7_10_2018 NAVIGATOR FOA 2018_FINAL.PDF

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

Center for Consumer Information and Insurance Oversight

Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges

Notice of Funding Opportunity Invitation to Apply for 2018

Funding Opportunity Number: CA-NAV-18-001

CFDA: 93.332

Funding Opportunity Posting Date: July 10, 2018

Applicable Dates:

Mandatory Letter of Intent to Apply Due Date

Electronic Application Due Date:

Anticipated Issuance Notices of Award:

Anticipated Period of Performance:

N/A

August 9, 2018 (3:00 p.m. EDT)

September 12, 2018

12 months from the date of initial award

Table of Contents

EXECUTIVE SUMMARY

A. PROGRAM DESCRIPTION

A1. Purpose A2. Authority A3. Background A4. Program Requirements A5. Technical Assistance and Information for Prospective Applicants

B. FEDERAL AWARD INFORMATION

B1. Total Funding B2. Award Amount B3. Anticipated Award Date 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 Requirements C6. Continued Eligibility C7. EIN, DUNS, and SAM Regulations C8. Foreign and International Organizations C9. Faith-Based Organizations

D. APPLICATION AND SUBMISSION INFORMATION

D1. Address to Request Application Package D2. Content and Form of Application Submission D3. Unique Entity Identifier and System for Award Management (SAM)—Required 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 and Integrity Information Systems (FAPIIS) ..48

F. FEDERAL AWARD ADMINISTRATION INFORMATION

F1. Federal Award Notices F2. Administrative and National Policy Requirements F3. Terms and Conditions F4. Cooperative Agreement Terms and Conditions F5. Reporting

G. CMS CONTACTS

G1. Programmatic Questions G2. Grants Management Specialist/Business Administration Questions

H. APPENDICES

APPENDIX I: Guidance for Preparing a Budget Request and Narrative APPENDIX II: Application and Submission Information APPENDIX III: Business Assessment of Applicant Organization (Questions) APPENDIX IV: Accessibility Provisions APPENDIX V: Review and Selection Process APPENDIX VI: List of States for which Cooperative Agreement Funding is Available APPENDIX VII: Application Check-off List

Executive Summary

The Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges (Funding Opportunity) will enable recipients to operate as Exchange Navigators in States with a Federally-facilitated Exchange (FFE), as authorized by the Patient Protection and Affordable Care Act (PPACA)1. To view a current list of States that will have an FFE in benefit year 2019, see Appendix VI, List of States for which Cooperative Agreement Funding is Available.

When Exchanges were in their infancy, and public awareness and understanding of coverage options was low, the U.S. Department of Health and Human Services (HHS) encouraged Navigators to cast a wide net and to provide intensive face-to-face assistance to consumers. The FFEs have been in operation since 2013 for the 2014 open enrollment period, and the public is more aware of the options for private coverage available through them. Certified application counselors, direct enrollment partners, and Exchange-registered agents and brokers serve as additional resources to consumers. It is appropriate to scale down the Navigator program to reflect the enhanced public awareness of health coverage through the Exchanges.

Even as the FFE Navigators’ role evolves, awarded entities must still carry out the required statutory Navigator duties and the additional requirements laid out in Sections B. Award Information and E. Application Review Information of this Funding Opportunity: 1) conduct public education activities to raise awareness of the availability of qualified health plans; 2) distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of premium tax credits under Section 36B of the Internal Revenue Code of 1986 and cost-sharing reductions under Section 1402 of the PPACA; 3) facilitate enrollment in qualified health plans; 4) 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; and 5) provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the FFE.

This document describes how to submit proposals for available funding in fiscal year (FY) 2018- 2019 and how the Centers for Medicare & Medicaid Services (CMS) will determine which proposals will be funded. This document should be read in its entirety, as some information has changed from the previous award cycles.

1 The Patient Protection and Affordable Care Act (Pub. L. 111–148) was enacted on March 23, 2010. The Health Care and Education Reconciliation Act of 2010 (Pub. L. 111–152), which amended and revised several provisions of the Patient Protection and Affordable Care Act, was enacted on March 30, 2010.

Item Description

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

CMS Awarding Center Center for Consumer Information and Insurance Oversight (CCIIO)

Notice of Funding Opportunity Title Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges

Authorization Patient Protection and Affordable Care Act (PPACA), Sections 1311(d)(4)(K), 1311(i), and 1321(c)(1)

Funding Opportunity Type New

Funding Opportunity Number CA-NAV-18-001

Type of Award Cooperative Agreement

Catalog of Federal Domestic Assistance 93.332

Letter of Intent to Apply Due Date (if applicable) Not Applicable

Application Due Date & Time August 9, 2018 3:00 PM Eastern U.S. Time

Anticipated Issuance Notice(s) of Award September 12, 2018

Anticipated Period of Performance 12 months from the date of award

Anticipated Total Available Funding $10 million

Estimated Number of Awards 25-50

A. PROGRAM DESCRIPTION

A1. Purpose

The Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges (Funding Opportunity) will enable recipients to operate as Exchange Navigators in States with a Federally-facilitated Exchange (FFE), as authorized by the PPACA. To view a current list of eligible States that will have an FFE in benefit year 2019, see Appendix VI, List of States for which Cooperative Agreement Funding is Available.

