nat'l background ck ninth solicitationfinalrevised.pdf

Department of Health and Human Services

Centers for Medicare & Medicaid Services

Center for Clinical Standards and Quality/Survey & Certification Group

Nationwide Program for National and State Background Checks for

Direct Patient Access Employees of Long Term Care Facilities and Providers

Ninth Announcement CFDA # 93.506

Funding Opportunity Number: CMS-1A1-13-002

Competition ID: CMS-1A1-13-002-017299

Applications will be accepted on a flow basis and acted on every 30 days

Background Check Questions and Answers Available at:

https://www.cms.gov/SurveyCertificationGenInfo/Downloads/backgroundcheckqanda.pdf

May 2013 https://www.cms.gov/SurveyCertificationGenInfo/Downloads/backgroundcheckqanda.pdf

TABLE OF CONTENTS

CHAPTER PAGE

Executive Summary 3

Timetable 4

I. Funding Opportunity Description 5

II. Award Information 6

III. Eligibility Information 7

IV. Application and Submission Criteria 8

V. Application Review Information 16

VI. Award Administration Information 19

VII. Agency Contact 21

APPENDICES

Appendix 1 - Statutory Provisions, Section 6201 of the Affordable Care Act of 2010 Appendix 2 - Program Narrative Requirements/Components of a Background Check Program Appendix 3 - Sample Work Plan and Timeline Appendix 4 - Sample Flow Diagram Appendix 5 - Sample Budget Forms Appendix 6 - Section 307 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 Appendix 7 - Definitions Applicable to this Solicitation Appendix 8 - Resource Information Related to Non-Federal Match Appendix 9 - Application Submission Checklist

EXECUTIVE SUMMARY

The Centers for Medicare & Medicaid Services (CMS) is inviting proposals from States and U.S.

territories to be considered for inclusion in the legislatively mandated National Background Check Program.

CMS is conducting a nationwide program that will identify efficient, effective and economical procedures for long term care facilities and providers to conduct background checks on prospective direct patient/resident access employees. Eligible facilities and providers include skilled nursing facilities, nursing facilities, home health agencies, hospice care providers, long-term care hospitals, personal care service providers, adult day care providers, residential care providers, assisted living facilities, intermediate care facilities for individuals with intellectual disabilities (ICFs/IID) and other entities that provide long-term care services, as specified by each participating State.

The State Office of the Governor, State Medicaid Agency, or the State Survey Agency may apply for funding under this grant opportunity. CMS will accept only one application per State;

therefore we encourage State offices and agencies to work collaboratively to develop one application packet when deemed appropriate. If more than one application is received for one State, CMS reserves the right to determine which application to select. Successful applicants will receive a Notice of Award (NOA) from the CMS Grant Management Officer approximately 60 days after the application due date. Grantees will receive funding through a 36-month project/budget period.

In order to participate in this nationwide program, a State must guarantee that it will make available non-Federal funds to cover a portion of the cost to be incurred by the State to carry out the Program in their State. The participating State must make available non-Federal contributions as a condition of receiving the Federal match under this Agreement. CMS will provide Federal grant funds to each newly participating State that enters into this Agreement with CMS at a rate which will be three times the amount that the State guarantees, not to exceed $3 million dollars in Federal funds from the beginning of the award period through a 36-month project/budget period. CMS will provide Federal grant funds to each previously participating State that enters into this agreement with CMS at a rate that will be three times the amount that the State guarantees, not to exceed $1.5 million dollars in Federal funds from the beginning of the award period through a 36-month project/budget period.

This grant is not competitive. All States submitting an application that is scored by the Federal technical evaluation panel at 70.2 out of the possible 101 points or greater shall receive a grant.

Applications that score below 70.2 points will not be included as grantees. In addition to the minimum score all applicants must meet all statutory requirements as described in section 6201 of the Patient Protection and Affordable Care Act (Affordable Care Act).

TIMETABLE

MILESTONE DATE

Grant Applications Due to CMS Applications will be reviewed every 30 days.

Grant Awards – Successful applicants will receive a Notice of Award (NOA) signed and dated by the CMS Grants Management Officer, Office of Acquisition and Grants Management. The Notice Of Award will be sent through the U.S. Postal Service.

Approximately 60 days after application due date.

I. FUNDING OPPORTUNITY DESCRIPTION

1. Introduction

Title VI, Subtitle B, Part III, Subtitle C, section 6201 of the Affordable Care Act directs the Secretary of Health and Human Services (HHS), to establish a nationwide program to identify efficient, effective, and economical procedures for long term care facilities and providers to conduct background checks on a statewide basis on all prospective direct patient access employees. A copy of Section 6201 of the Affordable Care Act of 2010 is included as Appendix 1.

