1945A_NOFO_Clean_508_Approved.pdf

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U.S. Department of Health and Human Services

Centers for Medicare & Medicaid Services

Center for Medicare & CHIP Services

Health Home for Children with Medically Complex Conditions

Notice of Funding Opportunity Type: New

Funding Opportunity Award Type: -Grant

Notice of Funding Opportunity Number: CMS-3J3-23-001

Federal Assistance Listings Number (CFDA): 93.778

Notice of Funding Opportunity Posting Date: September 30, 2022

Letter of Intent to Apply Due Date: Not Applicable

Electronic Application Due Date: January 4, 2024 3:00 pm Eastern Standard Time

Anticipated Issuance Notice(s) of Award: April 1, 2023

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

A4. Program Requirements

Health Home for Children with Medically Complex Conditions Eligibility Criteria

Health Home Services for Children with Medically Complex Conditions

Health Information Technology (IT)

Enhanced Federal Medical Assistance Percentage (FMAP)

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

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D. Application and Submission Information

D1. Address to Request Application Package

D2. Content and Form of Application Submission

a. Application format

b. Standard forms

c. Application cover letter or cover page (Mandatory)

d. Project Narrative

e. Budget Narrative

f. Business assessment of applicant organization (maximum 12 pages)

g. Required Supporting Documentation

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

a. Progress Reports

b. Financial Reports

c. Federal Funding Accountability and Transparency Act Reporting Requirements

d. Audit Requirements

e. Payment Management System Reporting Requirements

f. Government-wide Suspension and Debarment Reporting Requirements

G. CMS Contacts

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G1. Programmatic Questions

G2. Administrative/Budget Questions

H. Other Information

Appendix I. Guidance for Preparing a Budget Request and Narrative

Budget Narrative – Sample Narrative and Instructions

A. (Personnel) Salaries and Wages

B. Fringe Benefits

C. Travel

D. Equipment

E. Supplies

F. Consultant/Subrecipient/Contractual Costs

G. Construction (not applicable)

H. Other

I. Total Direct Costs

J. Indirect Costs

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) “Health Home for Children with

Medically Complex Conditions” is to award a planning grant for activities related to the development of a State Plan Amendment (SPA) pursuant to section 1945A of the Social Security

Act (the Act) directed to children with medically complex conditions in order to plan and develop this health home model.

Title Descriptions

Item Health Home for Children with Medically Complex 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 Children with Medically Complex Conditions

Authorization Section 1945A of the Social Security Act (“the Act”), enacted as part of the Medicaid Services Investment and Accountability Act of 2019

Federal Assistance

Listings Number

(CFDA)

93.778

Funding Opportunity

Type

New

Funding Opportunity

Number

CMS-3J3-23-001

Type of Award Grant

Type of Competition New

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Letter of Intent N/A

Application Due Date and Time

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

October 1

Anticipated Issuance

Notice(s) of Award

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

Period of Performance

Start Date

April 1, July 1, October 1, and January 4

Period of Performance

End Date

36 months from the date of award

Anticipated Total

Available Funding

$5,000,000, pending the availability of funds

Estimated Maximum

Award Amount

$100,000, 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 Children with

Medically Complex Conditions” is to award funding for planning activities related to the development of a section 1945A State Plan Amendment (SPA) for children with medically complex conditions in order to plan and develop this health home model.

A2. Authority

Section 1945A of the Social Security Act (“the Act”), enacted as part of the Medicaid Services

Investment and Accountability Act of 2019.

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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-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.

1 ACA; P.L. 111-148

CMS expects state implementation of the new health home state plan option under section

1945A of the Act to improve care coordination for children with medically complex conditions.

Section 1945A of the Act provides an opportunity for states to cover care coordination and other services that are expected to support a family-centered system of care for children with medically complex conditions and could help to improve health outcomes for these children.

By implementing the health home option under section 1945A, states can cover coordination of care provided by the full range of pediatric specialty and subspecialty medical services, including coordination of care and services from out-of-state providers.

