CMS FINAL 2021-2024 Navigator NOFO_06 04 2021 (508 Compliant).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 Type: New

Funding Opportunity Award Type: Cooperative Agreement

Notice of Funding Opportunity Number: CA-NAV-21-001

Federal Assistance Listings Number (CFDA): 93.332

Notice of Funding Opportunity Posting Date: June 4, 2021

Applicable Dates:

Letter of Intent to Apply Due Date: N/A

Electronic Application Due Date: July 6, 2021, 3:00 pm Eastern Standard Time

Anticipated Issuance Notice(s) of Award: August 27, 2021

Anticipated Period of Performance: 36 months from the date of initial award with 12-month budget periods

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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 Dates

B4. Period of Performance

B5. Number of Awards

B6. Type of Award

B7. Type of Competition

C. Eligibility Information

C1. Eligible Applicants

C2. Cost Sharing or Matching

C3. Letter of Intent

C4. Ineligibility Criteria

C5. Single Application Requirement

C6. Continued Eligibility

C7. EIN, DUNS, and SAM Regulations

C8. Foreign and International Organizations

C9. Other Eligibility Requirements

D. Application and Submission Information

D1. Address to Request Application Package

D2. Content and Form of Application Submission

a. Application Format

b. Standard Forms

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c. Mandatory Application Cover Letter

d. Project Narrative (maximum of 20 pages)

e. Work Plan and Timeline (maximum of five pages)

f. Budget Narrative (maximum of 15 pages per FFE state)

g. Business Assessment of Applicant Organization (maximum 12 pages)

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

D4. Submission Dates and Times

D5. Intergovernmental Review

D6. Cost Restrictions

D7. Mandatory Disclosure

E. Application Review Information

E1. Criteria

E2. Review and Selection Process

E3. Federal Awardee Performance Integrity Information System (FAPIIS)

F. Federal Award Administration Information

F1. Federal Award Notices

F2. Administrative and National Policy Requirements

a. National/Public Policy Requirements

b. Administrative Requirements

F3. Terms and Conditions

F4. Cooperative Agreement Terms and Conditions of Award

F5. Reporting

a. Progress Reports

b. Financial Reports

c. Federal Funding Accountability and Transparency Act Reporting Requirements

d. Audit Requirements

e. Payment Management System Reporting Requirements

f. Government-wide Suspension and Debarment Reporting Requirements

G. CMS Contacts

G1. Programmatic Questions

G2. Administrative/Budget Questions

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H. Other Information

Appendix I. Guidance for Preparing a Budget Request and Narrative

Appendix II. Application and Submission Information

Appendix III. Business Assessment of Applicant Organization

Appendix IV: Accessibility Requirements

Appendix V. Review and Selection Process

Appendix VI. List of States for which Cooperative Agreement Funding is Available through this Funding Opportunity

Appendix VII. Application Check-Off List

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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 Affordable Care Act (ACA)1. To view a current list of states that will have an FFE in benefit year 2022, see Appendix VI, List of States for which Cooperative Agreement Funding is Available.

Each year, the Centers for Medicare & Medicaid Services (CMS) makes grant awards to organizations who serve as Navigators in FFE states. Navigators help consumers prepare applications to establish eligibility and enroll in coverage through the Exchanges, and help determine whether consumers potentially qualify for insurance affordability programs. They also provide outreach and education to raise awareness about the Exchanges. As trusted community partners, Navigators are required to provide targeted assistance to underserved and vulnerable populations within the Exchange service area, which is critical to improving access to health care coverage for communities that often experience a disproportionate burden of disease2. In furtherance of the Biden Administration’s goals on ensuring access to and expanding affordable and high-quality health care coverage3 and improving health equity4, Navigators are well-positioned to reach historically underserved and vulnerable communities, especially those who continue to face significant health disparities.

Navigators operate year-round—increasing awareness among the remaining uninsured about the coverage options available to them, helping consumers find affordable coverage that meets their needs, and assisting consumers beyond the enrollment process to ensure they’re equipped with the tools and resources needed to utilize and maintain their health coverage all year. The increased funding available to applicants through this Funding Opportunity will enable FFE Navigators to further expand their reach, with a renewed focus on outreach to diverse, underserved, and vulnerable communities.

Organizations that receive funding to serve as FFE Navigators must carry out the required statutory and regulatory Navigator duties, along with the additional requirements laid out in

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. We refer to these collectively as the Affordable Care Act.

