FinalOmbudsmanNOFO_03282019_508clear.pdf

U.S. Department of Health and Human Services

Centers for Medicare & Medicaid Services Medicare-Medicaid Coordination Office

Center for Medicare & Medicaid Innovation

Support for Ombudsman and Beneficiary Counseling Programs for States Participating in Financial Alignment Model Demonstrations for Dually Eligible Individuals

Initial Announcement

Cooperative Agreement

Funding Opportunity Number: CMS-1J1-19-001

CFDA: 93.634

Date: April 1, 2019

Applicable Dates:

Electronic Cooperative Agreement Application Due Date: May 30, 2019 First Round May 1, 2020 Second Round

August 17, 2020 Third Round

(3:00 pm Eastern Daylight Time)

Anticipated Notices of Award: July 30, 2019 – First Round August 3, 2020 – Second

Round November 17, 2020 – Third

Round Anticipated Cooperative Agreement Period of Performance: Up to 45 months from date of award, not to exceed the timeframe of the state’s financial alignment model demonstration with a demonstration close-out period, with up to 12 month budget periods

Table of Contents

Executive Summary

A. Program Description

A1. Purpose

A2. Authority

A3. Background

A4. Program Requirements for Demonstration Ombudsman Programs

A5. Program Requirements for one-on-one counseling program

A6. Opportunity for a Combined Application

A7. One state agency applies for both options

A8. Two different state agencies apply for the two options

B. FEDERAL AWARD INFORMATION

B1. Total Funding

B2. Award Amount

B3. Anticipated Award Date

B4. Period of Performance

B5. Number of Awards

B6. Type of Award

B7. Type of Competition

C. ELIGIBILITY INFORMATION

C1. Eligible Applicants

C2. Cost Sharing or Matching

C3. Letter of Intent

C4. Ineligibility Criteria

C5. Single Application Requirements

C6. Continued Eligibility

C7. EIN, DUNS, and SAM Regulations

C8. Foreign and International Organizations

C9. Faith-Based Organizations

D. APPLICATION AND SUBMISSION INFORMATION

D1. Address to Request Application Package

D2. Content and Form of Application Submission

D3. Unique Agency Identifier and Systems for Award Management (SAM) - Required . 36

D4. Submission Dates and Times

D5. Intergovernmental Review

D6. Funding Restrictions

D7. Mandatory Disclosures

E. APPLICATION REVIEW INFORMATION

E1. Application Review Criteria

E2. Review and Selection Process

E3. Anticipated Announcement and Award Dates

F. FEDERAL AWARD ADMINISTRATION INFORMATION

F1. Federal Award Notices

F2. Administrative and National Policy Requirements

F3. Terms and Conditions

F4. Cooperative Agreement Terms and Conditions

F5. Reporting (Frequency and Means of Submission)

G. AGENCY CONTACTS

G1. Programmatic Contact Information:

G2. Administrative Questions:

Appendix A. Guidance for Preparing a Budget Request and Narrative

Appendix B. Application and Submission Information

Appendix C. Application Check-Off List Required Contents

Appendix D. Business Assessment of Applicant Organization

Appendix E. Review and Selection Process

Appendix F. Accessibility Requirements

Executive Summary

The Centers for Medicare & Medicaid Services (CMS) is partnering with states to test models that integrate care and financing for individuals who are dually eligible to receive services through both Medicare and Medicaid (referred to in this funding opportunity as beneficiaries).

Demonstrations testing these financial alignment models are currently in operation in ten states,1 serving hundreds of thousands of beneficiaries. At the time of the initial posting of this Notice of Funding Opportunity (NOFO), CMS is engaged in discussions with states regarding the future of these demonstrations.

Through this NOFO, CMS is making available resources to states and entities designated by states to support and assist beneficiaries eligible for ongoing financial alignment model demonstrations. CMS has previously provided similar support to financial alignment model demonstration states for ombudsman and one-on-one counseling programs, most recently through a NOFO issued in 2016, “Support for Ombudsman and Beneficiary Counseling Programs for States Participating in the Medicare-Medicaid Financial Alignment Initiative.”

This NOFO offers two types of activities to support beneficiary decision-making and empowerment: 1) ombudsman services; and 2) one-on-one counseling. It is open only to states that are currently receiving funding to conduct these activities as part of a financial alignment model demonstration, and to entities designated by these states. States will only receive funding for a particular activity (i.e. ombudsman services or one-on-one counseling) if they have received funding for that activity under the prior NOFO (Funding Opportunity Number # CMS-1J1-17-001). In addition, to be eligible for funding under this NOFO, applying states must have a financial alignment model demonstration or a comparable model test using authority under Section 1115A of the Social Security Act that will operate beyond the end of the award under the prior NOFO.

Please note the following:

• States may choose one applicant to submit one combined application for both ombudsman services and one-on-one counseling (see Section A6.). This would result in one grant encompassing both types of activities and would give states the maximum flexibility.

