EAW NOFO 6-5-24v3_CLEAN.pdf

2024-6-7 Page 0 of 65

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

Center for Consumer Information and Insurance Oversight

Expanding Access to Women’s Health Grant

Notice of Funding Opportunity Type: New

Funding Opportunity Award Type: Grant

Notice of Funding Opportunity Number: CMS-2R2-24-001

Federal Assistance Listings Number (CFDA): 93.797

Notice of Funding Opportunity Posting Date: June 7, 2024

Applicable Dates:

Letter of Intent to Apply Due Date: July 8, 2024

Electronic Application Due Date: August 7, 2024, 11:59 pm Eastern Standard Time

Anticipated Issuance Notice(s) of Award: September 13, 2024

Anticipated Period of Performance: September 13, 2024 through September 12, 2024-6-7 Page 1 of 65

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, UEI, Login.gov and SAM Regulations C8. Faith-Based 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

c. Application cover letter or cover page (required)

d. Project Narrative (maximum of 15 pages)

2024-6-7 Page 2 of 65

e. Work Plan (maximum 15 pages)

f. Budget Narrative (maximum of 5 pages)

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

h. Required Supporting Documentation

D3. Unique Entity Identifier and System for Award Management (SAM) D4. Submission Dates and Times D5. Intergovernmental Review D6. Cost Restrictions D7. Mandatory Disclosure D8. HHS Form 690

E. Application Review Information E1. Criteria E2. Merit 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 F3. Terms and Conditions F4. Reporting

G. CMS Contacts G1. Programmatic Questions G2. Administrative/Budget Questions

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. Merit Review and Selection Process Appendix VI. Application Check-off List Appendix VII. Workload Funds - Example Appendix VIII. List and Summary of Provisions under Part A of Title XXVII of the PHS Act for which Grant Funding is Available Appendix IX. Definitions in this Funding Opportunity

2024-6-7 Page 3 of 65

Executive Summary

Section 2794(c) of the Public Health Service Act (PHS Act) appropriates $250 million to the Secretary to award grants to States to assist them with the health insurance rate review process from fiscal years (FYs) 2010 through 2014. Section 2794(c)(2)(B)0F

1 specifies that any rate review grant funds not obligated by the end of FY 2014 will remain available to the Secretary for grants to States for planning and implementing the health insurance market reforms and consumer protections under Part A of Title XXVII of the PHS Act.

Applicants may use grant funds for a variety of objectives related to planning and implementation of the following pre-selected provisions of Part A of Title XXVII of the PHS Act to expand coverage of, and access to, reproductive and maternal health services

I. Section 2707 – Comprehensive Health Insurance Coverage (Essential Health Benefits Package)

II. Section 2713 – Coverage of Preventive Health Services

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

Expanding Access to Women’s Health Grant

Authorization Section 2794 of the Public Health Service Act (PHS Act)

Federal Assistance Listings Number

93.797

Funding Opportunity Type

New

Funding Opportunity Number

CMS-2R2-24-001

1 PHS Act section 2794(c)(2)(B) states in full: “If the amounts appropriated under subparagraph (A) are not fully obligated under grants under paragraph (1) by the end of fiscal year 2014, any remaining funds shall remain available to the Secretary for grants to States for planning and implementing the insurance reforms and consumer protections under part A.”

2024-6-7 Page 4 of 65

Type of Award Grant

Type of Competition Competitive Grant

Letter of Intent All applicants must submit a mandatory Letter of Intent (signed by the head of the applicable State regulatory agency) by July 8, 2024.

Application Due Date and Time

August 7, 2024 by 11:59 pm EDT (Baltimore, MD)

Anticipated Issuance Notice(s) of Award

September 13, 2024

Period of Performance Start Date

September 13, 2024

Period of Performance End Date

September 12, 2026

Anticipated Total Available Funding

$11.1M

Estimated Maximum Award Amount

$210,0001F

Estimated Maximum Number of Awardees

A. Program Description A1. Purpose

The Expanding Access to Women’s Health Grant Program will provide a funding source to States for activities related to planning and implementing the market reforms and consumer protections under the below-listed provisions of Part A of Title XVII of the PHS Act to enhance and expand access to reproductive health and maternal health coverage and services.

2 The maximum award amount may increase based upon the number of actual Letters of Intent received. See section B1. Total Funding for more information.

2024-6-7 Page 5 of 65

I. Section 2707 – Comprehensive Health Insurance Coverage (Essential Health Benefits Package) II. Section 2713 – Coverage of Preventive Health Services

A summary of these provisions is found under Appendix VIII, List and Summary of Provisions under Part A of Title XXVII of the PHS Act for which Grant Funding is Available.