2 HHS Notice of Benefit and Payment Parameters for 2017, 81 Fed. Reg. 12246 (May 9, 2016) (amending 45 C.F.R.

§ 155.210), at https://www.govinfo.gov/content/pkg/FR-2016-03-08/pdf/2016-04439.pdf.

3 Executive Order on Strengthening Medicaid and the Affordable Care Act (Jan. 28, 2021), at https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/executive-order-on-strengthening-medicaid-and-the-affordable-care-act/.

4 Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government (Jan. 20, 2021), at https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/.

https://www.govinfo.gov/content/pkg/FR-2016-03-08/pdf/2016-04439.pdf https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/executive-order-on-strengthening-medicaid-and-the-affordable-care-act/ https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/executive-order-on-strengthening-medicaid-and-the-affordable-care-act/ https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/ https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/ https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/

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Sections B. Award Information and E. Application Review Information of this Funding Opportunity. This document describes how to submit proposals in fiscal years (FY) 2021 through 2024 and how 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.

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

Federal Assistance Listings Number (CFDA) 93.332

Funding Opportunity Type New

Funding Opportunity Number CA-NAV-21-001

Type of Award Cooperative Agreement

Type of Competition Open to All Eligible Applicants

Letter of Intent N/A

Application Due Date and Time July 6, 2021 by 3:00 pm EST (Baltimore, MD)

Anticipated Issuance Notice(s) of Award August 27, 2021

Period of Performance Start Date Anticipated August 2021

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Item Description

Period of Performance End Date

36 months from the date of award with 12-month budget periods

Anticipated Total Available Funding

$80 million allotted per 12-month budget period; $240 million total for 36-month period of performance, subject to funding availability

Estimated Maximum Award Amount $14,532,590.00

Estimated Maximum Number of Awardees 120

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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 an FFE, as authorized by the ACA. To view a current list of eligible states that will have an FFE in benefit year 2022, 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 the U.S. Department of Health and Human Services (HHS) pursuant to Sections 1311(d)(4)(K), 1311(i), and 1321(c)(1) of the ACA. Section 1311(i) of the ACA 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, part 155, subpart C of the Code of Federal Regulations: https://ecfr.io/Title- 45/cfr155_main.

A3. Background

Section 1311(i) of the ACA 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 ACA and 45 C.F.R. §155.210(a) and (c)) applying to serve consumers in states with an FFE. Entities and individuals cannot serve as federally certified Navigators without receiving federal cooperative agreement funding to perform Navigator duties. This is the sixth Funding Opportunity since 20135 that will fund Navigators serving in FFEs.

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 ACA and HHS regulations. The primary regulations that establish requirements for awardees under this Funding Opportunity are 45 C.F.R. §§ 155.2106 and 155.2157.

5 For more information on the previous Navigator funding opportunities and awardees, see https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance.html.

6 45 C.F.R. § 155.210, at https://ecfr.io/Title-45/se45.1.155_1210 7 45 C.F.R. § 155.215, at https://ecfr.io/Title-45/se45.1.155_1215 https://ecfr.io/Title-45/cfr155_main 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

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These regulations establish duties that are required of all recipients of funding under this Funding Opportunity, including, but not limited to:

• 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; and

• Providing targeted assistance to serve underserved or vulnerable8 populations, as identified by the Exchange, within the Exchange service area.

As explained in 45 C.F.R. § 155.210(e)(8) and the preamble language discussing that provision9, the primary criteria to be used in identifying underserved or vulnerable populations in the FFEs is whether the community is disproportionately without access to coverage or care, or is at a greater risk for poor health outcomes as a result of disparities in health insurance coverage, access to quality care, and other social, environmental, and economic factors shown to impact health.

