2024 CMS Navigator NOFO_06 03 02024.pdf

Notice of Funding Opportunity

Application due July 8, 2024

Cooperative Agreement to Support Navigators in Federally-Facilitated Exchanges Opportunity number: CMS-NAV-24-001

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 7

Program description 10

Step 2: Get Ready to Apply 23

Get registered 24

Find the application package 24

Step 3: Prepare Your Application 25

Application contents and format 26

Step 4: Learn About Review and Award 47

Application review 48

Award notices 55

Step 5: Submit Your Application 56

Application submission and deadlines 57

Step 6: Learn What Happens After Award 60

Post-award requirements and administration 61

Contacts and Support 64

Endnotes 66

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registration is active and up-to-date.

SAM.gov registration (this can take several weeks)

You must have an active account with SAM.gov. This includes having a Unique

Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days)

You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by July 8, 2024

Applications are due by 11:59 p.m. Eastern Time on July 8, 2024.

To help you find what you need, this NOFO uses internal links. In Adobe

Reader, you can go back to where you were by pressing Alt + Left Arrow

(Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 7

Program description 10

Basic information Centers for Medicare & Medicaid Services (CMS)

Center for Consumer Information and Insurance Oversight (CCIIO)

Funding organizations that serve as Navigators in states with a Federally-facilitated health insurance exchange.

Have questions?

See Contacts and

Support.

Key facts

Opportunity Name:

Cooperative Agreement to Support Navigators in

Federally-Facilitated

Exchanges

Opportunity Number:

CMS-NAV-24-001

Federal Assistance

Listing:

CFDA 93.332

Statutory authority number:

Affordable Care Act

(ACA), sections

1311(d)(4)(K), 1311(i), and

1321(c)(1)

Key dates

Application deadline:

July 8, 2024, by 11:59 pm

EST

Expected award date:

Friday, August 23, 2024

Expected start date:

Tuesday, August 27, 2024

Summary Each year, the Centers for Medicare & Medicaid Services (CMS) awards funding to organizations serving as Navigators in states with a Federally-facilitated Exchange (FFE). Navigators help people (consumers) access health insurance through their state’s FFE.

Funded organizations operate as Navigators year-round, using funding from

CMS to conduct outreach and education in their communities. They raise awareness among uninsured consumers about the coverage options available to them, help consumers find affordable coverage that meets their needs, and assist them beyond the enrollment process. Navigators make sure consumers have the tools and resources they need to use and maintain their health coverage all year, including help with unauthorized enrollment or switching health plans.

Navigators are required to provide targeted assistance to underserved and vulnerable populations within their state’s FFE. We refer to these populations throughout this NOFO as priority populations. This targeted assistance is critical to improving access to health care coverage for communities that have been historically disenfranchised and disproportionately impacted by significant health disparities.[1] We encourage applications from organizations that are members of, or have a history of trusted ties within, the communities and populations they will serve as Navigators, if awarded funding. This goal is in line with Executive Order 13985 on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 5 https://www.federalregister.gov/documents/2021/01/25/2021-01753/advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government https://www.federalregister.gov/documents/2021/01/25/2021-01753/advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government

Funding details Type: Cooperative agreement, which means that you and CMS will have a role in the project. Throughout the life of your project, we will be there to help and work with you.

Expected total funding for the program: $500M total over five years, subject to availability of funds.

Expected total awards: Up to 120.

Funding range per FFE state for the period of performance: $6.25M to $84M over five years.

We will provide funding in five budget period increments of 12 months each over a five-year period of performance.

Step 1: Review the Opportunity 6

Eligibility Who can apply

Eligible applicants The following types of organizations may apply:

Government organizations

• State governments.

• County governments.

• City or 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.

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.

• Community and consumer-focused nonprofit groups.

Other organizations

• For-profit businesses.

• Small businesses.

• Individuals.

• Other entities capable of meeting the program requirements, including but not limited to:

◦ Trade, industry, and professional associations.

Step 1: Review the Opportunity 7

◦ Commercial fishing industry organizations.

◦ Ranching and farming organizations.

◦ Chambers of commerce.

◦ Unions.

◦ Resource partners of the Small Business Administration.

◦ State or local human service agencies.

Consortium applicants You may apply under one application as a consortium to reach a larger total portion of the priority populations within FFE states.

A consortium, for the purposes of this funding opportunity, refers to two or more individuals, two or more private or public organizations, or a combination of individual(s) and private or public organization(s) that have identified a lead recipient to serve as the primary applicant and recipient of federal funding. As the identified lead recipient, you will also serve as a “pass-through” entity, issuing subawards or contracts, to consortium members carrying out

Navigator duties. Recipients must serve as the primary contact to CMS and will be responsible for monitoring the performance of its consortium members, ensuring they comply with all the requirements and terms and conditions established under this cooperative agreement.

