mih-initiativefoa-512015f.pdf

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

Center for Medicaid and CHIP Services

Adult Medicaid Quality:

Improving Maternal and Infant Health Outcomes in Medicaid and CHIP

Announcement Type: Initial

Funding Opportunity Number: CMS-1F1-15-001

CFDA: 93.644

Date: May 5, 2015

Applicable Dates:

State Voluntary Letter of Intent to Apply Due Date: June 3, 2015

Electronic Grant Application Due Date: July 7, 2015 3:00 PM ET

CMS Anticipated Notice of Award Date: September 2, 2015

Grant Period of Performance: September 2, 2015 – September 1, 2019

Table of Contents

OVERVIEW INFORMATION

I. FUNDING OPPORTUNITY DESCRIPTION

1. Purpose

2. Authority

3. Background

4. Program Requirements: Qualifying for Receipt of Reporting Payments

5. CMS Procedures for Acting on Requests for Award Payments

II. AWARD INFORMATION

1. Total Funding

2. Award Amount

3. Anticipated Award Date

4. Period of Performance

5. Number of Awards

6. Type of Award

III. ELIGIBILITY INFORMATION

1. Eligible Applicants

2. Cost Sharing or Matching

3. Foreign and International Organizations

4. Faith Based Organizations

5. Letter of Intent to Apply

IV. APPLICATION AND SUBMISSION INFORMATION

1. Address to Request Application Package

2. Content and Form of Application Submission

3. Submission Dates and Times

4. Intergovernmental Review

5. Funding Restrictions

V. APPLICATION REVIEW INFORMATION

1. Criteria

2. Review and Selection Process

3. Anticipated Announcement and Award Date

VI. AWARD ADMINISTRATION INFORMATION

1. Award Notices

2. Administrative and National Policy Requirements

3. Terms and Conditions

4. Programmatic Reporting

5. Federal Financial Report (FFR)

6. Transparency Act Reporting Requirements

7. Payment Management Requirements

VII. AGENCY CONTACTS

A. Programmatic Content

B. Administrative Questions

VIII. APPENDICES

Appendix A: Optional Letter of Intent to Apply

Appendix B: Guidance for Preparing a Budget Request and Narrative in Response to

SF 424A

Appendix C: Application Check-Off List

OVERVIEW INFORMATION

Agency Name: Department of Health and Human Services Centers for Medicare & Medicaid Services Center for Medicaid and CHIP Services

Funding Opportunity Title: Adult Medicaid Quality: Improving Maternal and Infant Health Outcomes in Medicaid and CHIP

Announcement Type: Initial

Funding Opportunity Number: CMS-1F1-15-001

Catalog of Federal Domestic Assistance (CFDA) Number: 93.644

Key Dates:

Date of Issue: May 5, 2015 Letter of Intent Due Date: June 3, 2015 Application Due Date: July 7, 2015 3:00 PM ET Anticipated Notice of Award: September 2, 2015 Period of Performance: September 2, 2015 – September 1, 2019

Applicant’s Teleconference:

May 13, 2015 from 2:00 to 3:00 p.m. Eastern Time Registration link:

http://w.on24.com/r.htm?e=989669&s=1&k=919F8E1F142CF894364D93649C55DB11

I. FUNDING OPPORTUNITY DESCRIPTION

1. Purpose This funding opportunity will support the Center for Medicaid and CHIP Services (CMCS) Maternal and Infant Health Initiative: Improving the Health of Mothers and Infants in Medicaid and CHIP – Investing in the Future of Our Nation (the Initiative) (http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of- Care/Downloads/Maternal-and-Infant-Health-Initiative.pdf), which seeks to focus improvement efforts in two distinct yet related areas: 1) increasing the rate and content of postpartum visits;

and 2) increasing the rate of pregnancies that are intended through increased use of effective contraception. This grant will support states in collecting and reporting data to CMCS on a new developmental quality measure to assess performance on the latter goal.

The data gathered through this grant activity will be used to improve CMCS’ understanding of the provision of contraceptive services in Medicaid and CHIP populations. This grant activity will aid CMS in developing future efforts to improve maternal and infant health outcomes in Medicaid and/or CHIP. Data collected through this grant may be publically reported by CMS.

http://w.on24.com/r.htm?e=989669&s=1&k=919F8E1F142CF894364D93649C55DB11 http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/Maternal-and-Infant-Health-Initiative.pdf http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/Maternal-and-Infant-Health-Initiative.pdf

States are encouraged to align this data collection and reporting effort with other activities of the CMCS Maternal and Infant Health Initiative and/or other state level efforts. Included is a detailed description of the funding opportunity, including eligibility requirements, award information, application and submission information, and the application review criteria.

2. Authority This grant is being issued under the authority of the Affordable Care Act, Title II, Subtitle I, Improving the Quality of Medicaid for Patients and Providers, section 2701, Adult Health Quality Measures, which added section 1139B of the Social Security Act (Act) directing the Secretary of Health and Human Services (HHS) to identify an initial core set of quality measures that could be used to monitor and improve the care provided to adults covered by Medicaid.

