CHIPRA-MACRA FOA Final.pdf

U.S. Department of Health and Human Services

Centers for Medicare & Medicaid Services Center for Medicaid and CHIP Services

Medicare Access and CHIP Reauthorization Act (MACRA) Funding Opportunity:

Connecting Kids to Coverage

OUTREACH AND ENROLLMENT COOPERATIVE AGREEMENTS

Initial Announcement

Cooperative Agreement

Funding Opportunity Number: CMS-1Z0-16-001

CFDA: 93.767

Date: November 16, 2015

Applicable Dates:

FOA Posting Date: November 16, 2015 Letter of Intent to Apply Due Date: December 16, 2015 Electronic Cooperative Agreement Application Due Date: January 20, 2016

(3:00 p.m. EST) Anticipated Issuance of Notices of Award: May 20, 2016 Anticipated Cooperative Agreement Period of Performance: May 20, 2016 –

May 19 2018 Potential Applicant Teleconferences:

Thursday, November 19th 3:00 pm to 4:00 pm EST 1-877-267-1577, 992 099 111 Monday, November 30th 3:00 pm to 4:00 pm EST1-877-267-1577, 998 168 839

Password: Meeting1 (only necessary for November 30th call) (There are a limited number of phone lines for each call, please visit http://www.insurekidsnow.gov/ for all information regarding this announcement) http://www.insurekidsnow.gov/

Table of Contents

I. EXECUTIVE SUMMARY

II. FUNDING OPPORTUNITY DESCRIPTION

1. Purpose

2. Background

3. Program Requirements

III. AWARD INFORMATION

1. Total Funding

2. Award Amount

3. Anticipated Award Dates

4. The Period of Performance

5. Number of Awards

6. Type of Award

IV. ELIGIBILITY INFORMATION

1. Eligible Applicants

2. Cost Sharing/Matching and Maintenance of Outreach Funding ………………..13

3. Single Application Requirement ……………………………………………….13

4. CMS/Grantee Collaboration …………………………………………………….14

V. APPLICATION INFORMATION

1. Content and Form of Application Submission

2. Submission Dates and Times

3. Funding Restrictions

VI. APPLICATION REVIEW INFORMATION

1. Criteria

2. Review and Selection Process

3. Anticipated Award Date

VII. AWARD ADMINISTRATION INFORMATION

1. Award Notices

2. Administrative and National Policy Requirements

3. Terms and Conditions

4. Cooperative Agreement Terms and Conditions of Award

5. Grantee Communications

VIII. AGENCY CONTACTS

IX. APPENDICES

APPENDIX A: Outreach Activities to Consider ………………………………….32 APPENDIX B: Guidance for Preparing a Budget Request and Narrative in

Response to SF424A APPENDIX C: Application and Submission Information

APPENDIX D: Application Check-Off List Required Contents

APPENDIX E: Definitions of Frequently Used Terms

APPENDIX F: Letter of Intent to Apply ………………………………………… 52

APPENDIX G: 504 Compliance……………………………………………

I. EXECUTIVE SUMMARY

The Connecting Kids to Coverage Outreach and Enrollment Cooperative Agreements grant program, as authorized under Section 2113 of the Social Security Act, as amended by Section 303 of the Medicare Access and CHIP Reauthorization Act (MACRA) Pub. L. 114- 10 provides funding opportunities to reduce the number of children who are eligible for Medicaid and CHIP, but are not enrolled, and improve retention of eligible children who are currently enrolled.

Funding Opportunity Title: Connecting Kids to Coverage

OUTREACH AND ENROLLMENT

COOPERATIVE AGREEMENTS

Announcement Type: New Funding Opportunity Number: CMS-1Z0-16-001 Catalog of Federal Domestic

93.767

Letter of Intent to Apply Due Date: December 16, 2015 Cooperative Agreement Application Due Date:

January 20, 2016 3:00 p.m. Eastern (Baltimore MD) Standard Time (EST)

Anticipated Notice of Award: May 20, 2016 Performance Period: 24 months Anticipated Total Annual Available

$32,000,000

Estimated Number and Type of

30 Cooperative Agreements Estimated Award Amount: $250,000 up to $1,000,000.

Estimated Award Date: May 20, 2016 Eligible Applicants: • A state with an approved child health plan under this title [42 U.S.C. Section1397aa et seq.];

• A local government;

• An Indian tribe or tribal consortium, a tribal organization, an urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.), or an Indian Health Service provider;

• A federal health safety net organization;

• A national, state, local, or community-based public or nonprofit private organization, including organizations that use community health workers or community-based doula programs;

• A faith-based organization or consortia, to the extent that a cooperative agreement awarded to such an entity is consistent with the requirements of Section 1955 of the Public Health Service Act (42 U.S.C. 300x-65) relating to a grant award to nongovernmental entities; and/or

• An elementary or secondary school.