CMS is inviting proposals from all States and U.S. territories to be considered for inclusion in this National Background Check Program. Federal matching funds are available to all States and U.S. territories that meet the requirements described in section 6201 of the Affordable Care Act and that provide an application that is scored at 70.2 out of a possible 101 points by the Federal review panel. The national program will be evaluated by the HHS Office of Inspector General (OIG). CMS has awarded a technical support contract to support the States that are selected to participate in the program. This program announcement provides States information concerning application procedures, policy considerations, and criteria to be used in reviewing applications and selecting States.

2. Background

Since the Omnibus Budget Reconciliation Act passed in 1987, long term care patient abuse, neglect and misappropriation of funds have been identified as a widespread problem for millions of Americans receiving long term care services. Protecting this vulnerable population continues to be a national challenge. Over the years, Congress has initiated several measures to address this challenge. CMS established regulations that prohibit long term care facilities and providers from employing individuals found guilty of abuse, neglect, or misappropriation of patient funds. In 1998 Congress enacted Public Law 105-277 which allows long term care facilities to request the Federal Bureau of Investigation (FBI) search its fingerprint database for criminal history matches. During 2003-2007 CMS piloted a program to evaluate the effectiveness of conducting background checks on prospective employees of long term care facilities and providers who had direct access to patients. The pilot supported the importance of background screening which included fingerprinting for individuals who have direct access to patients of nursing facilities, skilled nursing facilities, home health agencies, hospice care providers, long term care hospitals, long term care residential care providers (including assisted living facilities), personal care services providers, adult day care services providers, intermediate care facilities for individuals with intellectual disabilities and all other long term care providers. The pilot evaluation final report can be found at:

https://www.cms.gov/reports/downloads/White8-2008.pdf https://www.cms.gov/reports/downloads/White8-2008.pdf

3. Key Requirements for State Participation in the National Background Check Program

The specific requirements that applicant States must meet are in accordance with the legislative language and can be found in their entirety in Appendix 1 of this document.

Participating States must guarantee non-Federal funds to cover a portion of the cost to conduct the program in their State. CMS will provide a three-to-one match for State funds to each grantee. The participating State must require fingerprint checks as part of the criminal background check for all direct patient access employees. The participating State must have a plan to implement the program (a) statewide and (b) in all long term care entities specified in section 6201 of the Affordable Care Act. States may phase-in the program over a multi-year period, and the phase-in may be accomplished by geographical location, provider type, or other factors determined by the State. NOTE:

Key provider types identified by CMS must be phased-in by the time periods identified in section B.3 of Appendix 3 of this solicitation.

Participating States must ensure background checks include checks of State criminal history records for all relevant States, and the records of any proceedings that may contain disqualifying information (such as licensing and disciplinary boards and State Medicaid Fraud Control Units). According to the stipulations in section 6201, the participating State must require providers to search the abuse registries of all known States in which the employee lived. The background checks must include FBI fingerprint checks. The State must describe and test methods to reduce duplication of fingerprinting including “rap back” capabilities which will include a provision for State law enforcement departments to immediately inform the State of any criminal offenses by the employee that occur following the pre-employment background check. The “rap back” provision requires the State to immediately notify the provider when law enforcement notifies the State that an employee is convicted after the pre-employment background check. Participating States must have a procedure for (1) monitoring provider compliance with the National Background Check Program; (2) providing privacy and security safeguards; and (3) providing an independent dispute/appeal process.

II. AWARD INFORMATION

Funding for this Program shall become effective upon CMS’ issuance of Notice of Award. Grants will be awarded to every State that meets the terms of agreement as described in this solicitation. This includes submission of an application that meets all provisions of the Law and scores at least 70.2 out of 101 possible points from the Federal technical panel review. The estimated total amount available for all awards is approximately $140 million. Individual State grant funding will range between $1.5million and $3 million. The anticipated number of awards combined from all solicitations is up to 54 and the expected duration of support is up to 3 years. States will have 36 months from the grant period start date to implement their program. Although

CMS will fully fund grant awards under this program, CMS shall impose drawdown restrictions, as necessary to ensure State program pre-approved milestones are met.

III. ELIBIBILITY INFORMATION

1. Eligible Applicants

States may apply for funding under this grant opportunity. By “State” we refer to the definition provided under 45 CFR 74.2 as “any of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State exclusive of local governments.” By “territory or possession” we mean Guam, the U.S. Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands. A State’s Office of the Governor, State Medicaid Agency, or State Survey Agency may apply for funding under this grant opportunity. Any previously-awarded State that received less than the maximum permitted may at any time request an increase up to the maximum allowed by law provided that (a) the State submits a proposed modification to their plan that details and justifies the increase, (b) the State provides the requisite matching funds from acceptable sources, (c) CMS will evaluate the proposals on a flow basis; and (d) CMS reserves the right to fund less than requested.