• Alternatively, if two separate state agencies or state-designated entities prefer to apply separately for two separate grants for ombudsman and one-on-one

1 California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, Texas and Washington. CMS and Minnesota are also operating an administrative alignment demonstration program.

counseling, they may do so. This would result in two separate grant awards (one for ombudsman services and one for one-on-one counseling).

• States are not required to apply for both programs.

• States must have previously received funding for an activity (either ombudsman services2 or one-on-one counseling3) under Funding Opportunity Number CMS - 1J1-17-001 to be eligible for funding for that same activity under this NOFO or to designate an entity to apply.

At the time of the initial posting of this NOFO, no decision has been made regarding the extension of any individual State’s demonstration beyond currently scheduled completion dates, and no decision has been made at the time of the initial posting of the NOFO regarding continuation of ombudsman and one-on-one counseling grants during potential extensions of any such demonstrations. Eligible states whose prior awards have not yet ended should schedule their application so that they will be less than four months from the end of the prior award period by the anticipated award date for this award.

2 See A1. Purpose for a list of eligible states for ombudsman services.

3 See A1. Purpose for a list of eligible states for one-on-one counseling activities.

Item Description

Notice of Funding Opportunity Title: Support for Ombudsman and Beneficiary Counseling Programs for States Participating in Financial Alignment Model Demonstrations for Dually Eligible Individuals

Authorization Section 1115A of the Social Security Act (as added by Section 3021 of the Patient Protection and Affordable Care Act (P.L. 111-148)).

Funding Opportunity Type New

Funding Opportunity Number CMS-1J1-19-001

Type of Award Cooperative Agreement

Catalog of Federal Domestic Assistance 93.634

Letter of Intent to Apply Due Date Not applicable Cooperative Agreement Application Due Dates

May 30, 2019 – First Round May 1, 2020 - Second Round August 17, 2020 – Third Round

Anticipated Issuance Notice(s) of Award July 30, 2019 – First Round August 3, 2020 – Second Round November 17, 2020 – Third Round

Period of Performance Up to 45 months from date of award

Anticipated Total Available Funding The total funding available through this NOFO through the life of the program is expected to be approximately $22.5 million (pending funding availability). The total funding available for FY 2019 is $4.3 million.

Estimated Number of Awards: 10-12

Estimated Award Amount: • Ombudsman Activities up to $850,000 to $5,600,000 per state

• One-on-one Counseling up to $800,000 to

$1,300,000 per state

A. Program Description

A1. Purpose

The purpose of this NOFO is to support two types of activities to promote beneficiary decision-making and empowerment of beneficiaries eligible for financial alignment model demonstrations in eligible states. To be eligible, a state must: a) have previously received funding for these activities as part of a financial alignment model demonstration; b) have a demonstration that will continue operation beyond the end date of their prior award; and c) be less than four months from the end of the prior award period by the anticipated award date for this award. The activities are:

• 1.1 Ombudsman services empower beneficiaries and support their engagement in resolving problems. This NOFO provides up to 45 months of funding for ombudsman programs in eligible states (California, Illinois, Massachusetts, Michigan, Ohio, Rhode Island, and South Carolina). The 45 month performance period will allow better alignment with the overall timeframes of the demonstrations.

• 1.2 One-on-one counseling activities enables informed decision-making by beneficiaries in eligible states by delivering information and counseling on options for health coverage. Under this NOFO, states have the flexibility to determine what entity will provide this service, and how they wish to structure the one-on-one counseling program. The state-selected entity could be a State Health Insurance Assistance Programs (SHIP), an Aging and Disability Resource Center (ADRC), a joint project of a SHIP and ADRC, an ombudsman program, or another appropriate entity. This NOFO allows for up to 45 months of funding for one-on-one counseling programs in eligible states (California, Illinois, Massachusetts, Michigan, New York, Ohio, and Rhode Island). The 45 month performance period will allow better alignment with the overall timeframes of the demonstrations.

A2. Authority

Section 1115A of the Social Security Act (the Act) as added by Section 3021 of the Patient Protection and Affordable Care Act (P.L. 111-148)), authorizes the Innovation Center to test innovative payment and service delivery models to reduce expenditures under Medicare, Medicaid, and the Children’s Health Insurance Program while preserving or enhancing the quality of all beneficiaries’ care.

A3. Background

CMS is partnering with states to test models designed to better align the financing of the Medicare and Medicaid programs and integrate primary, acute, and behavioral health services, long term services and supports. The states eligible for awards under this NOFO are all operating capitated models, under which a state, CMS, and a health plan enter into contracts (typically a three-way contract), and the plan receives a prospective blended Medicare-Medicaid payment to provide comprehensive, coordinated care.

Through this NOFO, CMS is supporting up to 45 months of Ombudsman services (not to exceed the timeframe of the state’s demonstration plus a 3-month close-out period at the end of the demonstration) for states involved in testing models to ensure that beneficiaries, caregivers, and authorized representatives continue to have access to person-centered assistance in resolving problems related to the demonstrations. CMS is also supporting up to three years of one-on-one counseling through this NOFO. A project period of up to 45 months will enable funding for these activities to align with demonstration years, which run on a calendar year basis, as well as for an additional three months to cover any demonstration close-out or transition activities.

