1945 NOFO_Final Draft_Clean_508_Approved.pdf

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U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services

Center for Medicaid and Chip Services

Health Home for Individuals with Chronic Conditions

Notice of Funding Opportunity Type: New

Funding Opportunity Award Type: Grant

Notice of Funding Opportunity Number: CMS-2J2-23-001

Federal Assistance Listings Number (CFDA): 93.778

Notice of Funding Opportunity Posting Date: September 30, 2022

Applicable Dates:

Letter of Intent to Apply Due Date: Not Applicable

First Electronic Application Due Date: January 4, 2023, 3:00 pm Eastern Standard Time; Quarterly application deadlines to follow

Anticipated Issuance Notice(s) of Award: April 1, 2023 with rolling award notices to follow.

Anticipated Period of Performance: 36 months from date of award

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Table of Contents Executive Summary

A. Program Description

A1. Purpose

A2. Authority

A3. Background

A5. Technical Assistance and Information for Prospective Applicants

A6. Limited Competition, Notice of Funding Opportunity

B. Federal Award Information

B1. Total Funding

B2. Award Amount

B3. Anticipated Award Dates

B4. Period of Performance

B5. Number of Awards

B6. Type of Award

B7. Type of Competition

C. Eligibility Information

C1. Eligible Applicants

C2. Cost Sharing or Matching

C3. Letter of Intent

C4. Ineligibility Criteria

C5. Single Application Requirement

C6. Continued Eligibility

C7. EIN, UEI, and SAM Regulations

C8. Faith-Based Organizations

C9. Other Eligibility Requirements

D. Application and Submission Information

D1. Address to Request Application Package

D2. Content and Form of Application Submission

a. Application format

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b. Standard forms

C. Application cover letter or cover page (Mandatory)

d. Project Narrative

e. Budget Narrative

f. Business assessment of applicant organization (maximum 10pages)

D3. Unique Entity Identifier and System for Award Management (SAM)

D4. Submission Dates and Times

D5. Intergovernmental Review

D6. Cost Restrictions

D7. Mandatory Disclosure

E. Application Review Information

E1. Criteria

E2. Review and Selection Process

E3. Federal Awardee Performance Integrity Information System (FAPIIS)

F. Federal Award Administration Information

F1. Federal Award Notices

F2. Administrative and National Policy Requirements

F3. Terms and Conditions

F4. Reporting

G. CMS Contacts

G1. Programmatic Questions

G2. Administrative/Budget Questions

H. Other Information

Appendix I. Guidance for Preparing a Budget Request and Narrative

Appendix II. Application and Submission Information

Appendix III. Business Assessment of Applicant Organization

Appendix IV: Accessibility Requirements

Appendix V. Review and Selection Process

Appendix VI. Application Check-off List

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Executive Summary

The purpose of this Notice of Funding Opportunity (NOFO) is to provide funding to states for the implementation of section 1945 of the Social Security Act (“the Act”), entitled “State Option to Provide Coordinated Care Through A Health Home For Individuals With Chronic Conditions.”

Item Health Home for Individuals with Chronic Conditions

HHS Awarding Agency Centers for Medicare & Medicaid Services (CMS)

CMS Awarding Center Center for Medicare & CHIP Services

Notice of Funding Opportunity Title

Health Home for Individuals with Chronic Conditions

Authorization Authorized under the Affordable Care Act (Section 2703) and Section 1945 of the Social Security Act

Federal Assistance Listings Number

(CFDA)

93.778

Funding Opportunity Type

New

Funding Opportunity Number

CMS-2J2-23-001

Type of Award Grant

Type of Competition New

Letter of Intent N/A

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Application Due Date(s) and Time

Applications will be accepted January 4, April 1, July 1, and October 1

Anticipated Issuance Notice(s) of Award(s)

April 1, 2023. Future award dates are based on when applications are received and reviewed.

Period of Performance Start Date(s)

April 1, July 1, October 1, January 1

Period of Performance End Date(2)

Thirty-six months from date of award

Anticipated Total Available Funding

$15,000,000, pending the availability of funds

Estimated Maximum Award Amount

Up to $500,000, pending the availability of funds

Estimated Maximum Number of Awardees

A. Program Description

A1. Purpose The purpose of this Notice of Funding Opportunity (NOFO) “Health Home for Individuals with Chronic Conditions” is to award funding to States that would like to receive support in planning their health home State Plan Amendments (SPAs), in accordance with section 1945(c)(3) of the Act. CMS will use title XIX funding to support state health home planning efforts.

A2. Authority

Authorized under the Affordable Care Act (Section 2703) and Section 1945 of the Act.