This Funding Opportunity is open to all fifty States2F

3 and the District of Columbia. Only one application per State is permitted, except for a State in which there is more than one regulating entity responsible for implementation and enforcement of the two pre-selected market reforms and consumer protections identified above. If a State has more than one regulating entity responsible for implementation and enforcement of the two pre-selected market reforms and consumer protections identified above, the State is eligible to submit multiple applications, but will be required to split the total grant award allocated for that State. The regulatory agencies involved must collaborate with each other regarding a proposed budget. Also, each State regulatory agency will be viewed as a distinct recipient responsible for submitting separate programmatic and financial reports required by this Expanding Access to Women’s Health Grant Program. All awards are subject to funding availability.

These pre-selected market reforms and consumer protections under Part A of Title XXVII of the PHS Act were selected because of their connection to reproductive health and maternal health coverage and services and the positive impact that CMS anticipates this funding will have on enhancing and expanding access to reproductive and maternal health coverage and services for women in each awardee State.

CMS will award grants through a competitive process.

A2. Authority

CMS administers the Expanding Access to Women’s Health Grant Program under the authority of section 2794 of the PHS Act entitled, “Ensuring That Consumers Get Value for Their Dollars.” Section 2794 of the PHS Act appropriates $250 million to the Secretary of HHS to award grants to States to assist them with the health insurance rate review process from FYs 2010 through 2014 (the Rate Review Grant Program). Section 2794(c)(2)(B)3F

4 specifies that any appropriated Rate Review Grant funds that are not fully obligated by the end of FY 2014 shall

3 Effective July 16, 2014, HHS determined the definition of “State” in the context of the new PHS Act requirements for health insurance coverage and funding opportunities enacted in Title I of ACA does not include the United States Territories. See 42 U.S.C. § 18024(d). Also see the July 16, 2014, letters to the insurance regulators in Guam, the Virgin Islands, Northern Mariana Islands, American Samoa, and Puerto Rico, available at:

https://www.cms.gov/cciio/Resources/Letters/index.html#Health Market Reforms. The United States Territories are thus not eligible to apply for awards under the Expanding Access to Women’s Health Grant Program.

4 PHS Act section 2794(c)(2)(B) states in full: “If the amounts appropriated under subparagraph (A) are not fully obligated under grants under paragraph (1) by the end of fiscal year 2014, any remaining funds shall remain available to the Secretary for grants to States for planning and implementing the insurance reforms and consumer protections under part A.”

2024-6-7 Page 6 of 65 remain available to the Secretary for grants to States for planning and implementing the insurance market reforms and consumer protections under Part A of Title XXVII of the PHS Act.

A3. Background

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), and on March 30, 2010, the Health Care and Education Reconciliation Act of 2010 was also signed into law (collectively referred to as the “ACA”). The ACA includes a number of provisions that reform the health insurance markets and provide Federal consumer protections through amendments to Title XXVII of the PHS Act and corresponding amendments to the Employee Retirement Income Security Act and the Internal Revenue Code. The ACA also includes significant grant funding for States to work with the Federal government to implement the Federal market reforms and consumer protections.

Section 1003 of the ACA adds a new section 2794 to the PHS Act entitled, “Ensuring That Consumers Get Value for Their Dollars.” Specifically, section 2794(a) of the PHS Act requires the Secretary, in conjunction with the States, to establish a process for the annual review of health insurance premiums4F

5 to protect consumers from unreasonable rate increases. Section 2794(c) directs the Secretary to carry out a program to award grants to States.

Congress appropriated $250 million to be awarded in FYs 2010 through 2014 for the Rate Review Grant Program. Through FYs 2010-2014, there were four cycles of Rate Review Grants awarded. Section 2794(c)(2)(B) specifies that if there are any appropriated Rate Review Grant funds that are not fully obligated by the end of FY 14, such amounts shall remain available to the Secretary for grants to States for planning and implementing the insurance market reforms and consumer protections under Part A of Title XXVII of the PHS Act.

Subsequently, using the authority under Section 2794(c)(2)(B) of the PHS Act, CMS has issued to date three separate grants related to various market reforms and consumer protections under Part A of Title XXVII of the PHS Act. In FY 2017, CMS awarded the Health Insurance Enforcement and Consumer Protections Grant and in FY 2018 and FY 2021, CMS awarded the State Flexibility to Stabilize the Market Grants (Cycle I awarded in FY 2018 and Cycle II awarded in FY 2021).

The provisions in Part A of Title XXVII of the PHS Act include market-wide reforms in the group and individual private health insurance markets intended to protect consumers, increase transparency, and regulate health insurance industry practices.

Please visit the following link on the U.S. Government Publishing Office Website to view the full list of relevant regulations that HHS has published under Title 45 of the Code of Federal Regulations.