A2. Authority

This Cooperative Agreement is being issued by the Secretary of HHS pursuant to Sections 1311(d)(4)(K), 1311(i), and 1321(c)(1) of the PPACA. Section 1311(i) of the PPACA states that an Exchange “shall establish a program under which it awards grants” to entities which facilitate education about and enrollment in qualified health plans (QHPs) through Exchanges. These entities are known as “Navigators.”

Please visit the following link to view the full list of relevant regulations that HHS has published under Title 45 of the Code of Federal Regulations: https://ecfr.io/Title-45/cfr155_main

A3. Background

Section 1311(i) of the PPACA requires Exchanges to establish a Navigator grant program. This Funding Opportunity is open to eligible entities and individuals (described in Section 1311(i)(2) of the PPACA and 45 C.F.R. §155.210(a) and (c)) applying to serve consumers in States with a FFE. Entities and individuals cannot serve as federally certified Navigators without receiving federal cooperative agreement funding to perform Navigator duties. This is the fourth Funding Opportunity since 20132 provided for Navigators serving FFE consumers.

A4. Program Requirements

Entities or individuals eligible to apply for this Funding Opportunity must be capable of carrying out, at a minimum, all Navigator duties required by the PPACA and HHS regulations. The primary regulations that establish requirements for awardees under this Funding Opportunity are 45 C.F.R. §§ 155. 2103 and 155.2154. These regulations establish duties that are required of all recipients of funding under this Funding Opportunity, including, but not limited to:

2 For more information on the previous Navigator Funding Opportunity announcements and awardees, please see https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance.html.

3 See 45 C.F.R. § 155.210, at https://ecfr.io/Title-45/se45.1.155_1210 4 See 45 C.F.R. § 155.215, at https://ecfr.io/Title-45/se45.1.155_1215 https://ecfr.io/Title-45/cfr155_main https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance.html https://ecfr.io/Title-45/se45.1.155_1210 https://ecfr.io/Title-45/se45.1.155_1215

• Conducting public education activities to raise awareness about the Exchange;

• Facilitating selection of a QHP;

• Providing 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 ensuring accessibility and usability of Navigator tools and functions for individuals with disabilities;

• Providing 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;

• Complying with applicable training and conflict of interest standards;

• Obtaining the authorization of applicants for coverage available through an Exchange application prior to accessing their personally identifiable information.

In addition to the duties summarized above, federal regulations at 45 C.F.R. § 155.210(e) outline additional duties that recipients of FFE Navigator cooperative agreements awarded in 2018 and beyond must carry out:

• Provide targeted assistance to serve underserved or vulnerable5 populations, as identified by the Exchange, within the Exchange service area. Throughout this Funding Opportunity, we refer to these populations as the “left behind” populations.

For purposes of this Funding Opportunity, the FFEs will consider “left behind” populations to include those individuals who are disproportionately without access to health insurance coverage or care and who may be unaware of the full range of the different types of coverage options available to them, including coverage options in addition to QHPs, such as association health plans and short-term, limited-duration insurance.

Examples of “left behind” populations may include: hourly wage workers (restaurant and retail workers); variable income workers (workers with unpredictable annual incomes who fluctuate in and out of eligibility for financial assistance when purchasing health insurance); and persons who did not get health insurance because of a lack of affordable coverage options in their area, or because they lacked a general knowledge about affordable health insurance options and how to enroll.

Applicants may propose additional “left behind” populations in their applications for the FFE’s approval.

5 See 45 C.F.R. § 155.210(e)(8)

• Provide information and assistance on all of the following topics6:

Understanding the process of filing Exchange eligibility appeals;

Understanding and applying for exemptions from the individual shared responsibility payment that are granted through the Exchange, understanding the availability of exemptions from the requirement to maintain minimum essential coverage and from the individual shared responsibility payment that are claimed through the tax filing process and how to claim them, and understanding the availability of IRS resources on this topic7;

The Exchange-related components of the premium tax credit reconciliation process, and understanding the availability of IRS resources on this process;

Understanding basic concepts and rights related to health coverage and how to use it; and

Referrals to licensed tax advisers, tax preparers, or other resources for assistance with tax preparation and tax advice related to consumer questions about the Exchange application and enrollment process, exemptions from the requirement to maintain minimum essential coverage and from the individual shared responsibility payment, and premium tax credit reconciliations.