A3. Background In 2010, the Affordable Care Act was enacted.1 This law added section 1945 to the Act, and thereby established an option for states to cover specifically care coordination for Medicaid-

ACA; P.L. 111-148

2022-09-23 Page 5 of 54 eligible individuals with two or more chronic conditions, one chronic condition and at risk for a second, or one serious and persistent mental health condition. States’ implementation of section 1945 health homes has helped to ensure that certain Medicaid beneficiaries’ care is better integrated and coordinated, thereby helping to ensure that these beneficiaries can receive “whole-person” care that addresses both clinical and non-clinical needs. Since January 2011, 27 states and the District of Columbia have successfully implemented a section 1945 health home benefit for Medicaid beneficiaries with chronic conditions such as asthma, diabetes, substance use disorder (SUD), and mental health conditions in accordance with section 1945 of the Act. As of August 2022, there are 33 active health home programs targeting different populations under section 1945 of the Act.

The health home provision authorized by the Affordable Care Act provides an opportunity to build a person-centered system of care that achieves improved outcomes for beneficiaries and better services and value for state Medicaid programs. This provision supports CMS’s overarching approach to improving health care through the simultaneous pursuit of three goals:

improving the experience of care; improving the health of populations; and reducing per capita costs of health care (without any harm whatsoever to individuals, families, or communities).

A4. Program Requirements for State Plan Amendment

Section 1945(a) of the Act permits States the option to offer health home services to “eligible individuals with chronic conditions” who select a designated health home provider.

Section 1945(h) of the Act sets forth the minimum criteria that an “eligible individual with chronic conditions” must meet. The health home population the State elects must consist of individuals eligible under the State plan or “under a waiver of such plan” who have at least two chronic conditions, as listed in section 1945(h)(2) of the Act, one chronic condition and be at risk for another, or one serious and persistent mental health condition.

The State may elect in its State plan to provide health home services to individuals eligible to receive health home services based on all the chronic conditions listed in the statute, or provide health home services to individuals with particular chronic conditions. While all individuals served must meet the minimum statutory criteria, States may elect to target the population to individuals with higher numbers or severity of chronic or mental health conditions. The population must include all categorically needy individuals who meet the State’s criteria (including those eligible based on receipt of services under a section 1915(c) home and community-based services waiver) and a State option may include individuals in any medically needy group or section 1115 demonstration population. There is no statutory flexibility to exclude dual eligible beneficiaries from receiving health home services. CMS recognizes the challenges States face in serving dual eligible beneficiaries and is working to assist States in their efforts to more effectively integrate Medicare and Medicaid benefits.

Because the statute waives the comparability requirement at section 1902(a)(10)(B) of the Act, it allows States to offer health home services in a different amount, duration, and scope than services provided to individuals who are not in the health home population.

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Definitions Applicable definitions regarding the Section 1945 health home program can be found at Section 1945(h)(1) of the Act and include the following:

Eligible Individuals with Substance Use Disorder (SUD) SUD-eligible individuals - The term “SUD-eligible individual” means, with respect to a State, an individual who satisfies all of the following:

• The individual is an eligible individual with chronic conditions.

• The individual is an individual with a substance use disorder.

• The individual has not previously received health home services under any other State plan amendment approved for the State under this section by the Secretary.

Eligible Individual with Chronic Conditions In general - Subject to subparagraph (B), the term “eligible individual with chronic conditions” means an individual who: Is eligible for medical assistance under the State plan or under a waiver of such plan; and has at least:

• 2 chronic conditions;

• 1 chronic condition and is at risk of having a second chronic condition; or

• 1 serious and persistent mental health condition.

SUD-focused State Plan Amendment The term “SUD-focused State plan amendment” means a State plan amendment under this section that is designed to provide health home services primarily to SUD-eligible individuals.

Chronic condition The term “chronic condition” has the meaning given that term by the Secretary and shall include, but is not limited to, the following:

• A mental health condition

• Substance use disorder

• Asthma

• Diabetes

• Heart disease

• Being overweight, as evidenced by having a Body Mass Index (BMI) over 25.

Health home The term “health home” means a designated provider (including a provider that operates in coordination with a team of health care professionals) or a health team selected by an eligible individual with chronic conditions to provide health home services.

Section 1945(h)(4) of the Act defines health home services as “comprehensive and timely high-quality services,” and includes the following health home services to be provided by designated health home providers or health teams:

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• Comprehensive care management;

• Care coordination and health promotion;

• Comprehensive transitional care from inpatient to other settings, including appropriate follow-up;

• Individual and family support, which includes authorized representatives;

• Referral to community and social support services, if relevant; and

• The use of health information technology to link services, as feasible and appropriate.

This list of definitions is not exhaustive but is meant to demonstrate some of the key features of the Section 1945 health home program. Please refer to Section 1945(h)(1) for a full list of definitions. Payment methodologies and enhanced federal match assistance percentage information can be found in Section 1945(c). Provider standards are further described in Section 1945(b). Statutory references can be found at https://www.ssa.gov/OP_Home/ssact/title19/1945.htm

Support for State Planning Activities

In order to aid states that would like to receive support in planning their health home SPAs, in accordance with section 1945(c)(3) of the Act, CMS will use title XIX funding to support state health home planning efforts at the state’s regular, pre-Recovery Act, medical assistance service match rate. Since the purpose of the planning opportunity is to develop a SPA, such requests will only be considered prior to a state submitting a health home SPA to CMS.