5 The Patient Protection and Affordable Care Act (PPACA) uses the term “premium” however, the National Association of Insurance Commissioners uses the term, “rate” for purposes of industry review. To remain aligned with industry terminology, “rate” will be used in lieu of "premium" in this grant announcement.

https://www.ecfr.gov/current/title-45 https://www.ecfr.gov/current/title-45

2024-6-7 Page 7 of 65

A4. Program Requirements

The Expanding Access to Women’s Health Grant Program is a new grant program that will provide a funding source to States for activities related to planning and implementation of the pre-selected provisions under Part A of Title XXVII of the PHS Act to enhance and expand access to reproductive and maternal health coverage and services. Applicants may use grant funds for planning and implementation of a variety of objectives, including but not limited to:

• Developing campaigns to educate women on what reproductive healthcare coverage options and family planning services are available in the State to support a woman’s ability to make safe and informed decisions regarding her reproductive health and provide women with more flexibility regarding family planning,

• Expanding access to reproductive health and family planning services,

• Assessing and updating current Essential Health Benefits (EHB)-benchmark plans to include a broader scope of benefits coverage for reproductive and maternal health services, and

• Assessing the cost of broadening coverage of reproductive healthcare services in the State.

Enhancing and expanding coverage of, and access to, reproductive health and maternal health services will aid in reducing maternal and infant mortality rates by ensuring women have access to and are able to obtain timely lifesaving treatments. Each year in the United States, hundreds of women die during pregnancy or in the year after. More than 80% of pregnancy-related deaths in the U.S. are preventable.5F

6 Additionally, black women are three times more likely to die from a pregnancy-related condition than white women.6F

7 Providing women with reproductive healthcare and maternal healthcare information will help women recognize urgent maternal warning signs, and empower women to advocate for their own health and medical needs when it comes to making critical healthcare decisions.

Through the Expanding Access to Women’s Health Grant Program, States may develop activities and programs to address disparities in reproductive and maternal health outcomes resulting from women having difficulty accessing reproductive healthcare information or reproductive healthcare and coverages. Ensuring women have access to reproductive and maternal health coverage, services, and information is a critical component in supporting a woman’s ability to make safe and informed decisions regarding her reproductive health and provides women with more flexibility regarding family planning.

Section 2707(a) of the PHS Act requires issuers that offer non-grandfathered coverage in the individual and small group markets to ensure that such coverage includes the EHB package required under section 1302(a) of the ACA, whose ten benefit categories include coverage of preventive and wellness services and maternity and newborn care. The Expanding Access to

6 Centers for Disease Control and Prevention. (2023, April 3). Working Together to Reduce Black Maternal Mortality. CDC.gov. Retrieved December 18, 2023, from https://www.cdc.gov/healthequity/features/maternal-mortality/index.html 7 Ibid https://www.cdc.gov/healthequity/features/maternal-mortality/index.html https://www.cdc.gov/healthequity/features/maternal-mortality/index.html

2024-6-7 Page 8 of 65

Women’s Health Grant Program will give States the opportunity to use funds to assess and update current EHB-benchmark plans to include a broader scope of benefits coverage for reproductive health and maternal health coverage and services.

The Expanding Access to Women’s Health Grant Program also provides the opportunity for States to use funds to develop campaigns to educate women on what reproductive healthcare coverage options and family planning services are available in a State, and to assess the cost of broadening reproductive healthcare in the State.

Prior to the ACA, consumers faced more financial obstacles in obtaining birth control than they may today. Under Section 2713 of the PHS Act, non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage are required to provide coverage without imposing any cost-sharing requirements for a range of recommended preventive services. With respect to women, plans and issuers are required to cover, without imposing cost-sharing requirements, preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA). The currently applicable HRSA-supported Women’s Preventive Services Guidelines recommends that as part of their contraceptive care, women have access to the full range of Food and Drug Administration (FDA)- approved, -granted, or -cleared contraceptives, effective family planning practices, and sterilization procedures. The Expanding Access to Women’s Health Grant Program also provides the States the opportunity to ensure that coverage of the required preventive health services is provided without cost sharing to women by enhancing their review of issuer form filings through the development of additional tools and/or checklists, as well as performing targeted market conduct examinations of health insurance issuers.

Recommended Areas of Focus for Activities

The goal of the Expanding Access to Women’s Health Grant Program is to support State planning and implementation efforts with respect to the pre-selected market reforms and consumer protections under Part A of Title XXVII of the PHS Act to enhance and expand coverage of and access to reproductive and maternal health services. Provided below are recommended areas of focus for these grant-related activities.