This authority was established in the same manner as the child health quality measures efforts under section 1139A of the Social Security Act, which provided for quality measurement and improvement demonstrations.

3. Background In comparison to other nations, the United States fares poorly on perinatal outcomes, ranking 27th globally with an infant mortality rate of 6 per 1,000 live births.1 While infant mortality has trended downward slightly over the past few years, rates of preterm birth and low birth weight have declined more slowly and racial/ethnic disparities in perinatal health outcomes persist.2 Preterm birth and low birth weight, with their associated economic and social costs, are far reaching; furthermore, their impacts can be long-lasting, particularly among the most vulnerable populations. Medicaid and CHIP are an important source of coverage for vulnerable individuals and families; and while birth outcomes have improved among individuals with public and private coverage, the rate of births reported as preterm or low birth weight remains higher in Medicaid than private insurance (10.4% vs. 9.1%).3

CMCS has a unique opportunity to improve perinatal outcomes and reduce disparities as a result of the Affordable Care Act’s coverage expansion and its dedicated funding for quality measurement and improvement. In addition to federal interest, States, providers, and maternal and infant health advocacy groups have demonstrated their commitment to improving maternal and infant health outcomes through their participation in a variety of targeted efforts.

Considering the importance of Medicaid and CHIP as the payer for almost half of all births, CMCS has an important role to play in improving maternal and infant health outcomes. In 2012, CMS embarked on two major activities to improve perinatal health outcomes: the Strong Start for Mothers and Newborns Initiative,4 and an Expert Panel on Improving Maternal and Infant

1 MacDorman MF, Hoyert DL, Mathews TJ. NCHS Data Brief, No. 120. April 2013.

2 Lu MC, Kotelchuck, Hogan V, Jones L, Wright K, Halfon N. Closing the Black-White Gap in Birth Outcomes: A life course approach. Ethnicity and Disease, Vol 20, Winter 2010.

3 Barradas D.T., et. al. “Hospital Utilization and Costs among Preterm Infants by Payer: Nationwide Inpatient Sample, 2009.” Unpublished manuscript, 2014.

4 Additional information on Strong Start can be found at http://innovation.cms.gov/initiatives/strong-start/.

http://innovation.cms.gov/initiatives/strong-start/

Health Outcomes in Medicaid and CHIP (Expert Panel). 5 The Expert Panel provided valuable information to CMCS about near term opportunities to improve birth outcomes. Based on the feedback of the Expert Panel, CMCS established the Maternal and Infant Health Initiative which defines national goals to promote healthier outcomes among Medicaid and CHIP enrollees.

These goals, selected based on potential impact, resources and partnership opportunities, are:

• To increase by 10 percentage points the rate of postpartum visits among pregnant women in Medicaid and CHIP in at least twenty states over a 3-year period; and

• To increase by 15 percentage points use of effective methods of contraception in at least twenty states over a 3-year period.

Both of these goals have the potential to improve overall perinatal outcomes in the U.S. The postpartum visit provides the opportunity to not only assess women’s physical recovery from pregnancy and childbirth, but also to address any chronic health conditions, postpartum mental health status, and family planning, including contraception and inter-conception counseling.

CMCS will focus on increasing postpartum visits as a way to reduce maternal morbidity and improve the quality of maternal and infant health care. Unintended pregnancy is associated with poorer preconception health, delayed prenatal care, reduced birth spacing and increased risks of preterm birth and low birth weight. To gather more data on pregnancy planning and spacing, CMCS will track the use of effective contraception (i.e. long acting reversible contraceptives (LARCs), injectables, oral pills, patches, or rings).

In order to gather more data on the second Initiative goal, states are encouraged to uniformly collect and report on a new developmental quality measure. Through these grant funds, CMS will support states’ data collection, measurement and reporting efforts for the developmental measure related to the Initiative. These data are also useful in identifying opportunities to improve health care quality for women of child-bearing age enrolled in Medicaid and to drive changes in care practices and delivery accordingly.

4. Program Requirements: Qualifying for Receipt of Reporting Payments Under the authority of section 2701 of the Affordable Care Act, $10 million will be available for this funding opportunity. Specifically, a total of 25 grant awards are available for the initial one year period of performance; these may be continued for up to three non-compete option years, assuming satisfactory performance, for a maximum four-year period of performance. Each of the 25 recipients will be eligible to receive up to $400,000 total for the four years, assuming satisfactory performance, defined as submission of measure data by the required due date (see chart below). Under this funding opportunity, there is no required state match.

This grant opportunity will be open to all 56 State Medicaid agencies to support collecting and reporting the developmental Initiative quality measure to CMS. By “State,” we refer to the

5 The Expert Panel was co-chaired by Dr. Mary Applegate, Ohio’s Medicaid Medical Director and Dr. James Martin, past chair of American College of Obstetricians and Gynecologists (ACOG). More information on the Expert Panel may be found at www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of- Care/Maternal-and-Infant-Health-Care-Quality.html.