The HHS Notice of Benefit and Payment Parameters for 2019 final rule 83 FR 16930 (April 17, 2018), which takes effect June 18, 2018, amended CMS regulations to remove the requirement that Navigators maintain a physical presence in the Exchange service area. It also removed the requirement for there to be at least two Navigator entities, and for one of them to be a community and consumer-focused non-profit.

Applicants should be creative, proposing innovative strategies for meeting the statutory and regulatory requirements outlined above (See Section E. Application Review Information). For example, with respect to consumer outreach and education activities, innovative cost-effective strategies might include: distributing educational flyers, posting information on an organization’s website, or other cost-effective approaches to sharing information with consumers. Applicants are also encouraged to think critically about their proposed work plan and outline strategies that maximize their impact on the community and that use federal cooperative agreement funds efficiently —such as through strategic partnerships with public and

6 See 45 C.F.R. § 155.210(e)(9) 7 The elimination of the shared responsibility payment applies to months beginning after December 31, 2018. Prior to this effective date, consumers are still required to have full-year coverage, or qualify for an exemption, in order to avoid paying the individual shared responsibility payment for tax years 2017 and 2018. More information can be found here: https://www.irs.gov/affordable-care-act/individuals-and-families/individual-shared-responsibility-provision.

https://www.congress.gov/bill/115th-congress/house-bill/1/text https://www.irs.gov/affordable-care-act/individuals-and-families/individual-shared-responsibility-provision https://www.irs.gov/affordable-care-act/individuals-and-families/individual-shared-responsibility-provision private organizations, coordinating outreach activities with local CHIP outreach or other similar outreach programs, or providing more virtual or mobile assistance to consumers.

Prohibitions:

The regulations at 45 C.F.R. §§ 155. 210 and 155.215 establish prohibitions that apply to all recipients of funding under this Funding Opportunity (see Section D6. Cost Restrictions for additional prohibitions). These include, but are not limited to:

• Receiving 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;

• Charging any applicant for or enrollee in coverage available through the Exchange for application or other assistance related to Navigator duties;

• Compensating individual Navigators on a per-application, per-individual-assisted, or per-enrollment basis;

• Providing gifts8 of any value to any applicant or potential enrollee as an inducement for enrollment;

• Providing gifts to any applicant or potential enrollee for a reason other than as an inducement for enrollment that exceed $15, either individually or in the aggregate, when provided to that individual during a single encounter.

• Using 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 for or potential enrollee in coverage available through the Exchange;

• Soliciting any consumer for application or enrollment assistance by going door-to-door or through other unsolicited means of direct contact, except in cases where the individual has a pre-existing relationship with the individual Navigator or Navigator entity and other applicable state and federal laws are otherwise complied with; and

• Initiating any telephone call to a consumer using an automatic telephone dialing system or an artificial or prerecorded voice, except in cases where the individual Navigator or Navigator entity has a relationship with the consumer and other applicable state and federal laws are otherwise complied with.

Required Training:

All entities and individuals carrying out Navigator functions under cooperative agreements awarded through this Funding Opportunity must successfully complete an HHS-developed

8 See 45 C.F.R. 155.201(d)(6) for definition of gifts: https://ecfr.io/Title-45/se45.1.155_1210 https://ecfr.io/Title-45/se45.1.155_1210 training program and pass an online exam to ensure appropriate understanding of relevant Exchange-related information and must be federally certified before carrying out any Navigator functions. After initial certification, all entities and individuals carrying out Navigator functions must obtain continuing education and be recertified on at least an annual basis. Navigator entities awarded cooperative agreement awards must also comply with any state-specific requirements, so long as these state-specific requirements do not prevent application of the provisions of Title I of the PPACA. Navigators will receive technical assistance from HHS to complete the required federal certification/recertification training in the Marketplace Learning Management System.

Referrals and Consumer Assistance:

Navigators will be required to assist any consumer seeking assistance, even if that consumer is not a member of the “left behind” population or is otherwise not a member of the community(ies) or group(s) the applicant expects to target, as outlined in its funding proposal.

There may be some instances where a Navigator does not have the immediate capacity to help an individual. In such cases, the Navigator should make every effort to provide assistance in a timely manner, but could also refer consumers seeking assistance to other resources, such as the toll-free Exchange call center or certified application counselors. Although Navigators should not refer consumers to specific agents and brokers, they may refer consumers to general resources they can use to search for an agent or broker near where they live, such as the Find Local Help feature on HealthCare.gov. Additionally, if a Navigator in a FFE is approached by a consumer who lives in a state with a State-based Exchange, or in a state with an FFE in which the Navigator has not been funded to serve, the Navigator must refer the consumer to a Navigator or other Exchange-approved assister in the consumer’s state.

