NOFO FY24 Medicaid SBS Planning Grant_FINAL_CLEAN_DGMCLEARANCE_AMENDED_revised_3.8.2024.pdf

U.S. Department of Health and Human Services

Centers for Medicare & Medicaid Services

State Grants for the Implementation, Enhancement, and Expansion of Medicaid and CHIP

School-Based Services

Notice of Funding Opportunity Type: New

Funding Opportunity Award Type: Cooperative Agreement

Notice of Funding Opportunity Number: CMS-2M2-24-001

Federal Assistance Listings Number (CFDA): 93.771

Notice of Funding Opportunity Posting Date: January 24, 2024

Applicable Dates:

Letter of Intent to Apply Due Date: February 23, 2024

Electronic Application Due Date: March 25, 2024, 11:59 pm Eastern Standard Time

Anticipated Issuance Notice(s) of Award: July 1, 2024

Anticipated Period of Performance: July 1, 2024 through June 30, 2027

2024-01-24 Page 2 of 80

Table of Contents

A. Program Description

A1. Purpose

A2. Authority

A3. Background

A4. Program Requirements

A5. Technical Assistance and Information for Prospective Applicants

B. Federal Award Information

B1. Total Funding

B2. Award Amount

B3. Anticipated Award Dates

B4. Period of Performance

B5. Number of Awards

B6. Type of Award

B7. Type of Competition

C. Eligibility Information

C1. Eligible Applicants

C2. Cost Sharing or Matching

C3. Letter of Intent

C4. Ineligibility Criteria

C5. Single Application Requirement

C6. Continued Eligibility

C7. EIN, UEI, and SAM Requirements

C8. Faith-Based Organizations

C9. Other Eligibility Requirements

D. Application and Submission Information

D1. Address to Request Application Package

D2. Content and Form of Application Submission

a. Application format

b. Standard forms

c. Application Cover Letter (optional)

2024-01-24 Page 3 of 80

d. Program Requirements and Expectations

Project Narrative (maximum 40 pages)

e. Initial Planning Period Work Plan and Timeline (maximum 2 pages)

f. Budget Narrative (maximum 10 pages)

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

h. Appendices (maximum 50 pages)

D3. Unique Entity Identifier and System for Award Management (SAM)

D4. Submission Dates and Times

D5. Intergovernmental Review

D6. Cost Restrictions

D7. Mandatory Disclosure

D8. HHS Form 690

E. Application Review Information

E1. Criteria

E2. Merit Review and Selection Process

E3. Federal Awardee Performance Integrity Information System (FAPIIS)

F. Federal Award Administration Information

F1. Federal Award Notices

F2. Administrative and National Policy Requirements

F3. Terms and Conditions

F4. Cooperative Agreement Terms and Conditions of Award

F5. Health Information Technology (IT) Interoperability Language

F6. Reporting

G. CMS Contacts

G1. Programmatic Questions

G2. Administrative/Budget Questions

H. Other Information

Appendix I. Guidance for Preparing a Budget Request and Narrative

Appendix II. Application and Submission Information

Appendix III. Business Assessment of Applicant Organization

Appendix IV. Accessibility Requirements

2024-01-24 Page 4 of 80

Appendix V. Review and Selection Process

Appendix VI. Application Check-off List

2024-01-24 Page 5 of 80

Executive Summary

The Centers for Medicare & Medicaid Services (CMS) is committed to increasing access to health care services in ways that can narrow disparities in rates of care, promote quality education and achievement, and build a reliable system of support for every young person.

Schools are uniquely positioned to help increase health equity and to help ensure that all children, including adolescents, have access to necessary health care services. Although schools are primarily providers of education, the school setting provides a unique opportunity to: enroll eligible children and adolescents in Medicaid and the Children’s Health Insurance Program

(CHIP); deliver covered services, including behavioral health services (mental health and substance use disorder (SUD) services) to eligible children; and help children who are enrolled in

Medicaid or CHIP access the services they need.

School-based services (SBS), which are Medicaid or CHIP-coverable services provided to children and adolescents in a school setting, play an important role in the health and well-being of children and adolescents, particularly for those enrolled in the Medicaid or CHIP programs.

