Connecting Kids to Coverage (CKC).pdf

Department of Health and Human Services

Centers for Medicare & Medicaid Services

Center for Medicaid and CHIP Services

HEALTHY KIDS Funding Opportunity:

Connecting Kids to Coverage (CKC)

HEALTHY KIDS AI/AN 2020

Outreach and Enrollment Cooperative Agreements

Focused on Increasing the Enrollment and Retention of American Indian/Alaska Native

Children in Medicaid and CHIP

Initial Announcement

Cooperative Agreement

Funding Opportunity Number: CMS-2D2-20-001

CFDA: 93.767

Date: July 17, 2019

Applicable Dates:

FOA Posting Date: July 17, 2019

Letter of Intent to Apply Due Date: August 19, 2019

Electronic Cooperative Agreement Application Due Date: September 16, 2019 Anticipated Announcement of Awards: December 18, 2019

Anticipated Cooperative Agreement Period of Performance: January 2, 2020 through December 31, 2022

Applicant Teleconference: August 13, 2019 Conference Call Time: 3:00 pm

Please visit https://www.insurekidsnow.gov/ for the applicant teleconference call information and additional information regarding this announcement

Table of Contents

I. EXECUTIVE SUMMARY

II. PROGRAM DESCRIPTION

1. Purpose ………………………………………………………………………..7

2. Authority ………………………………………………………………………..8

3. Background

4. Program Requirements ……………………………………………………………10

III. FEDERAL AWARD INFORMATION

1. Total Funding

2. Award Amount

3. Anticipated Award Dates

4. Period of Performance

5. Number of Awards

6. Type of Award

7. Type of Competition

IV. ELIGIBILITY INFORMATION

1. Eligible Applicants

2. Cost Sharing or Matching and Maintenance of Outreach Funding

3. Mandatory Letter of Intent

4. Ineligibility Criteria

5. Single Application Requirement

6. Continued Eligibility

7. CMS/Grantee Collaboration

8. EIN, DUNS, and SAM Regulations

9. Foreign and International Organizations

10. Faith Based Organizations

V. APPLICATION and SUBMISSON INFORMATION

1. Application Package

2. Content and Form of Application Submission

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

4. Mandatory Letter of Intent

5. Intergovernmental Review

6. Cost Restrictions

7. Mandatory Disclosure ……………………………………………………………27

VI. APPLICATION REVIEW INFORMATION

1. Criteria

2. Review and Selection Process

3. Anticipated Award Date

VII. AWARD ADMINISTRATION INFORMATION

1. Federal Award Notices

2. Administrative and National Policy Requirements

3. Terms and Conditions

4. Cooperative Agreement Terms and Conditions of Award

5. Reporting…………………………………………………………………………..39

VIII. AGENCY CONTACTS

IX. APPENDICES

APPENDIX A: Inreach and Outreach Activities to Consider

APPENDIX B: Using Parents of Medicaid or CHIP-enrolled Children as Mentors to Parents of Uninsured Children

APPENDIX C: Guidance for Preparing a Budget Request and Narrative

APPENDIX D: Application and Submission Information

APPENDIX E: Application Check-Off List Required Contents

APPENDIX F: Definitions of Frequently Used Terms

APPENDIX G: Letter of Intent to Apply

APPENDIX H: Accessibility Provisions

APPENDIX I: Business Assessment of Applicant Organization

APPENDIX J: Review and Selection Process

I. EXECUTIVE SUMMARY

The Connecting Kids to Coverage HEALTHY KIDS American Indian and Alaska Native (AI/AN) 2020 Outreach and Enrollment Cooperative Agreements program provides funding opportunities to increase the enrollment and retention of American Indian/Alaska Native (AI/AN) children who are eligible for, but not enrolled in, Medicaid and the Children’s Health Insurance Program (CHIP). This program is authorized under Section 2113 of the Social Security Act, as amended by Section 3004(a) of the Helping Ensure Access for Little Ones, Toddlers and Hopeful Youth by Keeping Insurance Delivery Stable Act (referred to as the HEALTHY KIDS Act and included in Pub. L. 115-120) and by Section 50103 of the Advancing Chronic Care, Extenders, and Social Services Act (referred to as the ACCESS Act and included in Pub. L. 115-123). This announcement focuses on increasing the participation of eligible AI/AN children in Medicaid and CHIP because this population of children has the highest uninsurance rate compared to other U.S.