Section 2707 – Comprehensive Health Insurance Coverage (Essential Health Benefits

States may use grant funds to:

• Assess and update current EHB-benchmark plans to include broader scope of benefits coverage for reproductive health and maternal health coverage and services are available in the State to support a woman’s ability to make safe and informed decisions regarding her reproductive health and provide women with more flexibility regarding family planning,

• Conduct surveys, interviews, and focus groups with women to gauge their knowledge of, access to, and satisfaction with their State’s EHB-benchmark plan selection as it pertains to their reproductive healthcare needs, https://www.hrsa.gov/womens-guidelines

2024-6-7 Page 9 of 65

• Consult with medical providers or associations on how best to update the State’s EHB-benchmark plans to include broader scope of benefits coverage for reproductive and maternal healthcare services,

• Research other State EHB-benchmark plans and perform an analysis of potential adjustments to the respective State’s existing EHB-benchmark plan to support a broader scope of benefits coverage for reproductive and maternal healthcare services.

Section 2713 - Coverage of Preventive Health Services

Women continue to experience difficulties accessing contraceptive healthcare without cost sharing. States may use grant funds to engage in activities including:

• Design and disseminate educational materials to help women understand their ability to obtain contraceptive healthcare without cost sharing, as well as provide additional information, such as website addresses or phone numbers, for local contraceptive and maternal healthcare providers as additional resources.

• Conduct workshops and seminars to educate consumers on the coverage options they have regarding reproductive healthcare in their State as well as in other States.

• To ensure that coverage of the required preventive health services is provided without cost sharing to women, States may also use grant funds to enhance their review of issuer form filings through development of additional tools and/or checklists and perform targeted market conduct examinations of health insurance issuers. These activities will help ensure that the State is able to identify whether or not health insurance issuers are providing coverage of the required preventive health services without cost sharing.

A5. Technical Assistance and Information for Prospective Applicants

Before the mandatory signed Letter of Intent due date of July 8, 2024, CMS will post on its website a pre-recorded presentation to potential applicants that will provide an overview of the grant program, offer budget guidance, and walkthrough the guidance provided by this Notice of Funding Opportunity (“Funding Opportunity”).

B. Federal Award Information

B1. Total Funding

Under section 2794 of the PHS Act, funds are available to support grants as necessary to fulfill the purpose of this funding opportunity to all eligible States and the District of Columbia. CMS is anticipating approximately a total of $11.1 million will be available for the Expanding Access to Women’s Health Grant Program, pending availability of funds.

The amount of funds awarded to each recipient will be conditional upon funding availability and the number of awarded applicants. All applicants must submit the mandatory, signed Letter of Intent to apply by the July 8, 2024 deadline. At a minimum, the baseline funding for the https://www.cms.gov/marketplace/resources/funding-opportunities

2024-6-7 Page 10 of 65

Expanding Access to Women's Health Grant is $210,000 for the two-year project period.

However, the total award amount may increase based upon the number of Letters of Intent received.

Following submission of the mandatory, signed Letters of Intent, CMS will inform States of funding allocations, including whether baseline award amounts have increased and if there are sufficient funds available for the “Workload” supplemental awards. The baseline funding formula will be consistent, regardless of how many market reforms an Applicant selects.

Workload funds are determined based on the population and number of health insurance issuers in the State, as further described in Appendix VII, “Workload- Funds Example.” Prior to July 12, 2024, CMS will provide applicants that submitted a signed Letter of Intent with information on maximum award amounts allocated to each State.

B2. Award Amount

Award amounts will consist of Baseline and Workload awards, as follows:

• Baseline Award Amount: Each eligible State will be awarded a minimum of approximately $210,0007F

8 baseline award for 24 months.

• Workload Awards: Workload funds will only be available if there are sufficient funds available after providing baseline awards for all eligible applicants.

Funding Formula for Workload Awards: States may be eligible to receive additional grant funds based on the State population size and the number of issuers with five percent or more market share (combined individual and small group markets) within the State, as further described in Appendix VII, “Workload Funds-Example.”

If funding is available for Workload awards, the Workload funds will be awarded along with the Baseline Award. CMS will inform States whether sufficient funds are available for Workload funds following CMS’ review of the submitted mandatory Letters of Intent.

See Appendix VII, “Workload Funds Example” for additional information.

B3. Anticipated Award Dates

Expected Award Date: September 13, 2024.

B4. Period of Performance The grant will have a project and budget period of 24 months from the award date.

B5. Number of Awards

8 The maximum award amount may increase based upon the number of actual Letters of Intent received. See section B1. Total Funding for more information.

2024-6-7 Page 11 of 65

Up to an estimated 51 Baseline awards.

However, if a State has more than one regulating entity responsible for implementation and enforcement of the following two pre-selected market reforms and consumer protections under Part A of Title XVII of the Public Health Service Act (PHS Act):

I. Section 2707 – Comprehensive Health Insurance Coverage (Essential Health Benefits Package) II. Section 2713 – Coverage of Preventive Health Services

The State will be eligible to submit multiple applications, but will be required to split the total grant award allocated for that State. The regulatory agencies involved must collaborate with each other regarding a proposed budget. Also, each State regulatory agency will be viewed as a distinct recipient responsible for submitting separate programmatic and financial reports required by this Expanding Access to Women’s Health Grant Program. All awards are subject to funding availability.