A4. Program Requirements for Demonstration Ombudsman Programs

Through this cooperative agreement, CMS seeks to fund activities necessary for states to deliver Demonstration Ombudsman Program services to beneficiaries and their families, as appropriate. CMS may award up to one cooperative agreement per eligible state to any state government agency that previously received funding from CMS for their Demonstration Ombudsman Program, or to another entity designated by that state government agency. The state or designee may apply for this funding in order to provide ombudsman services directly, by contract with another state agency or other arrangement with a public or private non-profit entity or entities (referred to in this document as “designated entity”). The state agency or designated entity must meet the following principles and capabilities.

A4.1. Demonstration Ombudsman Program Principles and Capabilities

Demonstration Ombudsman Programs must adhere to the following principles and have the following capacities:

i. Credible to beneficiaries

The Demonstration Ombudsman Program must:

• Serve as a problem-resolver – providing resolution of beneficiary problems when a Medicare-Medicaid Plan (plan) has not been able to successfully address the issue.

• Be free of conflicts of interest – neither an individual serving as an ombudsman nor the organizational placement of the Demonstration Ombudsman Program should have a conflict with the beneficiaries’ interests.

The entity should not be co-located with a health plan, service providers of the plan, an entity funding or administering the plan, or an entity making eligibility or enrollment decisions for beneficiaries.

• Be knowledgeable in areas relevant to beneficiary service – about beneficiary rights under Medicaid and Medicare programs, long-term services and supports, health and behavioral health services, accessibility and non-discrimination laws and regulations as they apply to access to medical plans, providers and benefit design (including the Americans with Disabilities Act, Sections 504 and 510 of the Rehabilitation Act of 1973, and Section 1557 of the Affordable Care Act), and person-centered planning and service approaches.

• Be confidential – the identity of the individual at issue and the complainant (if other than the individual at issue) and information provided to the ombudsman shall not be revealed without consent of the beneficiary.

Individuals who contact an ombudsman should be protected from retaliation.

• Be skilled in negotiation – experienced in alternative dispute resolution techniques; sufficiently independent to have access to negotiate; access to plans, plan service providers, state policy-makers, and others with authority to resolve the problem.

• Work to empower beneficiaries and support their engagement in resolving problems – engage with beneficiaries to empower and support them in concerns they have with their health care, behavioral health care, and long-term services and supports.

ii. Accessible to beneficiaries

The services of the Demonstration Ombudsman Program must be:

• Free of charge to beneficiaries and applicants.

• Accessible by phone, web, and e-mail.

• Able to provide in-person access when necessary (e.g., this may require in-person visits to homes or facilities, depending on the functional limitations of the beneficiary).

• Able to provide culturally and linguistically competent services – including, but not limited to, competency to serve individuals of varying ethnicities and functional and cognitive abilities and of limited English proficiency (For more information about culturally and linguistically competent services, go to: https://minorityhealth.hhs.gov/default.aspx).

iii. Authorized to access information needed to investigate complaints

The Demonstration Ombudsman Program must be:

• Provided, with the beneficiary’s approval, with access to records needed to investigate and resolve beneficiary complaints. Relevant records include records of the plan, service providers, and regulatory agencies.

• Required to comply with HIPAA (Health Insurance Portability and Accountability Act of 1996) Privacy Rule and other relevant privacy laws and regulations.

iv. Coordinate with other entities in order to resolve beneficiary problems

The Demonstration Ombudsman Program must:

• Coordinate its services and develop referral protocols with other entities, including, but not limited to:

SHIPs, State Protection and Advocacy Programs, No Wrong Door (NWD) systems and ADRCs, Medicaid certified application counselors, Long Term Care Ombudsman Programs, state enrollment brokers, other Managed Care Ombudsman Programs (where applicable) and health care marketplace navigators – in order to make appropriate pre-enrollment, benefits counseling, and one-on-one counseling on the demonstration referrals;

Relevant licensing and regulatory agencies – in order to make appropriate regulatory referrals; and

Civil legal services providers (including services for low-income individuals, individuals with disabilities and older Americans, such https://minorityhealth.hhs.gov/default.aspx as those funded by the Legal Services Corporation or the Administration for Community Living) – in order to make appropriate referrals for legal representation and counsel of beneficiaries.

• Regularly communicate with representatives of the plan, including service providers and enrollment brokers – in order to negotiate on behalf of beneficiaries and make appropriate referrals related to enrollment and disenrollment processes.

v. Capable of identifying systems-level trends and emerging issues

The Demonstration Ombudsman Program must:

• Collect data on complaints received and outcomes of efforts to resolve complaints.

• Provide reports on identified systemic trends to policy-makers, stakeholders, the CMS contract management team, and plans.