2. Federally Matched Funding and State Guarantee Requirements

The National Background Check Program legislation mandates States must guarantee they will make available non-Federal funds to cover a portion of the cost to be incurred to carry out the background check program in their State. State funding may be from any source; such as State funds, local funds, bona-fide donations, or health care-related taxes that qualify as permissible sources of the non-Federal share in order to obtain Federal Medicaid matching funds. Funding requirements are specified in 42 CFR 433 subpart B, except that sections 42 CFR 433.53(b) and §433.70 will not apply to this background check program. For example, any provider-related donations must be determined to be bona fide in accordance with Section 1903(w)(2) of the Social Security Act and 42 CFR

433.54. CMS reserves the right to grant exceptions to the limitations on non-Federal share sources if the agency determines it is in the best interest of the public. Please refer to Appendix 9 for more details.

CMS will provide Federal grant funds to each newly participating State that enters into this agreement with CMS at a rate that will be three times the amount that the State guarantees, not to exceed $3 million dollars in Federal grant funds for the 36-month award period starting with the grant period start date. Due to grants beginning on a flow basis, grant funding and grant period start dates will vary. States that participated in the pilot background check program under Section 307 of the Medicare Modernization Act, and are now entering into this agreement with CMS will receive Federal grant funds at a rate that will be three times the amount that the State guarantees not to exceed $1.5 million dollars.

3. Foreign and international organizations are not eligible to apply under this solicitation.

4. Faith based organizations are not eligible to apply under this solicitation.

IV. APPLICATION and SUBMISSION CRITERIA

1. Address to Request Application Package

An electronic application package for this program announcement is available at www.grants.gov. Applicants may request an application package by sending an email to Background_Checks@cms.hhs.gov. Please be sure to include the name, mailing address and phone number of a contact person for the agency requesting an application. Please note that only one application request will be accepted per State.

NOTE: Although the application may be downloaded from the CMS website, applications must be electronically submitted to CMS through www.grants.gov.

2. Content and 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” pages with 1” top, bottom and side margins;

• Font not smaller than 12-point and an average character density not greater than 14 characters per inch;

• Abstract may be single-spaced but no more than one page;

• Double-space (no more than 3 lines per vertical inch);

• Paginate all pages of the narrative; and

• The Program Narrative portion of the application is limited to 40 pages*.

*The following items are not included in the Program Narrative portion of the application and, therefore, they do not count toward the total page limit:

http://www.grants.gov/

• Applicant’s Title Page and Cover Letter;

• Standard Forms from the Application Forms Kit;

• Letters of Agreement and Endorsement;

• Program Abstract;

• Budget Narrative/Justification and resources;

• Budget Forms; and

• Appendices.

(a) Required Content of the Application

A complete proposal consists of the following materials organized in the listing sequence indicated (see Appendix 10 for an application submission checklist).

• Applicant’s Title Page and Cover Letter

• Standard Forms from the Grant Application Package

• A letter of endorsement from the Governor or State Survey Agency

Director, etc.

• Program Abstract

• Program Narrative (see Appendix 3 for content)

• Budget Narrative/Justification

• Budget Forms

• Required Appendices

• Attachments (e.g., Letters of Agreement and Support)

Applicant’s Title Page and Cover Letter

A letter from the applicant identifying the Agency serving as the lead organization, indicating the title of the program, the principal contact person, amount of funding requested, and the names of all other State entities involved in the design, implementation of the program, and a point of contact for each. The letter should indicate that the submitting Agency has clear authority to oversee and coordinate the proposed activities and is capable of convening a suitable working group of all relevant partners.

Standard Forms from the Grant Application Package

The following standard forms must be completed and enclosed as part of the proposal.

Grant Application Package

SF 424: Application for Federal Assistance

SF 424A: Budget Information SF 424B: Assurances – Non-Construction Programs

SF LLL: Disclosure of Lobbying Activities Additional Assurances and Certifications

Key Contacts

Letters of Endorsement and Support

CMS advises all applicants to include a limited number of additional letters of support from key stakeholders. These letters will not be counted toward the narrative’s page limitation and should be included as attachments.

Program Abstract

The one-page abstract should serve as a succinct description of the proposed program and should include:

• The overall goals of the program;

• A description of how the grant will be used; and

• Budget allocations as follows:

o Total budget for 36-month project/budget period o Total Federal funds requested

Program Narrative

The program narrative should (1) Provide a concise and complete description of the proposed program; (2) Contain all information necessary for the review panelists to fully understand the proposed program; (3) Address the components of a background check program, (current infrastructure, use of grant funds, work products and timeline and staffing); and(4) Application narrative must not exceed 40 pages. See Appendix 3 for a detailed description of information that should be included in the program narrative.