For purposes of this Funding Opportunity, the Exchange will consider a population to be underserved or vulnerable using factors such as race or ethnicity, gender, education or income, disability, geographic location (e.g., rural or urban), or sexual orientation. Examples of underserved or vulnerable populations may include, but are not limited to10:

• Racial and ethnic minorities

• Rural communities

8 45 C.F.R. § 155.210(e)(8) 9 See https://www.federalregister.gov/documents/2016/03/08/2016-04439/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2017 10 See Serving Vulnerable and Underserved Populations (Oct. 15, 2020), at: https://marketplace.cms.gov/technical-assistance-resources/training-materials/vulnerable-and-underserved-populations.pdf https://www.federalregister.gov/documents/2016/03/08/2016-04439/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2017 https://www.federalregister.gov/documents/2016/03/08/2016-04439/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2017 https://marketplace.cms.gov/technical-assistance-resources/training-materials/vulnerable-and-underserved-populations.pdf https://marketplace.cms.gov/technical-assistance-resources/training-materials/vulnerable-and-underserved-populations.pdf

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• Lesbian, gay, bi-sexual, transgender, queer, and other (LGBTQ+) individuals

• Low income or homeless individuals

• American Indians and Alaska Natives (AI/AN)

• People with physical or intellectual disabilities or cognitive, hearing, speech, and/or vision impairments

• Pregnant women, new mothers, and women with children

• Individuals with mental health or substance-related disorders

• Individuals with HIV/AIDS

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

Applicants may also propose additional underserved or vulnerable populations in their application for the FFE’s approval.

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 gifts11 of any value to any applicant or potential enrollee as an inducement for enrollment;

11 See 45 C.F.R. § 155.201210(d)(6) for definition of gifts: https://ecfr.io/Title-45/se45.1.155_1210 https://ecfr.io/Title-45/se45.1.155_1210

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• Providing gifts to any applicant or potential enrollee for a reason other than as an inducement for enrollment must not exceed nominal value12, either individually or in the aggregate, when provided to that individual during a single encounter13;

• 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 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 ACA. Navigators will receive technical assistance from HHS to complete the required federal certification/recertification training in the Marketplace Learning Management System (MLMS).

12 We have previously defined ‘‘nominal value’’ as a cash value of $15 or less, or an item worth $15 or less, based on the retail purchase price of the item, regardless of the actual cost. See 79 FR 30239, 30283 (May 27, 2014) at https://www.govinfo.gov/content/pkg/FR-2014-05-27/pdf/2014-11657.pdf.

13 This nominal value limit applies to all gifts, including gift items, gift cards, cash cards, cash, and promotional items that market or promote the products or services of a third party. Some illustrative examples of permissible gifts and promotional items include pens, magnets, or key chains worth $15 or less each, including if such items bear the name or logo of a local business, or community or social service program. Such items may, for example, be provided to consumers at outreach and education events or at other forums attended by members of the general public, as long as they are not being provided as an inducement to enrollment. See 81 FR 12258 (March 8, 2016) at https://www.govinfo.gov/content/pkg/FR-2016-03-08/pdf/2016-04439.pdf.

https://www.govinfo.gov/content/pkg/FR-2014-05-27/pdf/2014-11657.pdf https://www.govinfo.gov/content/pkg/FR-2016-03-08/pdf/2016-04439.pdf

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Referrals and Consumer Assistance:

Navigators will be required to assist any consumer seeking assistance, even if that consumer is 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 Find Local Help on HealthCare.gov. Additionally, if a Navigator in an FFE is approached by a consumer who lives in a state with a State-based Exchange (SBE), or in a state with an FFE in which the Navigator has not been funded to serve, the Navigator must refer the consumer to an Exchange-approved assister in the consumer’s state or, if available, a toll-free SBE consumer assistance number.

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.

Continued Funding:

Continued funding throughout the 36-month period of performance will be contingent on timely submission of the non-competing continuation application, strong performance during the previous budget period(s), funding availability, and the awardee’s ability to continue meeting all eligibility requirements laid out in this Funding Opportunity, including continuing to serve in a state(s) with an FFE.

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

• Awardee’s ability to meet the self-imposed performance metrics (project goals) laid out in their original approved application, including:

o Ensuring its target number of FFE Navigators are federally trained and certified/re-certified each year by October 1, and o Achieving a completion rate of at least 50% for each of the remaining project goals in its approved application by the sixth month mark of each budget period;

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• Quality and timeliness of weekly, monthly, quarterly, annual, and final report submissions, as determined by CMS, including:

o Ensuring key personnel have access to all required CMS systems by the prescribed due date of the first programmatic report, and o Ensuring all FFE Navigators receive guidance supplied by CMS and are trained on how to properly count and report the number of consumers they assist with Navigator activities;

• Awardee’s compliance with the terms and conditions provided with its Notice of Award, including compliance with all applicable statutory and regulatory requirements14; and

• Awardee’s ability to effectively communicate with and respond in a timely manner to requests from their Project Officer throughout the period of performance.