populations.1

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

CMS Awarding Center: Center for Medicaid and Children’s Health Insurance Program (CHIP) Services

Notice of Funding Opportunity Title: Connecting Kids to Coverage HEALTHY KIDS AI/AN 2020 Outreach and Enrollment Cooperative Agreements Focused on Increasing the Enrollment of American Indian/Alaska Native Children in Medicaid and CHIP

Authorization: Section 2113 of the Social Security Act, amended by Section 3004(a) of the Helping Ensure Access for Little Ones, Toddlers and Hopeful Youth by Keeping Insurance Delivery Stable Act (referred to as the HEALTHY KIDS Act and included in Pub. L. 115-120) and by Section 50103 of the Advancing Chronic Care, Extenders, and Social Services Act (referred to as the ACCESS Act and included in Pub. L. 115-123).

Funding Opportunity Type: New

Funding Opportunity Number: CMS-2D2-20-001

Type of Award Cooperative Agreement

Haley, Jennifer, Genevieve Kenney, Robin Wang, Clare Pan, Victoria Lynch, and Matthew Buettgens. Uninsurance and

Medicaid/CHIP Participation among Children and Parents. September 2018. The Urban Institute.

https://www.urban.org/sites/default/files/publication/99058/uninsurance_and_medicaidchip_participation_among_childre n_and_parents_updated_1.pdf

Catalog of Federal Domestic Assistance: 93.767

Letter of Intent to Apply Due Date: August 19, 2019

Application Due Date and Time: September 16, 3:00 p.m. Eastern (Baltimore MD) Standard Time (EST)

Anticipated Issuance Notice of Award: January 2, 2020

Anticipated Period of Performance Period: 36 months

Anticipated Total Available Funding: $6 million

Estimated Number of Awards: 8-10

Estimated Award Amount: $250,000 up to $750,000

Eligible Applicants: This funding opportunity is open to the following individual eligible entities, or coalitions headed by eligible entities:

a. Indian Health Service (IHS) Providers

b. Tribes and Tribal organizations operating a health program under a contract or compact with the Indian Health Service under the Indian Self- Determination and Education Assistance Act (ISDEAA) (P.L. 93- 638, as amended)

c. Urban Indian organizations operating a health program under the Indian Health Care Improvement Act (IHCIA)(P.L. 94-437, as amended)

II. PROGRAM DESCRIPTION

This notice of funding opportunity (NOFO) seeks applications for the Connecting Kids to Coverage HEALTHY KIDS AI/AN 2020 Outreach and Enrollment Cooperative

Agreements Focused on Increasing Enrollment of American Indian/Alaska Native

Children (HEALTHY KIDS AI/AN 2020 Cooperative Agreements). Eligibility for this NOFO is limited to applicants who are either Indian health care providers or tribal entities as defined in the chart above.

These grants will support innovative outreach strategies aimed at increasing the enrollment and retention of eligible AI/AN children in Medicaid and CHIP, emphasizing activities tailored to communities where AI/AN children and families reside, and enlisting tribal and other community leaders and tribal health and social services programs that serve eligible AI/AN children and families.

Engagement with the tribal community is important because AI/AN families are sometimes reluctant to enroll in Medicaid and CHIP because they can receive health care directly from their local tribal hospitals and clinics. However, when AI/AN families enroll in Medicaid and CHIP, the entire tribal community benefits from increased access to care.

When AI/AN children and families sign up for Medicaid and CHIP, the Indian health hospitals and clinics can bill these programs for services provided. This brings money into the health care facility which is then used to hire more staff, pay for new equipment, and renovate buildings. When AI/AN children and families enroll in Medicaid and CHIP, they are not only helping themselves, but they are supporting their Indian health hospital and clinics.

These cooperative agreements will also support outreach strategies similar to those conducted in previous Connecting Kids to Coverage (CKC) grant cycles, such as activities designed to help families understand application procedures and health coverage opportunities in Medicaid and CHIP. All funded projects should incorporate both initial application and renewal assistance into their proposed activities. Based on past experiences of successful enrollment of AI/AN families, applications should also incorporate providing one-on-one assistance to families seeking to enroll their children in health coverage or linking families with groups or individuals in the community who are trained to provide such direct application assistance. As with previous rounds of cooperative agreements, grantees will also be required to participate in key outreach initiatives coordinated by the Connecting Kids to Coverage National Campaign (the National Campaign). The National Campaign provides outreach training and support for grantees and other partners who are working to help enroll eligible children in Medicaid and CHIP.