Other eligibility criteria Funding under this NOFO is only available to eligible individuals, entities, and consortia proposing to operate as FFE Navigators in a state with an FFE for

Plan Year (PY) 2025. See Table 1: State funding allocations for additional information.

Eligibility limitations You are ineligible for funding under this funding opportunity if you or your organization are:

• Health insurance issuers.

• Subsidiaries of health insurance issuers.

• Issuers of stop loss insurance and their subsidiaries.

• Associations that include members of, or lobby on behalf of, the insurance industry.

• Recipients of any direct or indirect consideration from any health insurance issuer or issuer of stop loss insurance in connection with the

Step 1: Review the Opportunity 8 enrollment of any individuals or employees in a qualified health plan

(QHP) or non-QHP.[2]

You may submit only one application under this NOFO. Each applicant is eligible for only one cooperative agreement award, so long as the FFE state in which they are awarded cooperative agreement funds remains an FFE.

Cost sharing This program has no cost-sharing requirement. If you choose to include cost-sharing funds, we will not consider it during review. However, we will hold you accountable for any funds you add, including the requirements for grant reporting.

Step 1: Review the Opportunity 9

Program description Purpose The purpose of this funding opportunity is to provide funding to eligible individuals or organizations to operate as Navigators in states with an FFE, as authorized by the Affordable Care Act (ACA).[3]

Background Section 1311(i) of the ACA requires Exchanges (more commonly called

Marketplaces) to establish a Navigator program. This funding opportunity is open to eligible entities and individuals (described in Section 1311(i)(2) of the

ACA and 45 C.F.R. §155.210(a) and (c)) applying to serve consumers in states with an FFE. The Navigator program has been in operation since 2013.

Organizations and individuals cannot serve as Navigators without receiving funding through this NOFO. To learn more about the Navigator program, please read the CMS guide to in-person assistance in the health insurance marketplaces.

Program requirements You must be capable of carrying out, at a minimum, all required Navigator duties. You also have to follow all the cooperative agreement terms of your award.

Required Navigator duties If your application is funded, you must perform all required Navigator functions as outlined in the ACA and HHS regulations at 45 C.F.R. §§ 155.210 and 155.215. These functions include, but are not limited to:

• Conduct public education activities to raise awareness about the

Exchange.

• Provide information and services in a fair, accurate, and impartial manner.

• Facilitate selection of a QHP.

• Provide information in a manner that is culturally and linguistically appropriate to the needs of the population served by the Exchange, including individuals with limited English proficiency, and ensure accessibility and usability of Navigator tools and functions for individuals with disabilities.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 10 https://www.cms.gov/marketplace/in-person-assisters/programs-procedures/in-person-assistance https://www.cms.gov/marketplace/in-person-assisters/programs-procedures/in-person-assistance https://www.govinfo.gov/content/pkg/CPRT-111HPRT61643/pdf/CPRT-111HPRT61643.pdf https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-B/part-155/subpart-C/section-155.210 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-B/part-155/subpart-C/section-155.215

• Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under section

2793 of the Public Health Service Act, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage.

• Comply with applicable training and conflict of interest standards.

• Obtain the authorization of applicants for coverage available through an

Exchange application prior to accessing their personally identifiable information (PII).

• Assist consumers with complex cases, coverage to care issues, general tax information related to the Exchange, exemptions, and appeals.

Navigators cannot act as tax advisers, attorneys, or give tax or legal advice.

• Provide targeted assistance to underserved or vulnerable populations

(referred to throughout this funding opportunity as priority populations), as identified by the Exchange, within the Exchange service area.

About priority populations For purposes of this funding opportunity, the term priority populations refers to members of communities that have been historically disenfranchised and disproportionately impacted by health disparities and inequities. Priority populations are often affected by social determinants of health (SDOH), such as geographic location, gender, and sexual orientation. They are also frequently impacted by health-related social needs (HRSNs), such as housing instability, housing quality, food insecurity, and lack of employment, personal safety, transportation, and affordable utilities. All of these factors can have a major impact on people’s health, well-being, and quality of life.[4]

Examples of priority populations include:

• Racial and ethnic minorities.

• Rural communities.

• Lesbian, gay, bisexual, transgender, queer, and other LGBTQ+ individuals.

• Low-income or unhoused individuals.

• American Indian and Alaska Native (AI/AN) individuals.

• People with physical or intellectual disabilities.

• Individuals with cognitive, hearing, speech, and/or vision impairments.

• Pregnant women, new mothers, and women with children.

Step 1: Review the Opportunity 11

• Individuals with mental health or substance-related disorders.

• Individuals with HIV/AIDS.

• Medicaid-eligible consumers who are not enrolled in coverage despite being eligible for Medicaid.