B6. Type of Award

Funding Instrument Type: Grant

B7. Type of Competition

This NOFO is open to all eligible applicants identified in Section C1. Eligible Applicants.

C. Eligibility Information

C1. Eligible Applicants These types of entities may apply:

State governments.

Government Organizations

State governments

County governments

City of Township governments

Special District governments

Native American tribal governments (Federally recognized)

2024-6-7 Page 12 of 65

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

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

For-profit Businesses (organizations other than small businesses)

Small Businesses

Individuals

Others

Unrestricted

This Funding Opportunity is open to all fifty States8F

9 and the District of Columbia. Only one application per State is permitted, except for a State in which there is more than one regulating entity. See Section C5. Single Application Requirement for more information.

Please refer to Section A.3. for the PHS Act provisions applicable to this Funding Opportunity.

Applicants must submit the following letters (or other permissible document as outlined):

9 Effective July 16, 2014, HHS determined the definition of “State” in the context of the new PHS Act requirements for health insurance coverage and funding opportunities enacted in Title I of ACA does not include the United States Territories. See 42 U.S.C. § 18024(d). Also see the July 16, 2014, letters to the insurance regulators in Guam, the Virgin Islands, Northern Mariana Islands, American Samoa, and Puerto Rico, available at:

https://www.cms.gov/cciio/Resources/Letters/index.html#Health Market Reforms. The United States Territories are thus not eligible to apply for awards under the Expanding Access to Women’s Health Grant Program.

2024-6-7 Page 13 of 65

• A letter attesting that the State is not receiving other Federal grant dollars for the same activity(ies) for which it will receive (if awarded) Expanding Access to Women’s Health Grant funds,9F

10 signed by the head of the applicable State regulatory agency; and

• A State certification of Maintenance of Effort verifying that the grant funds will not supplant existing State expenditures for related reproductive and maternal coverage and services activities, signed by the head of the applicable State regulatory agency.

These two letters may be combined into one if both requirements are fully addressed.

C2. Cost Sharing or Matching

Cost sharing or matching is not a requirement for this program.

C3. Letter of Intent

A Signed Letter of Intent is required.

The purpose of the Letter of Intent is to determine the number of applications and total funding for award-planning purposes. A Letter of Intent must include (1) a brief explanation of a State’s intent to apply for the Expanding Access to Women’s Health Grant Program and (2) contact information, including the State’s street address and a contact person’s name, position, e-mail address, and phone number, and (3) the signature of the head of the applicable State regulatory agency. Following review of the Letters of Intent, eligible applicants will be notified of the maximum baseline and workload award amount available.

Please note that submitting a Letter of Intent is mandatory to apply. The signed Letter of Intent must be submitted electronically in PDF format to James.Taing@cms.hhs.gov by July 8, 2024.

C4. Ineligibility Criteria

The applicant must ensure that they are only seeking funding to plan and implement those activities that they are not currently receiving Federal grant funding to plan and implement.

C5. Single Application Requirement

There will be no more than fifty-one initial Baseline Amounts awarded, for each of the fifty States and the District of Columbia.

However, if a State has more than one regulating entity responsible for implementation and enforcement of the following two pre-selected market reforms and consumer protections under Part A of Title XVII of the Public Health Service Act (PHS Act):

10 EHB grant activities not currently funded through the State Flexibility to Stabilize the Market Cycle II Grant Program are allowable under the Expanding Access to Women’s Health Grant Program.

mailto:James.Taing@cms.hhs.gov

2024-6-7 Page 14 of 65

I. Section 2707 – Comprehensive Health Insurance Coverage (Essential Health Benefits

II. Section 2713 – Coverage of Preventive Health Services

The State will be eligible to submit multiple applications, but will be required to split the total grant award allocated for that State. The regulatory agencies involved must collaborate with each other regarding a proposed budget. Also, each State regulatory agency will be viewed as a distinct recipient responsible for submitting separate programmatic and financial reports required by this Expanding Access to Women’s Health Grant Program. All awards are subject to funding availability.

C6. Continued Eligibility

Continued access to funding is contingent on satisfactory progress, compliance with the terms and conditions, and the availability of funds.

Recipients must demonstrate satisfactory performance during the previous funding cycle(s) to be issued additional year funding; or, in the case of awards where all funding is issued in the first year, to ensure continued access to funding.

At any time in the period of performance, recipients could receive decreased funding or their award could be terminated in accordance with 45 CFR § 75.372 “Termination” if they fail to perform the requirements of the award.