1. Purpose

The HEALTHY KIDS Act provides $120 million for activities aimed at reducing the number of children who are eligible for, but not enrolled in, Medicaid and CHIP, and improving retention of enrolled children for fiscal years 2018-2023.

Of the total $120 million in funding, 10 percent will be set aside for outreach to American Indian/Alaska Native (AI/AN) children in accordance with section 2113(b)(3) of the Act, 10 percent will be set aside for the National Campaign in accordance with section 2113(h) of the Act, and the remainder will be awarded for outreach and enrollment of uninsured children and their parents. On November 30, 2018, CMS issued the Connecting Kids to Coverage HEALTHY KIDS 2019 Outreach and Enrollment Cooperative Agreement NOFO, which made available $48 million in cooperative agreements to states, local governments, Indian tribes, tribal consortium, urban Indian organizations receiving funds under title V of the Indian Health Care Improvement Act, federal health safety net organizations, community-based organizations, faith-based organizations, and schools for fiscal years 2024-2027. These awards were announced in June 2019. While the HEALTHY KIDS 2019 Outreach and Enrollment Cooperative Agreement NOFO broadly targeted the enrollment and retention of all eligible children in Medicaid and CHIP, this specific NOFO is focused on the enrollment and retention of eligible AI/AN children.

This specific NOFO makes available $6 million in grants to Indian tribes, tribal coalitions, tribal organizations operating a health program under a contract or compact with IHS under ISDEAA, urban Indian organizations, and IHS providers for use during calendar years 2020-2022. The complete list of eligible entities can be found in the Executive Summary of this NOFO.

This HEALTHY KIDS Act funding for outreach and enrollment grants will build upon successful strategies facilitated by previous Connecting Kids to Coverage (CKC) grant funding initiatives under the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 (Pub. L. 111-3), the Patient Protection and Affordable Care Act (ACA) of 2010 (Pub. L. 111-148), and the Medicare Access and CHIP Reauthorization Act (MACRA) (Pub. L. 114-10). To date, CHIPRA, the ACA, and MACRA provided the Centers for Medicare and Medicaid Services (CMS) with funding to award $162 million to eligible entities to support the enrollment and retention of eligible children in Medicaid and CHIP. This funding has been disbursed through four cycles of grants that were broadly targeted to eligible but unenrolled children, and three rounds of grants that were specifically targeted to AI/AN children. In addition, as announced in June 2019, the HEALTHY KIDS Act made available $48 million to 39 eligible entities to broadly target the enrollment and retention of eligible children in Medicaid and CHIP.

Since 2009, CKC enrollment grants have been awarded to over 269 community-based organizations, states, and tribal and local governments. Community-based organization awardees have included health care providers, schools, tribal organizations, and other types of nonprofits. Community-based organizations typically have access to and credibility with low-income families in their communities, making them indispensable partners for carrying out specialized strategies to target the hard-to-reach children who remain uninsured.

Grantees implemented a variety of outreach and enrollment strategies aimed at educating families about the availability of Medicaid and CHIP, identifying children likely to be eligible for these programs, and directly assisting families with the application and renewal process. For example, grantees used mobile enrollment strategies to provide one-on-one direct assistance to families living in rural areas, and worked closely with partners, often leveraging partners’ service sites, community relationships, and other resources to reach more children and families.

Beginning in 2016, applicants were encouraged to include parents in outreach and enrollment efforts because a large body of research suggests this is effective in increasing children’s enrollment and access to care. Grantees also participated in key initiatives coordinated by the National Campaign, such as back-to-school outreach efforts.

The National Campaign also continues under the HEALTHY KIDS Act to provide resources for outreach training and support for grantees and partner organizations. The National Campaign, led by CMS, 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. Most materials are available in English and Spanish, and some are available in other languages as well. The National Campaign regularly conducts training webinars on key outreach and enrollment topics and also augments media outreach in selected target markets. All materials produced by the National Campaign, including recordings of all past webinars along with information about previous grantees, are available at https://www.InsureKidsNow.gov

The CMS Division of Tribal Affairs has additional outreach and education materials specifically designed for the AI/AN population that can be found at:

http://go.cms.gov/AIAN-OutreachEducationResources.