Prohibited Navigator activities As a Navigator awardee, you must not do any of the following:

• Receive any consideration directly or indirectly from any health insurance issuer or issuer of stop loss insurance in connection with the enrollment of any individuals or employees in a QHP or a non-QHP.[5]

• Charge any applicant or enrollee, or request or receive any form of remuneration from or on behalf of an individual applicant or enrollee, for application or other assistance related to Navigator duties.[6]

• Compensate individual Navigators on a per-application, per-individual-assisted, or per-enrollment basis.

• Provide gifts[7] of any value to any applicant or potential enrollee[8] as an inducement for enrollment.

• Provide gifts to any applicant or potential enrollee for purposes other than inducement for enrollment that exceed the nominal value,[9] either individually ($15 per consumer) or in the aggregate (multiple items totaling less than $15), when provided to that individual during a single encounter.[10]

• Use Exchange funds to purchase gifts or gift cards, or promotional items that market or promote the products or services of a third party, that would be provided to any applicant or potential enrollee in coverage available through the Exchange.

• Initiate any telephone call to a consumer using an automatic telephone dialing system or an artificial or prerecorded voice (frequently referred to as “robo-calls”), except in cases where the individual Navigator or

Navigator entity already has a relationship with the consumer, the consumer gave prior consent, and this method complies with any applicable state laws.[11]

• Act as a tax adviser, attorney, or give tax or legal advice.

Step 1: Review the Opportunity 12

Required Navigator training

• Before assisting consumers or carrying out any Navigator activities

(including outreach and education), all Navigators must successfully complete a CMS-approved training and pass an online exam to be federally certified.

• After initial certification, all Navigators must complete continuing education and be recertified on an annual basis.

• FFE Navigators must also comply with any state-specific certification requirements, so long as they do not prevent the application of the provisions of Title I of the ACA.[12]

We provide additional guidance on the training, certification, and recertification requirements and procedures for FFE Navigators through the annual Enrollment Assistance Bulletin. The most recent version is the CMS

Enrollment Assistance Bulletin, 2023-01.

Referrals and consumer assistance

• You must ensure your Navigators are prepared to assist any consumer seeking assistance, even if that consumer is not a member of your organization’s approved service area or priority population(s).

• In instances where the consumer is outside of your approved service area, including another FFE, State-based Exchange (SBE), or State-based

Exchange on the Federal Platform (SBE-FP), you should make every effort to provide assistance in a timely manner. You should refer the consumer to other resources such as the Marketplace Call Center, Find Local Help

(FLH), or other assister organizations such as certified application counselor designated organizations (CDOs). If the consumer requests to work with an agent or broker, refer them to a list of licensed agents and brokers in their area or to FLH.[13]

Conflict of interest (COI) requirements As a Navigator awardee, you must ensure your organization and staff do not have any relationships that could interfere with your ability to provide assistance.

Avoiding conflicts of interest when helping consumers apply for and enroll in coverage as a Navigator includes:

• Providing unbiased outreach and enrollment assistance.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 13 https://www.cms.gov/files/document/2023-cms-assister-bulletin-final-508.pdf https://www.cms.gov/files/document/2023-cms-assister-bulletin-final-508.pdf https://www.healthcare.gov/contact-us/ https://localhelp.healthcare.gov/ https://www.cms.gov/marketplace/in-person-assisters/programs-procedures/become-certified-application-councelor-organization https://www.cms.gov/marketplace/in-person-assisters/programs-procedures/become-certified-application-councelor-organization https://localhelp.healthcare.gov/

• Providing fair, accurate, and impartial information.

• Ensuring you are not steering consumers towards a certain plan.

Navigator COI requirements apply to both individual Navigators and Navigator organizations.[14] Individuals whom the requirements apply to include but are not limited to:

• Staff and volunteers of a Navigator organization who perform work related to Navigator program activities, as well as those who perform

Navigator services.

• Sub-awardees or subcontractors of a Navigator organization, as well as their staff and volunteers who are performing work related to Navigator program activities or are performing Navigator services.

• Anyone working for a Navigator organization in roles supervising

Navigator program activities, even if they’re not performing on-the-ground application and enrollment assistance.

• Anyone working for a Navigator organization who is engaged in Navigator outreach and education activities.

Staff at your organization who are in no way involved with the organization’s

Navigator program are not required to comply with Navigator COI requirements.

Prohibited conflicts of interest The following are all prohibited conflicts of interest:

• Being a health insurance issuer.

• Being a subsidiary of a health insurance issuer.

• Being an issuer of stop loss insurance or their subsidiary.

• Being a part of an association that includes members of, or lobbies on behalf of, the insurance industry.

• Receiving any direct or indirect consideration from any health insurance issuer or issuer of stop loss insurance in connection with the enrollment of any individuals or employees in a QHP or non-QHP[15].

COI attestation The project narrative section of your application must include a written attestation that your organization, along with anyone who will perform work related to the organization’s Navigator program activities, or who will perform

Navigator services for the organization, does not have any of the prohibited conflicts of interest.