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Maternal-and-Infant-Health-Care-Quality.html http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Maternal-and-Infant-Health-Care-Quality.html definition provided under 45 CFR §75.2, Definitions, as “any state of the United States, the District of Columbia, the Commonwealth of Puerto Rico, U. S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, and any agency or instrumentality thereof exclusive of local governments.”

This grant will facilitate data collection and reporting on a developmental measure, Use of Contraceptive Methods by Women. This will be the first time CMCS will collect this measure.

Additional details about the developmental Use of Contraceptive Methods by Women measure can be found on Medicaid.gov at http://www.medicaid.gov/Medicaid-CHIP-Program- Information/By-Topics/Quality-of-Care/Maternal-and-Infant-Health-Care-Quality.html.

As part of this grant opportunity, states may find it necessary to work with their partners, including managed care organizations, other providers, Departments of Public Health, and other stakeholders to obtain the necessary data to report on the measure.

• States may use grant funds to improve data validation methods/initiatives, evaluate data sources and measures, and train and educate providers in collecting and reporting the measure.

• States may use funds for staff training in the use of tools for collecting and analysis of data from claims, surveys, medical records, or encounter records.

• States may use the grant funding to develop a plan to sustain collection beyond the grant period.

• States may use the grant funds to participate in CMCS sponsored technical assistance activities related to the Initiative measure.

Participation (and the receipt of all monies available under the award) is contingent on:

• A state submitting baseline data using Calendar Year 2014 data on the measure;

• A state submitting remeasurement data annually using CY 2015-2017 data on the measure; and

• A state submitting the baseline and remeasurement data by the required due date

(satisfactory performance).

Grant payments will be issued annually by May 1st, following reporting of the quality measure information into the measure reporting system6 no later than January 31st of each year.

The chart below describes the reporting required under this grant. It also specifies the percentage of the total award that is associated with each data submission.

6 The reporting system refers to a web-based tool which is used for reporting the Medicaid Adult and Child Core Set Measures.

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Maternal-and-Infant-Health-Care-Quality.html http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Maternal-and-Infant-Health-Care-Quality.html

Reporting Deadline

Data Name and Year

Funds Release

Date

Maximum Funds (as a percentage of the total possible award)

January 31, Baseline

(CY 2014)

May 1, 2016 25%

January 31, 1st Remeasurement

(CY 2015)

May 1, 2017 25%

January 31, 2nd Remeasurement

(CY 2016)

May 1, 2018 25%

January 31, 3rd Remeasurement

(CY 2017)

May 1, 2019

25%

5. CMS Procedures for Acting on Requests for Award Payments CMS will issue up to $400,000 over 4 years to entities based upon application submitted. The maximum initial award amount is up 25% ($100,000) of overall amount available to each entity.

Each subsequent year an entity is eligible to receive up to an additional 25% ($100,000) of the overall amount available through non-competing continuation awards. Funds awarded each year will not be released for drawdown until May 1st of each year in accordance with the information included under Section I.4. Program Requirements: Qualifying for Receipt of Reporting Payments. CMS will make determinations that a state is qualified for a quality reporting payment under this grant based on submission of the performance measure data to the CMS reporting system by January 31st of each year. The reporting system is the vehicle States use to report the CMS Child and Adult Core quality measures to CMS. Additional details regarding the submission of measure data to the measure reporting system, and the issuance of the grant funds, will be specified in the Standard and Program Terms and Conditions which will accompany the Notice of Award.

II. AWARD INFORMATION

1. Total Funding In total, $10 million has been designated for this funding opportunity. Grants will be awarded with consideration to: (1) available funding; and (2) the quality of each application and the applicants’ demonstrated ability to meet the goals of the project. Awardees will not receive the total award requested if they fail to fully participate in the grant (see full participation description under Section I.4. Program Requirements: Qualifying for Receipt of Reporting Payments).

2. Award Amount A total of up to 25 grants could be awarded to States, the District of Columbia, and the US Territories. Grant awardees may receive up to $400,000 over the performance period assuming the grantee is found eligible for all payments.

Initial award amounts will not exceed 25% ($100,000) of the overall amount available to each entity. Each subsequent year an entity is eligible to receive up to an additional 25% ($100,000) of the overall amount available through non-competing continuation awards. Approximately sixty days prior to the end of each 12-month budget period, awardees must submit a non-competing continuation application to receive funds for the subsequent 12-month budget period.

Funds awarded will not be available for drawdown until released by CMS. Please see Sections I.4 Program Requirements: Qualifying for Receipt of Reporting Payments and I.5 CMS Procedures for Acting on Requests for Award Payments for more information. Additional guidance on submitting a non-competing continuation application will be included in the terms and conditions of award.

3. Anticipated Award Date The anticipated award date is September 2, 2015.

4. Period of Performance The anticipated period of performance for the 4-year project period is September 2, 2015 through September 1, 2019. The 4-year project period will be comprised of four, 12-month budget periods. The first budget period will be September 2, 2015 to September 1, 2016. Upon notification of the grant award, States will receive a Notice of Award which will specify the award amount for the initial 12-month budget period. In the absence of funding, CMS is under no obligation to make awards under this program.