• Provide recommendations to improve financial alignment model demonstrations and Medicaid or Medicare-covered services to beneficiaries.

vi. Capable of performing tasks

The state shall use an entity consistent with the principles and capabilities indicated above (Section A4.1) and, if services are provided through a designated entity, develop any needed contracts or other agreements to carry out the program. In selecting the state agency or designated entity to host the Demonstration Ombudsman Program, the state must consider:

• Entities that have previously delivered ombudsman services to beneficiaries in the Financial Alignment Initiative. CMS encourages, but does not require, states using a designated entity to continue to use the same entity that delivered ombudsman services in the previous CMS-funded demonstration ombudsman grant. States may wish to consider the capacity of entities (or collection of entities) to continue to provide services to these demonstration populations. Such existing entities could include, but not be limited to, the Protection and Advocacy network, the entity hosting the Office of the State Long-Term Care Ombudsman, state-authorized health or behavioral health ombudsman programs, and state agencies or programs specifically designed to help consumers resolve problems with health insurance programs or plans.

• How to avoid compromising the capacity of the state or designated entity to provide current services to its existing service populations.

A4.2 State Assurances to CMS

The state (or state-designated applicant) must provide assurance to CMS that, in implementing the Demonstration Ombudsman Program, the state must:

• Not divert resources from or diminish the capacity of existing consumer protection services.

• Provide any needed legal authority to the Demonstration Ombudsman Program in order to ensure that:

Demonstration Ombudsman Program representatives have access to beneficiaries (including in their places of residence) and access to records needed for investigations;

The identities of beneficiaries and complainants served by the Demonstration Ombudsman Program are protected; and

The information provided to the Demonstration Ombudsman Program from beneficiaries and complainants is protected.

• Operate the Demonstration Ombudsman Program in alignment with the principles and capabilities indicated above.

• Ensure that the Demonstration Ombudsman Program will provide regular reports to CMS contract management teams overseeing demonstration plans.

• Coordinate its efforts with the state Medicaid program.

If the state agency applying for the cooperative agreement is not the state Medicaid agency, the application must include a written attestation that the state Medicaid director supports the application. A statement by the applicant that they have discussed the application with officials at the state Medicaid agency and obtained the agency’s support is sufficient for these purposes, and should be included in the Resources section of the application’s Project Narrative as described in Section D2.e. CMS may confirm the Medicaid agency’s support.

If a state designates a non-governmental entity as its applicant for the cooperative agreement, the application must include a letter of support from the state Medicaid agency.

• Coordinate its efforts with the state agency providing one-on-one counseling on the demonstration to beneficiaries (if not the same state agency).

• Establish procedures for systematically using the analysis and recommendations produced by the Demonstration Ombudsman Program to improve the performance of the financial alignment model demonstration to better serve beneficiaries.

• Ensure that federal funding under this project will not be used by the Demonstration Ombudsman Program as match for Medicaid funding.

• Provide status reports and updates on beneficiary experiences and the ombudsman program to CMS.

• Participate in periodic teleconferences as requested by CMS and the Administration for Community Living (ACL), in order to keep CMS informed of the progress of the cooperative agreement.

• Attend up to two, two-day meetings/conferences and/or webinars organized by CMS and/or its technical assistance provider, ACL, in Baltimore/Washington D.C. or another national conference location as specified by CMS and ACL.

The award recipient shall be responsible for the implementation of this cooperative agreement. If the Demonstration Ombudsman Program is housed within a designated entity, the state recipient will have an additional responsibility to monitor the quality and compliance of the designated entity with the terms and conditions of the contract or other arrangement under which this service is provided.

A4.3 State Plans for Sustainability

The project period for ombudsman activities within the cooperative agreement will be up to 45 months from the date of award, but no later than the timeframe of the demonstration plus up to an additional three months for close-out and transition. CMS may choose to end the cooperative agreement at an earlier date if a demonstration ends sooner, although transition and close-out ombudsman activities may continue for a period of up to three months after a Demonstration ends. The state shall include in its application plans for sustaining ombudsman services (as described in Section A4.4 and F4.) beyond the period of this cooperative agreement as long as the state continues to partner with CMS in serving beneficiaries through a financial alignment model demonstration.

A4.4 Demonstration Ombudsman Program activities

In general, the Demonstration Ombudsman Program shall investigate and resolve complaints with or on behalf of dually eligible beneficiaries participating in (or enrolling in) a financial alignment model. Like any ombudsman program4, the Demonstration Ombudsman Program is designed to be a safe entity to which individuals may complain or ask questions without fear of retaliation. Ombudsman complaints generally relate to access to a needed service, the quality of a service, and individuals’ rights or allegations of unfair treatment.