Through this Notice of Funding Opportunity (NOFO), CMS will fund recipient States to implement, enhance, or expand the provision of assistance through school-based entities under

Medicaid and CHIP. The Bipartisan Safer Communities Act (BSCA) authorized this funding and stipulates that States shall not use any grant funds to provide medical assistance, child health assistance, or other health services.

Item Description

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

CMS Awarding Center Center for Medicaid & CHIP Services (CMCS)

Notice of Funding

Opportunity Title

State Grants for the Implementation, Enhancement, and

Expansion of Medicaid and CHIP School-Based Services

Authorization Section 11003(b) of the Bipartisan Safer Communities Act

Federal Assistance

Listings Number (CFDA)

93.771

Funding Opportunity

Type

Cooperative Agreement

Funding Opportunity

Number

CMS-2M2-24-001

Type of Award New

Type of Competition Competitive

2024-01-24 Page 6 of 80

Letter of Intent CMS requests a letter of intent to apply for this funding opportunity. These are optional.

See Section C.3 for more information.

Application Due Date and Time

March 25, 2024 by 11:59 pm EST (Baltimore, MD)

Anticipated Issuance

Notice(s) of Award

July 1, 2024

Period of Performance

Start Date

July 1, 2024

Period of Performance

End Date

June 30, 2027

Anticipated Total

Available Funding

$50,000,000 (subject to availability of funds)

Estimated Maximum

Award Amount

$2,500,000

Estimated Maximum

Number of Recipients

A. Program Description

A1. Purpose

CMS, through its Center for Medicaid and CHIP Services (CMCS), seeks applications for the

State Grants for the Implementation, Enhancement, and Expansion of Medicaid and CHIP SBS.

This initiative provides funding support to bolster State and local infrastructure for the provision, billing, and claiming of Medicaid and CHIP SBS programs. Recipients may not use any grant funds to provide medical assistance, child health assistance, or other health services.

This NOFO is open to State governments, specifically State Medicaid Agencies, with State

Education Agencies (SEAs) as required partners. In addition to SEAs, State Medicaid Agencies should partner with local education agencies (LEAs), and schools, as appropriate, to determine the needs and processes to be addressed through this funding opportunity, and work closely to implement those strategies at the state and local levels.

A2. Authority

Section 11003 (b) of the Bipartisan Safer Communities Act authorizes $50,000,000 (subject to availability of funds) for the Secretary to award grants to States for the purpose of implementing, enhancing, or expanding the provision of assistance through school-based entities under Medicaid and CHIP.

2024-01-24 Page 7 of 80

A3. Background

Since the inception of the Individuals with Disabilities Education Act (IDEA) in 1975, SBS have become an important and growing resource for Medicaid- and CHIP-enrolled IDEA eligible children and their families in the provision of medically necessary services. The 1988 amendment to IDEA, included in the Medicare Catastrophic Coverage Act, clarified that

Medicaid funds could be used to pay for Medicaid-coverable services that are part of the eligible child’s Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).

Until 2014, Medicaid would only pay for those Medicaid services that were in a student’s IEP or

IFSP. IEP services are delivered without cost to the child’s family. It is important to note that

IEP/IFSP services, such as speech therapy, are designed to assist a child’s success in school or to advance their development. A child with an IEP may also need Medicaid-covered services, such as speech therapy, for medical reasons. Thus, State Medicaid agencies must work in partnership with SEAs to ensure that children with disabilities receive the necessary Medicaid- or CHIP coverable services that can be reimbursed by Medicaid or CHIP as applicable. IDEA requires states to establish interagency agreement between the SEA and the State Medicaid Agency.

These agreements should contain the following elements: Medicaid may be the payor of first resort for IEP services under section 1903(c) of the Act; the SEA must resolve any payment disputes so that there is no cost to the child’s family; and if Medicaid pays the education system for any IEP services, Medicaid is prohibited from reducing any Medicaid benefit available to the child, including any benefit delivered under a Medicaid waiver or through a managed care organization.