II. FUNDING OPPORTUNITY DESCRIPTION

This solicitation seeks applications for Connecting Kids to Coverage Outreach and Enrollment (Cycle IV) grant funding. Indian health care providers and tribal entities are eligible to apply for cooperative agreements under this funding opportunity announcement (FOA). These Cycle IV cooperative agreements will support outreach strategies similar to those conducted in previous grant cycles, and also will support grantee participation in key outreach initiatives coordinated by the Connecting Kids to Coverage National Campaign (the Campaign). The Campaign is also funded under the Medicare Access and CHIP Reauthorization Act (MACRA) Pub. L. 114-10, and is led by the Center for Medicaid and CHIP Services (CMCS) and the CMS Office of Communications. The Campaign provides a full range of outreach and enrollment materials including customizable posters and flyers, as well as radio and TV public service announcements, videos featuring successful outreach strategies and outreach strategy guides that suggest effective ways to use the materials produced by the Campaign. Most materials are available in English and Spanish, and some are available in other languages, as well. A series of training webinars on key outreach and enrollment topics are presented on a monthly basis. The Campaign also augments media outreach in selected target markets. All materials produced by the Campaign, including recordings of all past webinars along with information about previous grantees, are available at www.InsureKidsNow.gov.

1. Purpose

MACRA, signed into law by President Obama on April 16, 2015, provides funding for the Children’s Health Insurance Program (CHIP) through federal fiscal year (FFY) 2017.

MACRA also provides $40 million for activities aimed at reducing the number of children who are eligible for Medicaid and CHIP, but are not enrolled and improving retention of eligible children who are currently enrolled. Of the total $40 million in funding for grants and the national outreach and enrollment campaign, this Funding Opportunity Announcement (FOA) makes available $32 million in grants to states, local government, schools, or health care providers.

MACRA funding for outreach and enrollment grants will build upon successful strategies facilitated by previous grant funding initiatives under the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 (Pub. L. 111-

3) and the Patient Protection and Affordable Care Act (ACA) of 2010 (Pub. L.

111-148). To date, under CHIPRA and the Affordable Care Act, a total of approximately $126 million in grant funding has been awarded. The first $40 million, released in Cycle I, was awarded to 68 grantees in 42 states in September 2009.

This was followed in April 2010 with awards amounting to $10 million in grants to 41 Native American Indian/Alaska Native (AI/AN) grantees in 19 states. Cycle II grants were awarded in August 2011, with another $40 million going to 39 grantees in 23 states. Cycle III grants were awarded in July 2013, with $32 million awarded to 41 grantees in 22 states. Finally, in November 2014, grants totaling nearly $4 million were awarded to ten AI/AN grantees in seven states. All of these grants supported projects aimed at raising awareness about the availability of health insurance for eligible children under Medicaid and CHIP and facilitating their enrollment into coverage. Details on the grantees and the activities they were funded to conduct can be found at:

http://www.insurekidsnow.gov/professionals/funding/history.html

2. Background

Since 2009, the nation has made substantial progress on reducing the number of uninsured children and toward providing health coverage to all children who are eligible for Medicaid and CHIP but who are not enrolled. A recent analysis of Census data by Georgetown University’s Center for Children and Families found that the rate of uninsured children fell from 9.3 percent in 2008 to an all-time low of 6.0 percent in 2014. Just under 4.4 million children remain uninsured in 2014.

(For more information on this analysis please consult http://ccf.georgetown.edu/ccf-resources/childrens-uninsured-rate-2014-affordable-care-act/). In FFY 2014, Medicaid and CHIP served nearly 44 million children.

That is 1 in every 3 children in America.

In addition to the decline in the percentage of uninsured children, Medicaid and CHIP participation rates increased, indicating that a greater proportion of eligible children were enrolling and gaining access to the health benefits that Medicaid and CHIP provide. A study by the Urban Institute, which has been tracking Medicaid and CHIP participation rates, found that nationally, participation rates have increased steadily from 81.7 percent in 2008 to 85.8 percent in 2010 and, most recently, to 88.3 percent in 2013. Similarly, participation rates have increased over time in every state, and a growing number of states in every region of the country have attained participation rates of 90 percent or higher. (For the most recent data on state participation rates, visit http://www.insurekidsnow.gov/chip/reports/index.html.)

The researchers attribute these achievements to the efforts states have made to simplify eligibility rules and streamline enrollment and renewal procedures, and also to state and community-based outreach efforts that have helped families get their eligible children enrolled in Medicaid and CHIP.

While this progress is significant, the Urban Institute analysis shows that there are still approximately 3.7 million children eligible for Medicaid and CHIP but not enrolled. Recent improvements have narrowed gaps in coverage among subgroups of children such as adolescents, Hispanic and American Indian/Alaska Native children, yet coverage disparities persist. In short, the nation is moving http://www.insurekidsnow.gov/professionals/funding/history.html http://ccf.georgetown.edu/ccf-resources/childrens-uninsured-rate-2014-affordable-care-act/ http://ccf.georgetown.edu/ccf-resources/childrens-uninsured-rate-2014-affordable-care-act/ http://www.insurekidsnow.gov/chip/reports/index.html forward to ensure that children have the health coverage they need, but there is more work to be done.