Budget Narrative/Justification and Resources

The designated lead agency is solely responsible for the fiscal management of the program, and as such is responsible for providing the narrative/justification as well as aggregate numbers for the budget recorded on Standard Form 424 (SF 424). Application for Federal Assistance, must include allocations for each set of proposed activities and tasks. Additionally, allocations should distinguish the proportion of grant funding designated for each grant activity and task.

The budget must clearly delineate funds which will be administered directly by the lead agency and funds which will be subcontracted to other partners. The State’s application must specifically identify the amount and source of projected funding to meet the non-financial recipient contribution that is identified in Item 15 (Estimated Funding) on SF 424.

Budget Forms

Include the following as distinct line items on the budget forms that will accompany State proposals:

• Management Staffing Expenses

• Other Staffing Expenses

• Cost for Fingerprint Collection

• Fees for Fingerprint Searches ( distinguish FBI fees from State fees)

• Fees for Registry Searches (if any)

• Identify and justify fees paid to other agencies in addition to those previously identified

• Information Systems Software Costs

• Information Systems Hardware Costs

Sample Budget Forms can be found in Appendix 6 of this solicitation.

Required Appendices

• Key Staff Qualifications: Include a brief biographical sketch or resume of key staff describing their qualifications.

• Visual Map or Diagram: Include a flow diagram or process map of the current background check process in use (if any), and a revised flow diagram that is illustrative of how the Program will function. A sample Flow Diagram is located in Appendix 5 of this document.

(b) Data Universal Numbering System (DUNS)

Beginning October 1, 2003, applications are required to have a Dun and Bradstreet (DUNS) number to apply for a grant or cooperative agreement from the Federal Government. The DUNS number is a nine-digit identification number, which uniquely identifies business entities. Obtaining a DUNS number is easy and there is no charge.

To obtain a DUNS number, access the following website: www.dunandbradstreet.com or call 1-866-705-5711.

Your assigned DUNS number should be entered in Item 5 (applicant name and address) on Form SF-424 (Application for Federal Assistance) with the annotation “DUNS” followed by the DUNS number that identifies the applicant. The name and address in the application should be exactly as given for the DUNS number.

http://www.dunandbradstreet.com/

(c) Matching Requirement – Non-Federal Funds

Federal legislation stipulates for States to participate in this nationwide program, the State must guarantee that it will make available non-Federal funds to cover a portion of the cost to be incurred to carry out the background check program in its State. Funds may either be provided directly through State revenues (including provider taxes or certification fees) or through donations. All donations must be in accordance with section 1903(w)(2) of the Social Security Act 42 CFR 433.54. Note: Applicant fees may not be charged to persons participating in a Medicaid program who self-directs their own care, or to the applicants of such self-directed care employers. CMS will provide matched funding to each newly participating State that enters into this Agreement with CMS. Matched funding will be three times the amount the State guarantees not to exceed $3 million dollars.

CMS will provide matched funding to each previously participating State that conducted their statewide Background Check Program. CMS’ matching funds will be three times the amount the State guarantees not to exceed $1.5 million dollars. Appendix 9 of this document contains additional information with regard to non-Federal sources of funds.

(d) Indirect Cost Rate Agreement (if applicable)

If indirect costs are included in the budget, a copy of the approved Indirect Cost Rate Agreement must be submitted with the application and uploaded in Grants.gov as an attachment.

3. Submission Dates and Times

All grant applications must be submitted electronically through http://www.grants.gov.

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

Note: Grants.gov may take up to 2 days to validate your application as accepted or rejected.

Applications submitted by facsimile (fax) transmission, email or postal mail will not be accepted.

4. Intergovernmental Review

This grant is not subject to Executive Order 12372 concerning “Intergovernmental Review of Federal Programs”.

5. Funding Restrictions

(a) Grant funds may be used for any of the following:

Costs of data collection and transmission, which may include the costs of dedicated computers, software, necessary IT support, and data transmission costs as they relate to the National Background Check Program.

Costs of electronic fingerprint collection and transmittal systems.

Costs of rap-back systems that reduce the need for repeated full background checks of individuals by providers.

Personnel costs, which may include program support staff and contracts for collaboration with staff working in the long term care industry and/or consultants with expertise in background investigation and tracking. Please note the program must include a lead point of contact and program manager for the State, whose salary may or may not be paid through the use of grant funds.

Travel costs as they pertain to the administration and implementation of the grant.