The Ombudsman helps even the playing field for the individual who may be overwhelmed by an entity that may be large, bureaucratic or complex. Specific services include:

i. Empowering beneficiaries

a. Ombudsman programs provide one-on-one education to individual beneficiaries (and their caregivers and representatives) relating to beneficiary rights to Medicare and/or Medicaid benefits and to the quality of services provided to the individual by such benefits.

b. Ombudsman programs provide education to groups of beneficiaries or other stakeholders, relating to beneficiary rights to Medicare and/or Medicaid benefits and the quality of services provided to the individual by such benefits.

ii. Conducting outreach

a. Ombudsman programs conduct outreach to help raise awareness on the part of demonstration-eligible beneficiaries (and their caregivers and representatives) of the availability of ombudsman services as part of the overall demonstration.

iii. Complaint investigation and resolution

a. Complaint intake: Ombudsman programs accept complaints relating to

4 For a description of Ombudsman models and minimum standards, see American Bar Association, Standards for the Establishment and Operation of Ombuds Offices (February, 2004).

beneficiary rights to Medicare and/or Medicaid benefits and the quality of services provided. Complaints may be received from any source.

b. Investigation of complaints: Ombudsman programs investigate complaints to determine whether there is sufficient merit to pursue resolution. The investigation does not need to produce sufficient evidence to substantiate the claim for purposes of any legal proceeding.

c. Resolving the complaint: Ombudsman programs implement strategies to resolve complaints, including, but not limited to, negotiating with involved parties (e.g., service provider, the plan, the Medicaid agency, other relevant state agencies), assisting the beneficiary to file appeals, and making referrals to appropriate regulatory or licensing entities.

d. Representing the interest of the beneficiary – Throughout the complaint resolution process, the ombudsman should represent the beneficiary’s interest, for example:

i. Beneficiary consent: Complaints should not be investigated by the ombudsman when a beneficiary has indicated that he/she does not want the ombudsman to investigate on his/her behalf. If a beneficiary is unable to provide informed consent, the ombudsman may receive consent from a beneficiary representative.

ii. Working with the beneficiary (or representative if beneficiary is unable to do so) to develop the strategy for resolution of the complaint.

iii. While Ombudsman programs typically coordinate with relevant regulatory agencies, the Ombudsman is often able to resolve individuals’ complaints informally, thereby avoiding initiation of more expensive and often-prolonged regulatory processes.

NOTE: States are not prohibited from using funds under this cooperative agreement to support outside services that would assist beneficiaries in appeals of plan, service provider, or Medicaid determinations. However, in designing the Demonstration Ombudsman Program sustainability plan (for after the completion of the award) the state should be aware that CMS will not provide funding for outside services in such appeals or legal services for beneficiaries. There should be mechanisms in place to avoid supplanting or duplicating funding or overlapping of identical services between operation of the Demonstration Ombudsman Program and other existing programs.

A4.5. Systems analysis and recommendations

i. Collection and reporting of complaint data: Demonstration Ombudsman Programs must submit this data to CMS or its contractor on a monthly basis, as described in Section A4.6

ii. Analysis of complaint trends: Ombudsman programs will analyze complaints to identify emerging trends.

iii. Coordination: Ombudsman programs coordinate with stakeholders and other agencies involved in Medicaid and Medicare benefits, and other third-party health insurance as applicable to identify trends and formulate recommendations.

iv. Provide information and recommendations: Ombudsman programs will inform and make recommendations to the CMS contract management team overseeing demonstration plans, MMCO staff, the state, the plan, and other stakeholders of systemic analysis findings.

v. Share information: Ombudsman programs will participate in conference calls scheduled by CMS and/or ACL (CMS’s technical assistance provider), to discuss trends and systemic analysis findings.

A4.6 Reporting for Demonstration Ombudsman Program

The state or designated entity shall be responsible for providing informal monthly reports on the Demonstration Ombudsman Program to CMS or its contracted technical assistance provider. Identifying information of individual beneficiaries or complainants shall not be included in the data transmitted by the Demonstration Ombudsman Program to any other entity.

In addition, the state or designated entity will be responsible for submitting semi-annual progress reports and a final report to CMS for the cooperative agreement as described in Section F5.1.

The Demonstration Ombudsman Program will be evaluated as a part of the overall independent evaluation of each demonstration. States and designated entities are required to cooperate, and shall require any other individuals or entities performing functions or services related to demonstration evaluation activities to cooperate with CMS and its designee(s). States and designated entities must provide data needed to assess the impact of the Ombudsman program to CMS or its independent evaluator. CMS shall have full rights to use such data to disseminate successful complaint resolution techniques, including factors associated with performance, to other providers and suppliers and the public and to evaluate the demonstration. States and designated entities shall cooperate, and shall require any other individuals or entities performing functions or services related to demonstration activities to cooperate, in any site visits conducted by CMS or its designee(s). For any such site visits, CMS or its designee(s) shall schedule the visit with the awardee no less than 15 days in advance.