Since implementation of the Affordable Care Act began in 2010, states have made significant changes to their Medicaid and CHIP eligibility determination policies, procedures and systems. At the same time, more people have become eligible for health coverage under Medicaid, as well as for financial assistance to help pay for premiums and other costs associated with coverage under qualified health plans (QHP) available through the Health Insurance Marketplaces. Intensive work is going on and great progress is being made to assure that application and enrollment systems are seamless among programs and that the consumer experience is first-rate. States have also worked to simplify the eligibility verification process. For example, a single streamlined application – for all insurance affordability programs including Medicaid, CHIP and enrollment in a QHP – is available online, over the phone, and on paper. State Medicaid and CHIP agencies must rely on electronic data and if no data is available or the data is not consistent with the information on the application, then the state can request documentation. States are also working to improve the renewal process for Medicaid and CHIP enrollees. States are using a data-driven redetermination process and if additional information is needed to redetermine eligibility, the state must send a pre-populated renewal form. Other crucial components in creating a first-rate consumer experience involve providing families and individuals applying for health insurance with reliable information and direct application assistance. Families and individuals continue to seek such help from organizations they know and trust – health care providers, their child’s school, familiar community-based organizations and faith-based groups. Thus, the services of Connecting Kids to Coverage grantees remain fundamental to achieving the goal of reducing the number of children eligible for Medicaid and CHIP who are not enrolled and also helping children stay covered for as long as they qualify.

While the opportunity to obtain coverage under a QHP in the Marketplace is generally limited to a specific open-enrollment period, eligible individuals can enroll in Medicaid and CHIP year-round. The Connecting Kids to Coverage grantees are among the organizations and institutions reminding families in their communities that they can apply for Medicaid and CHIP at any time. The grantees will be emphasizing this message and helping families apply year-round.

3. Program Requirements

Project activities

a. Grants awarded under the cooperative agreement will fund activities aimed at educating families to the availability of free or low-cost health coverage under Medicaid and CHIP, identifying children likely to be eligible for these programs, and assisting families with the application and renewal process.

Applicants are encouraged to consider any of the following outreach strategies (See Appendix A for more information):

o Engaging schools in outreach, enrollment and retention activities;

o Bridging health coverage disparities by reaching out to subgroups of children with lower than average health coverage rates (e.g. teens, Hispanics, or children in rural areas); and, o Establishing and developing application assistance resources to provide high quality, reliable Medicaid/CHIP enrollment and renewal services in local communities.

b. Grantees will be required to work with the Connecting Kids to

Coverage National Campaign (described in Section II) on two special initiatives each year. These initiatives are designed to capitalize on key opportunities for outreach that are expected to be particularly productive:

o The first of the initiatives will take place after the 2016

Marketplace open enrollment period comes to an end and will feature the Medicaid/CHIP year- round application and enrollment message.

o The second will be focused on outreach during Back-to-School time.

The National Campaign will make outreach materials available that can be customized for local use. It will also host a robust series of training webinars to help guide grantees and others who will be conducting activities locally. During these initiatives, grantees will have the flexibility to tailor activities to the needs of their communities and to build on what they have been doing throughout the cooperative agreement period. The goal is to coordinate an intensive set of activities and a cohesive campaign during these two critical times of the year.

Applicants should take these additional factors into consideration when designing proposals:

o To be most effective, outreach efforts should link families to direct enrollment and renewal assistance.

o Incorporating the use of online applications and renewals into outreach and enrollment activities can make the application and renewal process more efficient and consumer-friendly, helping families to successfully get coverage for their children and for eligible children to retain coverage.

o While the emphasis of the Connecting Kids to Coverage Outreach and Enrollment Cooperative Agreement program (Cycle IV) remains focused on enrolling eligible children in Medicaid and CHIP, a large body of research finds that when eligible parents get enrolled in health insurance, their children are more likely to get enrolled and receive necessary preventive care.

Appropriate messaging and strategies that help enroll eligible parents can also facilitate the enrollment of eligible children. Given that more than half the states and the District of Columbia have expanded their Medicaid programs to cover more low-income adults, more parents and other adults are eligible for Medicaid than ever before. This provides an important opportunity to take a two-generation approach, helping to enroll eligible parents as a means to getting more eligible children enrolled and improving the health and financial security of the family.

o Families often seek health insurance for their children at times when they are most attuned to needing health services for them, such as when they are sick or injured, need physical exams to enroll in school or summer programs, or need routine preventive care, including immunizations, vision and hearing tests, or asthma and allergy screenings. Organizations and institutions that provide such services – such as hospitals, health clinics, departments of health, and schools