Examples of allowable travel costs may include costs associated with data collection and program implementation with rural providers and travel to the CMS Background Check conferences. Federal travel regulations and cost limits will govern reimbursement for travel expenditures. Travel costs should be built into the State’s budget application.

Direct costs of conducting background checks (e.g., fees paid to law enforcement).

State funds used in an existing program may be used as the State matching funds required in this solicitation provided the increased Federal funds provide for reasonable expansion and improvement of the background check program.

Proposals that include an existing program without reasonable expansion or improvement will not be approved.

Training costs for State agencies, providers and human resources personnel participating in the implementation of the National Background Check Program Training costs must be specified with detail in the grant budget.

Indirect and overhead costs will be allowed at the State’s approved rate.

(b) Grant funds may not be used for any of the following:

To provide direct services to individuals except as explicitly permitted under the grant solicitation.

To match any other Federal funds.

To provide services, equipment, or supports that are already the legal responsibility of another party under Federal law (e.g., Nurse Aid Registry for the job categories currently required) or under any Federal civil rights laws. Such legal responsibilities include, but are not limited to, modifications of a workplace or other reasonable accommodations that are a specific obligation of the employer or other party.

To provide infrastructure for which Federal Medicaid matching funds are available at the 90/10 matching rate, such as certain Medicaid Management Information System improvements.

6. Other Submission Requirements

All applications must be submitted electronically through www.grants.gov.

(a) Grants.gov Registration in Brief

1. Your organization will need to obtain a DUNS Number. The DUNS number is a nine-digit identification number that uniquely identifies business entities. Obtaining a DUNS number is easy and free of charge. To obtain a DUNS number, access the following Website: www.dunandbradstreet.com or call 1-866-705-5711. It may take up to two business days to obtain a DUNS Number.

2. Ensure that your organization is registered with the System for Award Management (SAM)* at www.sam.gov. Registering an account with SAM is a separate process from submitting an application. Applicants are encouraged to register early. Therefore, registration should be completed in sufficient time to ensure that it does not impair your ability to meet required submission deadlines

*Applicants were previously required to register with the CCR. However, SAM has integrated the CCR and 7 other Federal procurement systems into a new, streamlined system. If an applicant has an active record in CCR, there will be an active record in SAM. Nothing more is needed unless a change in the business circumstances requires updates to the Entity record(s) in order for the applicant to be paid, receive an award, or to renew the Entity prior to expiration. Please consult the SAM website listed above for additional information.

3. 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 http://www.sam.gov/ their username and password, at http://grants.gov/applicants/get_registered.jsp. AORs must wait at least one business day after registration in 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.

4. When an AOR registers with Grants.gov to submit applications on behalf of an organization, that organization’s E-Biz point-of-contact will receive an e-mail notification. The e-mail address provided in the profile will be the e-mail used to send the notification from Grants.gov to the E-Biz POC with the AOR copied on the correspondence.

5. 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.

6. The AOR and the DUNS must match. If your organization has more than one DUNS number, be sure you have the correct AOR for your application. Please note that there can be more than one AOR for an organization.

7. 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 format 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.

8. At any time, you can track your AOR status by going to the applicant login page at http://www.grants.gov/track.

(b) Submit Your Application Early!

CMS strongly encourages applicants to submit early to ensure resubmission time if your application is rejected due to errors. An applicant containing errors or omissions can require protracted time to correct the errors and/or to solicit help from Grants.gov. Note:

Validation or rejection of your application by Grants.gov may take up to 2 business days after submission. Please consider this in developing your submission timeline.

For issues including, but not limited to downloading the application, retrieving your password, or assistance with error messages, please contact Grants.gov directly at 1-800- 518-4726 or support@grants.gov . Hours of Operation: Monday-Friday, 7:00 a.m. to 9:00 p.m., Eastern Time, closed on Federal Holidays. Please have the following information available when contacting grants.gov to help expedite your inquiry:

• Funding Opportunity Number (FON)

• Name of Agency You Are Applying To

• Specific Area of Concern http://grants.gov/applicants/get_registered.jsp http://www.grants.gov/track mailto:support@grants.gov

V. APPLICATION REVIEW INFORMATION

1. Criteria

CMS uses the following criteria to evaluate all applications for inclusion in the Program. Only States whose application is scored at 70.2 out of a possible 101 points or greater will be accepted as grantees. In addition to the minimum score all applicants must meet all statutory requirements as described in section 6201 of the Affordable Care Act.

The total score for the criteria below is 101 points.

(a) Background and Areas for Improvement or Expansion of Current Program

(10 Points)

1. The application evidences a clear, comprehensive description of the current system in the State to conduct background screening for health care employees.