In 2014, CMS reversed the 1997 Medicaid policy known as the Free Care Rule that limited schools’ ability to bill Medicaid for student health care services. The reversal allowed schools to claim payment for covered services provided to students enrolled in Medicaid, regardless of whether the services were identified in an IEP or IFSP, or were generally furnished to students without charge.1 The opportunity for Medicaid to pay for Medicaid services outside of

IEP/IFSPs furnished to Medicaid-enrolled students supports student health and learning. It helps students to obtain services they need through a school, instead of leaving and missing class. Expanding Medicaid payment for more eligible students, as well as broadening the types of services covered in schools, could also bring more federal revenue to states and school districts. Given that most states already provide some services to Medicaid- and CHIP-enrolled students without an IEP, and pay for them using state education funds, increased federal payment can help avoid reliance on limited education dollars and ultimately help states expand the staffing needed to provide health services to students.

As a result of the Free Care Rule Reversal, states can now seek Medicaid payment for services provided to all Medicaid-enrolled students, provided they meet certain conditions, including: 1) the services are covered by the Medicaid program (including services covered under The Early

1 See https://www.medicaid.gov/sites/default/files/federal-policy-guidance/downloads/smd-medicaid-payment-for-services-provided-without-charge-free-care.pdf.

https://www.medicaid.gov/sites/default/files/federal-policy-guidance/downloads/smd-medicaid-payment-for-services-provided-without-charge-free-care.pdf https://www.medicaid.gov/sites/default/files/federal-policy-guidance/downloads/smd-medicaid-payment-for-services-provided-without-charge-free-care.pdf

2024-01-24 Page 8 of 80 and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit2; 2) the services are administered by a provider that is participating in the Medicaid program (Medicaid-participating provider); and 3) the state has billing mechanisms in place to properly bill Medicaid for services provided in schools to Medicaid beneficiaries. However, some states need to act if they wish to access Medicaid payment for school health services under the Free Care Rule reversal. Some states have codified the older policy into state law and/or their Medicaid State plans, and they will need to update their Medicaid plans (after enacting any necessary changes in state law, if required) to avail themselves of current federal policy. Implementing this policy change may require submitting a state plan amendment (SPA) to expand Medicaid coverage for student health services or passing legislation to reverse free care exclusions, depending on state law.

CMS is committed to increasing access to health care services in ways that can narrow disparities in rates of care, promote quality education and achievement, and build a reliable system of support for every young person. This commitment recognizes research that consistently demonstrates a positive link between scholastic attainment and improved health outcomes while also acknowledging that the educational environment is an optimal place to promote wellbeing. In addition to requiring State Medicaid and SEA partnership, we strongly encourage State Medicaid and CHIP agencies looking to advance SBS, to partner with education services agencies (ESAs), LEAs including charter schools that are LEAs, public boards of education or other public authorities within a State that maintain administrative control of public elementary or secondary schools in a city, county, township, school district, or other political subdivision of the State.

Medicaid and CHIP cover many services provided through schools to students enrolled in

Medicaid. This includes services provided by school-based health centers, which can significantly improve key health and educational outcomes among students. State Medicaid agencies, SEAs, ESAs and LEAs can work together to explore opportunities to obtain payment for covered services provided to Medicaid- and CHIP-enrolled students. Many services such as immunizations, health screenings, oral health care, substance use disorder treatment, and behavioral health care can be provided in schools and may be eligible for Medicaid coverage and payment.

Schools are uniquely positioned to increase health equity and to help ensure that all children have access to necessary health care services. This includes services provided through a formal

Individualized Education Program and Individualized Family Service Plan under the Individuals with Disabilities Education Act, or other plan and services provided outside of those plans where the services are made available without charge to the beneficiary, including when the services are available without charge to other students not enrolled in Medicaid or CHIP. It is important

2 The Early and Periodic Screening, Diagnostic and Treatment is a Medicaid benefit that mandates coverage of services described in section 1905(r) of the Social Security Act (the Act) for EPSDT-eligible beneficiaries, which include a range of services including medical, dental, personal care, and long-term services and supports, regardless of whether the services provided are covered under the State plan. Most Medicaid beneficiaries under age 21 are eligible for the EPSDT benefit.

2024-01-24 Page 9 of 80 to note that services provided in school settings may compliment, and are not inherently duplicative of, similar services provided in out-of-school settings. States providing SBS that are part of a student’s IEP must adhere to IDEA statutory and regulatory requirements that prohibit charging Medicaid or CHIP if it decreases the availability of coverage or benefits for that child or result in the family paying increased premiums or fees for services that are otherwise covered by Medicaid or CHIP.3

A4. Program Requirements

Initial Planning Period Work Plan and Timeline

The purpose of the planning period is to ensure that needed project leadership is engaged and

States have started to design their approaches to implement, expand, and enhance Medicaid and

CHIP services in schools. All recipients must submit a proposed timeframe regarding their initial planning period. Planning periods should be identified in timeframes of 3, 6, 9, or 12 months, and should be used specifically for the planning of activities intended to implement, expand, or enhance the SBS program. CMS will allow recipients to use grant funds to employ individuals and begin operations during this time.