– are in a good position to conduct outreach and help families get their eligible children enrolled. They may also be more likely to have the infrastructure to sustain and track progress of outreach and enrollment efforts. Applicants that are not one of these types of organizations or institutions may wish to consider partnering with one or more of these entities.

c. Data and Reporting Requirements

Grantees will be required to collect and report to CMS data related to the project goals. Such data will demonstrate the project outcomes, and will also be used to help evaluate the success of outreach and enrollment strategies and identify areas that needs improvement or mid-course corrections. All grantees will be responsible for collecting and reporting particular data elements (presented below). In addition, applicants are encouraged to identify additional metrics that will be used to evaluate the efforts of the grantee’s work. All required data must be reported to CMS on a semi-annual basis utilizing a web-based reporting tool provided by CMS. Additional data that is not required should also be reported on a semi-annual basis and can be included in written reports.

The required data that all grantees must collect include:

o Number of children assisted in applying for health coverage o Number of children enrolled in Medicaid and CHIP as a direct result of the project o Number of children assisted in renewing Medicaid or CHIP o Number of children retained in Medicaid and CHIP as a direct result of the project

If the applicant proposes to enroll eligible parents in health coverage, the following data is required:

o Number of parents assisted in applying for health coverage o Number of parents enrolled in an insurance affordability program as a direct result of the project o Number of parents assisted in renewing health coverage o Number of parents retained in an insurance affordability program as a direct result of the project

To the extent possible, the best way to demonstrate project outcomes is to obtain enrollment data from the state or county Medicaid and/or CHIP agency. This would typically require the establishment of a Memorandum of Understanding (MOU) or other data-sharing agreement with the state or county Medicaid/CHIP agencies. Non-state applicants must secure an MOU or other data-sharing agreement with the state or county Medicaid/CHIP agencies within 90 days after the cooperative agreement is awarded. However, it may not always be possible to obtain data from these sources. Therefore, proposals must describe alternative methods for collecting and reporting accurate enrollment data. All non- state applicants who cannot secure a MOU or data-sharing agreement must provide an alternate plan for collecting accurate enrollment data.

If the applicant is a state agency or a collaborative that includes the state agency, the proposal must include assurance that required enrollment and retention data will be reported by the state semi-annually using ever-enrolled data to ensure that a child is not counted more than once.

III. AWARD INFORMATION

1. Total Funding

The total amount of federal funds available is anticipated to be $32,000,000. Please also refer to Section I. Executive Summary for the total funding.

2. Award Amount

The amount of each cooperative agreement award made to eligible applicants may range from $250,000 up to $1,000,000. Please also refer to Section I. Executive Summary for the award amount.

3. Anticipated Award Dates

The anticipated award date may vary depending on agency circumstances but is projected to be up to four months after the application deadline to allow for adequate application review and grantee selection. Please also refer to I.

Executive Summary for the anticipated award date.

4. The Period of Performance

The project period of performance for each Cooperative Agreement awarded will be two years from the date of award. There will be two one-year budget periods for the period of performance from May 20, 2016 to May 19, 2018. Please refer to I. Executive Summary for the length of the period of performance.

5. Number of Awards

CMS has no way to know the actual number of applicants and quality of award submission at this time. However; based on previous grant experience we anticipate awarding up to 30 cooperative agreements. Please also refer to I.

Executive Summary for the number of awards.

6. Type of Award

These awards will be structured as Cooperative Agreements. The Federal Grant and Cooperative Agreement Act of 1977, 31 U.S.C. 6301, defines the cooperative agreement as an alternative assistance instrument to be used in lieu of a grant whenever substantial federal involvement with the recipient during performance 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 Statement that are applicable to grants also apply to cooperative agreements, unless the award itself provides otherwise.

IV. ELIGIBILITY INFORMATION

1. Eligible Applicants

This cooperative agreement opportunity is open to the following individual eligible entities, or collaboratives of eligible entities:

a. A state with an approved child health plan under this title [42 U.S.C.

Section1397aa et seq.];

b. A local government;

c. An Indian tribe or tribal consortium, a tribal organization, an urban

Indian organization receiving funds under title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.), or an Indian Health Service provider;

d. A federal health safety net organization;

e. A national, state, local, or community-based public or nonprofit private organization, including organizations that use community health workers or community-based doula programs;

f. A faith-based organization or consortia, to the extent that a cooperative agreement awarded to such an entity is consistent with the requirements of Section 1955 of the Public Health Service Act (42 U.S.C. 300x-65) relating to a grant award to nongovernmental entities; and/or

g. An elementary or secondary school.

Former and current Connecting Kids to Coverage Grantees from (Cycle I, II or III) or AI/AN grantees submitting proposals under this FOA (Cycle IV) must be or have been grantees in good standing, meaning they must be meeting or have met all reporting requirements and other contractual obligations under their grants.