Additional information about reporting requirements and FFE Navigator certification will be provided with the Notice of Award for the Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges.

Additionally, HHS could terminate a cooperative agreement for poor performance, or alternatively the awardee might withdraw from the cooperative agreement program before the end of the 36-month period of performance. Should the FFE in a state (or, in the case of a multi-state award, all applicable states) in which a Navigator awardee has received funding through this Funding Opportunity transition from an FFE to an SBE or State-based Exchange on the Federal Platform (SBE-FP) before the 36-month project period of performance ends, the Navigator cooperative agreement would end and any unused funds would be returned to HHS. In accordance with 45 C.F.R. §155.106, any state seeking approval from HHS to operate an SBE or SBE-FP must coordinate with HHS on a jointly-developed transition plan, including a process and timeline for ending this cooperative agreement. In the case of a multi-state award, the Navigator cooperative agreement would remain in place for any FFE in a state that remains an

FFE.

14 Failure to comply with the terms and conditions of this cooperative agreement, including compliance with all statutory and regulatory requirements, may result in placement on a formal corrective action plan. Awardees placed on a formal corrective action plan during the course of the 36-month period of performance may not receive additional Navigator cooperative agreement funding for the subsequent 12-month budget period, depending on their progress in meeting all of the terms in the corrective action plan.

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Multi-Year Project Period and Funding Structure:

The period of performance under this specific Funding Opportunity will be for 36 months, funded in 12-month increments known as budget periods. Continued funding will be contingent on the awardee continuing to meet all Navigator program requirements, current program priorities, and the availability of funds. This multi-year funding structure is designed to provide greater consistency for Navigator awardee organizations and their staff from year to year, reducing yearly start up time and providing for a more efficient use of cooperative agreement funds.

Applicants must submit a proposal which covers the full 36-month period of performance.

Although initial funding awarded through this Funding Opportunity will cover only the first 12-month budget period of the three-year period of performance, applicants must still submit an estimated budget for each budget period (years 1, 2, and 3) using the funding allocations appropriated for each FFE provided for the first budget year (see Section B2. Award Amount).

For Years 2 and 3, recipients will be able to revise their budgets, based on actual15 funding available from HHS, as part of their non-competing continuation applications which will be required from all recipients prior to the end of each of the first two budget periods.

A non-competing continuation application is a financial assistance request (in the form of an application or performance/progress report) for a subsequent budget period within a previously approved period of performance for which a recipient does not have to compete with other applicants. Approval of this application will allow the awardee to continue implementing its project plan and to receive its next 12-month increment of funding. Non-competing continuation applications should be submitted no later than 90 days before the end of the current budget period (e.g., if the budget period will end on August 10, submit the non-competing continuation application by May 10). Exact requirements for the non-competing continuation application as well as due dates will be laid out in the terms and conditions that accompany each awardee’s Notice of Award and guidance provided by the CMS Project Officer.

Due to their non-competitive nature, continuation applications will not be reviewed or scored by an objective review panel. Instead, all continuation applications will be reviewed by CMS staff.

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, relay budget guidance, 15 Actual funding available to awardees from HHS during years 2 and 3 of this 36-month project period will be determined based on the total amount of funding made available to the Navigator program for the 12-month budget period, as well as each awardee’s performance during the prior budget period, as outlined in Section A4. Continued Funding. As a result, individual award amounts during years 2 and 3 may be higher or lower than the amount awarded for the first 12-month budget period.

2021-06-03 Page 15 of 102 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.

Technical Assistance Session #1

• Wednesday, June 9, 2021 from 3:00 to 4:00pm Eastern Daylight Time

• https://goto.webcasts.com/starthere.jsp?ei=1418490&tp_key=a3299cfc8e

Technical Assistance Session #2

• Monday, June 28, 2021 from 3:00 to 4:00pm Eastern Daylight Time

• https://goto.webcasts.com/starthere.jsp?ei=1470197&tp_key=d748689859

B. Federal Award Information

B1. Total Funding

HHS expects to award up to $240,000,000 over the 36-month period of performance and up to $80,000,000 during the first 12-month budget period of this multi-year award, pending availability of funds and current program priorities.