Multi-State Awardees:

An applicant may propose to serve populations in multiple FFEs through the submission of one application. However, the applicant must submit separate Budget Narratives and project (metric) goals for each FFE it proposes to serve (See Section D. Application and Submission Information for additional information). If an applicant is proposing to serve in more than one FFE, the applicant should be prepared to revise its project scope and budget upon award if it is not funded to serve in all proposed FFEs and/or at the full amount requested.

A5. Technical Assistance and Information for Prospective Applicants

HHS will hold two sessions designed to provide technical assistance for potential applicants.

These sessions will provide applicants with an overview of this project, budget guidance, and review the instructions for applying outlined in this Funding Opportunity. Applicants are encouraged to submit questions in advance of each session to Navigatorgrants@cms.hhs.gov.

mailto:Navigatorgrants@cms.hhs.gov

Technical Assistance Session #1 Thursday, July 18th from 3:00 to 4:00 pm Eastern Daylight Time Link: TBD (will be posted on the CCIIO website

[https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance- Marketplaces/assistance.html] as soon as it becomes available)

Technical Assistance Session #2 Wednesday, July 25th from 3:00 to 4:00 pm Eastern Daylight Time Link: TBD (will be posted on the CCIIO website

[https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance- Marketplaces/assistance.html] as soon as it becomes available)

B. FEDERAL AWARD INFORMATION

B1. Total Funding

HHS expects to award up to $10,000,000 for the 12-month period of performance, depending on the availability of funds and current program priorities. In the absence of funding, HHS is under no obligation to make awards under this announcement or can change the award amount prior to the issuance of a Notice of Award.

As the Navigator program enters its sixth year, HHS is using this opportunity to explore alternative approaches to funding and structuring the Navigator program. The funding available to Navigator awardees is reflective of a maturing Exchange and is intended to align with ongoing operational changes to the enrollment process—such as the launch of the proxy Direct Enrollment (DE) pathway for plan year (PY) 20189 and the forthcoming Enhanced Direct Enrollment (EDE) pathway for PY 201910, both of which aim to further improve the consumer enrollment experience by providing multiple avenues through which a consumer can apply for coverage. In light of consumers’ increased familiarity with the FFEs’ eligibility and enrollment platform, and the introduction of these additional enrollment avenues and resources, HHS believes that Navigators will be able to stretch their funding further as a result of not needing to focus as much on providing resource-intensive face-to-face assistance to consumers with the enrollment process as in prior years. This shift will instead allow awardees to utilize less

9 See Proxy Direct Enrollment Pathway for 2018 Individual Market Open Enrollment Period, CMS Health Insurance Exchange Guidance, May 17, 2017, https://www.cms.gov/CCIIO/Resources/Regulations-and- Guidance/Downloads/Guidance-for-the-Proxy-Direct-Enrollment-Pathway-for-2018-Individual-Market-Open- Enrollment-Period.pdf.

10 See Third-party Auditor Operational Readiness Reviews for the Enhanced Direct Enrollment Pathway and Related Oversight Requirements, CMS Health Insurance Exchange Guidelines, February 21, 2018, https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Third-party-Direct- Requirements.pdf.

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance.html https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance.html https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance.html https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance.html https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Guidance-for-the-Proxy-Direct-Enrollment-Pathway-for-2018-Individual-Market-Open-Enrollment-Period.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Guidance-for-the-Proxy-Direct-Enrollment-Pathway-for-2018-Individual-Market-Open-Enrollment-Period.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Guidance-for-the-Proxy-Direct-Enrollment-Pathway-for-2018-Individual-Market-Open-Enrollment-Period.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Third-party-Direct-Requirements.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Third-party-Direct-Requirements.pdf resource-intensive methods of facilitating enrollment and disseminating information to consumers in their communities.

B2. Award Amount

HHS expects to award up to $10,000,000 for the 12 month period of performance, depending on the availability of funds and current program priorities. The $10,000,000 in total available funding is allocated among the 34 FFE states (See Appendix VI, List of States for which Cooperative Agreement Funding is Available) based on the size of the remaining, eligible uninsured (legal residents under age 65) population in each FFE state, with a minimum of $100,000 available for awards in each FFE. In cases where a FFE’s initial allocation was less than $100,000, their funding was rounded up to $100,000 by proportionately reducing the total available funding from all FFEs with initial allocations larger than $100,000.

The 34 FFE states have been sorted into funding tiers, outlined in the below table, based on their state’s total number of remaining, eligible uninsured consumers. Those FFEs with the highest number of remaining uninsured, and therefore the FFEs that are the most likely to have the highest number of consumers who have been “left behind” for Navigators to reach, are in the tier with the highest available funds—tier 6. On the contrary, those FFE states with the lowest number of remaining uninsured consumers are in the tier with the minimum amount of available funding – tier 1. The funding allocation formula and funding tier table will be updated for subsequent budget periods based on funding availability and new data (if available).

