security Act) - in order to permit implementation of a State initiative in a selected area or areas of the State. 2. Comparability (Section 1902(a)(10)(B) - in order to permit a State initiative to assist a selected category or categories of individuals enrolled in the demonstration. 3. Income and Resource Eligibility (Section 1902(a)(10)(C)(i)(III) - in order to permit a State to apply institutional eligibility rules to individuals transitioning to community-based care. 4. Provider agreement (Section 1902(a)(27)) - in order to permit a State to implement self-direction services in a cost-effective manner for purposes of this demonstration program. By "State" we refer to the definition provided under 45 CFR 74.2 as any of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State exclusive of local governments. By "territory or possession" we mean Guam, the U. S. Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands. CMS will reimburse States for home and community-based services provided under the demonstration on a quarterly basis at a rate equal to the State's Federal Medical Assistance Percentage (FMAP) or the State's Enhanced FMAP, as specified in the solicitation. Administrative costs will be reimbursed according to the requirements of CFR 42, 433.15. A complete electronic application package, including all required forms, for this demonstration grant is available at https://apply.grants.gov/forms_apps_idx.html Standard application forms and related instructions are available online at http://gsa.gov/forms. Standard forms are available as detailed in, Section V.A, Address to Request Application Package. The following standard forms must be completed with an original signature and enclosed as part of the proposal: SF 424: Official Application for Federal Assistance (see Note below*) SF 424A: Budget Information SF 424B: Assurances - Non-Construction Programs SF LLL: Disclosure of Lobbying Activities PHS-5161-1 (7/00) Additional Certifications - can be found at the following website: http://apply.grants.gov/forms/sample/SSA_additionalassurances_VI.0.pdf Usual Requirements that must be adhered to by law and regulation: Specific administrative and policy requirements of grantees as outlined in 45 CFR 74 and 45 CFR 92, apply to this grant opportunity. All grantees receiving awards under these grant programs must meet the requirements of: 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.

Information Contacts

Regional or Local Office

None.

Headquarters Office

Headquarters Office Program Contact: Cathy M. Cope, Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Mail Stop S2-14-26, Baltimore, MD 21244. Telephone: (410) 786-8287. Web Site Address: http://www.cms.hhs.gov/NewFreedomInitiative/02_WhatsNew.asp.

Criteria for Selecting Proposals

The application for this demonstration is comprised of the following 4 parts: Part 1: Systems Assessment and Gap Analysis Part 2: Demonstration Design Part 3: Preliminary Operational Plan and Budget Part 4: Assurances (as defined by statute) An independent review of all applications will be conducted by a panel of experts including members of the disability community, advocates, providers and staff from State and Federal agencies including CMS. The review panel will assess each application to determine the merits of the proposal and the extent to which it furthers the purposes of the demonstration program. The panel will evaluate each application for further review by CMS. CMS reserves the right to request that States revise or otherwise modify certain sections of their proposals based on the recommendations of the panel and the budget. A low score in one or two areas, even if offset by high scores in other areas, may result in a rejection of the proposal. Final approval of demonstration projects will be made by the Administrator of CMS after consideration of the comments and recommendations of the review panelists, program office recommendations, and the availability of funds. CMS reserves the right to approve or deny any or all proposals for funding. CMS seeks to achieve reasonable balance among the grants to be awarded in a particular category in terms of key factors such as geographic distribution and broad target group representation. CMS may redistribute grant funds (as detailed in the "Award Information" section of this solicitation) based upon the number and quality of applications received. (e.g., to adjust the minimum or maximum awards permitted or adjust the aggregate amount of Federal funds allotted to a particular category of grants).



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