Satisfactory performance for selected award recipients includes but not limited to: meeting the milestones proposed in the grant application and outlined in the Work Plan to continue to be eligible throughout the project period.

C7. EIN, UEI, Login.gov and SAM Regulations

All applicants must have the following to apply to submit an application to Grants.gov:

• a valid Employer Identification Number (EIN), otherwise known as a Taxpayer Identification Number (TIN)

• a Unique Entity Identifier (UEI)

• a Login.gov account, and

• active registration in the System for Award Management (SAM) database

See Appendix II. Application and Submission Information on how to get registered.

C8. Faith-Based Organizations

Faith-based organizations are not eligible to apply.

https://sam.gov/content/home

2024-6-7 Page 15 of 65

C9. Other Eligibility Requirements

Not applicable.

D. Application and Submission Information

D1. Address to Request Application Package You must submit your application through Grants.gov. Grants.gov has information about the online application process. See “How to Apply for Grants” at Grants.gov for electronic submission instructions. Refer to Appendix II. Application and Submission Information for additional requirements and instructions.

D2. Content and Form of Application Submission

a. Application format

Any application that is ineligible, incomplete, or non-responsive will not move forward.

Disqualifying Factors CMS may not consider an application that:

• Is from an organization that does not meet the eligibility conditions.

• Requests funding above the award ceiling shown in the funding range, unless CMS announces that the applicant qualifies for additional funding due to the actual number of Letter of Intent's received

• Is not submitted through Grants.gov.

• Is incomplete based on the initial screening.

However, the CMS, Division of Grants Management Director/Deputy Director 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 of the application package, in the order indicated, and conform to the following formatting specifications:

• Page size is 8.5” x 11” letter-size pages (one side only) with 1” margins (top, bottom, and sides). CMS does not accept other paper sizes.

• All pages of the project and budget narratives as well as other required narrative documents must be paginated in a single sequence.

• Font size must be at least 12-point with an average of 14 characters per inch (CPI).

• The Project Narrative must be double-spaced. The page limit for this document is 15 pages.

2024-6-7 Page 16 of 65

• The Work Plan may be single-spaced. The page limit for this document is 5 pages.

• The Budget Narrative may be single-spaced. The page limit for this document is 5 pages.

• The Business Assessment of Applicant Organization may be single spaced. The page limit for this document is 12 pages.

• Tables included within any portion of the application must 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.

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

• The following required application documents are excluded from the page limitations described previously:

o Standard Forms (SF-424, SF-424A, SF-LLL) o Application Cover Letter/Cover Page (required) o Copy of Letter of Intent o Project Site Location Form, and o Indirect Cost Rate Agreement/Cost Allocation Plan.

• Required supporting documentation. See Section D2. h. Required Supporting Documentation for more information.

b. Standard forms You must complete the five standard forms identified below. You can also view them and see their instructions at Grants.gov Forms.

1. Project Abstract Summary

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

Include:

• Goals of the project

• Total budget

• Description of how funds will be used.

2. SF-424: Official Application for Federal Assistance

You must complete all sections of the SF-424.

The Authorized Organizational Representative (AOR) must complete and electronically sign this form. Note: The signature of the individual that submits the application to Grants.gov populates throughout the application. The signature must match the name of the AOR.

Other signatures will not be accepted. The AOR is the applicant’s designated representative, who can make legally binding commitments for your organization. When the AOR authorizes an application, they agree that the organization will assume all award obligations.

Special instructions include:

https://grants.gov/forms

2024-6-7 Page 17 of 65

In Item 15 “Descriptive Title of Applicant’s Project”:

HHS awarding agencies must establish detailed and accurate award descriptions at the time they make a federal financial assistance award. Award descriptions are:

• critical to ensuring accountability and transparency and

• a primary means to inform the public of the purpose of the federal funding that is distinct from the programmatic level information in the Assistance Listings.

Elements of a Strong Award Description Robust award descriptions provide an understanding of the award’s purpose and include a description of award-specific activities and purpose. A strong award description will have all the following elements:

Specifics about the award purpose

• Activities to be performed

• Expected deliverables and outcomes

• Intended beneficiary(ies) or recipients

• Subrecipient activities, (if known)

Characteristics of a Strong Award Descriptions A strong award description will have the following characteristics:

• Uses plain language an average reader can fully understand

• Is brief and succinct

• Is unique on USA Spending

• Does not use or limits abbreviations or acronyms

Examples of Strong Award Descriptions:

The Council of Inspectors General on Integrity and Efficiency’s Pandemic Response Accountability Committee (PRAC) shared the following examples of effective award descriptions. These, or other agency-specific examples, can be shared with applicants to assist them in developing their award descriptions.

• Example One: Construction of pedestrian & bicycle facilities on the Broadway corridor.

Broadway @ St. James St- Foxhall Ave. Streetscape improvements & enhancements include sidewalks, curbing, bike lanes, ped bump-outs, and lighting.