When developing their budget request, each applicant should ensure that the amount of funding being requested in their application is reasonable and appropriate for the activities being proposed. The amount of funding being requested by an applicant within a FFE for the 12-month budget period should be proportional to the scope and breadth of the activities being proposed and the portion of the FFE they plan to target. For example, an applicant proposing to serve the entire State of Alaska could apply for a maximum of $100,000 for the 12-month budget year.

Alternatively, an applicant only proposing to serve part of the State of Alaska could apply for $50,000 for the 12-month budget year, allowing multiple applicants (if available) to be selected for award in the State of Alaska. When making awards, HHS reserves the right to reduce the budget requested, or only partially fund proposed activities, based on its review of the expected activities, the reasonableness of the budget submitted by the applicant, and the availability of remaining funds for the FFE for which an award is made.

Table 1. Funding Allocation Tiers for 2018-2019 Budget Period, Per FFE State ($100,000 minimum in total funding available per state)

Funding Allocation Tier 1 Uninsured population less than 200,000 per FFE

States with a FFE 2016 State

Uninsured Rate (under age 65)11

Funding Allocation per FFE for 2018-2019

Budget Period

Alaska 101,000

$100,000

Delaware 53,000 Hawaii 49,000 Iowa 132,000

Maine 106,000 Montana 83,000 Nebraska 161,000

New Hampshire 78,000 North Dakota 52,000 South Dakota 74,000 West Virginia 96,000

Wyoming 67,000

Funding Allocation Tier 2 Uninsured population less than 450,000 per FFE

States with a FFE 2016 State

Uninsured Rate (under age 65)

Funding Allocation per FFE for 2018-2019

Budget Period Alabama 435,000

$200,000 Kansas 249,000

Mississippi 346,000 Utah 265,000

Wisconsin 300,000

11 Numbers in thousands and represent civilian, noninstitutionalized population. For information on confidentiality protection, sampling error, non-sampling error, and definitions, see https://www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2016.pdf. For complete data by state, see Health Insurance in the United States: 2016, Table A-5, US Census Bureau, September 12, 2017, https://www.census.gov/data/tables/2017/demo/health-insurance/p60-260.html.

https://www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2016.pdf https://www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2016.pdf https://www.census.gov/data/tables/2017/demo/health-insurance/p60-260.html

Funding Allocation Tier 3 Uninsured population less than 700,000

States with a FFE 2016 State Uninsured Rate (under age 65)

Funding Allocation per FFE for 2018-2019

Budget Period Arizona 681,000

$300,000

Indiana 530,000 Louisiana 470,000 Michigan 527,000 Missouri 532,000

Ohio 644,000 Oklahoma 530,000

South Carolina 486,000 Tennessee 592,000

Funding Allocation Tier 4 Uninsured population less than 900,000 per FFE

States with a FFE 2016 State Uninsured Rate (under age 65)

Funding Allocation per FFE for 2018-2019

Budget Period Illinois 817,000

$400,000 New Jersey 705,000

Pennsylvania 708,000 Virginia 715,000

Funding Allocation Tier 5 Uninsured population less than 1.5 million per FFE

States with a FFE 2016 State Uninsured Rate (under age 65)

Funding Allocation per FFE for 2018-2019

Budget Period Georgia 1,310,000

$500,000 North Carolina 1,038,000

Funding Allocation Tier 6 Uninsured population more than 2 million per FFE

States with a FFE 2016 State Uninsured Rate (under age 65)

Funding Allocation per FFE for 2018-2019

Budget Period Florida 2,544,000

$1,250,000 Texas 4,545,000

Strong performance during the period of performance will be measured by looking at:

• The awardee’s ability to meet the performance metrics laid out in its original application,

• The quality and timeliness of required report submissions,

• The awardee’s compliance with the terms and conditions provided with its Notice of

Award, including compliance with all applicable statutory and regulatory requirements, and

• The awardee’s ability to communicate with and respond in a timely manner to requests from their Project Officer throughout the period of performance. Information about reporting and certification will be provided with the Notice of Award for the Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges.

This solicitation provides detailed information on the cooperative agreement requirements related to these activities and instructions for application submission.

Individual cooperative agreement award amounts will vary annually depending on:

• The total funding available to the Navigator program,

• Annual rate of uninsured,

• Current program priorities,

• The number and quality of eligible Navigator cooperative agreement applicants for a given FFE,

• The size and scope of the left behind population a Navigator cooperative agreement applicant proposes to reach, and

• Whether funds requested are for allowable costs.

When making awards, HHS reserves the right to reduce the budget requested, or only partially fund proposed activities, or not at all, based on its review of:

• The expected scope of the proposed targeted FFE service area,

• The performance metric goals laid out in the application,

• Target population(s) served by the applicant,

• Scope and breadth of the activities being proposed and the size of the population to be targeted,

• Proposed budget submitted by the applicant,

• Other awarded Navigator recipients in a given FFE, and

• The availability of remaining funds for the Exchange service area or areas which an award is made.