Step 1: Review the Opportunity 14

Prior to making this attestation, it is important to carefully evaluate the relationships of anyone for whom the Navigator COI requirements apply.

These relationships may include family, friendships, financial relationships, or other factors that could compromise an individual’s ability to perform

Navigator duties.

You’re encouraged to review the Assister Conflict of Interest Requirements

Job Aid for additional information and guidance on COI requirements applicable to Navigators.

COI disclosures Certain relationships are not a barrier to serving as a Navigator. However, organizations must disclose non-prohibited relationships to both CMS and each consumer seeking assistance from a Navigator.[16]

This disclosure must be in plain language and inform the consumer that the

Navigator, their Navigator organization, or anyone who performs work related to the organization’s Navigator program activities or who performs Navigator services for the organization has one of the non-prohibited relationships.

Relationships that require disclosure

Examples of non-prohibited relationships that require disclosure include:

• Any lines of insurance business (typically non-health-related insurance such as auto, life, and homeowners’ policies) that the Navigator or their organization intend to sell while serving as a Navigator.[17]

• Any existing employment relationships or any former employment relationships within the last five years with any health insurance issuers or issuers of stop loss insurance or subsidiaries of health insurance issuers or issuers of stop loss insurance.[18]

• Any financial, business, or contractual relationships that the person or organization has with a health insurance issuer or issuer of stop loss insurance or subsidiaries of health insurance issuers or issuers of stop loss insurance.[19]

COI plan As a Navigator awardee, you will be required to submit a COI plan. Your COI plan must outline how you’ll remain free of prohibited COIs while carrying out

Navigator duties, as well as how you will disclose any non-disqualifying relationships to CMS and consumers.[20]

Your organization’s COI plan will be due within 30 days of award and we will provide additional guidance on the required components of the COI plan.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 15 https://www.cms.gov/marketplace/technical-assistance-resources/conflict-of-interest-requirements.pdf https://www.cms.gov/marketplace/technical-assistance-resources/conflict-of-interest-requirements.pdf

Technical assistance and information for applicants There will be two sessions designed to provide technical assistance for potential applicants. These sessions will provide you with an overview of this project, provide budget guidance, and review the application instructions outlined in this NOFO. We encourage you to submit questions in advance of each session to Navigatorgrants@cms.hhs.gov.

Technical Assistance Session #1

You can join the session at CMS’s Zoom site.

• Thursday, June 13, 2024, from 2 to 3 pm ET

• Meeting ID: 160 924 9299

• Password: 294113

Technical Assistance Session #2

You can join the session at CMS’s Zoom site.

• Tuesday, July 2, 2024, from 2 to 3 pm ET

• Meeting ID: 161 815 5550

• Password: 829693

Cooperative agreement terms All awards under this NOFO will be structured as cooperative agreements.

Cooperative agreements require substantial CMS project involvement after an award is made. There are specific roles for both you and CMS. We may be in contact at least once a month, and more frequently when appropriate.

Your responsibilities

• Comply with the terms and conditions of the award.

• Ensure timely access to all CMS-required systems by key personnel.

• Attend and take part in CMS-sponsored onboarding, meetings, and technical assistance trainings.

• Collaborate with CMS staff to implement and monitor the project.

• Immediately notify CMS of needed or anticipated modifications to your approved project plans.

• Implement or leverage an existing data collection system to collect and track program data.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 16 mailto:Navigatorgrants@cms.hhs.gov https://cms.zoomgov.com/j/1609249299?pwd=ZFZoaXNGU1FMbTBYeVMxY3h5SHFMZz09 https://cms.zoomgov.com/j/1618155550?pwd=a21uR0hBVEg3OTRabVBRTVRheFpRUT09

• Implement or leverage existing scheduling tools for scheduling 1:1 enrollment assistance appointments between consumers and Navigators.

• Submit the performance measures requested.

• Submit all required performance assessments, evaluations, and programmatic and financial reports included in the terms and conditions to CMS.

• Attend and take part in routine monitoring calls with the CMS project officer or grants management specialist on progress and challenges. The meetings will include key personnel and the project officer.

Our responsibilities

• Monitor the project’s performance and progress.

• Collaborate with you and provide substantial project planning, implementation, and evaluation input.

• Provide substantial input in evaluation activities.

• Make recommendations for continuing the project.

• Review and approve website content before launch and updates.

• Review and approve all key personnel, such as the Authorized

Organizational Representative (AOR) and Project Director (PD). [21]

• Maintain regular communication with you through at least monthly conference calls along with technical assistance and consultation.

• Review and approve Conflict of Interest (COI) plan.

• Review and provide feedback on all required performance assessment reports.

• Review and approve all required submitted data.

• Provide a structured approach to sharing, integrating, and actively applying improvement concepts, tactics, and lessons learned.

Substantial involvement relates to programmatic involvement, not administrative oversight.

Funding policies and limitations State funding allocations

• Funds awarded in Year 1 of the five-year period of performance will cover the first 12-month budget period (August 27, 2024 to August 26, 2025).