• Example Two: Levittown Beauty Academy, LLC is creating distance education for students affected by Covid-19. Schools cannot use physical location and students are now doing their schoolwork online.

Check “No” to item 19c. as review by State Executive Order 12372 does not apply.

2024-6-7 Page 18 of 65

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

4. SF-LLL: Disclosure of Lobbying Activities

You must submit the SF-LLL form. If you do not engage in lobbying, please insert “Non- Applicable” on the form and include the required AOR name, contact information, and signature.

Please note that the application kit available online on the Grants.gov website is used for many programs and therefore Grants.gov may designate this form as optional to allow for flexibility amongst programs. However, this form is required as part of the application package and must be submitted for the application to be considered eligible for review.

5. Project/Performance Site Location(s) Form

This form is required as part of the application package and must be submitted for the application to be considered eligible for review. 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.

c. Application cover letter or cover page (required) The applicant is required to include a cover letter or cover page to detail its interest in participation in the Expanding Access to Women’s Health Grant Program.

d. Project Narrative (maximum of 15 pages)

The project narrative should give a clear and concise description of your project. Articulate in detail the proposed goals, measurable objectives, and milestones in accordance with the instructions and content requirements provided below, consistent with the criteria described in A4. Program Requirements and Section E1. Criteria. Review these sections carefully to make sure you answer all questions and cover all topics the reviewers will look at.

Both the required and optional sections of the Project Narrative are described below.

For expansion of reproductive health and maternal coverage and services activities under each selected market reform, the applicant must address the following sections:

• Section (i), ““Eligibility”

• Section (ii), “Description of Current Processes;” and

• Section (iii), “Proposed Activities for Expanding Access to Reproductive and Maternal

Health Coverage and Services”

• Section (iv) “Evaluation”

• Section (v), “Commitment to Mentor States” (optional)

Section (i), Eligibility Mandatory: This section is mandatory for all applicants.

2024-6-7 Page 19 of 65

Each applicant must identify the criteria under which they are eligible for an Expanding Access to Women’s Health Grant and describe how the applicant meets the relevant eligibility criteria.

An applicant must be an agency responsible for oversight and implementation of the pre-selected market reform and consumer protection provisions referenced throughout this Notice of Funding Opportunity in one of the 50 States or the District of Columbia.

Section (ii), Description of Current Processes Mandatory: This section is required for all applicants.

As part of the Project Narrative, applicants must provide a detailed description of their current efforts to plan and implement the identified pre-selected market reforms and consumer protections under Part A of Title XXVII of the PHS Act to enhance and expand reproductive and maternal health coverage and services. States must include in the Project Narrative a comprehensive description of the State’s current authority and/or process for each of the activities that they plan on pursing with the grant.

Section (iii), Proposed Activities for Expanding Access to Reproductive and Maternal Health Coverage and Services Mandatory: This section is required for all applicants.

The Expanding Access to Women’s Health Grant provides States a funding source for activities that enhance and expand access to reproductive health and maternal coverage and services.

Applicants may use grant funds for planning and implementation of a variety of objectives, including but not limited to:

• Developing campaigns to educate women on what reproductive healthcare coverage options and family planning services are available in the State,

• Expanding access to reproductive health and family planning services,

• Assessing and updating current EHB-benchmark plans to include broader scope of benefits coverage for reproductive health and maternal health coverage and services are available in the State to support a woman’s ability to make safe and informed decisions regarding her reproductive health and provide women with more flexibility regarding family planning,

• Assessing the cost of broadening coverage of reproductive healthcare services in the State.

Section (iv), Evaluation Plan Mandatory: This section is required for all applicants.

To ensure accountability, States are required as part of the grant application to:

• describe the current state of their program,

• identify the goal(s) of the grant funding,

• specify how the grant funds would be used to achieve the identified goal(s), and

2024-6-7 Page 20 of 65 provide a description of how the State would measure success of the outcome(s).

Throughout the course of the grant period, States will be required to provide quarterly reports that specify the milestones being met to achieve the goal(s) or outcome(s).

The Project Narrative must include specific measures on how the recipient will evaluate its progress and measure the success of its program. Please provide baseline information or data for each measurable objective to be evaluated. The recipient is expected to update information and data for each measure as part of the quarterly report and provide an evaluation plan that will assess the program on the overarching goals of the project. The recipient is also expected to comply with Federal evaluation requirements. Specifically, applicants are required to include all of the following in their application:

• Discussion of chosen key indicators to be measured;

• A description of baseline data for each indicator;

• Methods to monitor progress and evaluate the achievement of program goals both on an ongoing basis and at the conclusion of the program; and

• Inclusion of plans for timely interventions when targets are not met or obstacles delay progress.