Applicants selected for award under this Funding Opportunity will be issued funding for the first 12-month budget period of the multi-year award and will be required to submit a non-competing continuation application for continued funding of their award prior to the end of the first and second budget periods. Cooperative agreement award amounts may vary annually16 and all awards issued under this Funding Opportunity are subject to the availability of funds and current program priorities.

In the absence of funding, HHS is under no obligation to make awards under this Funding Opportunity or can change the award amount prior to the issuance of a Notice of Award.

B2. Award Amount

HHS expects to award up to $240,000,000 over the 36-month period of performance, with up to $80,000,000 awarded for the first 12-month budget period of this multi-year award, pending availability of funds. Although initial funding awarded through this Funding Opportunity will cover only the first 12-month budget period of the three-year period of performance, applicants must still submit an estimated budget for each budget period (years 1, 2, and 3), using the funding allocation for the FFE state(s) it will propose to serve as provided in Table 1: FFE State

16 Actual funding available to awardees from HHS during years 2 and 3 of this 36-month project period will be determined based on the total amount of funding made available to the Navigator program for the 12-month budget period, as well as each awardee’s performance during the prior budget period(s), as outlined in Section A4. Program Requirements, Continued Funding. As a result, individual award amounts during years 2 and 3 may be higher or lower than the amount awarded for the first 12-month budget period and is not appealable.

mailto:Navigatorgrants@cms.hhs.gov https://goto.webcasts.com/starthere.jsp?ei=1418490&tp_key=a3299cfc8e https://goto.webcasts.com/starthere.jsp?ei=1470197&tp_key=d748689859

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Funding Allocations below. Each applicant is eligible for only one cooperative agreement award, so long as the state(s) in which they are awarded cooperative agreement funds remains a FFE.

For Years 2 and 3 of the period of performance, awardees will be able to revise their budgets, based on actual funding available to HHS and current program priorities, as part of their non-competing continuation applications, which will be required from all awardees for continued funding of their award during the 36-month period of performance.

For the first 12-month budget period, each FFE service area (state) will receive an apportionment of the $80,000,000 in total available funding in the amounts listed in Table 1: FFE State Funding Allocations below, with a minimum of $1,000,000 available per FFE state.

Table 1: FFE State Funding Allocations ($1,000,000 minimum available per FFE state)

FFE State Total Number of

Uninsured (under 65) 17

FFE QHP

Selections

(2021 Plan Year) 18

Total Funding Apportioned to FFE

State19

Alabama 242,100 169,119 $1,842,245

Alaska 45,500 18,184 $1,000,000

Arizona 382,600 154,504 $2,340,415

Delaware 30,900 25,320 $1,000,000

Florida 1,608,000 2,120,350 $14,532,590

17 See Health Insurance Coverage in the United States: 2019, US Census Bureau, September 15, 2020, https://www.census.gov/library/publications/2020/demo/p60-271.html. This report presents statistics on health insurance coverage in the United States based on information collected in the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) and the American Community Survey (ACS).

18 See 2021 Marketplace Open Enrollment Period Public Use Files, available here: https://www.cms.gov/research-statistics-data-systems/marketplace-products/2021-marketplace-open-enrollment-period-public-use-files.

19 Should a state not currently included in this list revert from a State-based Exchange (SBE) or SBE using the Federal Platform (SBE-FP) to an FFE, CMS will determine how to establish funding for a Navigator program in that state at that time.

https://www.census.gov/library/publications/2020/demo/p60-271.html https://www.cms.gov/research-statistics-data-systems/marketplace-products/2021-marketplace-open-enrollment-period-public-use-files https://www.cms.gov/research-statistics-data-systems/marketplace-products/2021-marketplace-open-enrollment-period-public-use-files