5. Number of Awards A maximum of 25 awards will be made.

6. Type of Award These awards are structured as grants. CMS will evaluate each Grantee’s performance and ability to show demonstrated progress toward aims of the grant, specifically developing baselines for and conducting re-measurements of the Initiative measure. If a Grantee fails to meet the mutually agreed upon annual progress, CMS may rescind the grant award including all un-obligated balances.

III. ELIGIBILITY INFORMATION

1. Eligible Applicants Eligible applicants for this funding opportunity are limited to the 56 State Medicaid Agencies.

The single State Medicaid Agency will lead the project. Only one application can be submitted for a given State. By “State,” we refer to the definition provided under 45 CFR §75.2, Definitions, as “any state of the United States, the District of Columbia, the Commonwealth of Puerto Rico, U. S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, and any agency or instrumentality thereof exclusive of local governments.”

CMS expects that grant-funded activities would align with and not duplicate similarly-focused efforts, such as enhancements to the Medicaid Management Information System (MSIS) and associated data systems, health information exchange, and any meaningful use quality measure collection infrastructure developed for the administration of the Medicaid Electronic Health Record Incentive Program. As appropriate, there is an expectation that the State will coordinate with its Department of Public Health, other State agencies, and health care providers7 and hospitals, as necessary to ensure accurate and reliable data collection.

A letter or memorandum of agreement from any major partner that is not the lead agency is encouraged. An applicant should include all such letters as part of its application package as instructed in this solicitation (please see Section IV.2, Content and Form of Application Submission). CMS will disregard any letter received outside of the submitted application.

Letters should be included as a PDF file as instructed in the requirements of the application submission.

Only one grant application can be submitted for a given State.

Eligibility Threshold Criteria:

• Application deadline: Applications not received electronically through http://www.grants.gov by the application deadline of July 7, 2015 (3:00 pm Eastern Time) will not be reviewed.

• Application requirements: Applications will be considered for funding only if the application meets the requirements as outlined in, Section III, Eligibility Information and, Section IV, Application and Submission Information.

• Page limit: The application must not be more than 16 pages in length, including the project narrative (maximum of 5 pages), the attestation (1 page), the budget narrative (maximum of 6 pages), and any supporting materials (4 pages available, if needed). The Standard Forms, Cover Letter, and Project Abstract are not included in the page limit. For more information, see Section IV.2, Content and Form of Application Submission.

7 These providers may include primary, secondary and tertiary health providers (including Federally Qualified Health Centers and Rural Health Clinics, maternal and child health clinics, hospitals (including Medicaid disproportionate share hospitals); other primary and specialized care professionals (including members of the allied health professions); Tribal providers, behavioral health professionals; Medicaid managed care plans, primary care case management providers (PCCMs), medical groups, independent physician associations and quality improvement collaborative that include these providers.

http://www.grants.gov/

• Dollar limit: Applications will be considered for funding only if the Adult Medicaid Quality: Improving Maternal and Infant Health Outcomes in Medicaid and CHIP Grant application narrative includes an attestation acknowledging that the full value of the grant award is only available based on full participation.

Applicants are strongly encouraged to use the review criteria information provided in Section V, Application Review Information, to help ensure that the proposal adequately addresses all the criteria that will be used in evaluating the proposals.

Employer Identification Number

All applicants must have a valid Employer Identification Number (EIN), otherwise known as a Taxpayer Identification Number (TIN), assigned by the Internal Revenue Service.

Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS number)

All applicants must have a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number in order to apply. The DUNS number is a nine-digit identification number that uniquely identifies business entities. To obtain a DUNS number, access the following website:

www.dnb.com or call 1-866-705-5711. See Section IV.1, Application and Submission Information, for more information on obtaining a DUNS number.

System for Award Management (SAM) All applicants must register in the System for Award Management (SAM) database in order to be able to submit an application (https://www.sam.gov/). The SAM registration process is a separate process from submitting an application. In order to register, applicants must provide their DUNS and EIN numbers. Applicants should begin the SAM registration process as soon as possible after the announcement is posted to ensure that it does not impair your ability to meet required submission deadlines. Additional information about SAM is available at https://www.sam.gov/portal/public/SAM/.

Applicants must successfully register with SAM prior to submitting an application or registering in the Federal Funding Accountability and Transparency Act Subaward Reporting System (FSRS) as a prime awardee user. See Section IV, Application and Submission Information, for more guidance on SAM registration. Primary awardees must maintain a current registration with the SAM database, and may make subawards only to entities that have DUNS numbers.