Section (v), Commitment to Mentor States 10F

This section is optional for all grant applicants.

States may agree to mentor and collaborate with other States on discussing and sharing progress on activities and best practices. See Section D.9 for additional information.

e. Work Plan (maximum 15 pages) This section is required for all applicants.

Each State is required to develop and submit a Work Plan that outlines specific milestones for successful planning and/or implementation of proposed activities outlined in the grant application. These milestones must be articulated clearly, be measurable, and be appropriate for the period of performance. The Work Plan must:

• Indicate which milestones the Program plans to meet within the associated timeframes.

• The incremental steps to achieving these milestones must also be identified by the months in which they start, are carried out, and completed.

States are permitted to do a separate Work Plan for different aspects of their grant application.

There is not a specified template for the Work Plan. At the beginning of the Work Plan, please include a title that includes the words “Work Plan” in it. Each State will also provide Progress Metrics towards each of their objectives as described in Section F4, Reporting.

11 See D.9, “Other Submission Requirements,” on page 26.

2024-6-7 Page 21 of 65

f. Budget Narrative (maximum of 5 pages) Applicants must provide supplement Form SF-424A with a Budget Narrative. The Budget Narrative includes a yearly breakdown of costs for each line item outlined in the SF-424A, according to a 12-month period. Include a clear description of the proposed set of services covered with award funds for each activity/cost within the line item. The application must clearly define the proportion of the requested funding designated for each activity and justify the applicant’s readiness to receive funding. The budget separates out funding administered directly by the lead agency from funding subcontracted to other partners. Voluntary committed cost sharing or matching is not expected unless specifically stated otherwise in section C2.

Detailed budget justifications must be provided for each activity/cost proposed to be funded under this award along with full computations for budget estimates. Also clearly link each activity to the goals/milestones of this NOFO and be consistent with program requirements.

Indirect costs must be reasonable and are only reimbursable in accordance with HHS grants policy.

For additional information and instructions for completing the SF-424A and Budget Narrative, please refer to Appendix I. Guidance for Preparing a Budget Request and Narrative.

g. Business Assessment of Applicant Organization (maximum 12 pages) As required by 45 CFR §75.205 for competitive grants and cooperative agreements, CMS evaluates the risk posed by an applicant before they receive an award. This analysis of risk includes items such as financial stability, quality of management systems, internal controls and the ability to meet the management standards prescribed in 45 CFR Part 75.

An applicant must review, answer, and submit the business assessment questions outlined in Appendix III. Business Assessment of Applicant Organization.

h. Required Supporting Documentation The following supporting documentation must accompany the application. This information is excluded from the page limit for applications.

a) Applicants must submit the following letters:

• Each applicant must submit a letter attesting that the State is not receiving other Federal grant dollars for the same activity(s) for which it will receive the Expanding Access to Women’s Health Grant funds, signed by the head of the applicable State regulatory agency; and

• State certification of Maintenance of Effort verifying that the grant funds will not supplant existing State expenditures for related reproductive and maternal coverage and services activities, signed by the head of the applicable State regulatory agency. There is no designated form for the State certification of “Maintenance of Effort.”

These two letters may be combined into one if both requirements are fully addressed.

b) The State must provide a clear delineation of the roles and responsibilities of project staff and how they will contribute to achieving the project’s objectives including:

2024-6-7 Page 22 of 65

• The State’s capacity to implement the proposed project and manage grant funds, including a reasonable and cost-efficient budget; and

• An organizational chart and job descriptions of staff who will be dedicated to the project indicating the time that staff will spend on grant activities.

D3. Unique Entity Identifier and System for Award Management (SAM) Unless the applicant is an individual or Federal awarding agency that is excepted from those requirements under 2 CFR 25.110(b) or (c), or has an exception approved by the Federal awarding agency under 2 CFR 25.110(d)), each applicant is required to:

i. register in SAM.gov before submitting its application;

ii. provide a valid unique entity identifier in its application; and

iii. continue to maintain an active SAM registration with current information at all times during which it has an active Federal award or an application or plan under consideration by a Federal awarding agency.

The Federal awarding agency may not make a Federal award to an applicant until the applicant has complied with all applicable unique entity identifier and SAM requirements. If an applicant has not fully complied with the requirements by the time the Federal awarding agency is ready to make a Federal award, the Federal awarding agency may determine that the applicant is not qualified to receive a Federal award and use that determination as a basis for making a Federal award to another applicant.

D4. Submission Dates and Times

All applications must be submitted electronically and be received through Grants.gov by the date and time set forth below. Applications received after 11:59 pm, Eastern Time, of the date set forth below will not be reviewed or considered for award.

Due Date for Applications August 7, 2024 11:59 PM Eastern U.S. Time (Baltimore, MD)

D5. Intergovernmental Review Program is not subject to Executive Order…