Interested states should submit an application in response to this describing its health home planning activities, with an estimated budget for this grant opportunity. The following categories would be considered by CMS as appropriate planning activities:

• The hiring of personnel or contractors to determine feasibility and develop the health home program; outreach initiatives to obtain consumer and provider feedback;

• Outreach initiatives to obtain consumer and provider feedback;

• Training and consultation related to designing components of any provisions of the SPA;

• Development of systems for reporting and other infrastructure building tasks; and

• Travel to accomplish such activities

Applicants must meet one or more categories noted above that best meet the planning needs and activities for the intended SPA.

A state may discover through its planning activities that a health home SPA is not feasible.

Under such circumstances, those planning activities are also reimbursable at the regular Federal Medical Assistance Percentage (FMAP), in accordance with section 1945(c)(3)(B) of the Act.

Upon CMS approval of a state’s application outlining its health home planning activities described in this NOFO, we will authorize applicants to spend up to $500,000 of title XIX https://www.ssa.gov/OP_Home/ssact/title19/1945.htm

2022-09-23 Page 8 of 54 funding for planning activities related to the development of a SPA. Once the total funds available for this program are exhausted, no further applications will be considered.

States that have existing planning grants may apply for a new Section 1945 planning grant if it intends to award a new SPA under Section 1945 and targets a new population not currently targeted by a health home. Amendments to current health home programs do not qualify for additional planning grant funding.

In accordance with section 1945(c)(3)(B) of the Act, a state awarded a planning grant shall contribute an amount equal to the state percentage determined under section 1905(b) for each fiscal year for which the grant is awarded. Therefore, for a State with a pre-Recovery Act FMAP of greater than 50 percent, its planning activities will be matched at the higher medical assistance service rate. See also Matching and Cost Sharing Section C2. States will also be required to submit changes to their Cost Allocation Plans (CAP) to accommodate these health home planning activities. States could draw down the FMAP for planning activities before updating the CAP, as long as it is amended in a timely manner once the State obtains CMS approval for its health home planning activities.

For Additional information for State Monitoring and Reporting Requirements related to SPA requirements, please see: https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/health-home-information-resource-center/health-home-quality-reporting/index.html https://www.ssa.gov/OP_Home/ssact/title19/1945.htm

A5. Technical Assistance and Information for Prospective Applicants

States requiring technical assistance can utilize the CMS Planning Grants mailbox at HHPlanningGrants@cms.hhs.gov. Online resources are also available at https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/health-home-information-resource-center/index.html

A6. Limited Competition, Notice of Funding Opportunity

This funding opportunity provides applicants with title XIX funding for planning activities related to the development of a SPA.

B. Federal Award Information

B1. Total Funding

A total of $15,000,000 will be available for this award, pending the availability of funds.

B2. Award Amount https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/health-home-information-resource-center/health-home-quality-reporting/index.html https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/health-home-information-resource-center/health-home-quality-reporting/index.html https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/health-home-information-resource-center/health-home-quality-reporting/index.html https://www.ssa.gov/OP_Home/ssact/title19/1945.htm mailto:HHPlanningGrants@cms.hhs.gov

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The award amount for each grant will consist of up to $500,000 pending the availability of funds.

B3. Anticipated Award Dates

Applications will be accepted January 4, April 1, July 1, and October 1. Due to grants beginning on a rolling basis, grant funding and grant period start dates will vary.

B4. Period of Performance The award will have a project period of performance of up to 36 months from the award date.

B5. Number of Awards

B6. Type of Award

The type of award issued under this NOFO is a grant.

B7. Type of Competition

New.

C. Eligibility Information

C1. Eligible Applicants Government Organizations

State governments County governments City of Township governments Special District governments Native American tribal governments (Federally recognized) Native American tribal organizations (other than federally recognized tribal governments) Education Organizations

Independent School Districts Public and State Controlled Institutions of Higher Education

Private institutions of higher education Public Housing Organizations

Public housing authorities Indian housing authorities

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Nonprofit Organizations Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education For-profit Businesses (organizations other than small businesses) Small Businesses Individuals 0 Others (if selected, required additional narrative information below) Unrestricted (if selected, required to include additional narrative information below)

C2. Cost Sharing or Matching

A State awarded a planning grant shall contribute an amount equal to the State percentage determined under section 1905(b) (without regard to section 5001 of Public Law 111–5) for each fiscal year for which the grant is awarded. Matching is required for this Funding Opportunity.

C3. Letter of Intent

Not applicable

C4. Ineligibility Criteria

The applicant must ensure that they are only seeking funding to plan and implement those provisions that they are not currently receiving Federal grant funding to plan and implement.