2. The application evidences the strengths and weaknesses of the current system, and identifies opportunities for improvement of the current system, explaining why such changes are important.

(b) Goals/Objectives (3 points)

1. The application evidences clear goals and objectives that relate in a meaningful way to the issues and opportunities identified in the immediate preceding section.

2. The application evidences goals and objectives that are reasonable and will be effective in accomplishing the purpose of the grant.

3. The application addresses how the background check process will not create barriers to job application that significantly reduce the available workforce for direct patient access positions.

(c) Components and Methodology of the Background Check Program (38 points)

1. The application reflects a strong understanding of the scope, complexity and required components of a background check program.

2. The application fully addresses each component of the background check program and represents a sufficiently substantive undertaking in terms of design and scope;

that the proposal is likely, together with accepted applications of other States, to test the major hypotheses for this national program.

3. The application fully incorporates provisions for “rap back” capability by the State.

4. The application evidences effective uses of technology and other approaches that are effective in “low tech” environments.

5. The methodology and design of the State program is coherent and well-conceived.

(d) Work Plan and Flowchart (5 points)

1. The application includes a work plan that documents: goals and objectives, reasonable benchmarks, milestones, timeframes, measurable outcomes and products;

and identifies the responsible parties to accomplish the goals of the program. As a tool to assist applicants in developing their proposal and to facilitate CMS’ review panel process, CMS recommends applicants use the Sample Work Plan and Timeline (see Appendix 4) to formulate their Work Plan.

2. The application includes a work flow diagram or process map of the current background check process in use (if any), and a revised flow diagram that is illustrative of how the Program will function. A sample Flow Diagram can be found in Appendix 5.

(e) Key Personnel (5 points)

1. The application evidences that key program staff are qualified and possess the experience and skills necessary to design, implement and evaluate the program within the available timeframe.

2. The application evidences a single point of contact for the program known as the

Principal Investigator (PI) or Project Director (PD), and that person will be available and dedicated to the effort. The PI/PD must be clearly identified in the application.

3. The application evidences that key program staff have direct professional experience with conducting or overseeing a background check program.

(f) Collaboration among State Agencies (10 Points)

1. The application evidences collaboration and coordination amongst State entities (e.g., State survey agency, State law enforcement agencies, single State Medicaid agency, etc.) that will be required for a successful Program.

(g) Involvement of Providers and Stakeholders (10 Points)

1. The application evidences the involvement of consumer and provider interest groups in the design and implementation of the national program.

2. Describes partnerships with public and private organizations that possess expertise in workforce issues pertaining to direct patient access workers in long-term care facilities or providers.

3. Promotes partnerships with public and private organizations that represent people of any age who receive long-term care services.

(h) Budget Narrative/Justification and Resources (20 Points)

1. The application evidences a reasonable and detailed budget.

2. The application evidences budgeted costs that are reasonable in relation to the proposed objectives, design, and significance.

3. The application evidences that the budget follows the requirements stated in the program announcement and specifically does not use grant funds to supplant existing funds.

4. The budget demonstrates a logical interface between current resources and the anticipated grant funding.

2. Review and Selection Process

The review and selection process occurs in two parts. Upon timely receipt by CMS, all applications will be screened to assure that the application is complete. Applicants may be requested to provide additional information during the review process.

A panel of Federal experts will conduct the application reviews. The panelists will review the applications to determine if the proposed Background Check Program meets the requirements of the solicitation. Panelists will score the applications based on the review criteria set forth in Section V of this document. Applications not attaining a minimum score of 70.2 out of a possible 101 points will be considered unacceptable.

Final award decisions will be made by the Director of the Survey and Certification Group, within the Office of Clinical Standards and Quality (OCSQ) after consideration of the comments and recommendations of the technical review panel.

CMS reserves the right to offer a funding level that differs from the requested amount, and to negotiate with the applicant regarding the appropriate scope and intensity of effort that would be appropriate and commensurate with the final funding level.

3. Anticipated Announcement and Award Dates

Awards to those States submitting successful applications will be made on or about the date specified in the timetable.

VI. AWARD ADMINISTRATION INFORMATION

1. Award Notices

Successful applicants will receive via email an official Notice of Award (NOA), signed by the CMS Grants Officer that will set forth the amount of the award, the Terms and Conditions of the award, and other State specific pertinent information. The NOA is a legal document issued to notify the grantee that an award has been made and that funds may be requested from the HHS payment system. Grantees are considered to have accepted the grant and its Terms and Conditions as soon as funds are drawn down from the Payment Management System.

2. Administrative and National Policy Requirements

The following standard requirements apply to applications under this solicitation.

• Specific administrative and policy requirements of applicants, as outlined in 45 CFR 92, and OMB Circulars A-102, A-87, and A-133 apply to this grant opportunity.