A4. Program Requirements

Health Home for Children with Medically Complex Conditions Eligibility Criteria

Section 1945A of the Act gives states the option to cover health home services for Medicaid-eligible children under age 21 with medically complex conditions who choose to enroll in a section 1945A health home by selecting a designated provider, a team of health care professionals operating with a designated provider, or a health team as the child’s health home

2022-09-2022 Page 8 of 74 services provider. As described in section 1945A(i)(1), a “child with complex conditions” must be under 21 years of age and eligible for medical assistance. Additionally, under that definition, to have a “medically complex condition,” a Medicaid-eligible child must have:

• One or more chronic conditions that cumulatively affect three or more organ systems and severely reduce cognitive or physical functioning (such as the ability to eat, drink, or breathe independently) and that also require the use of medication, durable medical equipment, therapy, surgery, or other treatments; or

• One life-limiting illness or rare pediatric disease (as defined in Section 529(a)(3) of the

Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360ff(a)(3)).

A chronic condition is defined in section 1945A(i)(2) as “a serious, long-term physical, mental, or developmental disability or disease,” including the following:

• Cerebral palsy;

• Cystic fibrosis;

• HIV/AIDS;

• Blood diseases, such as anemia or sickle cell disease;

• Muscular dystrophy;

• Spina bifida;

• Epilepsy;

• Severe autism spectrum disorder; and

• Serious emotional disturbance or serious mental health illness.

The state may elect to provide health home services for children with a medically complex condition based on all of the conditions listed above who are otherwise eligible, or to children with particular chronic conditions.

Section 1945A(i)(1)(B) of the Act authorizes the Secretary to establish more restrictive eligibility standards for the section 1945A health home benefit by establishing higher levels as to the number or severity of chronic, life-threatening illnesses, disabilities, rare diseases or mental

2022-09-2022 Page 9 of 74 health conditions for purposes of determining eligibility for receipt of section 1945A health home services. Further guidance regarding program eligibility is available in the state Medicaid director letter available on https://www.medicaid.gov/federal-policy-guidance/downloads/smd22004.pdf.

Section 1945A of the Act waives the statewide geographic requirement at section 1902(a)(1) notwithstanding the comparability requirement at section 1902(a)(10)(B). This means that states can offer health home services less than statewide and offer section 1945A health home services only to persons eligible for those services, or in a different amount, duration, or scope than the same services provided to Medicaid beneficiaries who are not enrolled and eligible for section

1945A services. However, states may not require a child with medically complex conditions to enroll in a section 1945A health home and may not limit the child’s choice of designated provider, or qualified section 1945A health home providers. States may not reduce or modify the entitlement of children with medically complex conditions to early and periodic screening, diagnostic, and treatment (EPSDT) services as defined in section 1905(r). Additionally, states may not reduce or modify any requirements under section 1902(a)(43).

Health Home Services for Children with Medically Complex Conditions

Section 1945A(i)(4) of the Act defines “health home services” for children with medically complex conditions as comprehensive and timely high-quality services provided by a designated provider, team of health care professionals operating with a designated provider, or health team, and that include:

1) Comprehensive care management;

2) Care coordination, health promotion, and providing access to the full range of pediatric specialty and subspecialty medical services, including services from out-of-state providers, as medically necessary;

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

4) Patient and family support (including authorized representatives);

https://www.medicaid.gov/federal-policy-guidance/downloads/smd22004.pdf https://www.medicaid.gov/federal-policy-guidance/downloads/smd22004.pdf

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5) Referrals to community and social support services, if relevant; and

6) Use of health information technology to link services, as feasible and appropriate2

2 https://www.medicaid.gov/sites/default/files/2020-02/health-home-information-technology-questions.pdf

CMS’ recommended health home services definitions will be found in the implementation guide that CMS will provide to states. This implementation guide will be linked to the section 1945A state plan amendment (SPA) template in the Medicaid and CHIP Program (MACPro) system.

Health Information Technology (IT)

The Health Information Technology for Economic and Clinical Health Act (HITECH Act) amended the Public Health Service Act to provide HHS with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health information technology (IT), including electronic health records and private and secure electronic health information exchange. These improvements are achieved in part through the adoption of health IT standards, implementation specifications, and certification criteria adopted by the HHS Secretary.