C5. Single Application Requirement

Only one application may be submitted.

C6. Continued Eligibility

Applicants must continue to meet the program and eligibility requirements throughout the period of performance and comply with the terms and conditions that will accompany the Notice of Award (NoA).

Continued funding throughout the period of performance will be contingent upon the recipient’s compliance with all requirements laid out in this NOFO, as well as the Standard and Program Terms and Conditions of the NoA. At any time during the period of performance, recipient could receive decreased funding or their award could be terminated in accordance with 2 CFR 200.340 “Termination” if they fail to perform the requirements of the award.

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C7. EIN, UEI, and SAM Regulations In order to apply, all applicants are required to have a valid Employer Identification Number (EIN), otherwise known as a Taxpayer Identification Number (TIN); a Unique Entity Identifier*;

and be registered in the System for Award Management (SAM) database (https://www.sam.gov/)) to be able to submit an application at grants.gov. See Appendix II.

Application and Submission Information for descriptions of EIN, UEI, and SAM.

C8. Faith-Based Organizations

Not applicable

C9. Other Eligibility Requirements

Not applicable

D. Application and Submission Information

D1. Address to Request Application Package

Application materials will be available at https://www.grants.gov. Applicants will be able to download a copy of the application packet, complete it off-line, and then upload and submit the application via the GrantSolutions website. Refer to Appendix II, Application and Submission Information, for specific instructions.

D2. Content and Form of Application Submission

a. Application format

Applications determined to be ineligible, incomplete, and/or nonresponsive based on the initial screening may be eliminated from further review. However, in accordance with HHS Grants Policy, the CMS, Office of Acquisition and Grants Management (OAGM), Grants Management Officer in his/her sole discretion, may continue the review process for an ineligible application if it is in the best interests of the government to meet the objectives of the program. Each application must include all contents of the application package, in the order indicated, and conform to the following formatting specifications:

• All pages of the project and budget narratives as well as other required narrative documents must be paginated in a single sequence.

• Font size must be at least 12-point with an average of 14 characters per inch (CPI).

• The Project Narrative must be double-spaced. The page limit for this document is 10 pages. A Project Narrative is not required for states with current planning grants.

• The Budget Narrative may be single-spaced. The page limit for this document is 5 pages.

The Business Assessment may be single spaced. The page limit for this document is 12 pages.

• The project abstract is restricted to a one-page summary that may be single-spaced.

https://sam.gov/content/home https://www.grants.gov/

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b. Standard forms The following forms must be completed with an electronic signature and enclosed as part of the application:

1. Project Abstract Summary

A one-page abstract serves as a succinct description of the proposed project and includes the goals of the project, the total budget, and a description of how the funds will be used. The abstract is often distributed to provide information to the public and Congress, so please write the abstract so that it is clear, accurate, concise, and without reference to other parts of the application. Exclude personal identifying information from the abstract. In the Grants Application Package at https://www.grants.gov select the Project Abstract Summary and complete the form.

2. SF-424: Official Application for Federal Assistance

Note: On SF-424 “Application for Federal Assistance”

• On Item 15 “Descriptive Title of Applicant’s Project,” state the specific grant or cooperative agreement opportunity for which you are applying.

• Check “No” to item 19c, as Review by State Executive Order 12372 does not apply to this cooperative agreement funding opportunity.

• The Authorized Organizational Representative (AOR) completes and signs this form. Note: The signature of the individual that submits the application to GrantSolutions populates throughout the application. The signature must match the name of the AOR. Other signatures will not be accepted.

The AOR is the designated representative of the applicant/recipient organization with authority to act on the organization’s behalf in matters related to the award and administration of grants. In signing a grant application, the AOR agrees that the organization will assume the obligations imposed by applicable Federal statutes and regulations and other terms and conditions of the award, including any assurances, if a grant is awarded. These responsibilities include accountability both for the appropriate use of funds awarded and the performance of the grant-supported project or activities as specified in the approved application.

• SF-424A: Budget Information Non-Construction

• SF-424B: Assurances-Non-Construction Programs

3. SF-LLL: Disclosure of Lobbying Activities

All applicants must submit this SF-LLL form. If your entity does not engage in lobbying, please insert “Non-Applicable” on the form and include the required AOR name, contact information, and signature. Please note that the application kit available online on the Grants.gov website is utilized for many programs and therefore Grants.gov may designate this form as optional to allow for flexibility amongst programs. However, this form is required as part of the application package and must be submitted for the application to be considered eligible for review.

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4. Project Site Location Form(s)

All applicants must submit this Project Site Location form. Please note that the application kit available online in Grants.gov is utilized for many programs and therefore Grants.gov may designate this form as optional to allow for flexibility amongst programs. However, this form is required as part of the application package and must be submitted for the application to be considered eligible for review.