• Civil Rights - All Grantees receiving awards under these grant programs must meet the requirements of:

i. Title VI of the Civil Rights Act of 1964;

ii. Section 504 of the Rehabilitation Act of 1973;

iii. The Age Discrimination Act of 1975;

iv. Hill-Burton Community nondiscrimination provisions; and

v. Title II, Subtitle A, of the Americans with Disabilities Act of 1990.

This funding opportunity with CMS will include the Health and Human Services (HHS) Grants Policy Statement at http://www.hhs.gov/grantsnet/adminis/gpd/index.htm and may also include additional specific grant “special” terms and conditions. Potential applicants should be aware that special requirements could apply to grant awards based on the particular circumstances of the effort to be supported of deficiencies identified in the application by the review panel or CMS.

3. Reporting

As a condition for accepting funding under this grant program, States are required to comply with the following reporting requirements:

(a) Grantees must agree to fully cooperate with any Federal evaluation of the program and provide quarterly or semi-annually any required program progress and financial reports in a form prescribed by CMS (including the SF-425, Federal Financial Report). These reports are designed to outline how grant funds were used and to describe program progress, as well as barriers and measurable outcomes. CMS will provide a format for reporting.

http://www.hhs.gov/grantsnet/adminis/gpd/index.htm

(b) Grantees must also agree to respond to requests that are necessary for the evaluation of the National Background Check Program grant efforts to satisfy the statutory requirements for the Federal evaluation enumerated in Section 6201 of the Affordable Care Act. Grantees must also provide data on key elements of their Background Check Program grant activities. Grant activities will include detailed information on the number of background checks requested by various providers; information gathered in the course of background checks and employment decisions made based on gathered information and decision rationale; and whether prospective employees challenged the results of adverse decisions and the outcomes of these challenges.

Grantee reporting will also include cost accounting information of sufficient quality to allow reliable calculation of the costs of the various components of the background checks programs.

(c) Following the awarding of the grant, grantees must submit an operational protocol.

The operational protocol must describe in detail the policies and procedures the State will follow during the program period. The operational protocol should detail the responsibilities of the providers included in the program; the State government personnel and any additional responsible parties (e.g., contractors) involved in the program. Those who receive grant awards will be provided further detail outlining the expected contents of the operational protocol prior to or during the first grantee meeting.

VII. AGENCY CONTACT

For questions regarding forms and related materials, please contact:

CMS National Background Check Program Centers for Medicare & Medicaid Services Center for Clinical Standards and Quality/Survey & Certification Group Mail Stop: C2-21-16 7500 Security Boulevard Baltimore Maryland, 21244-1850

E-mail: Background_Checks@cms.hhs.gov or

OAGMGrantsBaltimore@cms.hhs.gov

Appendix 1

Statutory Provisions

Affordable Care Act of 2010 (section 6201)

Subtitle C—Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-term Care Facilities and Providers

SEC. 6201. NATIONWIDE PROGRAM FOR NATIONAL AND STATE BACKGROUND

CHECKS ON DIRECT PATIENT ACCESS EMPLOYEES OF LONG-TERM CARE

FACILITIES AND PROVIDERS.

(a) IN GENERAL.—The Secretary of Health and Human Services (in this section referred to as the “Secretary”), shall establish a program to identify efficient, effective, and economical procedures for long term care facilities or providers to conduct background checks on prospective direct patient access employees on a nationwide basis (in this subsection, such program shall be referred to as the ‘‘nationwide program’’). Except for the following modifications, the Secretary shall carry out the nationwide program under similar terms and conditions as the pilot program under section 307 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173; 117 Stat. 2257), including the prohibition on hiring abusive workers and the authorization of the imposition of penalties by a participating State under subsection (b)(3)(A) and (b)(6), respectively, of such section 307:

(1) AGREEMENTS.— H. R. 3590—604

(A) NEWLY PARTICIPATING STATES.—The Secretary shall enter into agreements with each State—

(i) that the Secretary has not entered into an agreement with under subsection (c)(1) of such section 307;

(ii) that agrees to conduct background checks under the nationwide program on a Statewide basis; and

(iii) that submits an application to the Secretary containing such information and at such time as the Secretary may specify.

(B) CERTAIN PREVIOUSLY PARTICIPATING STATES.—The Secretary shall enter into agreements with each State—

(i) that the Secretary has entered into an agreement with under such subsection (c)(1), but only in the case where such agreement did not require the State to conduct background checks under the program established under subsection (a) of such section 307 on a Statewide basis;

(ii) that agrees to conduct background checks under the nationwide program on a Statewide basis; and

(iii) that submits an application to the Secretary containing such information and at such time as the Secretary may specify.