2. Authority

Section 2113 of the Social Security Act, amended by Section 3004(a) of the Helping Ensure Access for Little Ones, Toddlers and Hopeful Youth by Keeping Insurance Delivery Stable Act (referred to as the HEALTHY KIDS Act and included in Pub. L. 115-120) and by Section 50103 of the Advancing Chronic Care, Extenders, and Social Services Act (referred to as the ACCESS Act and included in Pub. L. 115-123).

3. Background

Since 2009, the nation has made substantial progress on reducing the number of uninsured children and enrolling eligible children in Medicaid and CHIP. The rate of uninsured children fell from 7.0 percent in 2013 to an all-time low of 4.3 percent in 2016, and just over 3.3 million children remained uninsured.2

The researchers attribute these achievements to the efforts states have made to streamline eligibility, verification, enrollment and renewal rules and procedures, and also to state and community-based outreach efforts. Since January 1, 2014, states have made significant changes to their Medicaid and CHIP eligibility determination policies, procedures and systems. Progress has been made to ensure that application and enrollment processes and systems are seamless across insurance affordability programs, including Medicaid, CHIP, and Qualified Health Plans (QHP) through the Exchanges. States have also improved the renewal process for Medicaid and CHIP enrollees by using a data-driven redetermination process. States must use available data sources to determine eligibility without contacting enrollees, if possible, in accordance with 42 CFR 435.916 and 457.343.

If additional information is needed to determine eligibility, the state must send a renewal form pre-populated with information available to the agency. Other crucial components involve providing families and individuals applying for health insurance with reliable information and direct application assistance.

While this progress is significant, an Urban Institute analysis shows that there are still approximately 1.9 million children eligible for Medicaid and CHIP but not enrolled.3 Recent improvements have narrowed gaps in coverage, yet coverage disparities persist. For example, AI/AN children continue to experience the highest uninsured rate compared to other U.S populations, 8.0 percent in 2016, as compared to the national average of 4.3 percent. In addition, a recent analysis of data from the American Community Survey found that for the first time in a decade the uninsurance rate for children increased in 2017. The share of children without health insurance increased from 4.7 percent in 2016 to 5 percent in 2017.

This translates to approximately 276,000 more children who were uninsured in 2017 than in the previous year.4

In short, there is more work to be done to reduce health coverage disparities and reach the remaining eligible uninsured children

Haley, Jennifer, Genevieve Kenney, Robin Wang, Clare Pan, Victoria Lynch, and Matthew Buettgens. Uninsurance and Medicaid/CHIP Participation among Children and Parents. September 2018. The Urban Institute.

https://www.urban.org/sites/default/files/publication/99058/uninsurance_and_medicaidchip_participation_among_chi ldren_and_parents_updated_1.pdf 3 Ibid.

Alker, Joan, Pham, Olivia. Nation’s Progress on Children’s Health Coverage Reverses Course. November 2018.

Georgetown University Health Policy Institute Center for Children and Families.

https://ccf.georgetown.edu/2018/11/21/nations-progress-on-childrens-health-coverage-reverses-course/

Thus, the outreach and enrollment activities of CKC grantees remain fundamental to enrolling and retaining eligible children in Medicaid and CHIP, especially AI/AN children who experience among the highest rates of uninsurance.

4. Program Requirements

Planning Period

All awardees will be given a 90 day planning period to ensure that needed project leadership is engaged and the identified employees are fully trained and available to work on the cooperative agreement. CMS will allow grantees to use cooperative agreement funds to employ individuals and begin operations during this time.

However, full funding for the first year of the budget period will be restricted until the grantee demonstrates full staffing and readiness to begin operations. CMS will work with all awardees to evaluate their readiness and to provide full or conditional approval for further funding.

CMS may waive or reduce the 90 day planning period, and the restriction of first year funding if the awardee’s outreach and enrollment efforts, as specified in this funding opportunity, and as detailed in the grantee’s approved application, are well established with all project leadership, staffing, and support already in place.