C. Application cover letter or cover page (Mandatory) The applicant is required to include a cover letter or cover page to detail its interest in participation in the funding opportunity for the Health Home for Individuals with Chronic Conditions.

A letter from the applicant must identify the:

• Project Title

• Applicant Name

• Project Director Name (with email and phone number)

• Authorized Official (person with authority to sign off on all decisions for the award)

d. Project Narrative The applicant must provide a project narrative that articulates in detail the required elements included in Section A4. Program Requirements. Include the title “Project Narrative” at the beginning of the Project Narrative.

Below are the required elements (sections) of the project narrative including a brief description of the type of information required within each specific section. The project narrative is double-spaced and cannot exceed 10 pages in length.

Section (i), Eligibility (required) The Applicant must submit a statement attesting that the applicant is not receiving other Federal grant dollars for the same activity(ies) for which it will receive funds awarded by this grant.

Section (ii), Proposed Activities for Meeting Program Requirements (required) The applicant must describe planning and implementation activities related to. This should include, but is not limited to, description of appropriately skilled personnel who will provide support for activities relating to, engaging appropriate stakeholders, incorporating stakeholder feedback, Section (iii), Proposed Work Plan and Timeline of Activities (required) The applicant must provide a proposed timeline with dates for activities related to meeting the program requirements.

e. Budget Narrative Applicants supplement Form SF-424A with a Budget Narrative which includes a yearly breakdown of costs, for each line item outlined in the SF-424A, according to a 36-month budget period. Applicants include a clear description of the proposed set of services covered with award funds for each activity/cost within the line item. The application clearly defines the proportion of the requested funding designated for each activity, including the state share, and justifies the

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For additional information and instructions for completing the SF-424A and Budget Narrative, please refer to Appendix I. Guidance for Preparing a Budget Request and Narrative.

f. Business assessment of applicant organization (maximum 12 pages) As required by 45 CFR §75.205 for competitive grants and cooperative agreements, CMS evaluates the risk posed by an applicant before they receive an award. This analysis of risk includes items such as financial stability, quality of management systems, internal controls and the ability to meet the management standards prescribed in 45 CFR Part 75.

An applicant must review, answer, and submit the business assessment questions outlined in Appendix III. Business Assessment of Applicant Organization.

g. Required Supporting Documentation

The following supporting documentation should accompany the application and is excluded from the page limit for applications. (These items may be uploaded under “Miscellaneous” in the application kit available on GrantSolutions.)

Applicants must provide, at a minimum, contact information for the Project Director who will oversee the day to day management of the planning grant funds.

D3. Unique Entity Identifier and System for Award Management (SAM) Each applicant is required to:

i. be registered in SAM before submitting its application;

ii. provide a valid unique entity identifier in its application; and

iii. continue to maintain an active SAM registration with current information at all times during which it has an active Federal award or an application or plan under consideration by a Federal awarding agency.

D4. Submission Dates and Times

The application must be submitted electronically and be received through grants.gov by the date(s) and time set forth below.

Due Dates for Application:

Applications will be accepted January 4, April 1, July 1, and October 1.

No later than, 3:00 PM Eastern U.S. Time

D5. Intergovernmental Review An application for this grant program is not subject to Executive Order 12372, “Intergovernmental Review of Federal Programs” (45 CFR 100). Please check box “C” on item

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19 of the SF 424 (Application for Federal Assistance) as Executive Order 12372 does not apply to this award.

D6. Cost Restrictions

Indirect Costs

See section F2. Administrative and National Policy Requirements of this NOFO for more information on indirect costs.

Prohibited Uses of Award Funds

CMS prohibits funds under this award for any of the activities/costs outlined below unless an exception is specifically authorized by statute.

• To reimburse for pre-award costs.

• To match any other Federal funds.

• To provide services, equipment, or supports that are the legal responsibility of another party under Federal, State, or Tribal 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 provide goods or services not allocable to the approved project.

• To supplant existing State, local, Tribal or private funding of infrastructure or services, such as staff salaries, etc.

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

• To pay for construction.

• To pay for capital expenditures for improvements to land, buildings, or equipment which materially increase their value or useful life as a direct cost, except with the prior written approval of the Federal awarding agency.

• To pay for the cost of independent research and development, including their proportionate share of indirect costs (unallowable in accordance with 45 CFR 75.476).

• To expend funds related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or Executive Order proposed or pending before the Congress or any state government, state legislature or local legislature or legislative body.

D7. Mandatory Disclosure Submission is required for all applicants, in writing, to the awarding agency and to the HHS Office of Inspector General (OIG), all information related to violations of federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the federal award.