A5. Program Requirements for one-on-one counseling program

A5.1 One-on-one counseling program activities

State entities will provide dually eligible beneficiaries (and their caregivers and representatives) with comprehensive and objective information and, as necessary, one-on-one counseling, regarding the demonstration. Activities shall include but are not limited to:

i. Staying apprised of the status of the financial alignment model demonstration operating in their state, including plan participation, enrollment schedules, and outreach campaigns.

ii. Developing and providing one-on-one counseling entity staff in demonstration regions with the information, training, and tools they will need to effectively and efficiently help dually eligible beneficiaries.

iii. Conducting outreach to educate dually eligible beneficiaries (and their caregivers and representatives) about their coverage options, including those available through the demonstration.

iv. Partnering with stakeholders and other entities such as state Medicaid agencies, participating health plans, enrollment brokers, and demonstration ombudsman, to conduct beneficiary outreach and education.

v. Assisting beneficiaries (and their caregivers and representatives) in making informed decisions about what forms of coverage best meet an individual’s care needs (for example, considerations relative to enrolling in or changing Medicare- Medicaid Plans).

vi. Assisting beneficiaries with enrollment and disenrollment activities, including referring to or assisting with the state enrollment broker.

vii. Referring beneficiaries, as appropriate, to other organizations, including Demonstration Ombudsman Programs and other service organizations for additional assistance.

viii. Apprising CMS and ACL of trends or lessons learned affecting dually eligible beneficiaries in demonstration areas;

ix. Providing assistance to beneficiaries in a manner that:

a. Is fair, objective, accurate, timely, complete and impartial;

b. Empowers consumers to make informed decisions about selecting plans that best meet their health and LTSS needs, and continues to meet their needs;

c. Refers consumers and their families to other resources as needed;

d. Ensures that a decentralized process is used to reach populations at the local level, and that there is access to a statewide 1-800 number, and an appropriate availability of counselors;

e. Culturally and linguistically appropriate; and

f. Complies with accessibility and non-discrimination laws and regulations as they apply to access to medical plans, providers and benefit design (including the Americans with Disabilities Act, Sections 504 and 510 of the Rehabilitation Act of 1973, and Section 1557 of the Affordable Care Act), and person-centered planning and service approaches.

x. In addition to these activities, the applicant may choose to include additional program requirements and design elements that target specific geographic regions and/or Medicare-Medicaid sub-populations, including but not limited to those with limited English proficiency, intellectual and developmental disabilities, severe and persistent mental illness, and those with behavioral or cognitive disabilities. These subpopulations can also include serving individuals in rural, frontier, and/or federally-recognized American Indian tribes.

xi. As described in Section C1 applicants for one-on-one counseling activities will need to attest in writing that they have the support of partner agencies including the State Unit on Aging, State Department of Insurance, State Disability Agency/Agencies and State Medicaid Agency.

A5.2 Reporting for one-on-one counseling program

The state shall be responsible for providing quarterly reports on the one-on-one counseling program to CMS or its technical assistance provider. Reporting shall be through the ACL-administered STARS system or as otherwise specified by CMS and ACL. Identifying information of individual beneficiaries shall not be included in the data transmitted by the one-on-one counseling program to any other entity.

In addition, the state will be responsible for an informal semi-annual narrative progress report to CMS and ACL. The state is also responsible for submitting a final report to CMS for the cooperative agreement as described in Section F5.2.

A6. Opportunity for a Combined Application

Applicants may submit an application for one or both activities supported through the Notice of Funding Opportunity (NOFO). States applying for both options (i.e. ombudsman and one-on-one counseling funding) have several choices for structuring their applications described below. States pursuing both options and that wish to submit a single, combined application should include one set of standard forms as described in Section D2. The combined application should otherwise include separate project narratives, budget narratives, and work plans for the two sets of activities offered under this NOFO.

A7. One state agency applies for both options

One agency applying for both options (for example a state Department of Aging seeking both ombudsman and one-on-one counseling funding) should submit a combined application. One Notice of Award will be issued. An agency receiving funds under a combined application will have the discretion to make budget notifications, consistent with HHS grants policy, across the two activities.

A8. Two different state agencies apply for the two options

Two separate state agencies (or state-designated entities) may submit two separate applications for each program (for example, the state Medicaid agency could apply for ombudsman funding and the state Department of Aging could apply for one-on-one counseling funding). The application for ombudsman funding should include a letter of support from the agency applying for, or currently providing, one-on-one counseling funding and vice versa. Applications may otherwise be completed independently and submitted at different times. If awarded, two Notice of Awards (NoAs) for separate cooperative agreements will be issued to the two applicant agencies, and agencies funded through separate awards will not be able to shift funding between ombudsman and one-on-one counseling activities.

Alternatively, the two agencies may submit a combined application. In a combined application, the agency applying for ombudsman funding must be the prime applicant.

The combined application must include a letter of agreement between the two agencies expressing support for the combined application. The agencies awarded under this option will be required to execute a Memorandum of Understanding (MOU) (or, for existing two-agency combined applications, document an existing MOU) within 90 days of the date of the award explaining how the agencies will share responsibility and ensure accountability. The applicant will submit the MOU to CMS for review. A combined application, if awarded, would result in one NoA. The prime recipient will pass-through funds to the partner/subrecipient agency. The prime recipient under a combined application will have the discretion to make budget modifications, consistent with HHS grants policy, across the two activities.