You must submit an estimated budget for each budget period (Years 1

Step 1: Review the Opportunity 17 through 5), using the funding allocations for the FFE state(s) you are proposing to serve.

• For the first 12-month budget period, each FFE state will receive an apportionment of the $100M in total available funding in the amounts listed in Table 1: FFE state funding allocations. A minimum of $1.25M will be available per FFE state.

◦ If you are selected for an award under this funding opportunity, you will be required to submit an annual non-competing continuation

(NCC) for continued funding of your award for each of the remaining budget periods.[22]

◦ In subsequent funding cycles, awardees may receive decreased funding, or their cooperative agreement could be terminated, due to poor performance.

• The total funding available to applicants in each FFE state takes into account that Navigators will be working with uninsured individuals, as well as consumers currently enrolled in QHP coverage.

◦ The amount of funding you’re requesting for each 12-month budget period should be proportional to the scope and breadth of the activities you propose and the portion of the FFE state(s) you plan to operate in as a Navigator.

◦ You may not apply for more than the maximum amount allocated for the FFE state(s) you are proposing to serve.

◦ When making awards, CMS reserves the right to reduce the budget requested or partially fund proposed activities, based on the review of expected activities, the reasonableness of the proposed budget, and the availability of remaining funds for the FFE state for which an award is made.[23]

Funding example

If you are proposing to serve the entire state of Alaska, you could apply for the entire amount of funding ($2M) apportioned to the state for each 12-month budget period.

If you are only proposing to serve a portion of the state of Alaska (for example, the county of Anchorage) your project should apply for less than the total amount of appropriated funds in the FFE state, allowing multiple applicants (if available) to be selected for an award in the state of Alaska.

Step 1: Review the Opportunity 18

Table 1: FFE state funding allocations

FFE state Total number of eligible uninsured population[24]

FFE QHP selections

(PY 2024)[25]

Total funding available to FFE state (Budget Year 1)

Alabama 447,900 386,195 $3,000,000

Alaska 76,300 27,464 $2,000,000

Arizona 769,100 348,055 $3,500,000

Delaware 56,000 44,842 $1,500,000

Florida 2,495,000 4,211,902 $13,792,500

Hawaii 50,300 22,170 $1,250,000

Illinois 825,900 398,814 $5,300,000

Indiana 465,200 295,772 $2,300,000

Iowa 133,800 111,423 $1,250,000

Kansas 254,400 171,376 $3,000,000

Louisiana 333,100 212,493 $2,500,000

Michigan 470,700 418,100 $3,715,000

Mississippi 335,600 286,410 $2,500,000

Missouri 528,000 359,369 $4,300,000

Montana 89,800 66,336 $1,250,000

Nebraska 129,400 117,882 $1,250,000

New Hampshire 65,000 65,117 $1,500,000

North Carolina 1,001,600 1,027,930 $7,500,000

North Dakota 50,700 38,535 $1,250,000

Ohio 693,000 477,793 $3,100,000

Oklahoma 488,600 277,436 $3,100,000

South Carolina 480,800 571,175 $1,250,000

South Dakota 74,700 52,974 $1,600,000

Tennessee 678,000 555,103 $4,300,000

Step 1: Review the Opportunity 19

FFE state Total number of eligible uninsured population[24]

FFE QHP selections

(PY 2024)[25]

Total funding available to FFE state (Budget Year 1)

Texas 5,032,400 3,484,632 $16,792,500

Utah 273,900 366,939 $1,250,000

West Virginia 116,600 51,046 $1,250,000

Wisconsin 320,300 266,327 $3,200,000

Wyoming 67,700 38,565 $1,500,000

Limitations We do not allow the following costs:

• Pre-award costs.

• Meeting matching requirements for any other federal funds or local entities.

• Services, equipment, or supports that are the legal responsibility of another party under federal, state, or tribal law, such as vocational rehabilitation or education services, or under any civil rights laws, such as modifying a workplace or providing accommodations that are obligations under law.

• Goods or services not allocable to the project.

• Supplanting existing state, local, tribal, or private funding of infrastructure or services, such as staff salaries, etc.

• Construction.

• Capital expenditures for improvements to land, buildings, or equipment that materially increase their value or useful life as a direct cost, except with our prior written approval.

• The cost of independent research and development, including their proportionate share of indirect costs (see 45 C.F.R. 75.476).

• Funds related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order.

• Certain telecommunications and video surveillance equipment (see 2

C.F.R. 200.216).

• Meals, unless in limited circumstances such as:

◦ Subjects and patients under study.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 20 https://www.ecfr.gov/current/title-45/section-75.476 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-C/section-200.216 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-C/section-200.216

◦ Where specifically approved as part of the project or program activity, such as in programs providing children’s services.

◦ As part of a per diem or subsistence allowance provided in conjunction with allowable travel.