CMS decisions regarding funding levels for each of the FFEs, as established in the aforementioned Table 1, and decisions regarding the specific funding levels for each cooperative agreement award, are not appealable. The decision not to award a cooperative agreement is also not appealable12.

Multi-State Awardees:

An applicant may propose to serve populations in multiple FFEs through the submission of one application. However, the applicant must submit separate Budget Narratives and project (metric) goals for each FFE it proposes to serve (See Section D. Application and Submission Information for additional information). If an applicant is proposing to serve in more than one FFE, the applicant should be prepared to revise its project scope and budget upon award if it is not funded to serve in all proposed FFEs and/or at the full amount requested.

B3. Anticipated Award Date

The anticipated award date is September 12, 2018.

B4. Period of Performance

The period of performance is 12 months from the date of the notice of award.

B5. Number of Awards

HHS estimates the number of awards to be between 25 and 50. All awards are subject to funding availability. In the absence of funding, HHS is under no obligation to make awards under this announcement.

B6. Type of Award

These awards will be structured as cooperative agreements. Under the Federal Grant and Cooperative Agreement Act of 1977, 31 U.S.C. 6301, et seq., and implementing regulations at 45 C.F.R. part 75, a cooperative agreement is an alternative assistance instrument to be used in lieu of a grant whenever substantial Federal involvement with the recipient during performance

12 See https://cfda.gov/ https://cfda.gov/ is anticipated. The difference between grants and cooperative agreements is the degree of Federal programmatic involvement rather than the type of administrative requirements imposed.

Therefore, statutes, regulations, policies, and the information contained in the HHS Grants Policy Statement13 that are applicable to grants also apply to cooperative agreements, unless the award itself provides otherwise (see also F4. Cooperative Agreement Terms and Conditions).

B7. Type of Competition

This will be a competitive Funding Opportunity open to all eligible applicants identified in C1.

Eligible Applicants.

C. ELIGIBILITY INFORMATION

C1. Eligible Applicants

This Funding Opportunity is open to individuals and private and public entities capable of carrying out the Navigator duties and other program requirements in a FFE, as outlined in statute, regulations, and this announcement (See particularly Section A. Program Description).

Under section 1311(i) of the PPACA14, eligible entities may include, but are not limited to, trade, industry and professional associations; commercial fishing industry organizations; ranching and farming organizations; community and consumer-focused nonprofit groups; chambers of commerce; unions; resource partners of the Small Business Administration; other licensed insurance agents and brokers15 and other entities capable of meeting program requirements.

Eligible applicants may choose to partner with other entities and/or individuals to form a consortium of subrecipients16 in order to target a larger total portion of the “left behind”

13 The HHS regulation (45 C.F.R. Part 75) effective December 26, 2014, supersedes information on administrative requirements, cost principles, and audit requirements for grants and cooperative agreements included in the current (2007) HHS Grants Policy Statement where differences are identified.

14 See PPACA 1311(i)(2)(B).

15 PPACA 1311(i)(4) prohibits a Navigator from being “a health insurance issuer and from “receiv[ing] any consideration directly or indirectly from any health insurance issuer in connection with the enrollment of any qualified individuals or employees of a qualified employer in a [QHP].” CMS regulations at 45 C.F.R 155.210(d)(1)-(4) and 155.215(a)(1) implement this statutory provision. In guidance, CMS has explained that agents and brokers who sell lines of insurance other than health insurance or stop loss insurance (for example, auto, life, and homeowners’ policies) would not be prohibited from receiving consideration from the sale of those other lines of insurance while serving as a Navigator. However, agents and brokers that sell lines of insurance other than health insurance or stop loss insurance, and that opt to become Navigators, would have to disclose these non-prohibited lines of business to the FFE and (in plain language) to each consumer assisted, per 155.215(a)(1)(i)(iv)(A).

16 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 entity to serve as the primary applicant for, and recipient of, federal funding, and that will serve as the pass-through entity for making federal funds awarded under the funding opportunity available to other consortium members. The lead applicant should demonstrate through its application a plan to establish subawards and contracts with other consortium members to fulfill all the requirements of this Funding Opportunity. Applicants should be population. In the case of an application from more than one entity or individual (i.e., a consortium), applicants must designate a lead applicant to serve as the primary contact for, and recipient of, federal funding, and that will serve as the pass-through entity for making federal funds awarded under the funding opportunity available to other consortium members.

The Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2019 Final Rule17 amended 45 C.F.R. § 155.210(c)(2), effective 6/18/2018, to eliminate the requirements that each Exchange must have at least two Navigator entities and that one of these entities must be a community and consumer-focused non-profit (CCFN). Accordingly, by the time CMS expects to award Navigator cooperative agreements for the FFEs under this Funding Opportunity, it will have the flexibility, unlike prior Funding Opportunities, to select less than two awards per FFE, and will also have the flexibility to make that award to an organization other than a CCFN.