Project Activities

The SBS Grants will fund activities and strategies aimed at implementing, enhancing, and expanding the provision of assistance through school-based entities under Medicaid and CHIP.

Grant funds must be used to support infrastructure development in one of the following three categories, consistent with the current status of the applicant State’s SBS program as evidenced by its State plan, time study implementation plan (TSIP),which should be included to the extent that a TSIP is a component of the of the applicant’s State plan payment methodology, and any other relevant Medicaid approved materials:

• The Implementation of SBS – Applicants seeking funds to support implementation activities may include States that have yet to expand the coverage of and billing for

Medicaid and CHIP services provided in schools beyond that which is provided pursuant to a student’s IEP/IFSP. Proposals must specifically describe how the funds will be used.

Describe the issues that the funding will help resolve, including, but not limited to, the building out the school infrastructure for providing health care services, training, and assessment of needs, to allow for the provision, billing, and documentation of SBS for the

Medicaid- and CHIP-enrolled students.

• The Expansion of SBS – Applicants seeking funds to support expansion activities may include: States that have expanded the coverage and billing of Medicaid or CHIP services provided in schools beyond what is provided pursuant to a student’s IEP/IFSP. For purposes of this NOFO, the term “expansion” includes State Medicaid or CHIP programs that allow for at least one enrolled provider providing non-IEP/IFSP services (such as a school nurse). For example, a State that has included all Medicaid- or CHIP-coverable

3 See §300.154(d)(2) https://sites.ed.gov/idea/regs/b/b/300.154/d/2

2024-01-24 Page 10 of 80

IEP services in their State Plan, plus additional Medicaid or CHIP coverage of allowable vaccine administration and fluoride varnish treatments provided to Medicaid-enrolled students, would be included in this category. This could also include States that have only expanded billing of Medicaid- and CHIP-covered services provided to Medicaid- or

CHIP-enrolled students pursuant to a 504 plan.4 Proposals must specifically describe how the funds will be used. These states may also want to leverage relationships with

Medicaid Managed Care (MMC) entities to include coverage of school-based services in

MMC plans. Describe the issues that the funding will help resolve, including, but not limited to: the expansion of services beyond IEP/IFSPs in the State program; expanding the number and type of providers for Medicaid or CHIP services provided in schools;

and/or the expansion of the availability of services provided via telehealth delivery systems.

• The Enhancement of SBS – Applicants seeking funds to support enhancement activities may include States that have expanded the coverage and billing of Medicaid services provided in schools to include any Medicaid- or CHIP-covered service provided to a

Medicaid- or CHIP-enrolled student by a Medicaid- or CHIP-participating provider, regardless of whether that service is provided pursuant to a student’s IEP/IFSP, 504 Plan, or any other Medicaid- or CHIP-enrolled beneficiary (can be defined in a health care plan). Proposals must specifically describe how the funds will be used. Describe the issues that the funding will help resolve, for example, increasing availability of mental health services, the removal of coordination barriers between the schools and providers in the community, and/or the creation of school-based health clinics.

The purpose of the grant award is to increase access to Medicaid- and CHIP-covered services in the school setting, regardless of the funding category in which the applicant currently qualifies, with the intention of moving from the applicant’s current category into the next through the interventions supported by this grant award.

Program activities for the NOFO are described in detail in section D2.d, Program Requirements and Expectations.

A5. Technical Assistance and Information for Prospective Applicants

Prior to the application deadline, CMS will host a series of webinars to provide details about the

Medicaid and CHIP SBS program, and to answer questions from potential applicants and partners regarding this funding opportunity. Information about the webinars will be posted on the

Technical Assistance Center website at: https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/medicaid-and-school-based-services/technical-assistance-center-tac/index.html.