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Uninsured (under 65) 17

FFE QHP

Selections

(2021 Plan Year) 18

Total Funding Apportioned to FFE

State19

Georgia 711,600 517,113 $4,913,575

Hawaii 23,600 22,903 $1,000,000

Illinois 404,300 291,215 $3,218,700

Indiana 272,100 136,593 $1,846,845

Iowa 76,100 59,228 $1,000,000

Kansas 137,800 88,627 $1,017,470

Louisiana 199,000 83,159 $1,263,650

Michigan 298,200 267,070 $2,640,160

Mississippi 200,000 110,966 $1,330,800

Missouri 256,700 215,311 $2,138,790

Montana 53,000 44,711 $1,000,000

Nebraska 63,500 88,688 $1,000,000

New Hampshire 59,100 46,670 $1,000,000

North Carolina 650,100 535,803 $4,951,640

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Uninsured (under 65) 17

FFE QHP

Selections

(2021 Plan Year) 18

Total Funding Apportioned to FFE

State19

North Dakota 32,000 22,709 $1,000,000

Ohio 412,800 201,069 $2,705,270

Oklahoma 255,700 171,551 $1,884,390

South Carolina 301,200 230,050 $2,373,980

South Dakota 47,300 31,375 $1,000,000

Tennessee 376,300 212,052 $2,585,590

Texas 2,808,000 1,291,972 $13,843,410

Utah 138,100 207,911 $1,668,605

West Virginia 60,400 19,381 $1,000,000

Wisconsin 205,800 191,702 $1,901,875

Wyoming 50,700 26,728 $1,000,000

The formula used to calculate each FFE state’s allotment in the aforementioned Table 1: FFE State Funding Allocations incorporates the number of uninsured eligible residents under age 6520 and the number of individuals enrolled in individual market Exchange coverage in the FFEs.

20 See https://www.census.gov/library/publications/2020/demo/p60-271.html: “For all analyses, the population is restricted to the civilian, noninstitutionalized population. For reporting purposes, the Census Bureau broadly classifies health insurance coverage as private insurance or public insurance.”

https://www.census.gov/library/publications/2020/demo/p60-271.html

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This formula takes into account that Navigators will be working with uninsured individuals, as well as consumers currently enrolled in Exchange coverage. This formula is also intended to help HHS apportion funding to enable awardees to fulfill the full scope of responsibilities as FFE Navigators.

To obtain the portion (in percent) of the eligible uninsured in a given FFE state for the first 12-month budget period of the period of performance, the total number of uninsured (under age 65) eligible residents in each FFE state was divided by the total number of uninsured eligible residents among all FFE states. To obtain the portion (in percent) of consumers enrolled in QHP coverage in a given FFE state for the first applicable 12-month budget period of the 36-month period of performance, the total number of consumers enrolled in QHP coverage through a given FFE during the 2021 open enrollment for the individual market was divided by the total number of consumers enrolled in QHP coverage during the 2021 open enrollment for the individual market among all states with an FFE. The total funding amount available through this Funding Opportunity was then apportioned according to each FFE state’s portion of uninsured eligible residents and portion of consumers enrolled in QHP coverage through the FFEs in 2021. In cases where a FFE state’s apportionment was less than $1,000,000, funding was rounded up to $1,000,000 by proportionately reducing funding from all FFE states with apportionments larger than $1,000,000. The funding apportionment formula and funding table will be updated in subsequent budget periods based on funding availability and new data (if available). Updates to the funding allocation formula and funding table will be communicated to recipients as a part of the Non-Competing Continuation Application process.

The amount of funding being requested by an applicant within a FFE for the first 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 $1,000,000 of the appropriated funds in the aforementioned Table 1: FFE State Funding Allocations, for the first 12-month budget year.

Alternatively, an applicant only proposing to serve part of the State of Alaska could apply for less than the total amount of appropriated funds in their FFE state, allowing multiple applicants (if available) to be selected for an 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.

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Continued funding throughout the 36-month period of performance will be contingent on the following:

• Timely and complete submission of the annual non-competing continuation applications,

• Strong performance (see Section A4. Program Requirements) during the previous budget period(s),

• Funding availability,

• Current program priorities, and

• The awardee’s ability to continue meeting all eligibility requirements laid out in this Funding Opportunity, including continuing to serve in a state(s) with an FFE.

In subsequent funding cycles, awardees could receive decreased funding, or their cooperative agreement could be terminated, due to poor performance. This Funding Opportunity 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:

• Total funding available to the Navigator program;

• Annual rate of uninsured;

• Current program priorities;

• Number and quality of eligible Navigator cooperative agreement applicants for a given

FFE;

• Size and scope of the underserved or vulnerable population(s) a Navigator cooperative agreement applicant proposes to reach within the FFE(s) it proposes to serve; 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 reasonableness of performance metrics (project) 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

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• The availability of remaining funds for the Exchange service area(s) which an award is made.