During this planning period, CMS will hold one initial program launch meeting for all grantees. The date and time of this meeting will be announced after the awards are made. Applicants should budget for the project director and another key staff member to travel to Baltimore, Maryland, to participate in person for this one day meeting. See APPENDIX C: Guidance for Preparing a Budget Request and Narrative for additional information.

Project Activities

Grants awarded under the cooperative agreement will fund activities/strategies aimed at educating families about 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, including parents, to apply for coverage.

Funds will also support efforts to assist families with the annual renewal process.

Outreach must be targeted to settings where eligible AI/AN children may be easily identified and their families assisted with the application and renewal process.

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

o Partnering with tribal programs that work with children and families;

o Engaging schools and other programs serving young people in outreach, enrollment and retention activities;

o Establishing and developing application assistance resources to provide high quality, reliable Medicaid/CHIP enrollment and renewal services in local and tribal communities; and o Using parent mentors to assist families with enrolling in Medicaid and CHIP, retaining coverage and finding resources for addressing social determinants of health.

Grantees will be required to participate in National Campaign activities and adopt strategies promoted by the National Campaign that may include:

o Increasing awareness about children’s health coverage under Medicaid and CHIP, with respect to eligibility and how families can enroll their children and teens and keep them enrolled for as long as they qualify;

o Motivating families and providing opportunities to enroll and renew coverage for their eligible children and teens in Medicaid and

CHIP;

o Designing and promoting outreach and enrollment activities that can be adapted for tribal and community settings; and o Increasing awareness about opportunities for parents to be covered under Medicaid.

In particular, grantees will be required to work with the National Campaign on special initiatives designed to capitalize on key outreach opportunities such as the Back-to-School season each year, when families are thinking about enrollment in health insurance coverage. Other initiatives may include, but are not limited to, National Children’s Dental Health Month (February), National Child Abuse Prevention Month (April), National Child Health Day (first Monday each October), National Rural Health Day (November 15) and National Native American Heritage Month in November.

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. All materials produced by the National Campaign, including recordings of all past webinars along with information about previous grantees, are available at https://www.InsureKidsNow.gov.

The CMS Division of Tribal Affairs has Medicaid and CHIP fact sheets that can be customized for use by grantees. For more information on how these fact sheets can be customized please visit: https://www.cms.gov/Outreach-and- Education/American-Indian-Alaska-Native/AIAN/Outreach-and- Education/pdf/DTA_FactSheet_Customization_Guide_6-21_508.pdf and for additional resources including culturally appropriate outreach and education materials developed for AI/ANs of all ages please visit: http://go.cms.gov/AIAN- OutreachEducationResources.

All applicants should take these additional factors into consideration when designing proposals:

o To be most effective, outreach efforts should link families to direct

(one-on-one) enrollment and renewal support.

o Providing assistance with online applications and providing renewal support can make enrollment and retention more efficient, effective, and consumer-friendly.

o While the emphasis of the HEALTHY KIDS AI/AN 2020 Outreach and Enrollment Cooperative Agreements remains focused on enrolling eligible AI/AN 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.5 Appropriate messaging and strategies that help enroll eligible parents can also facilitate the enrollment of eligible children.

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.

o The HEALTHY KIDS Act amended Section 2113(f) of the Act to expand the types of organizations eligible for cooperative agreement awards to include organizations that use parent mentors. Parents who have at least one Medicaid or CHIP-enrolled child can serve as mentors to parents of uninsured children during the application and renewal process. Parent mentors educate families with uninsured children about health insurance coverage, and assist with completing and submitting applications for health insurance coverage. They can also provide guidance on identifying medical and dental homes and community pharmacies for children, provide assistance and referrals to successfully address social determinants of children’s health, and act as a liaison between the families and the state. One study showed

5 Hudson, Julie, Asako Moriya, “Medicaid Expansion for Adults Had Measureable ‘Welcome Mat’ Effects on Their Children,” Health Affairs, 36 no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0347 that the use of parent mentors was more effective than traditional methods in insuring children, achieving faster coverage, and renewing coverage.6 Applicant organizations may wish to work with parent mentors as a strategy to increase the participation of eligible, particularly hard-to-reach, children in Medicaid and CHIP (Please see Appendix B for more information).