Organizations must report executive compensation as part of the registration profile at https://www.sam.gov/ by the end of the month following the month in which this award is made, and annually thereafter (based on the reporting requirements of the Federal Funding Accountability and Transparency Act (FFATA) of 2006 (Pub. L. 109-282), as amended by Section 6202 of Public Law 110-252 and implemented by 2 CFR Part 170)). See Section VI, Award Administration Information, for more information on FFATA. The Grants Management Specialist assigned to monitor the subaward and executive compensation reporting requirements is Iris Grady, who can be reached at divisionofgrantsmanagement@cms.hhs.gov.

http://www.dnb.com/ https://www.sam.gov/ http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/Maternal-and-Infant-Health-Initiative.pdf?C=3X2kzw1F9US_u5hF6m_SbtBvceLd0s8IYU7KU2dvHT3HPqIRpWWdJraSJchlWaa9MHsL2hiaS5I.&URL=https://www.sam.gov/portal/public/SAM/ https://www.sam.gov/ mailto:divisionofgrantsmanagement@cms.hhs.gov

Each year organizations and entities registered to apply for Federal grants through http://www.grants.gov must renew their registration with the System for Award Management (SAM). You can register with SAM online; registration will take about 30 minutes to complete (https://www.sam.gov/). Failure to renew SAM registration prior to application submission will prevent an applicant from successfully applying via Grants.gov. Similarly, failure to maintain an active SAM registration during the application review process can prevent HHS from issuing your agency an award under this program.

2. Cost Sharing or Matching Grantees are not required to make a State match contribution.

3. Foreign and International Organizations Foreign and international organizations are not eligible to apply for this funding opportunity.

4. Faith Based Organizations Faith based organizations are not eligible to apply for this funding opportunity.

5. Letter of Intent to Apply Applicants are encouraged to submit a non-binding Letter of Intent to Apply. Letters of Intent to Apply are not required and their submission or failure to submit a letter has no bearing on the scoring of proposals received. Receipt of such notices enables CMS to better plan for the application review process. These may be submitted in any format; however, a sample is included in Section VIII, Appendices, Appendix A. Letters of Intent to Apply are due June 3, 2015, and should be emailed to Lekisha Daniel-Robinson at CMCS_MIH_Initiative@cms.hhs.gov.

IV. APPLICATION AND SUBMISSION INFORMATION

1. Address to Request Application Package This Funding Opportunity Announcement serves as the application package for this grant and contains all the instructions to enable a potential applicant to apply. The application should be written primarily as a narrative with the addition of standard forms required by the Federal government for all grants.

It is recommended that a Letter of Intent be submitted by 11:59 pm Eastern Time on June 3, 2015. The purpose of the Letter of Intent is to estimate the number of applications and enable CMS to plan its review process. The signed Letter of Intent must be submitted via e-mail to Lekisha Daniel-Robinson at CMCS_MIH_Initiative@cms.hhs.gov.

Application materials will be available for download at http://www.grants.gov. Please note that HHS requires applications for all announcements to be submitted electronically through http://www.grants.gov. For assistance with grants.gov, contact support@grants.gov or call 1- 800-518-4726. At http://www.grants.gov, applicants will be able to download a copy of the http://www.grants.gov/ https://www.sam.gov/ mailto:CMCS_MIH_Initiative@cms.hhs.gov mailto:CMCS_MIH_Initiative@cms.hhs.gov http://www.grants.gov/ http://www.fsrs.gov/ https://www.sam.gov/ mailto:support@grants.gov http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Maternal-and-Infant-Health-Care-Quality.html application packet, complete it off-line, and then upload and submit the application via the Grants.gov website. The Funding Opportunity Announcement can also be viewed on CMS website at http://www.medicaid.gov/medicaid-chip-program-information/by-topics/quality-of-care/quality-of-care.html.

Specific instructions for applications submitted via http://www.grants.gov:

• You can access the electronic application for this project at http://www.grants.gov. You must search the downloadable application page by the CFDA number 93.644.

• At the http://www.grants.gov website, you will find information about submitting an application electronically through the site, including the hours of operation. HHS strongly recommends that you do not wait until the application due date to begin the application process through http://www.grants.gov because of the time needed to complete the required registration steps.

• All applicants under this announcement must have an Employer Identification Number/Taxpayer Identification Number (EIN/TIN) to apply. Please note, applicants should begin the process of obtaining an EIN/TIN as soon as possible after the announcement is posted to ensure this information is received in advance of application deadlines.

• All applicants, as well as sub-recipients, must have a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number at the time of application in order to be considered for a grant. The DUNS number is a nine-digit identification number that uniquely identifies business entities. To obtain a DUNS number, access the following website: www.dandb.com or call 1-866-705-5711. This number should be entered in the block with the applicant's name and address on the cover page of the application (Item 8c on the Form SF-424, Application for Federal Assistance). The name and address in the application should be exactly as given for the DUNS number. Applicants should obtain this DUNS number as soon as possible after the announcement is posted to ensure all registration steps are completed in time.

• Authorized Organizational Representative: The Authorized Organizational Representative (AOR) who will officially submit an application on behalf of the organization must register with grants.gov for a username and password. AORs must complete a profile with Grants.gov using their organization’s DUNS Number to obtain their username and password at http://grants.gov/applicants/get_registered.jsp. AORs must wait one business day after successful registration in the System for Award Management (SAM) before entering their profiles in Grants.gov. Applicants should complete this process as soon as possible after successful registration in SAM to ensure this step is completed in time to apply before application deadlines.