Applicants that had Cycle I, Cycle II, Cycle III or AI/AN grants may apply for a Connecting Kids to Coverage (Cycle IV) cooperative agreement if their proposal meets one of the following: 1) New and distinct activities: A Cycle I, Cycle II, Cycle III or AI/AN grantee may submit a proposal for activities that are new and distinct from those previously funded under the Cycle I, Cycle II, Cycle III or AI/AN grant, OR 2) Continuation of successful activities: A Cycle I, Cycle II, Cycle III or AI/AN grantee that wishes to continue activities it is currently conducting, or conducted during a previous cycle, may submit a proposal for a Cycle IV grant, but must present data demonstrating that the activities it wishes to continue have proved successful in enrolling and/or retaining eligible children in Medicaid and CHIP and warrants further funding.

Non-State applicants may also be eligible as grant funds are intended to be widely distributed across a range of governmental and non-governmental organizations that have the ability to promote enrollment in children’s health coverage programs.

While not all state Medicaid and CHIP agencies will be interested in participating directly in this initiative, state support helps ensure success and, at a minimum, is important with respect to making data available to document progress and identify areas for improvement. Non-state applicants awarded grants will be required to demonstrate how they will determine the enrollment status of children enrolled or retained in Medicaid and CHIP (See Section II 4. c. for Data Reporting Requirements) so they can accurately report these outcomes to CMS.

Applicants that are collaboratives, and will utilize the strengths of each participating group, should identify all member organizations and the roles and responsibilities of each under the grant. Proposals must designate a lead agency or organization. Proposals from collaboratives will be considered on their strengths and merits in the same manner as proposals from individual state or other entities.

Proposals should include a Letter of Commitment from the director (or other responsible person) of each organization participating in the collaborative. The letter should confirm the organization’s participation in the collaborative and the role it will play. Alternatively, applicants may include one Statement of Collaborative Effort (SCE) which lists each partner organization, the role each will play and the signature of the director of each organization (or other responsible person). Where applicable, Letters of Commitment or the SCE should provide information about past joint endeavors.

Ineligible Applicants

Foreign and International Organizations and for-profit entities are not eligible to apply. Applicants must be public and/or not-for-profit entities.

Threshold Criteria o Application deadline: Applications not received electronically through www.grants.gov by the application deadline will not be reviewed.

o Applications will be considered for funding only if the application meets the requirements as outlined in, IV. Eligibility Information, and V. Application Information.

Applicants are strongly encouraged to use the review criteria information provided in Section VI. Application Review Information, Section V. Application Information, and Appendix C, Application and Submission Information, to ensure that the application proposal adequately addresses all the criteria.

2. Cost Sharing/Matching and Maintenance of Outreach Funding

Awardees, including states, are not required to provide a matching contribution.

However, any outside funding that will be contributed to the outreach and enrollment effort by other entities must be mentioned in the Budget Narrative. In the case of a state that is awarded a grant, the state funds expended for outreach and enrollment activities during the grant project period shall not be less than the level of such funds expended in the federal fiscal year proceeding the first fiscal year for which the grant is awarded.

3. Single Application Requirement

Only one application may be submitted by any given lead eligible entity for funding for a Connecting Kids to Coverage Cycle IV cooperative agreement;

however, an eligible entity may be a member of multiple applicant collaboratives.

Entities working together as a collaborative shall submit one application. Only one Cycle IV cooperative agreement will be awarded to a single eligible entity or to the lead agency of a collaborative.

If an eligible entity submits more than one application, only the latest eligible application submitted will be accepted for review. No others will be accepted. All awardees must attest that they will not finance the same scope of work under more than one Cycle IV cooperative agreement award or other federal or non-federal funding stream.

http://www.grants.gov/

4. CMS/Grantee Collaboration

Grantees will agree to fulfill all cooperative agreement requirements, including requirements to collaborate with CMS. They must agree to:

a. Participate in key grantee training activities as identified by CMS;

b. Participate in the Connecting Kids to Coverage National Campaign outreach initiatives described in this FOA;

c. Submit, in a timely manner, semi-annual reports to include all required data elements utilizing the progress reporting tool provided by CMS (see Section II.

4. c. for a description of the required data reporting process);

d. Submit timely, accurate Financial Status Reports (SF-425);

e. Participate on periodic conference calls, with CMS or its contractors, to provide updates on enrollment and renewal data, implementation status and other updates as needed;

f. Work collaboratively with CMS to identify successful strategies and share information about cooperative agreement activities;

g. Share best practices and lessons learned with other grantees via peer-to-peer learning opportunities provided by CMS;

h. Cooperate fully with the independent evaluation of the cooperative agreement program conducted by the CMS evaluator; and;

i. Cooperate fully with CMS and all CMS contractors associated with this cooperative agreement.

V. APPLICATION INFORMATION

1. Application Package

This solicitation serves as the application package for this grant and contains all the instructions that a potential applicant requires to apply for cooperative agreement funding. The application should be written primarily as a narrative with the addition of standard forms required by the federal government for all grants and cooperative agreements.