To receive a cooperative agreement, applicants will be expected to:

• Demonstrate that they have existing relationships with employers and employees, consumers (including uninsured and underinsured consumers), or self-employed individuals likely to be eligible for enrollment in a QHP in the communities they expect to target, or that they could readily establish those relationships18, with a particular emphasis on those populations which the Exchange has identified as being “left behind” (See Section A4. Program Description).

For purposes of this Funding Opportunity, the Exchange will consider “left behind” populations to include those individuals who are disproportionately without access to health insurance coverage or care and who may be unaware of the full range of coverage options available to them, including coverage options in addition to QHPs, such as association health plans and short-term, limited-duration insurance. Examples of “left behind” populations include: hourly wage workers (restaurant and retail workers); variable income workers (workers with unpredictable annual incomes who fluctuate in and out of eligibility for financial assistance when purchasing health insurance); and persons who did not get health insurance because of a lack of affordable coverage options in their area, aware that if they intend to transfer performance of any portion of the substantive programmatic work under a CMS Navigator cooperative agreement, they must indicate this information, to the extent known, at the time of the application. CMS prior approval is required for the transfer of substantive programmatic work from a recipient to a subaward or contract once the period of performance has commenced. CMS would consider activities that Navigators are required or authorized to perform under CMS Navigator program regulations to be substantive programmatic work subject to this prior approval requirement. See related CMS guidance and citations at https://marketplace.cms.gov/technical-assistance-resources/delegating-navigator-duties-faqs.pdf.

17 Federal Register: https://www.federalregister.gov/documents/2018/04/17/2018-07355/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2019 18 See PPACA Section 1311(i)(2): https://sites.google.com/site/healthreformnavigator/ppaca-sec-1311, and CMS regulations at 155.210(c).

https://marketplace.cms.gov/technical-assistance-resources/delegating-navigator-duties-faqs.pdf https://www.federalregister.gov/documents/2018/04/17/2018-07355/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2019 https://www.federalregister.gov/documents/2018/04/17/2018-07355/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2019 https://sites.google.com/site/healthreformnavigator/ppaca-sec-1311 or because they lacked a general knowledge about affordable health insurance options and how to enroll.

Applicants may propose additional “left behind” populations in their applications for the FFE’s approval.

• Describe their previous work with consumers, including “left behind” groups, and how their experience working with consumers will support their work as a Navigator awardee, including how it will support their efforts to facilitate enrollment in QHPs and Medicaid/CHIP through an FFE, or, in the alternative, describe how they are in a position to readily establish relationships with consumers in the community(ies) they propose to target and with “left behind” groups.

• Demonstrate their experience and expertise in meeting the linguistic and cultural needs of diverse communities.

Previous awardees should describe their success with achieving previous project goals under any of the prior CMS Navigator funding opportunities.

All applicants should indicate in the cover letter if they, or any of their consortium members if applicable, were ever on a formal corrective action plan, including receiving a warning letter, and for how long and when they successfully completed the corrective action plan, while serving as an HHS Navigator awardee or subawardee/contractor of an HHS Navigator awardee (or as an awardee of any other federal grant/cooperative agreement) and a description of how the issue(s) was resolved. In addition, CMS regulations, at 45 C.F.R. § 155.210(c)(1)(iii), require that entities that wish to become Navigators must meet any applicable State licensing, certification, or other standards, so long as such standards do not prevent the application of the provisions of title I of the PPACA.

C2. Cost Sharing or Matching

Cost sharing or matching is not a requirement of this Funding Opportunity.

C3. Mandatory Letter of Intent

A letter of intent is not a requirement of this Funding Opportunity.

C4. Ineligibility Criteria

Each award made under this Funding Opportunity should not be used for activities funded by other CMS or federal grant/cooperative agreement awards. In the budget request, applicants should distinguish between activities that will be funded under this application and similar activities funded with other CMS or federal sources, if applicable.

The following entities are ineligible to apply under this Funding Opportunity:

• 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; or

• Recipients of 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. CMS has clarified in regulation that no health care provider shall be ineligible to operate as a Navigator in an FFE solely because it receives consideration from a health insurance issuer for health care services provided.

Consistent with 45 C.F.R. § 155.215(a)(1)(i), all applicants (individuals, entities, and all members making up a consortium) should submit a brief statement (one or two short paragraphs) within the Cover Letter attesting that they, as Navigator cooperative agreement applicants, are not ineligible entities, and include attestations that all other Navigator entities (including subrecipients and contractors performing Navigator duties, the Navigator(s) including the Navigator's staff),19 do not have any of the prohibited relationships with health insurance or stop loss insurance issuers that are outlined above.