• Costs to provide direct health care services to individuals.

• Cost that supplant funds provided under Funding Opportunity CA-

NAV-21-001, entitled “Cooperative Agreement to Support Navigators in

Federally-facilitated Exchanges.”

• Costs that supplant funds for any other Notice of Funding Opportunity or

Financial Assistance Program.

• Costs of carrying out services that are the responsibility of the Exchange, such as eligibility determinations and transferring enrollment information for consumers to a QHP.

• Assistance for consumers residing in a SBE or SBE-FP state or in a state the Navigator has not been awarded cooperative agreement funding to serve.

• Staff retreats or promotional giveaways.

• Gifts or gift cards, or promotional items that market or promote the products or services of a third party, that would be provided to any applicant or potential enrollee.

Other than for normal and recognized executive-legislative relationships or participation by an agency or officer of a state, local, or tribal government in policymaking and administrative processes within the executive branch of that government, funding awarded under this NOFO may not be used for:

• Paying the salary or expenses of any grant recipient, or agent acting for such recipient, 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.

• Lobbying, but awardees can lobby at their own expense if they can segregate federal funds from other financial resources used for lobbying.

Indirect costs Indirect costs are those for a common or joint purpose across more than one project and that cannot be easily separated by project. Learn more at 45 C.F.R.

75.414, Indirect Costs.

To charge indirect costs you can select one of two methods:

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 21 https://www.ecfr.gov/current/title-45/section-75.414 https://www.ecfr.gov/current/title-45/section-75.414

Method 1 – Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency.

Method 2 – De minimis rate. Per 45 CFR 75.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you are awaiting approval of an indirect cost proposal you may also use the de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 10% of modified total direct costs (MTDC). See 45 CFR 75.2 for the definition of MTDC. You can use this rate indefinitely.

Statutory authority Affordable Care Act (ACA), Sections 1311(d)(4)(K), 1311(i), and 1321(c)(1).

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 22 https://www.ecfr.gov/current/title-45/part-75#p-75.414(f) https://www.ecfr.gov/current/title-45/part-75#p-75.2(Modified%20Total%20Direct%20Cost)

Step 2:

Get Ready to Apply

In this step

Get registered 24

Find the application package 24

Get registered SAM.gov You must have an active account with SAM.gov. This includes having a Unique

Entity Identifier. SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and click Get Started. From the same page, you can also click on the Entity Registration Checklist for the information you will need to register.

Grants.gov You must also have an active account with Grants.gov. You can see step-by-step instructions at the Grants.gov Quick Start Guide for Applicants.

Need Help? See Contacts and Support.

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number

CMS-NAV-24-001.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 24 https://sam.gov/content/entity-registration https://grants.gov/applicants/applicant-registration https://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/search-grants

Step 3:

Prepare Your Application

In this step

Application contents and format 26

Application contents and format Applications include five main components. The following sections include guidance and instructions on the required format for each.

You can find all referenced forms within the funding opportunity’s application package on grants.gov.

Make sure you include each of these:

Component Submission Format

Project abstract Use the Project Abstract Summary form

Project narrative Use the Project Narrative Attachment form

Budget narrative justification Use the Budget Narrative Attachment form

Attachments Insert each in the Other Attachments form

Other required forms Upload using each required form.

We will provide instructions on document formats in the sections below.

Project abstract Limit to one page. May be single spaced, but follow other formatting requirements listed for the project narrative.

Write a one-page summary of your proposed project including the purpose and outcomes. Do not include any proprietary or confidential information. We will use this document for information sharing and public information requests if you get an award.

Include:

• The name of your organization.

• Consortium name, if applicable.

• The names of any subrecipients or sub-awardee organizations, if applicable.

• Your organization type, such as:

◦ Community and consumer-focused nonprofit.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 26

◦ Hospital or clinic.

◦ Small business.

◦ State or local human services agency.

◦ Trade, industry, or professional association.

◦ Tribe or tribal organization.

◦ University or institution of higher education.

• Annual funding amounts for each 12-month budget period (Years 1 through 5).

• Name of the FFE state(s), specifying whether you’ll be operating statewide or in a portion of the state.

◦ If not operating statewide, include an alphabetized list of which counties you will operating in.

• Proposed priority population(s) you plan to serve.

• Total number of Navigator staff your organization or consortium will have federally trained and certified or re-certified for PY 2025 by October 1, 2024.

Project narrative

Required format for project narrative

Page limit: 25, excluding attachments

File name: Project Narrative

Format: PDF (Do not compress or encrypt.)

Size: 12-point font or bigger

Footnotes and text in graphics may be 10-point.

Spacing for project abstract, tables, and footnotes: Single-spaced

Spacing for main content: Double-spaced

Margins: 1-inch

Page size: 8.5 x 11

Include consecutive page numbers throughout.