• When an AOR registers with Grants.gov to submit applications on behalf of an organization, that organization’s E-Biz POC will receive an email notification. The email http://www.medicaid.gov/medicaid-chip-program-information/by-topics/quality-of-care/quality-of-care.html http://www.medicaid.gov/medicaid-chip-program-information/by-topics/quality-of-care/quality-of-care.html http://grants.gov/applicants/get_registered.jsp http://www.grants.gov/ http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Maternal-and-Infant-Health-Care-Quality.html http://www.grants.gov/ http://www.dandb.com/ http://grants.gov/applicants/get_registered.jsp address provided in the profile will be the email used to send the notification from Grants.gov to the E-Biz POC with the AOR copied on the correspondence.

• The E-Biz POC must then login to Grants.gov (using the organization’s DUNS number for the username and the special password called “M-PIN”) and approve the AOR, thereby providing permission to submit applications.

• Any files uploaded or attached to the Grants.Gov application must be PDF file format and must contain a valid file format extension in the filename. Even though Grants.gov allows applicants to attach any file formats as part of their application, CMS restricts this practice and only accepts PDF file formats. Any file submitted as part of the Grants.gov application that is not in a PDF file format, or contains password protection, will not be accepted for processing and will be excluded from the application during the review process. In addition, the use of compressed file formats such as ZIP, RAR, or Adobe Portfolio will not be accepted. The application must be submitted in a file format that can easily be copied and read by reviewers.

It is recommended that scanned copies not be submitted through Grants.gov unless the applicant confirms the clarity of the documents. Pages cannot be reduced in size, resulting in multiple pages on a single sheet, to avoid exceeding the page limitation.

• After you electronically submit your application, you will receive an acknowledgement from http://www.grants.gov that contains a Grants.gov tracking number. HHS will retrieve your application package from Grants.gov. Please note, applicants may incur a time delay before they receive acknowledgement that the application has been accepted by the Grants.gov system. Applicants should not wait until the application deadline to apply because notification by Grants.gov that the application is incomplete may not be received until close to or after the application deadline, eliminating the opportunity to correct errors and resubmit the application.

Applications submitted after the deadline, as a result of errors on the part of the applicant, will not be accepted.

• After HHS retrieves your application package from Grants.gov, a return receipt will be emailed to the applicant contact. This will be in addition to the validation number provided by Grants.gov.

Applications cannot be accepted through any email address. Full applications can only be accepted through http://www.grants.gov. Full applications cannot be received via paper mail, courier, or delivery service.

All grant applications must be submitted electronically and be received through http://www.grants.gov by 3:00 pm Eastern Time on July 7, 2015.

All applications will receive an automatic time stamp upon submission and applicants will receive an e-mail reply acknowledging the application’s receipt.

http://www.grants.gov/

Please be aware of the following:

• Search for the application package in Grants.gov by entering the CFDA number 93.644.

• If you experience technical challenges while submitting your application electronically, please contact Grants.gov Support directly at:

http://www.grants.gov/web/grants/support.html or (800) 518-4726. Customer Support is available to address questions 24 hours a day, 7 days a week (except on Federal holidays).

• When contacting Grants.gov, always obtain a tracking number as proof of contact. The tracking number is helpful if there are technical issues that cannot be resolved. To be considered timely, applications must be received on or before the published deadline date.

Grants.gov complies with Section 508 of the Rehabilitation Act of 1973. If an individual uses assistive technology and is unable to access any material on the site including forms contained with an application package, they can email the Grants.gov contact center at support@grants.gov or call 1-800-518-4726.

2. Content and Form of Application Submission

A. Form of Application Submission

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.

• Font size must be no smaller than 12-point with an average character density no greater than 14 characters per inch. This requirement does not apply to the organization chart and/or any other charts or tables provided.

• The Project Narrative must be DOUBLE-SPACED. This requirement does not apply to the text within any charts or tables that may be included within the Project Narrative.

• Applications must not be more than 16 pages in length including the project narrative (maximum of 5 pages), the attestation (1 page), the budget narrative (maximum of 6 pages), and any supporting materials (4 pages available, if needed). Standard forms, the http://www.grants.gov/web/grants/support.html mailto:support@grants.gov

Cover Letter, and the Project Abstract are not included in the page limit. The total size of all uploaded files may not exceed a total file size of 10 MB.

B. Overview of Grant Application Structure and Content

i. Standard Forms The following standard forms must be completed with an original signature and enclosed as part of the proposal:

SF 424: Official Application for Federal Assistance (see note below) SF 424A: Budget Information Non-Construction SF 424B: Assurances-Non-Construction Programs SF LLL: Disclosure of Lobbying Activities *All applicants must submit this document. Though this form may be listed as optional as part of application kit in Grants.gov, this form is mandatory. If your entity does not engage in lobbying, please insert “Non-Applicable” on the document and include the required Authorized Organizational Representative (AOR) name, contact information, and signature.

Project Site Location Form(s)*All applicants must submit this document. Though this form may be listed as optional as part of application kit in Grants.gov, this form is mandatory.