Disclosures must be sent in writing to:

U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services Office of Acquisition and Grants Management Attn: Director, Division of Grants Management

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7500 Security Blvd, Mail Stop B3-30-03 Baltimore, MD 21244-1850

AND

U.S. Department of Health and Human Services Office of Inspector General ATTN: Mandatory Grant Disclosures, Intake Coordinator 330 Independence Avenue, SW, Cohen Building Room 5527 Washington, DC 20201

URL: https://oig.hhs.gov/fraud/report-fraud/index.asp

(Include “Mandatory Grant Disclosures” in subject line)

Fax: (202) 205-0604 (Include “Mandatory Grant Disclosures” in subject line) or

Email: MandatoryGranteeDisclosures@oig.hhs.gov

Materials should be scanned and emailed to the Grants Management Specialist assigned to this

NOFO.

E. Application Review Information

E1. Criteria This Funding Opportunity provides applicants with the resources needed to develop planning activities. States will be evaluated based on its ability to articulate its requirements to plan a SPA submission pursuant to Section 1945 of the Act and based on the information outlined in Sections A4. Program Requirements, C. Eligibility Information, and D.2. Content and Form of Application Submission.

Applications must be submitted in the required format, no later than the deadline. If an applicant does not submit all of the required documents and does not address each of the topics described in D2. Content and Form of Application Submission Information (with cross reference to E1. Criteria), the applicant risks not being eligible and/or awarded. Applications are reviewed in accordance with criteria outlined below.

As indicated in Section D., Application and Submission Information, all applicants must submit the following:

Standard Forms;

A Cover Letter, if applicable;

A Project Narrative;

A Budget Narrative;

Cost Allocation Plan (current)

The following are also required.

https://oig.hhs.gov/fraud/report-fraud/index.asp mailto:MandatoryGranteeDisclosures@oig.hhs.gov

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Business Assessment of Applicant Organization

Review Criteria

1. PROJECT NARRATIVE

Provide a project narrative describing your goals, measurable objectives, planning activities, and timeline. CMS will consider one or more of the following categories as appropriate planning activities:

Hiring of personnel or contractors to determine feasibility and develop the health home program;

Outreach initiatives to obtain consumer and provider feedback;

Training and consultation related to designing components of any provisions of the

SPA;

Development of systems for reporting and other infrastructure building tasks; and Travel to accomplish such activities

Applicants will be reviewed on the category or categories noted above as well as any support provided for their intended SPA. Planning activities must be sufficiently justified and clearly defined.

2. ORGANIZATIONAL CAPABILITIES

This section outlines the broader capacity of the organization to complete the project outlined in the project narrative. It includes the identification of personnel responsible for completing tasks and the chain of responsibility for successful completion of the projects outlined in the project narrative.

3. PROJECT EVALUATION

The project requires an evaluation component to assess its planning activities and progression in its completion. Describe the applicant’s proposed plan to evaluate both outcomes and process. Outcome evaluation relates to the results identified in the key goals/aims, and process evaluation relates to the planning activities of the project.

4. BUDGET AND BUDGET JUSTIFICATION

This section should provide a clear estimate of the project’s program costs and justification for expenses for the entire award period. The budgets and budget justifications should be consistent with the tasks identified in the project narrative.

a) Provide a detailed budget for the 36-month budget performance period as instructed in Appendix 1.

b) Provide a narrative justification explaining why each line item is necessary/relevant to the proposed project. Include sufficient cost and other details to facilitate the determination of cost allowability (i.e., equipment specifications, etc.).

E2. Review and Selection Process

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Awards may be adjusted to a lower amount if the applicant fails to meet performance milestones (refer to section F5. Reporting).

The application itself is not a legally binding contract and does not require any applicant or CMS to enter into an award. CMS will select Recipients at CMS’s sole discretion unless statutorily prohibited. Such selection will not be subject to administrative or judicial review, per Section 1115A(d)(2)(B) of the Act.

Please refer to Appendix V. Review and Selection Process for more information on the review and selection process.

E3. Federal Awardee Performance Integrity Information System (FAPIIS) In accordance with 45 CFR Part 75:

i. CMS, prior to making a Federal award with a total amount of Federal share greater than the simplified acquisition threshold2, is required to review and consider any information about the applicant that is in the designated integrity and performance system accessible through SAM (currently FAPIIS) (see 41 U.S.C. 2313);

ii. An applicant, at its option, may review information in the designated integrity and performance systems accessible through SAM and comment on any information about itself that the HHS awarding agency previously entered and is currently in the designated integrity and performance system accessible through SAM.

iii. CMS will consider any comments by the applicant, in addition to the other information in the designated integrity and performance system, in making a judgment about the applicant’s integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicant as described in §75.205.

F. Federal Award Administration Information

F1. Federal Award Notices If successful, applicant will receive a Notice of Award (NoA) signed and dated by the CMS Grants Management Officer. The NoA is the legal document authorizing the award and issued to the applicant as listed on the SF-424 and available to the applicant organization through the online grants management system used by CMS and recipient organizations. Any communication between CMS and applicant prior to issuance of the NoA is not an authorization to begin performance of a project.