Health information technology is defined in Section 3000 of the PHSA. HHS has substantially adopted and codified that definition at 45 CFR 170.102. The regulation defines health information technology as hardware, software, integrated technologies or related licenses, IP, upgrades, or packaged solutions sold as services that are designed for or support the use by health care entities or patients for the electronic creation, maintenance, access, or exchange of health information.

If award funding involves implementing, acquiring, or upgrading health IT, successful applicants agree that:

https://www.medicaid.gov/sites/default/files/2020-02/health-home-information-technology-questions.pdf

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Where award funding involves: Recipients and subrecipients are required to:

Implementing, acquiring, or upgrading health IT for activities by any funded entity

Utilize health IT that meets standards and implementation specifications adopted in 45 CFR part 170, Subpart B, if such standards and implementation specifications can support the activity.

Implementing, acquiring, or upgrading health IT for activities by eligible clinicians in ambulatory settings, or hospitals, eligible under Section 4101, 4102, and 4201 of the HITECH Act

Utilize health IT certified under the ONC Health

IT Certification Program, if certified technology can support the activity.

If standards and implementation specifications adopted in 45 CFR part 170, Subpart B cannot support the activity, recipients and subrecipients are encouraged to utilize health IT that meets non-proprietary standards and implementation specifications developed by consensus-based standards development organizations. This may include standards identified in the ONC

Interoperability Standards Advisory, available at https://www.healthit.gov/isa/.

Enhanced Federal Medical Assistance Percentage (FMAP)

Section 1945A(c)(1) of the Act provides that the FMAP for state expenditures on health home services for children with medically complex conditions shall be increased by 15 percentage points (not to exceed 90 percent) for the first two fiscal year quarters that a state’s section 1945A health home SPA is in effect. After conclusion of this period of enhanced FMAP, states will receive the regularly applicable Medicaid services FMAP for their expenditures on section

1945A health home services. However, a state may be eligible for new periods of enhanced match under section 1945A(c)(1), if the state submits and receives approval of another section

1945A SPA to expand section 1945A health home services to new geographic areas or to target new conditions under this benefit in accordance with section 1945A.

After a state’s section 1945A health home SPA takes effect, the state can submit a claim to CMS for federal financial participation in its expenditures on section 1945A health home services, by recording the expenditures on a new line item XX in the Medicaid and Children’s Budget https://www.healthit.gov/isa/

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Expenditure System (MBES/CBES). The new line item will be called “Health Homes for

Children with Medically Complex Conditions”. Expenditures claimed at the enhanced match available under section 1945A(c)(1) should be recorded in line XX-a, and expenditures claimed at the regularly applicable match should be recorded in line XX-b. The first two fiscal year quarters of enhanced FMAP begin upon the effective date of the SPA. CMS suggests that states select a SPA effective date for the SPA at the beginning of a quarter, based on when providers will be ready to implement. Please note that if there is a delay in implementation, a state might be able to claim enhanced FMAP during only part of the first two fiscal year quarters its section

1945A SPA is in effect, because if the state is not covering health home services during part of that period, it would not have any expenditures on which to base a claim for the enhanced match.

There is no date by which a state’s section 1945A health home SPA must take effect in order for the state to receive the two fiscal year quarters of enhanced FMAP.

Further guidance and detail regarding program requirements and reporting is available in the state Medicaid director letter available on https://www.medicaid.gov/federal-policy-guidance/downloads/smd22004.pdf.

A5. Technical Assistance and Information for Prospective Applicants

States requiring technical assistance while applying for a planning grant 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 $5,000,000 will be available for this grant program, pending the availability of funds.

https://www.medicaid.gov/federal-policy-guidance/downloads/smd22004.pdf https://www.medicaid.gov/federal-policy-guidance/downloads/smd22004.pdf https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/health-home-information-resource-center/index.html https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/health-home-information-resource-center/index.html

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B2. Award Amount

The award amount for each grant will consist of up to $100,000 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)

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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

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.

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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 the recipient fails to perform the requirements of the award.

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 https://sam.gov/content/home

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D. Application and Submission Information

D1. Address to Request Application Package

Application materials will be available at 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

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

• The Business Assessment of Applicant Organization 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.

b. Standard forms http://www.grants.gov/

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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 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.

http://www.grants.gov/

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• 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; therefore, Grants.gov may designate this form as optional to allow for flexibility amongst programs. This form is required as part of the application package and must be submitted for the application to be considered eligible for review.