The project narrative is the most important part of your application and should clearly describe your proposed project. You must address the proposed goals, Step 3: Prepare Your Application 27 measurable objectives, and milestones in accordance with the instructions in the following sections.

See the merit review criteria to understand how reviewers will assess and score your project narrative.

Your project narrative should include the following seven sections:

• Priority populations: Who are you going to serve?

• Proposed activities: What are you going to do?

• Project goals: What do you expect to achieve?

• Capabilities: Why are you qualified to serve the priority populations?

• Work plan and timeline: What is your action plan to meet the project goals and carry out the proposed activities?

• Conflict of interest (COI) attestation: How will you remain free of COIs?

• Ensuring privacy and security of consumer personally identifiable information (PII): What will you do to comply with and monitor PII requirements?

1. Priority populations: Who are you going to serve?

While Navigators should be prepared to assist any consumer seeking assistance, you should focus your project on one or more priority populations, as defined in this funding opportunity. We encourage applications from organizations that are members of, or have a history of trusted ties within, the communities and populations they will serve as Navigators.

You should assess each of your proposed priority population’s needs, taking into account:

• The uninsured rate for the proposed priority populations within the state.

• The FFE state and county in which the priority population resides.

◦ Note: Tribal applicants must specify the proposed tribal population(s) you will serve. List the tribal community (that is, the federally recognized Indian tribes and geographic locations/counties.)

Additional requirements for multi-state applicants If you are proposing to serve as a Navigator in multiple FFE states, you must also include the following within your project narrative:

• A description of how your efforts will be balanced amongst the various states, based on the needs of the priority populations that you plan to serve.

Step 3: Prepare Your Application 28

• Separate project goals for each FFE state you are proposing to serve.

• A separate budget narrative for each FFE state.

Resources

• Healthy People 2030 provides additional information on how addressing social determinants of health can reduce health disparities and maintain healthy communities and populations. Resources include tools for action, data sources and methods, and research related to specific determinants.

• For information on addressing the health care needs of rural, tribal, and geographically isolated communities, see the CMS Framework for

Advancing Health Care in Rural, Tribal, and Geographically Isolated

Communities.

• See also the report on Addressing Social Determinants of Health:

Examples of Successful Evidence-Based Strategies and Current Federal

Efforts.

What you need to write

• Say which priority populations you plan to focus your services on.

• Tell us where your priority populations reside.

• Describe the social determinants of health and health-related social needs

(SDOH and HRSNs) that contribute to health disparities and disproportionate access to healthcare coverage for members of your priority populations.

• Say why you chose to focus on the selected priority populations and the targeted service areas.

2. Proposed activities: What are you going to do?

Describe your proposed project and how you will carry out all the required

Navigator duties. Your project plan must include all of the following subsections:

Providing targeted assistance Explain your organization’s strategy for providing targeted assistance to your chosen priority populations within the proposed FFE states, while also being prepared to assist any consumer seeking assistance.

Your strategy should:

• Address SDOH and HRSNs identified within the priority populations.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 29 https://health.gov/healthypeople/priority-areas/social-determinants-health https://health.gov/healthypeople/tools-action https://health.gov/healthypeople/objectives-and-data/data-sources-and-methods https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDAsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNtcy5nb3YvZmlsZXMvZG9jdW1lbnQvY21zLWdlb2dyYXBoaWMtZnJhbWV3b3JrLnBkZiIsImJ1bGxldGluX2lkIjoiMjAyNDAyMDcuODk4MzMyNDEifQ.Qe_zhMPveCJKPz0oa4-B_sAcglWDcmBJXu7QSzGG_0c/s/1097954350/br/236696900938-l https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDAsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNtcy5nb3YvZmlsZXMvZG9jdW1lbnQvY21zLWdlb2dyYXBoaWMtZnJhbWV3b3JrLnBkZiIsImJ1bGxldGluX2lkIjoiMjAyNDAyMDcuODk4MzMyNDEifQ.Qe_zhMPveCJKPz0oa4-B_sAcglWDcmBJXu7QSzGG_0c/s/1097954350/br/236696900938-l https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDAsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNtcy5nb3YvZmlsZXMvZG9jdW1lbnQvY21zLWdlb2dyYXBoaWMtZnJhbWV3b3JrLnBkZiIsImJ1bGxldGluX2lkIjoiMjAyNDAyMDcuODk4MzMyNDEifQ.Qe_zhMPveCJKPz0oa4-B_sAcglWDcmBJXu7QSzGG_0c/s/1097954350/br/236696900938-l https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOH-Evidence-Review.pdf?ref=letsgetchecked-blog.ghost.io https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOH-Evidence-Review.pdf?ref=letsgetchecked-blog.ghost.io https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOH-Evidence-Review.pdf?ref=letsgetchecked-blog.ghost.io https://health.gov/healthypeople/priority-areas/social-determinants-health https://health.gov/healthypeople/priority-areas/social-determinants-health

• Explain the activities you will use to carry out this strategy and why you chose them.