4 Section 504 requires recipients to provide to students with disabilities appropriate educational services designed to meet the individual needs of such students to the same extent as the needs of students without disabilities are met.

https://www2.ed.gov/about/offices/list/ocr/504faq.html https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/medicaid-and-school-based-services/technical-assistance-center-tac/index.html https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/medicaid-and-school-based-services/technical-assistance-center-tac/index.html https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/medicaid-and-school-based-services/technical-assistance-center-tac/index.html https://www2.ed.gov/about/offices/list/ocr/504faq.html

2024-01-24 Page 11 of 80

B. Federal Award Information

B1. Total Funding

Up to $50 million in total funds.

B2. Award Amount

CMS expects to award each recipient up to $2.5 million over the 3-year grant period of performance.

B3. Anticipated Award Dates

The anticipated award date is July 1, 2024.

B4. Period of Performance

The anticipated Period of Performance is 36 months from the date of the Notice of Award and funded in 12-month increments called budget periods as listed below:

- Budget Period 1: July 1, 2024 to June 30, 2025 ($500,000)

- Budget Period 2: July 1, 2025 to June 30, 2026 ($1 million)

- Budget Period 3: July 1, 2026 to June 30, 2027 ($1 million)

B5. Number of Awards

Up to an estimated 20 awards. Priority will be given to states applying with the intent of

“Implementation” of SBS programming.

No less than 10 grant awards have been designated for the “Implementation” category, dependent upon the number and type of grant applications received.

Up to 7 grant awards have been designated for SBS “Expansion” needs, and up to 3 awards will go to the “Enhancement” of SBS, dependent upon the number and type of applications received.

During the application review process, if the total number of grants designated for any funding category is not utilized, the remaining number of grants available will be redistributed into the remaining categories.

B6. Type of Award

Funding Instrument Type: Cooperative Agreement

The type of award issued under this NOFO is a cooperative agreement. The difference between grants and cooperative agreements is the degree of federal programmatic involvement rather than the type of administrative requirements imposed. A cooperative agreement differs from a

2024-01-24 Page 12 of 80 grant in that it provides for substantial involvement between the federal awarding agency and the non-federal entity in carrying out the activity contemplated by the federal award. Therefore, statutes, regulations, policies, that are applicable to grants also apply to cooperative agreements, unless the award itself provides otherwise. References throughout this NOFO to grants also apply to cooperative agreements unless this NOFO states otherwise. Please refer to section F4.

Cooperative Agreement Terms and Conditions of Award for more information about cooperative agreements.

Both States and CMS will have a role in the project. Throughout the life of a State’s project, CMS staff will provide support and technical assistance. See Section F5.

B7. Type of Competition

This NOFO is open to all eligible applicants.

C. Eligibility Information

C1. Eligible Applicants

These types of entities may apply:

State governments, specifically State Medicaid Agencies

Eligible applicants are State Medicaid Agencies from all 50 states, Washington, D.C., and U.S.

territories. Eligible U.S. territories include American Samoa, Guam, the Northern Mariana

Islands, Puerto Rico, and the United States Virgin Islands. Only one application can be submitted for a given State Medicaid Agency. The term “State Medicaid Agency” means the single State agency for medical assistance provided under Title XIX of the Act. A Tribal organization, if interested, must come under the auspices of and work with the State Medicaid Agency in the implementation of this demonstration program. The State Medicaid Agency or designee must be the recipient and oversee implementation of the grant; however other entities may apply in conjunction as subrecipient(s) including any other State agencies and/or Tribes, or Tribal organizations providing SBS through the State Medicaid or CHIP program.

C2. Cost Sharing or Matching

Cost Sharing or matching is not applicable for this program.

C3. Letter of Intent

A Letter of Intent is recommended but is not required. These are optional.

Letters of intent help CMS staff to estimate the number of independent reviewers needed and to avoid potential conflict of interest. Letters of Intent should include (1) an expression of interest, including the proposed regions of participation, (2) a brief description of the interested

2024-01-24 Page 13 of 80 organization, (3) and contact information, including the organization’s street address and a contact person’s name, position, email, and phone number.

Submit Letters of Intent to the SBS Program Team email:

MedicaidSBSPlanningGrants@cms.hhs.gov by February 23, 2024.