As is explained in 45 C.F.R. § 155.215 and the preamble language discussing that provision, some conflicts of interest (other than the prohibited relationships outlined above) would not be absolute bars to service as a Navigator, provided that the conflict of interest would not ultimately prevent the entity or individual from providing information and services in a fair, accurate, and impartial manner. In addition, in accordance with 45 C.F.R. § 155.215(a)(1)(ii) and in compliance with the Standard Terms and Conditions that will be included in a Notice of Award, all successful applicants will be required to provide a written plan to remain free of conflicts of interest and to disclose to CMS, as operator of the FFE, certain non-disqualifying conflicts of interest as specified in 45 C.F.R. § 155.215(a)(1)(iv).

C5. Single Application Requirements

An applicant may propose to serve populations in multiple FFE service areas through the submission of one application, by submitting separate budget narratives and project (metric) goals for each Exchange service area it proposes to serve (See Sections A4. Program Requirements and B2. Award Amount).

19 See the conflict of interest regulations at https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&rgn=div5&view=text&node=45:1.0.1.2.70&idno=45#se45.1.155_1215 https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&rgn=div5&view=text&node=45:1.0.1.2.70&idno=45#se45.1.155_1215 https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&rgn=div5&view=text&node=45:1.0.1.2.70&idno=45#se45.1.155_1215

C6. Continued Eligibility

An awardee must continue to meet the program and eligibility requirements (See Sections A4.

Program Requirements and C1. Eligible Applicants) throughout the period of performance and comply with the terms and conditions that will accompany the notice of award.

C7. EIN, DUNS, 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 Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number; and be registered in the System for Award Management (SAM) database (https://www.sam.gov/portal/public/SAM/) to be able to submit an application at grants.gov (See Appendix II, Application and Submission Information, for descriptions of EIN, DUNS, and SAM).

C8. Foreign and International Organizations

Foreign and International Organizations are not eligible to apply.

C9. Faith-Based Organizations

Faith-based or religious organizations that are otherwise eligible may apply for this award on the same basis as any other organization, as set forth at and subject to the protections and requirements of 45 C.F.R. § 75.218, 45 C.F.R. Part 87, and 42 U.S.C. 2000bb et seq. CMS will not, in the selection of Navigator grant recipients, discriminate for or against an organization on the basis of the organization’s religious character, including the definition, practice, and expression of its religious beliefs, or its religious affiliation, nor substantially burden an organization’s religious exercise absent an individualized compelling interest for, and absent any alternatives to, imposing such a burden. Eligibility criteria, policies, or regulations shall not be deemed “compelling” simply by virtue of their having been applied neutrally, broadly, or uniformly over time.

A faith-based or religious organization that participates in this program will retain its independence from the government and may continue to carry out its mission consistent with religious freedom protections in federal law, including the Free Speech and Free Exercise clauses of the constitution, 42 U.S.C. §§ 2000bb et seq., 42 U.S.C. § 238n, 42 U.S.C. § 18113, 42 U.S.C. §§ 2000e-1(a) and 2000e-2(e), 42 U.S.C. § 12113(d), and the Weldon Amendment, among others.

To the extent consistent with religious freedom protections under federal law, a faith-based or religious organization may not use direct financial assistance from HHS to support or engage in any explicitly religious activities20 and may not, in providing services or in outreach activities related to such services, discriminate against a program beneficiary or prospective program beneficiary on the basis of religion, a religious belief, a refusal to hold a religious belief, or a refusal to attend or participate in a religious practice.

D. APPLICATION AND SUBMISSION INFORMATION

D1. Address to Request Application Package

Application materials will be available at https://www.grants.gov. Please note that HHS requires applications for all announcements to be submitted electronically through 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 Grants.gov website (See Appendix II, Application and Submission Information, for specific instructions on how to apply).

D2. Content and Form of Application Submission

a. Application format

Each application must include all contents of the application package, in the order indicated, and conform to the following formatting specifications:

• Use 8.5” x 11” letter-size pages (one side only) with 1” margins (top, bottom, and sides).

Other paper sizes will not be accepted. This is particularly important because it is often not possible to reproduce copies in a size other than 8.5” x 11”.

• All pages of the project and budget narratives must be paginated in a single sequence.

• Font size must be at least 12-point with an average character density no greater than 14 characters per inch.

• The Project Narrative may be single-spaced, double-spaced, or a combination of single and double-spaced.

• The Budget Narrative may be single-spaced, double-spaced, or a combination of single and double-spaced (applicants should follow format in budget sample provided in Appendix I, Guidance for Preparing a Budget Request and Narrative).

• The application Project Narrative must not exceed 15 pages in length, the Work Plan and Timeline must not exceed 5 pages in length, the Budget Narrative must not exceed 10 pages per…