(2) NONAPPLICATION OF SELECTION CRITERIA.—The selection criteria required under subsection (c)(3)(B) of such section 307 shall not apply.

(3) REQUIRED FINGERPRINT CHECK AS PART OF CRIMINAL HISTORY

BACKGROUND CHECK.—The procedures established under subsection (b)(1) of such section 307 shall—

(A) require that the long-term care facility or provider (or the designated agent of the long-term care facility or provider) obtain State and national criminal history background checks on the prospective employee through such means as the Secretary determines appropriate, efficient, and effective that utilize a search of State-based abuse and neglect registries and databases, including the abuse and neglect registries of another State in the case where a prospective employee previously resided in that State, State criminal history records, the records of any proceedings in the State that may contain disqualifying information about prospective employees (such as proceedings conducted by State professional licensing and disciplinary boards and State Medicaid Fraud Control Units), and Federal criminal history records, including a fingerprint check using the Integrated Automated Fingerprint Identification System of the Federal Bureau of Investigation;

(B) require States to describe and test methods that reduce duplicative fingerprinting, including providing for the development of ‘‘rap back’’ capability by the State such that, if a direct patient access employee of a long-term care facility or provider is convicted of a crime following the initial criminal history background check conducted H. R. 3590— 605 with respect to such employee, and the employee’s fingerprints match the prints on file with the State law enforcement department, the department will immediately inform the State and the State will immediately inform the long term care facility or provider which employs the direct patient access employee of such conviction; and

(C) require that criminal history background checks conducted under the nationwide program remain valid for a period of time specified by the Secretary.

(4) STATE REQUIREMENTS.—An agreement entered into under paragraph (1) shall require that a participating State—

(A) be responsible for monitoring compliance with the requirements of the nationwide program;

(B) have procedures in place to—

(i) conduct screening and criminal history background checks under the nationwide program in accordance with the requirements of this section;

(ii) monitor compliance by long-term care facilities and providers with the procedures and requirements of the nationwide program;

(iii) as appropriate, provide for a provisional period of employment by a long-term care facility or provider of a direct patient access employee, not to exceed 60 days, pending completion of the required criminal history background check and, in the case where the employee has appealed the results of such background check, pending completion of the appeals process, during which the employee shall be subject to direct on-site supervision (in accordance with procedures established by the State to ensure that a long-term care facility or provider furnishes such direct on-site supervision);

(iv) provide an independent process by which a provisional employee or an employee may appeal or dispute the accuracy of the information obtained in a background check performed under the nationwide program, including the specification of criteria for appeals for direct patient access employees found to have disqualifying information which shall include consideration of the passage of time, extenuating circumstances, demonstration of rehabilitation, and relevancy of the particular disqualifying information with respect to the current employment of the individual;

(v) provide for the designation of a single State agency as responsible for—

(I) overseeing the coordination of any State and national criminal history background checks requested by a long-term care facility or provider (or the designated agent of the long-term care facility or provider) utilizing a search of State and Federal criminal history records, including a fingerprint check of such records;

(II) overseeing the design of appropriate privacy and security safeguards for use in the review of the results of any State or national criminal history background checks conducted regarding a H. R. 3590—606 prospective direct patient access employee to determine whether the employee has any conviction for a relevant crime;

(III) immediately reporting to the long-term care facility or provider that requested the criminal history background check the results of such review; and (IV) in the case of an employee with a conviction for a relevant crime that is subject to reporting under section 1128E of the Social Security Act (42 U.S.C. 1320a–7e), reporting the existence of such conviction to the database established under that section;

(vi) determine which individuals are direct patient access employees (as defined in paragraph (6)(B)) for purposes of the nationwide program;

(vii) as appropriate, specify offenses, including convictions for violent crimes, for purposes of the nationwide program; and

(viii) describe and test methods that reduce duplicative fingerprinting, including providing for the development of ‘‘rap back’’ capability such that, if a direct patient access employee of a long-term care facility or provider is convicted of a crime following the initial criminal history background check conducted with respect to such employee, and the employee’s fingerprints match the prints on file with the State law enforcement department—

(I) the department will immediately inform the State agency designated under clause (v) and such agency will immediately inform the facility or provider which employs the direct patient access employee of such conviction; and (II) the State will provide, or will require the facility to provide, to the employee a copy of the results of the criminal history background check conducted with respect to the employee at no charge in the case where the individual requests such a copy.

(5) PAYMENTS.—

(A) NEWLY PARTICIPATING STATES.—

(i) IN GENERAL.—As part of the application submitted by a State under paragraph (1)(A)(iii), the State shall guarantee, with respect to the costs to be incurred by the State in carrying out the…