C4. Ineligibility Criteria

Section 11003(b) of the BSCA includes a requirement that “A State shall not use any grant funds to provide medical assistance, child health assistance, or other health services.” Therefore, applicants that propose to use the grant award funding to provide medical assistance, child health assistance, or other health services, regardless of whether such other health services otherwise would be eligible for federal matching funds, will be considered ineligible for this grant award.

C5. Single Application Requirement

Applicants may submit only one application.

CMS intends to award one cooperative agreement per selected State. Applicants must be the

State Medicaid Agency. An applicant must demonstrate through its application that it is the State agency responsible for enrolling medical providers in Medicaid or CHIP and managing the coverage of Medicaid- or CHIP-covered SBS, and other relevant State agencies. State governments, specifically State Medicaid Agencies, cannot receive more than one award under this NOFO over the duration of the period of performance.

C6. Continued Eligibility

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

Recipients must meet reporting deadlines (as outlined in section F) throughout the initial 12-month budget period and to remain eligible for non-competing continuation award for subsequent budget periods. In addition, recipients must demonstrate satisfactory performance during the previous funding cycle(s) to be issued additional year funding. At any time in the award cycle, recipients could receive decreased funding, or their award could be terminated in accordance with 45 CFR Part 75.372 “Termination” if they fail to perform the requirements of the award.

Satisfactory progress is determined by the applicant’s adherence to the CMS approved detailed project work plan and timeline, other criteria for application approval, and in accordance with the terms and conditions at the time of the award.

Satisfactory performance for selected recipients includes, but is not limited to:

• Demonstration of newly purchased equipment/program material in pursuit of increasing the quality of SBS services in the State.

mailto:MedicaidSBSPlanningGrants@cms.hhs.gov

2024-01-24 Page 14 of 80

• Demonstration of newly hired qualified staff dedicated specifically to behavioral health services within school-based settings.

• Demonstration of continued progress towards achieving the initiatives listed in the accepted NOFO application, complete with stakeholder feedback.

• Demonstration of increased student enrollment in Medicaid or CHIP and provision of

Medicaid or CHIP services in school settings in the State including the expansion of available medical services offered in schools.

• Demonstration of either a draft, pending, or approved SPA, including relevant documents such as TSIP and Public Assistance Cost Allocation Plan (PACAP), to incorporate any changes to the Medicaid or CHIP SBS program intending to further the implementation, expansion, or enhancement of SBS within the state, as applicable.

• Execution of the goals based upon the timeline for those goals outlined by the applicant in the grant proposal.

C7. EIN, UEI, and SAM Requirements

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

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

Identification Number (TIN);

a Unique Entity Identifier (UEI);

a Login.gov account, and active registration in the System for Award Management (SAM) database

(https://www.sam.gov/)

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

C8. Faith-Based Organizations

This grant opportunity is available for State Medicaid Agencies only.

C9. Other Eligibility Requirements

Non-Applicable

D. Application and Submission Information

D1. Address to Request Application Package

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

D2. Content and Form of Application Submission https://sam.gov/content/home

2024-01-24 Page 15 of 80

a. Application format

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

Disqualifying Factors. CMS will not consider an application that:

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

• Requests funding above the award ceiling shown in the funding range.

• Is not submitted through Grants.gov.

• Is incomplete based on the initial screening

However, the CMS, Division of Grants Management Director/Deputy Director may continue the review process for an ineligible application if it is in the best interests of the government to meet the objectives of the program.

Each application must include all contents of the application package, in the order indicated, and conform to the following formatting specifications:

The required page size is 8.5” x 11” (one side only) 1” margins (top, bottom, and sides).

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

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

The Project Narrative must be double-spaced. The page limit for the Project Narrative is

40 pages.

The Initial Planning Period Work Plan and Timeline may be single-spaced. The page limit for this document is 2 pages.

The Budget Narrative may be single-spaced. The page limit for the Budget Narrative is

10 pages.

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

Tables must have a font size of at least 12- point with a 14 CPI and may be single spaced.

Tables are counted towards the applicable page limits.

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

2024-01-24 Page 16 of 80

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

o Standard Forms, (SF-424, SF-424A, SF-LLL) o Application Cover Letter/Cover Page (if applicable), o Copy of Letter of Intent (if applicable), o Project/Performance Site Location(s) Form o Public Assistance Cost Allocation Plan o State Plan Amendment o Time Study Implementation Plan (if applicable). Applicants for which a TSIP is a component of the applicant’s State plan payment methodology must submit this document as part of their application

The total number of additional appendices per application in addition to those listed above may be no more than 50 pages.

b. Standard forms

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

1. Project Abstract Summary

Write a one-page summary of the proposed project including the purpose and outcomes.