Applicants are required by the Department of Health and Human Services (HHS) to submit their applications in the form of a complete electronic application package, including all required forms, to http://www.grants.gov.

Applicants will be able to download a copy of the application packet, complete it off-line, and then upload and submit the application via the Grants.gov website. You must search the downloadable application page by the CFDA number shown on the cover page of this announcement.

For assistance with Grants.gov, contact Support@Grants.gov or call (800) 518- 4726. HHS strongly recommends that you do not wait until the application due date to begin the application process (through http://www.grants.gov) because of the time needed to complete the required registration steps.

mailto:Support@Grants.gov

Content and Format of Application

Please note that applications that fail to follow the strict formatting requirements outlined below regarding formatting, font size, and page limitations will be deemed ineligible and their applications will not be considered for review. The application must include all contents described below and must not exceed 28 pages.

Please note that some items must be double-spaced and other items may be single-spaced. Proposals that do not adhere to this strict page limitation will not be reviewed and will be rejected.

Each application must include all contents described below, in the order indicated, and conform to the following specifications:

o 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”.

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

o Font size must be at least 12-point with an average of 14 characters per inch

(CPI).

o The Project Narrative will be double-spaced.

o The Budget Narrative may be single-spaced and should follow the justifications and table formats provided in Appendix B, Sample Budget and Narrative Justifications.

o Tables included within any portion of the application should have a font size of at least 12-point with a 14 CPI and may be single spaced. Tables are counted towards the applicable page limits.

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

o The additional required documentation, including Standard Forms, copy of previously submitted Letter of Intent, Cover Letter, and Project Abstract is excluded from the page limitations.

504 Compliance - Recipients of federal financial assistance (FFA) from Health and Human Services (HHS) must administer their programs in compliance with federal civil rights laws. This means that recipients of HHS funds must ensure equal access to their programs without regard to a person’s race, color, national origin, disability, age and, in some circumstances, sex and religion. It is HHS’ duty to ensure access to quality, culturally competent care, including long- term services and supports, for vulnerable populations.

HHS provides guidance to recipients of FFA on meeting their legal obligation to take reasonable steps to provide meaningful access to their programs by persons with limited English proficiency. In addition, recipients of FFA have specific legal obligations for serving qualified individuals with disabilities by providing information in alternate formats.

Several sources of guidance provided below:

o http://www.hhs.gov/ocr/civilrights/understanding/index.html o http://www.hhs.gov/ocr/civilrights/resources/laws/summaryguidance.html o http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53 o http://www.hhs.gov/ocr/civilrights/understanding/section1557/index.html o HHSAR 352.270-1 o http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html

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

Overview of Cooperative Agreement Application Structure and Content

Standard Mandatory Forms

The following standard forms are found in the Grants Application Package at Grants.gov and must be completed with an electronic signature and submitted as part of the proposal:

o Project abstract summary o SF-424: Official Application for Federal Assistance (see note below) o SF-424A: Budget Information Non-Construction o SF-424B: Assurances-Non-Construction Programs o SF-LLL: Disclosure of Lobbying Activities.

All applicants must submit this document. If your entity does not engage in lobbying, please insert “Non-Applicable” on the document and include the required Authorized Organizational Representative (AOR) name, contact information, and signature. Please note that the application kit available online in Grants.gov is utilized for many programs and therefore Grants.gov may designate this form as optional to allow for flexibility amongst programs. The specific funding opportunity announcement will provide final, binding guidance. This form is required as part of your application package and must be submitted for your application to be considered eligible for review.

o Project Site Location Form(s) All applicants must submit this document. Please note that the application kit available online in Grants.gov is utilized for many programs and therefore Grants.gov may designate this form as optional to allow for flexibility amongst http://www.hhs.gov/ocr/civilrights/understanding/index.html http://www.hhs.gov/ocr/civilrights/resources/laws/summaryguidance.html http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53 http://www.hhs.gov/ocr/civilrights/understanding/section1557/index.html http://www.hhs.gov/regulations/hhsar/subpart352-40s-70s.html%23352.270-1Accessibilityofmeetingsconferencesandseminarstopersonswithdisabilities http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html http://www.hhs.gov/ocr/office/about/rgn-hqaddresses.html http://www.hhs.gov/ocr/office/about/rgn-hqaddresses.html programs. The specific funding opportunity announcement will provide final, binding guidance. This form is required as part of your application package and must be submitted for your application to be considered eligible for review.

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

o On Item 15 “Descriptive Title of Applicant’s Project”, state the specific cooperative agreement opportunity for which you are applying: Connecting Kids to Coverage Outreach and Enrollment Cooperative Agreements.

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

Project Abstract

A one-page abstract should serve as a succinct description of the proposed project and should include the goals of the project, the total budget, the number of projected clinician participants, projected total cost of care savings, and a description of how the funds will be used. The abstract is often distributed to provide information to the public and Congress, so please write the abstract so that it is clear, accurate, concise, and without reference to other parts of the application.