• Describe how your outreach and communication methods are culturally competent and linguistically appropriate for the priority populations.

Conducting education and outreach Navigators are required to conduct education and outreach activities to raise awareness about the FFE and help consumers understand their health coverage options.

Describe your organization’s plans for:

• Conducting education and outreach activities within your targeted service areas.

• Identifying settings and venues to host education and outreach activities.

You should explain why these locations are appropriate for reaching your chosen priority populations.

• Using community partnerships to carry out these activities.

• Providing information in a manner that is culturally and linguistically appropriate to the needs of the priority populations and ensuring accessibility and usability of Navigator tools and functions for individuals with disabilities.

Effective June 18, 2023, a regulation change at 45 C.F.R. § 155.210(d)(8) allows

Navigators to go door to door or use other unsolicited means of direct contact to provide enrollment assistance to consumers. This change in regulation was made to further eliminate barriers to coverage access by maximizing pathways to enrollment.[26]

Facilitating selection of a QHP Navigators are required to provide fair, accurate, and impartial information and services. Your plan should describe how you will:

• Provide information that is fair, accurate, and impartial when assisting consumers with submitting the eligibility application.

• Clarify the distinctions among health coverage options, including QHPs.

• Help consumers make informed decisions during the health coverage selection process.

• Develop or leverage existing scheduling tools to schedule 1:1 enrollment assistance appointments with consumers.

Step 3: Prepare Your Application 30

• Leverage CMS systems and coordinate with other FFE assister organizations[27] operating in your service area to facilitate seamless coverage transitions between Medicaid/CHIP and QHP coverage.

◦ For example, you could conduct direct assister-to-consumer outreach to transitioning consumers. You could also receive referrals from other FFE assister organizations operating in your service area to provide 1:1 enrollment assistance to consumers.

Providing post-enrollment information and assistance To ensure consumers have access to skilled assistance beyond applying for and enrolling in health insurance coverage, Navigators are also required to assist with a variety of post-enrollment activities.

Your plan should describe how you will:

• Help consumers understand their health coverage and how to use it, including accessing care and preventive services.

• Educate consumers about their rights with respect to essential health benefits available through the Exchange (Marketplace) plans.

• Connect consumers with consumer assistance programs, appeals programs, and ombudsmen to help with grievances, questions, or complaints, such as those related to unauthorized enrollment or switching of health plans.

What you need to write

• Say how you will carry out all the required Navigator duties and implement the proposed activities.

• Explain the strategy you will use to provide targeted assistance to the priority populations within your proposed FFE states.

◦ Tell us how your strategy meets the needs of your priority populations, SDOH and HRSNs, and service areas.

◦ Tell us how your outreach and communication methods will establish reach into communities and individuals you plan to serve.

• Explain the strategy and activities you will use to carry out each component of your proposed project and why you chose them.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 31 https://www.cms.gov/priorities/health-equity/c2c https://www.healthcare.gov/coverage/what-marketplace-plans-cover/ https://www.healthcare.gov/coverage/what-marketplace-plans-cover/ https://www.cms.gov/CCIIO/Resources/Consumer-Assistance-Grants https://www.cms.gov/marketplace/about/affordable-care-act/external-appeals https://www.cms.gov/marketplace/about/affordable-care-act/external-appeals https://www.cms.gov/medicare/appeals-grievances/ombudsman-center

3. Project goals: What do you expect to achieve?

Using a similar format to the table shown here, develop project goals for carrying out the required Navigator duties during the first 12-month budget period (August 27, 2024 to August 26, 2025) of your project. Your project goals should be realistic and attainable.

You must consider the following in establishing your project goals:

• Size of the FFE service areas your project will operate in.

• Size and needs of the priority populations you plan to serve.

• Amount of funding you are requesting for the first budget period.

Reminder: If you are proposing to serve multiple FFE states, you should prepare and submit separate project goals for each FFE state.

How your project goals are used

• CMS uses project goals to measure your progress and promote project improvements.

• Prior to the start of each budget period, you will be required to set annual project goals for Years 2 through 5 as part of your annual non-competing continuation (NCC).

• You will also be required to collect and report performance data to CMS on a weekly, monthly, and quarterly basis in the form of progress reports.

• CMS will use this data to evaluate your progress towards your project goals and determine the level of funding available to your organization for subsequent budget periods.

What you need to write

• Enter target numbers to represent your project goals for each of the

Navigator activities listed in Table 2. Do not alter the descriptions of the project goals.

• The target numbers measure your progress in performing Navigator duties.

Set your project goals based on:

◦ Key components of your proposed activities.

◦ Size of your FFE service areas.

◦ Size and needs of your priority populations.

◦ Funding received each budget period.

Step 3: Prepare Your Application 32

Table 2: Budget Year 1 (2024 to 2025) project goals

Navigator activity Description of project goal Target number

Training and…