Do not include any proprietary or confidential information. We will use this document for information sharing and public information requests if you get an award. Be succinct and use plain language.

Include:

o Goals of the project o Total budget o Description of how funds will be used.

2. SF-424: Official Application for Federal Assistance

You must complete all sections of the SF-424. Special instructions include:

https://www.grants.gov/forms/forms-repository/sf-424-family

2024-01-24 Page 17 of 80

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

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

• critical to ensuring accountability and transparency and

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

Elements of a Strong Award Description

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

• Specifics about the award purpose

• Activities to be performed

• Expected deliverables and outcomes

• Intended beneficiary(ies) or recipients

• Subrecipient activities, (if known)

Characteristics of a Strong Award Descriptions

A strong award description will have the following characteristics:

• Uses plain language an average reader can fully understand

• Is brief and succinct

• Does not duplicate existing award descriptions on USASpending.gov

• Does not use, or limits, abbreviations or acronyms

Examples of Strong Award Descriptions:

The Council of Inspectors General on Integrity and Efficiency’s Pandemic

Response Accountability Committee (PRAC) shared the following examples of effective award descriptions. These, or other agency-specific examples, can be shared with applicants to assist them in developing their award descriptions.

2024-01-24 Page 18 of 80

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

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

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

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

The Authorized Organizational Representative (AOR) completes and electronically signs this form.

Note: The signature of the individual that submits the application to Grants.gov populates throughout the application. The signature must match the name of the AOR. Other signatures will not be accepted.

Authorized Organization Representative (AOR), the AOR is the applicant’s designated representative, who can make legally binding commitments for your organization. When the AOR authorizes an application, they agree that the organization will assume all award obligations.

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

4. SF-LLL: Disclosure of Lobbying Activities

You must submit the SF-LLL form. If you do not engage in lobbying, please insert “Non-

Applicable” on the form and include the required AOR name, contact information, and signature.

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

5. Project/Performance Site Location(s) Form

All applicants must submit this Project/Performance Site Location(s) form. Please note that the application kit available online in Grants.gov is utilized for many programs and therefore Grants.gov may designate this form as optional to allow for flexibility amongst programs. However, this form is required as part of the application package and must be submitted for the application to be considered eligible for review.

c. Application Cover Letter (optional)

2024-01-24 Page 19 of 80

The applicant is required to include a cover letter or cover page to detail its interest in participation in Medicaid and CHIP School-Based Health Care Services Grant and the applicants’ intentions to implement, enhance, or expand SBS.

d. Program Requirements and Expectations

Project Narrative (maximum 40 pages)

The SBS Grants will fund activities/strategies aimed at implementing, enhancing, and expanding the provision of assistance through school-based entities under Medicaid or CHIP. Grant funds must be used primarily to support infrastructure development in one of the following three categories, consistent with the current status of the applicant State’s SBS program:

• The Implementation of SBS – Applicants seeking funds to support implementation activities may include States that have yet to expand the coverage of, and billing for

Medicaid and CHIP services provided in schools beyond that which is provided pursuant to a student’s IEP/IFSP. Proposals must specifically describe how the funds will be used.

Describe the issues that the funding will help resolve, including, but not limited to, the building out of school infrastructure for providing health care services, training, and assessment of needs, to allow for the provision, billing, and documentation of SBS for the

Medicaid- and CHIP-enrolled students.

• The Expansion of SBS – Applicants seeking funds to support expansion activities may include: States that have expanded the coverage and billing of Medicaid or CHIP services provided in schools beyond what is provided pursuant to a student’s IEP/IFSP. For purposes of this NOFO, the term “expansion” includes State Medicaid or CHIP programs that allow for at least one enrolled provider providing non-IEP/IFSP services (such as a school nurse). For example, a State that has included all Medicaid or CHIP coverable

IEP services in their State Plan, plus additional Medicaid or CHIP coverage of allowable vaccine administration and fluoride varnish treatments provided to Medicaid-enrolled students, would be included in this category. This could also include States that have only expanded billing of Medicaid and CHIP covered services provided to Medicaid- or

CHIP-enrolled students pursuant to a 504 plan.5 Proposals must specifically describe how the funds will be used. These states may also want to leverage relationships with

MMC entities to include coverage of school-based services in MMC plans. Describe the issues that the funding will help resolve, including, but not limited to: the expansion of services beyond IEP/IFSPs in the State program; expanding the number and type of providers for Medicaid or CHIP services provided in schools; and/or the expansion of the availability of services provided via telehealth delivery systems.