Personal identifying information should be excluded from the abstract. In the Grants Application Package that can be found at www.Grants.gov, select the Project Abstract Summary and complete the form.

Project Narrative Requirement

In the Grants Application Package that can be found at www.Grants.gov, select the Project Narrative Attachment Form and “Add Mandatory Project Narrative File”.

Budget Narrative Requirement

For more information on completing the budget narrative, please see Appendix B, Sample Budget and Narrative Justifications. This Appendix provides detailed instructions and examples of how the information in the budget narrative should be presented. Detailed explanations must be provided for each activity as well as full computations. Applicants must also clearly link each activity to the goals of this funding opportunity announcement and consistent with Connecting Kids to Coverage Outreach and Enrollment Grants Cycle IV requirements. Overhead and administrative costs must be reasonable. Detailed costs and breakdown for each SF 424A line item are as follows:

1. Personnel (itemized)

2. Fringe benefit costs

3. Travel and training cost

4. Equipment

5. Supplies

6. Contractual

7. Construction (unallowable)

8. Other

9. Indirect Cost

10. Totals

The Budget Narrative Attachment Form can be found in the Grants Application Package at www.Grants.gov; select the Budget Narrative Attachment Form and “Add Mandatory Budget Narrative”. Completion of the Standard form, SF- 424A, is also required and is an important part of our proposal and will be reviewed carefully by HHS staff.

For detailed application content, format and submission instruction, please refer to Appendix C. Application and Submission Information.

2. Submission Dates and Times

Applicants are required to submit a non-binding Notice of Intent to Apply (See Appendix F). CMS reserves the right to consider an applicant ineligible without a timely Notice of Intent (NOI). The notices of intent enable CMS to better plan for the application review process. Notices of Intent to Apply should be submitted by email to CMS at CMS_TA@grantreview.org by December 16, 2015, 3:00 p.m.

Eastern (Baltimore) time.

All grant applications must be submitted electronically through www.Grants.gov and are due on January 20, 2016. Applications received through www.grants.gov until 3:00 p.m. EST on January 20, 2016, will be considered “on time.” All applications will receive an automatic time stamp upon submission and applicants will receive an automatic e-mail reply acknowledging the application’s receipt.

Applications that do not meet the above criteria for submission through www.grants.gov will be considered late. Late applications will not be reviewed.

3. Funding Restrictions

Indirect Costs

If requesting indirect costs, an Indirect Cost Rate Agreement will be required. For more information about determination of Indirect Cost Rate Agreements please go to: http://www.psc.gov/financial/indirect-cost-negotiations.html.

Direct Services

Cooperative Agreement funds may not be used to provide individuals with services that are already funded through Medicare, Medicaid, and/or CHIP. These services do not include expenses budgeted for provider and/or consumer task force member participation in conferences, provision of technical assistance, or attendance at mailto:CMS_TA@grantreview.org http://www.grants.gov/ http://www.grants.gov/ http://www.grants.gov/ http://www.psc.gov/financial/indirect-cost-negotiations.html technical assistance conferences sponsored by CMS or its national technical assistance providers for the benefit of awardees.

Reimbursement of Pre-Award Costs

No cooperative agreement funds awarded under this solicitation may be used to reimburse pre-award costs.

Prohibited Uses of Cooperative Agreement Funds o To match any other Federal funds.

o To provide services, equipment, or supports that are the legal responsibility of another party under Federal or State law (e.g., vocational rehabilitation or education services) or under any civil rights laws. Such legal responsibilities include, but are not limited to, modifications of a workplace or other reasonable accommodations that are a specific obligation of the employer or other party.

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

o To be used by local entities to satisfy State matching requirements.

o Award dollars cannot be used for specific components, devices, equipment, or personnel that are not integrated into the entire service delivery model proposal.

VI. APPLICATION REVIEW INFORMATION

1. Criteria

a. Project Narrative (70 points, total of i - iv below)

i. Description of Need (10 points)

Describe the target population and provide data on the number and/or rate of uninsured children, as well as estimates of the number and/or percent of eligible children who are not enrolled in Medicaid and CHIP. If such data do not exist, provide other demographic data that can support the target population’s need for health coverage.

Supportive data may include poverty data, school lunch participation data, and other data, as appropriate. Identify barriers to enrollment and retention of target population.

ii. Statement of Project Goals (10 points)

Specify the measurable goals for your proposed project, including the number of children that will be enrolled and the number that will be retained in Medicaid and CHIP as a result of the project.

Provide adequate justification for how you determined these goals.