B. FEDERAL AWARD INFORMATION

B1. Total Funding

The total funding available for FY 2019 is $4.3 million. Funding beyond FY 2019, if any, will be determined based on decisions regarding any extensions for State demonstrations and associated grantee funding.

B2. Award Amount

CMS expects to fund ombudsman activities up to $850,000 to $5,600,000 per state for up to a 45-month period, not to exceed the timeframe of the demonstration plus a demonstration close-out period of up to three months.

CMS expects to fund one-on-one counseling activities up to $800,000 to $1,300,000 per state for up to a 45-month project period, not to exceed the timeframe of the demonstration plus a demonstration close-out period of up to three months. The total amount will depend in part on whether an applicant chooses to provide one-on-one counseling services to specific geographic regions and/or dually eligible sub-populations as discussed in Section A5.1.x.

Applicants can request up to $150,000 to serve one region or sub-population, and up to $300,000 for serving two or more regions or sub-populations.

The amount of each cooperative agreement award made to eligible applicants (see Section C., Eligibility Information) will be determined by a formula. States may not use this funding to supplant or duplicate funding from other funding sources. Award funds may not be used as match for other federal funds.

CMS reserves the right to award less than requested by the applicant depending on the scope and nature of the individual applications received. Awardees may be asked to revise the work plan to reflect the funding that CMS will award.

B3. Anticipated Award Date

CMS anticipates making cooperative agreement awards within approximately 90 days of application due dates.

Application Due Date Anticipated Award Date May 30, 2019 July 30, 2019 May 1, 2020 August 3, 2020 August 17, 2020 November 17, 2020

B4. Period of Performance

The anticipated cooperative agreement period of performance for the program is up to 45 months, not to exceed the timeframe of the states’ financial alignment model demonstration.

Funding will be awarded in up to three 12-month budget periods, and an additional shorter budget period will be permitted to align with demonstration end dates and to complete transition and close-out activities. Following the initial 12-month budget period, additional funding will be issued through non-competing continuation prior to each subsequent budget period contingent upon progress toward meeting the benchmarks set forth in the state’s draft implementation plan and detailed in the terms and conditions of the cooperative agreement.

Continued access to funding will also be conditional upon the grantee’s ability to comply with key deliverables within the period of performance. CMS is under no obligation to make additional awards under this program.

B5. Number of Awards

CMS anticipates making up to 12 awards, including 5 awards in FY 2019, pending funding availability.5 Submission of combined applications will result in fewer awards.

B6. Type of Award

These awards will be structured as cooperative agreements. The Federal Grant and Cooperative Agreement Act of 1977, 31 U.S.C. 6301, defines the cooperative agreement as an alternative assistance instrument to be used in lieu of a grant whenever substantial Federal involvement with the award recipient during performance is anticipated. 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 states otherwise.

CMS will monitor and evaluate award recipients’ activities performed under the cooperative agreement.

5 Potential FY 2019 awards are California ombudsman, Illinois (currently a combined award), Massachusetts ombudsman and one-on-one counseling (currently separate awards), and Ohio (currently a combined award), Continued disbursement of funding over the period of performance is conditional on the state entity meeting program requirements and the availability of funds. Program requirements will be further detailed in the terms and conditions of the cooperative agreement.

B7. Type of Competition

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

C. ELIGIBILITY INFORMATION

C1. Eligible Applicants

Ombudsman Funding

Funding for ombudsman services under this NOFO is only available to states that: a) have previously received funding for ombudsman activities as part of a financial alignment model demonstration under Funding Opportunity Number CMS-1J1-17-001 (California, Illinois, Massachusetts, Michigan, Ohio, Rhode Island, and South Carolina); b) intend to continue operation of that demonstration or a related demonstration; and c) will be less than four months from the end of the prior award period by the anticipated award date for this award.

An otherwise eligible state may designate a different entity to apply for ombudsman funding.

Regardless of which agency applies, CMS recommends that the state unit on aging, state disability agency, state protection and advocacy agency, state developmental disabilities council, state behavioral health agency, and state Medicaid agency should be involved in the implementation of the State's Demonstration Ombudsman Program under this NOFO.

For states pursuing a combined application to include both ombudsman and one-on-one counseling activities, the applicant must be the state agency implementing the ombudsman activities, even if two separate agencies will carry out the activities.

One-on-One counseling

Funding for one-on-one counseling activities under this NOFO is only available to states that: a) have previously received funding for one-on-one counseling activities as part of a financial alignment demonstration under funding opportunity number CMS-1J1-17-001 (California, Illinois, Massachusetts, Michigan, New York, Ohio, and Rhode Island); b) intend to continue operation of that demonstration or a related demonstration; and c) will be less than four months from the end of the prior award period by the anticipated award date for this award. Eligible applicants for one-on-one counseling activities under this NOFO include any one of the state agencies that administers the SHIP or ADRC program, (e.g.