CMS reserves the right to conduct pre-award Negotiations with potential awardees. Based on this review, CMS will determine which applicants will receive cooperative agreement awards and, consistent with the guidelines outlined in Section A. Program Requirements, the dollar amount of each award. Successful applicants will receive one cooperative agreement award based on this Funding Opportunity.

CMS decisions regarding funding levels for each of the FFEs, as established in the aforementioned Table 1: FFE State Funding Allocations, 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 appealable21. Please also note that awardees cannot receive more funding than requested in their application and may not apply for more than the maximum amount allocated for the FFE state(s) it proposes to serve, as noted in Table 1: FFE State Funding Allocations.

B3. Anticipated Award Dates

The anticipated award date is August 27, 2021.

B4. Period of Performance

The anticipated period of performance, also known as the project period, is 36 months from the date of the notice of award and funded in 12-month increments called budget periods.

B5. Number of Awards

HHS estimates the number of awards to be 85 to120. 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 is anticipated. The difference between grants and cooperative agreements is the degree of Federal programmatic involvement rather than the type of administrative requirements imposed.

21 See https://sam.gov/ https://sam.gov/fal/151a93292f7840609ed49006e3cbfee4/view

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Therefore, statutes, regulations, policies, and the information contained in the HHS Grants Policy Statement22 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 Section 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 an FFE, as outlined in statute, regulations, and this announcement (see Section A. Program Description).

Eligible applicants include:

Government Organizations

State governments

County governments

City of Township governments

Special District governments

Native American tribal governments (Federally recognized) Native American tribal organizations (other than federally recognized tribal governments)

Education Organizations

Independent School Districts

Public and State Controlled Institutions of Higher Education

Private institutions of higher education

Public Housing Organizations

Public housing authorities

Indian housing authorities

Nonprofit Organizations

22 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.

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Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education

Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education

Other Eligible Applicants

For-profit Businesses (organizations other than small businesses)

Small Businesses

Individuals

Others (see below)

Under section 1311(i)(2)(B) of the ACA, eligible entities may include, but are not limited to, community and consumer-focused nonprofit groups; trade, industry, and professional associations; commercial fishing industry organizations; ranching and farming organizations;

chambers of commerce; unions; resource partners of the Small Business Administration; other public or private entities or individuals that meet the requirements of this section. Other entities may include but are not limited to Indian tribes, tribal organizations, urban Indian organizations, Alaska Natives, and State or local human service agencies, other licensed insurance agents and brokers23 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 subrecipients24 in order to target a larger total portion of the underserved or

23 ACA 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).

24 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 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.

2021-06-03 Page 24 of 102 vulnerable populations. 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.

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

• Demonstrate that they have existing relationships in the communities they expect to target, or could readily establish those relationships25, including relationships with uninsured and underinsured consumers, and with a particular emphasis on those populations which the Exchange has identified in this Funding Opportunity as being vulnerable or underserved (see Section A4. Program Description);

For purposes of this Funding Opportunity, the Exchange will consider a population to be underserved or vulnerable using factors such as race or ethnicity, gender, education or income, disability, geographic location (e.g., rural or urban), or sexual orientation. Examples of underserved or vulnerable populations include, but are not limited to26:

• Racial and ethnic minorities

• Rural communities

• Lesbian, gay, bi-sexual, transgender, queer, and other (LGBTQ+) individuals

• Low income or homeless individuals

• American Indians and Alaska Natives (AI/AN)

• People with physical or intellectual disabilities or cognitive, hearing, speech, and/or vision impairments

• Pregnant women, new mothers, and women with children

• Individuals with mental health or substance-related disorders

• Individuals with HIV/AIDS

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

25 See ACA Section 1311(i)(2): https://sites.google.com/site/healthreformnavigator/ppaca-sec-1311, and CMS regulations at 155.210(c).

26 See Serving Vulnerable and Underserved Populations (Oct. 15, 2020), at: https://marketplace.cms.gov/technical-assistance-resources/training-materials/vulnerable-and-underserved-populations.pdf https://sites.google.com/site/healthreformnavigator/ppaca-sec-1311 https://marketplace.cms.gov/technical-assistance-resources/training-materials/vulnerable-and-underserved-populations.pdf https://marketplace.cms.gov/technical-assistance-resources/training-materials/vulnerable-and-underserved-populations.pdf

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Applicants may propose additional underserved or vulnerable populations in their applications for the FFE’s approval;

• Demonstrate their past successes leveraging local community partnerships and…