Project Abstract

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

• Item 15 “Descriptive Title of Applicant’s Project.” Please indicate in this section the name of this grant: Adult Medicaid Quality: Improving Maternal and Infant Health Outcomes in Medicaid and CHIP Grants.

• Check “No” to item 19c, as Review by State Executive Order 12372 does not apply to these grants.

ii. Cover Letter A letter from the State Medicaid Director identifying the Medicaid agency applicant as the lead organization, indicating the title of the project, the principal contact person, amount of funding requested, and the name of the division within the State Medicaid agency that will administer the grant and all major partners, departments, divisions, services, and organizations actively collaborating in the project is required.

This letter should be addressed to:

Shamia Blanks, Grants Management Specialist Center for Medicare and Medicaid Services Office of Acquisition and Grants Management Mailstop #7700 Bethesda 5600 Fishers Lane Rockville, MD 20857

iii. Project Narrative The application is expected to address the State’s interest in participating in the grant program and confirm its capability to report annually on the Initiative measure using the measure reporting system.

The required elements (sections) of the project narrative are outlined below. Also, provided is a brief description of the type of information that is required to be addressed within each specific section.

• Interest in participation – The application must include a brief statement expressing the State’s interest in participating in the Adult Medicaid Quality: Improving Maternal and Infant Health Outcomes in Medicaid and CHIP Grant. This statement may include a description of why the state is interested in the grant (for example, any current maternal and infant health initiatives the state is participating in, a description of any family planning-related activities, maternal and/or infant health performance measures, etc.).

• Organization and Administration – The application must include a description of the organizational and structural administrations that will be in place to implement, monitor, and operate the grant program. The tasks to be conducted by each administrative component must also be described. The application should document the State’s ability to successfully implement the proposed program. The application should describe State activity related to the grant including a description of other HHS grant funding the applicant has received that is related to quality measurement (e.g., Electronic Health Record Incentive Program, CHIPRA Quality Demonstration Grants). It should document how the proposed activities will complement, not duplicate, activities currently funded by other grants and/or cooperative agreements including those funded by CMS and explain how the grant activities will interact with other legislative efforts. Applicants must also include an organizational chart for the entity that is responsible for the management of this grant. Describe the relationship between that entity and all other departments, agencies, and service systems that will play a role in collecting information or data related to the measurement and evaluation of care and services under the grant program.

• Narrative Staffing Plan –

• The number, title, and, if known, the names of staff that will be dedicated to the grant program.

• Brief description of roles/responsibilities of each position.

• For each position, the percentage of that individual’s work that represents in-kind support.

• Number of contracted individuals supporting the grant.

• Reporting –

• The application must include a description of the State’s plan for collecting, reporting, and otherwise producing the data, information, and analysis required to be provided to

CMS.

iv. Attestation The application must include a signed attestation that the State understands that the full value of the grant will only be available to states that fully participate in the grant. Full participation requires the state to:

• Submit re-measurement data annually using CY 2015-2017 data on; and

• To submit the baseline and remeasurement data by the required due date.

v. Budget and Budget Narrative

a. Budget SF424A

All applicants must submit a SF424A. For the budget recorded on form SF 424A, the instructions outlined below should be followed, in addition to reviewing the general instructions provided for the SF424A.

Section A – Budget Summary Grant Program Function or Activity (column a) = Enter “Adult Medicaid Quality:

Improving Maternal and Infant Health Outcomes in Medicaid and CHIP” in row 1.

New or Revised Budget, Federal (column e) = Enter the Total Federal Budget Requested for the 4-year project period in rows 1 and 5.

New or Revised Budget, Non-Federal (column f) = Enter Total Amount of any Non-Federal Funds Contributed (if applicable) in rows 1 and 5.

New or Revised Budget, Total (column g) = Enter Total Budget Proposed in rows 1 and 5, reflecting the sum of the amount for the Federal and Non-Federal Totals.

Section B – Budget Categories Enter the total costs requested for each Object Class Category (Section B, number 6) for each year of the 4-year project period.

Column (1) = Enter Year 1 costs for each line item (rows a-h), including the sum of the total direct charges (a-h) in row i. Indirect charges should be reflected in row j. The total for direct and indirect charges for all year 1 line items should be entered in column 1, row k (sum of row i and j).

Column (2) = Enter Year 2 costs for each line item (rows a-h), including the sum of the total direct charges (a-h) in row i. Indirect charges should be reflected in row j. The total for direct and indirect charges for all year 2 line items should be entered in column 1, row k (sum of row i and j).

Column (3) = Enter Year 3 costs for each line item (rows a-h), including the sum of the total direct charges (a-h) in row i. Indirect charges should be reflected in row j. The total for direct and indirect charges for all year 3 line items should be entered in column 1, row k (sum of row i and j).

Column (4) = Enter Year 4 costs for each line item (rows a-h), including the sum of the total direct charges (a-h) in row i. Indirect charges should be reflected in row j. The total for direct and indirect charges for all year 4 line items should be entered in column 1, row k (sum of row i and j).