State Unit on Aging, State Department of Insurance, State Disability Agency(s), State Medicaid Agency) or another appropriate state entity designated by the state. Regardless of which agency or entity serves as the applicant agency, the State Unit on Aging, State Department of Insurance, State Disability Agency/Agencies and State Medicaid Agency must all be involved in the state’s one-on-one counseling efforts under this NOFO. An attestation from the applicant that each coordinating agency supports the effort must be provided with the submitted application. This attestation, which may be a statement by the applicant, should be included the Resources section of the application’s Project Narrative (see Section D2.e).

C2. Cost Sharing or Matching

Cost sharing or matching is not a requirement of this NOFO.

C3. Letter of Intent

A letter of intent is not a requirement of this NOFO.

C4. Ineligibility Criteria

Applicants must ensure that they are only seeking funding to plan and implement activities that they are not currently receiving Federal grant funding to plan and implement. Each award made under this Funding Opportunity should support different activities and should not be used for activities funded by other grant awards. In the budget request, applicants should distinguish between activities that will be funded under this application and activities funded with other sources.

C5. Single Application Requirements

A state (or a designated state entity) may only apply for one (1) award of the same type. For example, a State may apply for one ombudsman award and one (1) one-on-one counseling award.

C6. Continued Eligibility

Award recipients must meet reporting and programmatic deadlines throughout the initial 12 month budget period to remain eligible for a non-competing continuation award for the subsequent budget periods. Recipients will need to demonstrate strong performance during the initial budget period before additional years of funding are awarded. Additionally, recipients could receive decreased funding or their grant could be terminated due to poor performance if:

(1) the recipient is not making adequate progress; (2) the recipient has not complied with the terms and conditions of the award; (3) program priorities change, as per new or revised legislation; or, (4) the amount available to CMS for funding has been reduced or eliminated.

C7. EIN, DUNS, and SAM Regulations

In order to apply, all applicants are required to have a valid Employer Identification Number (EIN), otherwise known as a Taxpayer Identification Number (TIN); a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number; and be registered in the System for Award Management (SAM) database (https://www.sam.gov/SAM/) to be able to submit an application at grants.gov. See Appendix B, Application and Submission Information, for descriptions of EIN, DUNS, and SAM.

C8. Foreign and International Organizations

Foreign and International Organizations are not eligible to apply.

C9. Faith-Based Organizations

Faith-based organizations are eligible to serve as the designated entity if selected by the State.

D. APPLICATION AND SUBMISSION INFORMATION

D1. Address to Request Application Package

Application materials will be available at http://www.grants.gov. Please note that HHS requires applications for all NOFOs to be submitted electronically through Grants.gov. Applicants will be able to download a copy of the application packet, complete it off-line, and then upload and submit the application via the Grants.gov website. Refer to Appendix B, Application and Submission Information, for specific instructions.

D2. Content and Form of Application Submission

a. Application Format

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

• Use 8.5" x 11" letter-size pages (one side only) with 1" margins (top, bottom, and sides). Other paper sizes will not be accepted. This is particularly important because it is often not possible to reproduce copies in a size other than 8.5" x 11".

• All pages of the project narrative must be paginated in a single sequence.

https://www.sam.gov/SAM/ http://www.grants.gov/

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

• The application for each type of program (ombudsman or one-on-one counseling), with the appendices, shall not exceed 56 pages in length (i.e. a combined application shall not exceed 112 pages).

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

• The Project Narrative must be DOUBLE-SPACED with the exception of charts and tables and must not exceed 20 pages in length for each program. The Project Narrative shall include

Proposed Approach

Organizational Capacity and Management Plan

Evaluation and Reporting

• The Budget Narrative may be single or double-spaced and must not exceed 6 pages in length for each program.

• The Appendices for each program shall include (not exceeding 20 pages in length):

Work plan

Brief resumes from designated entity staff (if applicable)

• The Business Assessment of Applicant Organization must not exceed 10 pages.

Other required materials NOT included in page limits are:

• Abstract

• Standard forms (see D2. Content and Form of Application Submission)

• Indirect Cost Rate Agreements or Cost Allocation Plans (CAP)

• Letters of support or letters of agreement (for states applying for both programs)

Content of Combined Application

Combined applications should include:

• One set of Standard Forms (Section D2.b. below)

One combined SF-424A Form inclusive of funding for Ombudsman and one-on-one counseling

• Abstract for Demonstration Ombudsman Program (Section D2.c.)

• Abstract for one-on-one counseling program (Section D2.c.)

• Project Narrative for Demonstration Ombudsman Program (Section D2.e.)

• Project Narrative for one-on-one counseling program (Section D2.e.)

• Work Plan for Demonstration Ombudsman Program (Section D2.f.)

• Work Plan for One-on-One Counseling Program (Section D2.f.)

• Budget Narrative for Demonstration Ombudsman Program (Section D2.g.)

• Budget Narrative for one-on-one counseling program (Section D2.g.)

• Business Assessment of Applicant Organization (Section D2.h.)

• Letter of agreement for two-agency combined applications (Section D2.i.)

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…