If unsuccessful, CMS notifies the applicant electronically to the email address as listed on its SF- 424, within 30 days of the award date.

2 Simplified acquisition threshold means the dollar amount below which a non-Federal entity may purchase property or services using small purchase methods. Non-Federal entities adopt small purchase procedures in order to expedite the purchase of items costing less than the simplified acquisition threshold. The simplified acquisition threshold is set by the Federal Acquisition Regulation at 48 CFR Subpart 2.1 (Definitions) and in accordance with 41 U.S.C.

1908.

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F2. Administrative and National Policy Requirements

A. National/Public Policy Requirements

By signing the application, the authorized organizational official certifies that the organization will comply with applicable public policies. Once a grant is awarded, each recipient is responsible for establishing and maintaining the necessary processes to monitor its compliance and that of its employees and, as appropriate, subrecipients and contractors under the award with these requirements. Recipients should consult the applicable Appropriations Law, Exhibit 3 of the HHS Grants Policy Statement, titled Public Policy Requirements, located in Section II, pages 3-6, as well as the terms and conditions of award for information on potentially applicable public policy requirements.

Non-Discrimination/ Accessibility Provisions

Recipients receiving awards under this grant project must comply with all applicable Federal statutes relating to nondiscrimination, including, but not limited to:

a. Title VI of the Civil Rights Act of 1964,

b. Section 504 of the Rehabilitation Act of 1973,

c. The Age Discrimination Act of 1975,

d. Title II, Subtitle A of the Americans with Disabilities Act of 1990;

e. Section 1557 of the Affordable Care Act;

f. Title IX of the Education Amendments of 1972; and

g. Applicable federal religious nondiscrimination laws, https://www.hhs.gov/conscience/religious-freedom/index.html, and applicable federal conscience protection and associated anti-discrimination laws https://www.hhs.gov/conscience/conscience-protections/index.html.

Should you successfully compete for an award, recipients of federal financial assistance (FFA) from HHS must administer their programs in compliance with federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age and, in some circumstances, religion, conscience, and sex (including gender identity, sexual orientation, and pregnancy). This includes ensuring programs are accessible to persons with limited English proficiency and persons with disabilities. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. See https://www.hhs.gov/civil-rights/for-providers/index.html and https://www.hhs.gov/conscience/religious-freedom/index.html .

1. Recipients of FFA must ensure that their programs are accessible to persons with limited English proficiency. For guidance on meeting your legal obligation to take reasonable steps to ensure meaningful access to your programs or activities by limited English proficient individuals. See https://www.hhs.gov/ocr/get-help-in-other-languages/index.html and https://www.lep.gov .

https://www.hhs.gov/conscience/religious-freedom/index.html https://www.hhs.gov/conscience/conscience-protections/index.html https://www.hhs.gov/civil-rights/for-providers/index.html https://www.hhs.gov/civil-rights/for-providers/index.html https://www.hhs.gov/conscience/religious-freedom/index.html https://www.hhs.gov/ocr/get-help-in-other-languages/index.html https://www.hhs.gov/ocr/get-help-in-other-languages/index.html https://www.lep.gov/

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2. For information on your specific legal obligations for serving qualified individuals with disabilities, including reasonable modifications and making services accessible to them, see http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html.

3. HHS funded health and education programs must be administered in an environment free of sexual harassment, see https://www.hhs.gov/civil-rights/filing-a-complaint/index.html

4. For guidance on administering your program in compliance with applicable federal religious nondiscrimination laws and applicable federal conscience protection and associated anti-discrimination laws, see https://www.hhs.gov/conscience/conscience-protections/index.html and https://www.hhs.gov/conscience/religious-freedom/index.html.

Recipients should review and comply with the reporting and review activities regarding accessibility requests outlined in Appendix IV, Accessibility Provisions to this Notice of Funding Opportunity.

Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under federal civil rights laws at https://www.hhs.gov/ocr/about-us/contact-us/index.html or call 1-800-368-1019 or TDD 1-800-537-7697.

B. Administrative Requirements

• All equipment, staff, and other budgeted resources and expenses must be used exclusively for the projects identified in the applicant’s original application or agreed upon subsequently with CMS, and may not be used for any prohibited uses.

• Consumers and other stakeholders must have meaningful input into the planning, implementation, and evaluation of the project.

• This award is subject to 45 CFR Part 75, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS awards [available at http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75], which implements 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (“Uniform Guidance”) effective December 26, 2014. See below for more information.

Uniform Administrative Requirements, Cost Principles, and Audit Requirements

Applicant and recipients should take particular note of the information found in 45 CFR Part 75.

Requirements for development and submission of indirect (F&A) cost rate proposals and cost allocation plans are contained in Appendices III-VII, and Appendix IX to Part 75.