Data and Reporting Requirements

Grantees will be required to collect and report to CMS data related to their goals and accomplishments for this funding opportunity. Such data will demonstrate the outcomes that result directly from this funding opportunity, and will also be used to help evaluate the success of outreach and enrollment strategies and identify areas that need improvement or mid-course corrections. All grantees will be responsible for collecting and reporting particular data elements (presented below). All required data must be reported to CMS by adhering to a detailed data dictionary and uploading the required data to a web-based portal provided by CMS. If the grantees are unable to report the data according to the specifications indicated in the data dictionary, the data limitations must be described. Grantees will be provided with reporting tools for the submission of all required data and reporting elements. Grantees may also report additional data that illustrates their progress in increasing the participation of eligible children in Medicaid and

CHIP.

The required data that all grantees must report on a monthly basis include:

o Number of AI/AN children for whom an application for health coverage has been submitted as a direct result of CKC funding o Number of AI/AN children verified to be newly enrolled in Medicaid or CHIP as a direct result of CKC funding o Number of AI/AN children for whom the grantee submitted a renewal form for Medicaid or CHIP coverage o Number of AI/AN children verified to be renewed in Medicaid or CHIP as a direct result of CKC funding o The outreach and enrollment activities completed during the month

The following data must be reported on a monthly basis only if the applicant proposes to target parents with CKC funds:

o Number of parents for whom an application for health coverage has been submitted as a direct result of CKC funding o Number of parents verified to be newly enrolled in Medicaid as a

6 Flores G., Lin H., Walker C, et al. Parent Mentors and Insuring Uninsured Children: A Randomized Controlled Trial. Pediatrics. 2016; 137(4): e 0153519; Flores G., Lin H., Walker C, et al. Parent Mentoring Program Increases Coverage Rates for Uninsured Latino Children. Health Affairs. 2018; 37(3); 403–412.

direct result of CKC funding o Number of parents for whom the grantee submitted a renewal form for

Medicaid coverage o Number of parents verified to be renewed in Medicaid as a direct result of CKC funding

CMS may require the reporting of additional data elements over the course of the cooperative agreement in order to fully assess grantee performance.

Grantees will be required to verify which children are enrolled or renewed in coverage as a result of CKC funding. To the extent possible, the best way to verify new enrollments and successful renewals is with the state or county Medicaid and/or CHIP agencies and applicants are encouraged to partner with one or more of these entities. This would typically require the establishment of a detailed Memorandum of Understanding (MOU) or other data-sharing agreement between the grantee and the relevant state or county Medicaid/CHIP agencies that allow grantees to submit detailed identifying information about the people they have assisted and receive verifications in response. Applicants must describe their plans to secure an MOU or other data-sharing agreement with the state or county Medicaid/CHIP agencies within the 90 day planning period after the cooperative agreement is awarded.

Although some tribal, urban and IHS health care providers have the ability to verify patient insurance status through partnerships with states and counties for verifying enrollment in Medicaid and CHIP, that may not be the case in all states and counties. Because CMS recognizes that it may not always be possible to obtain data from state or county sources, CMS will provide technical assistance and work with the grantee on alternative data verification options.

If the applicant anticipates they will not be able to obtain a MOU, they should identify other alternative methods for verifying new enrollments and renewals that do not depend on cooperation by state or county agencies and that can be implemented with the requested funding. Successful grantees have employed a variety of alternative methods to validate the required data. In some cases, the grantee contacted the potential enrollee to verify if the potential enrollee was indeed enrolled or renewed into Medicaid or CHIP. In other cases, grantees utilized a state-maintained insurance database to verify insurance status of those they assisted.

If the grantee does not obtain an MOU, or create and implement a well-designed and effective alternative data methodology after working with CMS during the 90 day planning period, CMS may terminate the award for failing to have a process in place to collect and report the required data elements.

Please note, all applications, enrollments, and renewals reported should be directly attributable to this cooperative agreement. For example, if a CKC grantee also receives funding from another source and such funds are used to support FTEs for enrollment and retention activities, only enrollment and renewal data attributed to this funding should be reported on the monthly progress reporting tool. The semi-annual report progress tool will allow grantees to submit qualitative data on additional cooperative agreement outcomes, including enrollment and renewal data attributable to FTEs funded from other sources.