Specify the number of eligible parents your project will enroll and retain in health coverage, if applicable.

iii. Capacity to implement the project (10 points)

Describe the applicant’s capacity to implement the proposed project. Include information about the applicant’s level of knowledge about Medicaid and CHIP eligibility and enrollment procedures, as well as information about the applicant’s past experience conducting health coverage outreach and enrollment activities. (Information about the applicant’s experience conducting outreach and enrollment activities for other public benefit programs is also helpful). Describe the applicant’s readiness to implement the project if the proposal is successful.

iv. Outreach and Enrollment Plan (40 points)

Describe the year round strategies that will be used to enroll and retain eligible children in Medicaid and CHIP. Describe specific efforts your project will undertake to make the most of the following two important periods for conducting outreach and enrollment activities aimed at enrolling eligible children in Medicaid and CHIP. (Note that the Connecting Kids to Coverage National Campaign will be providing materials and other support to grantees)

1. Following Marketplace open enrollment period

(to remind families that enrollment in Medicaid and CHIP remain Available year round) and;

2. Back-to-School time.

Discuss the settings in which outreach and enrollment activities will take place, emphasizing why chosen settings are believed to be places where activity will be most productive.

Describe how application and renewal assistance will be delivered directly to families and the strategies that will be used to track and report on the number of children and parents the project assists and the outcome of those interactions.

Demonstrate the ability to modify and refine outreach, enrollment, and renewal strategies based on an ongoing self-assessment of the effectiveness of those strategies.

Discuss how the applicant will sustain the proposed efforts beyond the grant period using additional funding or in-kind support from sources other than the federal government, or through the adoption of ongoing systemic changes in the process or system for applying for or renewing coverage. While not a requirement, planning for ways outreach and enrollment activities can become part of the routine work of community organizations and institutions enhances the project’s value.

b. Data Collection and Reporting Plan (20 points)

Describe how required data (discussed in Section II(3)(c)) will be collected.

Also describe any non-required data/metrics the project will collect and report, why the data is useful, how it will be collected and reported and how it will be used.

Reminder: Non-state applicants that can secure a Memorandum of Understanding (MOU) or other data-sharing agreement with the state or county agencies will have until 90 days after the cooperative agreement is awarded to produce the agreement. Applicants unable to obtain this agreement must provide an alternate plan for collecting accurate enrollment data in case it turns out to be impossible or infeasible to obtain n MOU or other data-sharing agreement. Non-state applicants that do not expect to be able to obtain an MOU or other data-sharing agreement must provide an alternative plan for collecting and reporting accurate enrollment data.

c. Work Plan and Timeline (15 points)

The work plan section of the application should document activities, reasonable milestones and timeframes that are likely to lead to achievement of the stated project goal and identify the parties responsible for performing the activities.

d. Budget and Budget Narrative (15 points)

Applicants must provide a budget with appropriate budget line items and a narrative that describes the funding needed to accomplish the goals of the grant. For the budget recorded on form SF-424A, provide a breakdown of the aggregate numbers detailing their allocation to each major set of activities. The proposed budget for the program should distinguish the proportion of grant funding designated for each grant activity. The budget must separate out funding that is administered directly by the lead agency from funding that will be subcontracted to other partners.

State applicants or collaboratives with state agency membership must provide assurance that the state share of funds expended for outreach and enrollment activities under the state child health plan shall not be less than the state share of such funds expended in the fiscal year proceeding the first fiscal year for which the grant is awarded.

e. Evaluation (15 points)

Describe how the project will be evaluated. Discuss what data will be used to determine whether goals are being met and whether changes need to be made during the project to remain on course. Discuss how changes will be made, if necessary.

f. Staffing Plan (15 points)

Describe how the project will be staffed, including the number of staff, their skills and credentials and how they will be deployed. Include brief job descriptions for the Project Director and Assistant Director and a statement of the percentage of time that each person will be working on this project and the percentage of time that is spent on duties outside of the cooperative agreement activities.

2. Review and Selection Process

CMS will employ a multi-phase review process and each panel will consist of at least three expert reviewers. Panels will proceed as follows:

a. Phase I:

Applications will be screened for completeness and compliance with application requirements as listed in Section V and required certifications as noted in Section V. In addition, proposals will be reviewed to determine eligibility using the criteria detailed in Section IV (Eligibility Information) of this solicitation. Applications that are received late or fail to meet the eligibility requirements as detailed in this solicitation or do not submit the required forms will not be reviewed.

b. Phase II:

Eligible applications will be reviewed by a panel of experts, the exact number and composition of which will be determined by CMS at its discretion, but may include private sector subject matter experts, researchers, and federal policy staff who are not part of the cognizant program office. The review panels will establish an overall numeric score for each application.

In addition to the criteria listed, applicants should consider the following:

o Goals for the project are clearly stated and appear achievable o Description of need is compelling and is based on data that is clearly cited o Proposed metrics to be considered will adequately allow for project monitoring and measuring project success o The organization has sufficient capacity to accomplish the goals of the grant o There is a clear plan for collecting and reporting verified state enrollment data o The prospects for sustaining the project are clearly stated

c. Phase III:

A CMS review team will use the scores and comments from Phase II to inform its final recommendations to the CMS approving official.