Column 5 = Enter total costs for all years of the project period for each line item (rows a-h), direct total costs (row i), and indirect costs (row j). The total costs for all line items for the four years should be entered in row k (sum of row i and j). The total in column 5, row k should match the total provided in Section A - Budget Summary, New or Revised Budget, column g, row 5.

b. Budget Narrative

The Budget Narrative must include a yearly breakdown of costs for the 4-year performance period. Specifically, the Budget Narrative should provide a detailed cost breakdown for each line item outlined in the SF424A by grant year, including a breakdown of costs for each activity/cost within the line item. The yearly breakdown of costs should reflect the maximum amount of reimbursement based upon level of participation in project and percentage available for reimbursement (see Section I.4. Program Requirements: Qualifying for Receipt of Reporting Payments for more information). The proportion of grant funding designated for each grant activity should be clearly outlined and justify the State’s readiness to receive funding through 2019, including complete explanations and justifications for the proposed grant activities. The budget must separate out funding that is administered directly by the lead agency from funding that will be used by any entity other than the lead agency.

The following budget categories should be addressed (as applicable):

- Personnel

- Fringe benefits

- Contractual costs, including subcontract contracts

- Equipment

- Supplies

- Travel

- Indirect charges, in compliance with 45 CFR Part 75. A copy of the current indirect cost rate agreement must be provided if requesting indirect costs, unless an indirect cost rate agreement has never been established (refer to Section IV. 5, Funding Restrictions, for more information).

- Other costs (can include infrastructure, data collection, and data analysis costs)

Submissions must identify a Project Manager responsible for the overall project. It is recommended that each grantee dedicate a Project Manager by either hiring and compensating this individual with grant funds or voluntarily utilizing a state staff employee to dedicate time as a Project Manager through an in-kind contribution. The project manager should be an employee of the state, not a contractor.

The Budget Narrative should also outline the strategies and activities of the grant program, and cost breakdowns for any contracts that will be implemented to achieve the anticipated outcomes.

The Budget Narrative should clearly distinguish the funding source of any given activity/cost, as either Federal or Non-Federal. Applicants should pinpoint those costs funded through in-kind contributions. Applicants must include detailed salary and fringe benefit costs for State staff dedicated to this project through an in-kind contribution. Applicants must also include yearly salary costs and the percentage of time dedicated to this project (for any given year). For example, if a State employee regularly makes $75,000 a year and will dedicate 50% of his/her time to this project for Year 1 (as an in-kind contribution) then the Budget Narrative should include a formula to indicate this, such as ($75,000 x 50%) = $37,500.

Completion of the Budget Form SF424A remains a requirement for consideration of your application. This Estimated Budget and Budget Narrative are an important part of your proposal and will be reviewed carefully by HHS staff. Applicants should review and follow guidance and sample information provided in Appendix B: Guidance for Preparing a Budget Request and Narrative in Response to SF424A.

Additional Cost Considerations All grantees will be required to budget for two representatives from the grantee team to attend up to two Medicaid/CHIP quality conferences in the Washington, DC or Baltimore, MD area sponsored by CMS over the grant period. Therefore, applicants’ budgets must include travel funds for two people to attend CMS-sponsored conferences in the Washington, DC or Baltimore, MD area.

vi. Letter(s) or Memorandum of Agreement(s) – Optional

All grantees are encouraged to submit a letter or memorandum of agreement from any major partner that is not the lead agency. An applicant should include all such letters as part of its application package as instructed in this solicitation. CMS will disregard any letter received outside of the submitted application. Letters should be included as a PDF file as instructed in the requirements of the application submission.

3. Submission Dates and Times

Letter of Intent to Apply

Voluntary Letters of Intent to Apply are due by June 3, 2015 and should be e-mailed to Lekisha Daniel-Robinson, Project Officer at CMCS_MIH_Initiative@cms.hhs.gov. It is not mandatory for an applicant to submit a Letter of Intent to Apply; however, such submissions help CMS plan its review process, including its review panels. Submission of a Letter of Intent to Apply does not bind the applicant to apply; nor will it cause a proposal to be reviewed more favorably. A sample Letter of Intent to Apply is located in Section VIII, Appendices, Appendix A.

mailto:CMCS_MIH_Initiative@cms.hhs.gov

i. Grant Applications All grant applications are due by July 7, 2015. Applications submitted through http://www.grants.gov by 3:00 p.m. Eastern Time on July 7, 2015 will be considered “on time.”

All applications will receive an automatic time stamp upon submission and applicants will receive an e-mail reply acknowledging the application’s receipt.

All grant awards have an anticipated award date of September 2, 2015. All grants will have an initial budget period of 12 months.

4. Intergovernmental Review Applications for these grants are not subject to review by States under Executive Order 12372, “Intergovernmental Review of Federal Programs” (45 CFR 100). Please check box “C” on item 19 of the SF 424 (Application for Federal Assistance) as Review by State Executive Order 12372, does not apply to these grants.

5. Funding Restrictions Indirect Costs If the applicant entity has a current negotiated indirect cost rate agreement (NICRA) and is requesting indirect costs, a copy of the…