CMS will work with grantees during the planning period to assure all grantees are able to meet the data and reporting requirements.

III. FEDERAL AWARD INFORMATION

1. Total Funding

The total amount of federal funds available is anticipated to be $6,000,000.

2. Award Amount

The amount of each cooperative agreement award made to eligible applicants may range from $250,000 up to $750,000 for the three year period of performance, with the award amount commensurate with enrollment and renewal targets.

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.

4. Anticipated Period of Performance

There will be a three year project period of performance for each Cooperative Agreement awarded. There will be three one-year budget periods for the period of performance from January 2, 2020 to December 31, 2022.

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 approximately 8-10 cooperative agreements.

6. 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. 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 (see also VII. 4.

Cooperative Agreement Terms and Conditions).

7. Type of Competition

There will be a competitive Funding Opportunity open to all eligible applicants identified below in section IV. 1. Eligible Applicants.

IV. ELIGIBILITY INFORMATION

1. Eligible Applicants

This Funding Opportunity is open to the following individual eligible entities, or coalitions headed by eligible entities:

a. Indian Health Service (IHS) Providers;

b. Tribes and Tribal organizations operating a health program under a contract or compact with the Indian Health Service under the Indian Self-Determination and Education Assistance Act (ISDEAA) (P.L. 93-638, as amended); and

c. Urban Indian organizations operating a health program under the Indian Health Care Improvement Act (IHCIA)(P.L. 94-437, as amended)

Former and current Connecting Kids to Coverage grantees (from Cycles I, II, III, or IV) or AI/AN grantees (from Rounds I, II, or III) submitting proposals under this NOFO 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, II, III, or IV or AI/AN grants may apply for a Connecting Kids to Coverage (HEALTHY KIDS AI/AN 2020) cooperative agreement if their proposal meets one of the following:

o New and distinct activities: A Cycle I, Cycle II, Cycle III, Cycle IV 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, Cycle IV or AI/AN grant, OR o Continuation of successful activities: A Cycle I, Cycle II, Cycle III, Cycle IV or AI/AN grantee that wishes to continue activities it is currently or previously conducted, may submit a proposal for a HEALTHY KIDS AI/AN 2020 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.

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 and

Submission Information.

Applicants are strongly encouraged to use the review criteria information provided in Section VI. Application Review Information, Section V. Application and

Submission Information, and Appendix II, Application and Submission

Information, to ensure that the application proposal adequately addresses all the criteria.

2. Cost Sharing/Matching and Maintenance of Outreach Funding

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

However, any outside funding that will be contributed to the outreach and enrollment effort by other entities must be mentioned in the Budget Narrative

3. Mandatory Letter of Intent

Applicants are required to submit a non-binding Letter of Intent to Apply (See Appendix IX). CMS reserves the right to consider an applicant ineligible without a timely Letter of Intent (LOI). The Letter of Intent enables CMS to better plan for the application review process. Letters of Intent to Apply should be submitted by email to CMS at healthykids@grantreview.org by August 19, 2019 3:00 p.m. Eastern (Baltimore) time. A copy of the letter of intent should be submitted under “Other Attachments” as part of the application submission and will not counted towards the page limit.

4. Ineligibility Criteria

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

5. Single Application Requirement

Only one application may be submitted by any given lead eligible entity for funding of a Connecting Kids to Coverage HEALTHY KIDS AI/AN 2020 cooperative agreement; however, an eligible entity may be a member of multiple applicant coalitions. Entities working together as a coalition shall submit one application. Only one HEALTHY KIDS AI/AN 2020 cooperative agreement will be awarded to a single eligible entity or to the lead agency of a coalition.

If an eligible entity submits more than one application, only the last eligible application submitted, before the stated deadline, will be accepted for review. All awardees must attest that they will not finance the same scope of work under more than one HEALTHY KIDS AI/AN 2020 cooperative agreement award or other federal or non-federal funding stream.

6. Continued Eligibility

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

Sections II. 4. Program Requirements and IV. 1. Eligible Applicants) throughout the period of performance and comply with the terms and conditions that will accompany the notice of award.