Cost Allocation

In accordance with 45 CFR §75.416 and Appendix V to Part 75 – State/Local Government-wide Central Service Cost Allocation Plans, each state/local government will submit a plan to the HHS Cost Allocation Services for each year in which it claims central service costs under Federal awards. Guidelines and illustrations of central service cost allocation plans are provided http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html https://www.hhs.gov/civil-rights/filing-a-complaint/index.html https://www.hhs.gov/conscience/conscience-protections/index.html https://www.hhs.gov/conscience/conscience-protections/index.html https://www.hhs.gov/conscience/religious-freedom/index.html https://www.hhs.gov/conscience/religious-freedom/index.html https://www.hhs.gov/ocr/about-us/contact-us/index.html https://www.hhs.gov/ocr/about-us/contact-us/index.html http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75

2022-09-23 Page 21 of 54 in a brochure published by the HHS entitled “A Guide for State, Local and Indian Tribal Governments: Cost Principles and Procedures for Developing Cost Allocation Plans and Indirect Cost Rates for Agreements with the Federal Government.” A copy of this brochure may be obtained from the HHS Cost Allocation Services at https://www.hhs.gov/about/agencies/asa/psc/indirect-cost-negotiations/index.html A current, approved cost allocation plan must be provided to CMS if central service costs are claimed.

Public Assistance Cost Allocation Plans

Appendix VI to Part 75 – Public Assistance Cost Allocation Plans, provides that state public assistance agencies will develop, document and implement, and the Federal Government will review, negotiate, and approve, public assistance cost allocation plans in accordance with Subpart E of 45 CFR part 95. The plan will include all programs administered by the state public assistance agency. Where a letter of approval or disapproval is transmitted to a state public assistance agency in accordance with Subpart E, the letter will apply to all Federal agencies and programs. This Appendix (except for the requirement for certification) summarizes the provisions of Subpart E of 45 CFR part 95.

Audit Requirements

The audit requirements in 45 CFR Part 75, Subpart F, apply to each award recipient fiscal year that begins on or after December 26, 2014. A non-Federal entity that expends $750,000 or more during the non-Federal entity's fiscal year in Federal awards must have a single or program-specific audit conducted for that year in accordance with the provisions of Subpart F, Audit Requirements.

F3. Terms and Conditions This Notice of Funding Opportunity is subject to the Department of Health and Human Services Grants Policy Statement (HHS GPS) at https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html HHS regulation (45 CFR Part 75) supersedes information on administrative requirements, cost principles, and audit requirements for grants and cooperative agreements included in the current HHS Grants Policy Statement where differences are identified. Recipients must also agree to respond to requests that are necessary for the evaluation of national efforts and provide data on key elements of their own grant or cooperative agreement activities.

CMS may terminate any award for material noncompliance. Material noncompliance includes, but is not limited to, violation of the terms and conditions of the award; failure to perform award activities in a satisfactory manner; improper management or use of award funds; or fraud, waste, abuse, mismanagement, or criminal activity.

In the event a recipient or one of its subrecipients enters into proceedings relating to bankruptcy, whether voluntary or involuntary, the Recipient agrees to provide written notice of the bankruptcy to CMS. The recipient must furnish the written notice within five (5) days of the initiation of the proceedings relating to bankruptcy filing and sent to the CMS Grants Management Specialist and Project Officer. This notice includes:

1. the date on which the bankruptcy petition was filed,

2. the identity of the court in which the bankruptcy petition was filed,

3. a copy of any and all of the legal pleadings, and https://www.hhs.gov/about/agencies/asa/psc/indirect-cost-negotiations/index.html https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html

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4. a listing of Government grant and cooperative agreement numbers and grant offices for all, and

5. Government grants and cooperative agreements against which final payment has not been made.

Intellectual Property

Recipients under this funding opportunity must comply with the provisions of 45 CFR § 75.322, Intangible property and copyrights. The non-Federal entity may copyright any work that is subject to copyright and was developed, or for which ownership was acquired, under a Federal award. The Federal awarding agency reserves a royalty-free, nonexclusive, and irrevocable right to reproduce, publish, or otherwise use the work for Federal purposes, and to authorize others to do so. The non-Federal entity is subject to applicable regulations governing patents and inventions, including government-wide regulations issued by the Department of Commerce at 37 CFR part 401.

The Federal Government has the right to:

(1) Obtain, reproduce, publish, or otherwise use the data produced under a Federal award; and

(2) Authorize others to receive, reproduce, publish, or otherwise use such data for Federal purposes.

Prohibition on certain telecommunications and video surveillance services or equipment

As described in 2 CFR 200.216, recipients and subrecipients are prohibited to obligate or spend grant funds (to include direct and indirect expenditures as well as cost share and program) to:

(1) Procure or obtain;

(2) Extend or renew a contract to procure or obtain; or

(3) Enter into contract (or extend or renew contract) to procure or obtain equipment, services, or systems that use covered telecommunications equipment or services as a substantial or essential component of any system,…