4. Project Site Location Form(s)

All applicants must submit this Project Site Location form. Please note that the application kit is available online in Grants.gov is utilized for many programs; 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 Children with Medically

Complex Conditions.

A letter from the applicant must identify the following:

• 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)

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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 or activities 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 grant project. 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), Health Information Technology (IT) (optional)

If applicable, the applicant must identify if award funding will involve implementing, acquiring or upgrading health IT. See additional information in Section A4.

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

2022-09-2022 Page 20 of 74 the requested funding designated for each activity and justifies the applicant’s readiness to receive funding. The budget separates out funding administered directly by the lead agency from funding subcontracted to other partners. Budget narrative is single spaced and is limited to 5 pages.

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 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

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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 Date 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 cooperative agreement is not subject to Executive Order 12372, “Intergovernmental Review of Federal Programs” (45 CFR 100). Please check box “C” on item

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 and Cost Allocation Plans.

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

2022-09-2022 Page 22 of 74 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

7500 Security Blvd, Mail Stop B3-30-03

Baltimore, MD 21244-1850

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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 perform planning activities. A state will be evaluated based on its ability to articulate its requirements to plan a

SPA submission pursuant to Section 1945A of the Act 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.

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

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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: including a proposed Work plan and Timeline;

▪ A Budget Narrative;

▪ Cost Allocation Plan (current)

The following are also required:

▪ Job Descriptions for Key Personnel

Review Criteria

1. PROJECT NARRATIVE

Provide a project narrative describing 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

▪ Health Information Technology (IT)

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.

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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

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 agreement. CMS will select Recipients at CMS’s sole discretion

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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 threshold3, 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

3 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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If unsuccessful, CMS notifies the applicant electronically to the email address as listed on its SF-

424, within 30 days of the award date.

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 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

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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 .

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.

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/ 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

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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.

• Uniform Administrative Requirements

In accordance with 45 CFR §75.112, all award recipients receiving federal funding from CMS must establish and comply with the conflict of interest policy requirements outlined by CMS

(available for applicant upon request).

In accordance with 45 CFR §75.113, Mandatory Disclosures, the non-Federal entity or applicant for a Federal award must disclose, in a timely manner, in writing to the HHS awarding agency or pass-through entity all violations of Federal criminal law involving fraud, bribery, or gratuity 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

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Federal award including the term and condition outlined in Appendix XII to 45 CFR Part 75 are required to report certain civil, criminal, or administrative proceedings to SAM. Failure to make the required disclosures can result in the imposition of any of the remedies described in §75.371, including suspension or debarment. (See also 2 CFR Parts 180 and 376, and 31 U.S.C. 3321).

For specific information on reporting such disclosures to CMS and HHS please see Section F3.

Terms and Conditions of this NOFO.

• Cost Principles

CMS grant and cooperative agreement awards provide for reimbursement of actual, allowable costs incurred and are subject to the Federal cost principles. The cost principles establish standards for the allowability of costs, provide detailed guidance on the cost accounting treatment of costs as direct or indirect, and set forth allowability and allocability principles for selected items of cost. Applicability of a particular set of cost principles depends on the type of organization. Award recipients must comply with the cost principles set forth in HHS regulations at 45 CFR Part 75, Subpart E with the following exceptions: (1) hospitals must follow Appendix

IX to part 75; and (2) commercial (for-profit) organizations are subject to the cost principles located at 48 CFR subpart 31.2. As provided in the cost principles in 48 CFR subpart 31.2, allowable travel costs may not exceed those established by the Federal Travel Regulation (FTR).

There is no universal rule for classifying certain costs as either direct or indirect (also known as

Facilities & Administration (F&A) costs) under every accounting system. A cost may be direct with respect to some specific service or function, but indirect with respect to the Federal award or other final cost objective. Therefore, it is essential that each item of cost incurred for the same purpose is treated consistently in like circumstances either as a direct or F&A cost in order to avoid double-charging of Federal awards. Guidelines for determining direct and F&A costs charged to Federal awards are provided in 45 CFR §§75.412 to 75.419. 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

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