7. 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 NOFO;

c. Participate in monthly conference calls with the CMS Project Officer. The Project Director for the cooperative agreements is required to participate in these monthly calls.

d. Submit, in a timely manner, semi-annual reports to include all required data elements using the progress reporting tool provided by CMS (see Section II(4) for a description of the required data reporting process);

e. Submit, in a timely manner, monthly reports to include data on the number of applications submitted on behalf of the targeted populations, enrollments/renewals and data limitations etc.

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

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

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

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

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

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

8. EIN, DUNS, and SAM Regulations

In order to apply, all applicants are required to have a valid Employer Identification Number (EIN), otherwise known as a Taxpayer Identification Number (TIN); a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number;

and be registered in the System for Award Management (SAM) database (https://sam.gov/SAM) to be able to submit an application at grants.gov. See Appendix D for descriptions of EIN, DUNS, and SAM.

9. Foreign and International Organizations

Foreign and International Organizations are not eligible to apply.

10. Faith-Based Organizations

Faith-Based Organizations that do not meet the eligible applicant criteria above under Section IV. 1. are not eligible to apply.

V. APPLICATION and SUBMISSON INFORMATION

1. Application Package

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.

Application materials will be available at https://www.grants.gov. Please note that CMS requires applications for all announcements to be submitted electronically through the Grants.gov website. 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. Refer to Appendix II for additional details.

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

2. 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.

Applications determined to be ineligible, incomplete, and/or nonresponsive based on the initial screening may be eliminated from further review. However, in accordance with HHS Grants Policy, the CMS, Office of Acquisition and Grants Management (OAGM), Grants Management Officer in his/her sole discretion, may continue the review process for an ineligible application if it is in the best interests of the government to meet the objectives of the program.

Each application must include all contents 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 will be single-spaced and should follow the justifications and table formats provided in Appendix C, Guidance for Preparing a Budget Request and Narrative.

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 (including the Project Abstract Summary and Project Site Location Form), Copy of the previously submitted Letter of Intent, Application Cover Letter/Cover Page (if applicable), and the Indirect Cost Rate Agreement are 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/index.html o http://www.hhs.gov/ocr/civilrights/resources/laws/summaryguidance.ht ml o http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53 o http://www.hhs.gov/ocr/civilrights/understanding/section1557/index.ht ml 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

a. Standard 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 application:

1. Project abstract summary 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, targeted enrollment and retention goals for AI/AN children and parents (when applicable), and a description of how the funds will be used. Personal identifying information should also be excluded from the abstract. 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. In the Grants Application Package that can be found at www.Grants.gov, select the Project Abstract Summary and complete the form.

2. SF-424: Official Application for Federal Assistance

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

• On Item 15 “Descriptive Title of Applicant’s Project”, state the specific cooperative agreement opportunity for which you are applying: Connecting Kids to Coverage Outreach and Enrollment Cooperative Agreements Focused on Increasing Enrollment of American Indian/Alaska Native Children.

• Refer to section V. 5. Intergovernmental Review for item 19c.

3. SF-424A: Budget Information Non-Construction

4. SF-424B: Assurances-Non-Construction Programs

5. SF-LLL: Disclosure of Lobbying Activities.

All applicants must submit this document. Federal law prohibits the use of appropriated funds for publicity or propaganda purposes or for the preparation, distribution, or use of the information designed to support or defeat legislation pending before Congress or state legislatures. For more information, please see here. If your entity does not engage in lobbying with funds from any source, 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 used 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. However, this form is required as part of your application package and must be submitted for your application to be considered eligible for review.

6. Project Site Location Form(s)

All applicants must submit this form. 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. This form is required as part of your application package and must be submitted for your application to be considered eligible for review.

b. Project Narrative Requirement

The applicant must provide a Project Narrative that articulates in detail the proposed goals, measurable objectives, and milestones to be completed in accordance with the instructions and content requirements provided below and the specific criteria described in the Review Criteria, Section VI. 1. of this NOFO.

Please include the title “Project Narrative’’ at the beginning of the Project Narrative.

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”.

c. Budget Narrative Requirement

For more information on completing the budget narrative, please see Appendix C, 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 that are consistent with HEALTHY KIDS AI/AN 2020 cooperative agreement requirements. Overhead and administrative costs must be reasonable.

Awardees must submit budget estimates for one in-person meeting, for up to two individuals, who directly work on the cooperative agreement to attend a one-day face-to-face meeting in the Baltimore area.

Detailed costs and…