• The Enhancement of SBS – Applicants seeking funds to support enhancement activities may include States that have expanded the coverage and billing of Medicaid services

5 Section 504 requires recipients to provide to students with disabilities appropriate educational services designed to meet the individual needs of such students to the same extent as the needs of students without disabilities are met.

2024-01-24 Page 20 of 80 provided in schools to include any Medicaid or CHIP covered service provided to a

Medicaid- or CHIP-enrolled student by a Medicaid- or CHIP-participating provider, regardless of whether that service is provided pursuant to a student’s IEP/IFSP, 504 Plan, or any other Medicaid- or CHIP-enrolled beneficiary (can be defined in a health care plan). Proposals must specifically describe how the funds will be used. Describe the issues that the funding will help resolve, for example, increasing availability of mental health services, the removal of coordination barriers between the schools and providers in the community, and/or the creation of school-based health clinics.

Recipients will be required to participate in regular meetings with CMS and our contractors to discuss State strategies and implementation of the State’s efforts. In addition, applicants must include the following in their applications:

General Activities

1. Stakeholder Input: Recipients must develop a stakeholder input process to help inform the needs assessment, and to gauge the success of planned initiatives. A stakeholder input process would include:

• The development of a survey/evaluation system for school districts, LEAs, parents of

Medicaid- or CHIP-enrolled children and adolescents, and providers to provide feedback regarding program development and utilization.

• A timeline to ensure the stakeholder input process is conducted in a timely manner, taking no longer than six months post award date, and continuing throughout the grant award.

2. Needs Assessment: Recipients must conduct and provide a preliminary needs assessment on the current SBS program within the State at the time of the application submission and a final needs assessment no longer than six months post award date. The needs assessment and stakeholder input process must include:

• Preliminary feedback identifying program needs, areas for improvement, and barriers that have prevented the provision of services in schools to Medicaid or CHIP eligible students or more effective and efficient billing of Medicaid services in a school setting. This assessment should inform the Infrastructure Needs identified by the applicants.

• A description of current practices related to Medicaid or CHIP services beyond

IEP/IFSP services6 in the State’s SBS program, including a copy of all CMS approved SPAs relevant to SBS and the current and past utilization (at least the 3

6 https://www.medicaid.gov/federal-policy-guidance/downloads/smd-medicaid-payment-for-services-provided-without-charge-free-care.pdf https://www.medicaid.gov/federal-policy-guidance/downloads/smd-medicaid-payment-for-services-provided-without-charge-free-care.pdf https://www.medicaid.gov/federal-policy-guidance/downloads/smd-medicaid-payment-for-services-provided-without-charge-free-care.pdf

2024-01-24 Page 21 of 80 most recent years of complete, full-year data) of SBS, both overall services, as available, and those claimed for Medicaid payment.

3. Infrastructure Needs Assessment. Recipients must identify specific infrastructure needs, which could include, but are not limited to: staffing, data systems, or contracted assistance.

Like the Needs Assessment, applicants must submit a preliminary Infrastructure Needs

Assessment, with a final Infrastructure Needs Assessment submitted no longer than six months post award date. Infrastructure needs should enable more effective and efficient provision and/or billing of Medicaid and CHIP services in schools, for both IDEA required services and non-IDEA services. The infrastructure needs should identify ways to7 ensure compliance with:

• IDEA’s statutory and regulatory requirements regarding State interagency coordination when noneducational public agencies fund special education and related services (such as Medicaid and CHIP),8

• IDEA’s regulatory requirements regarding notice and obtaining initial parental consent prior to accessing a child's or parent's Medicaid of CHIP coverage for the first time,9 and

• regulatory requirements regarding Medicaid and CHIP services for non-IDEA services.

Recipients must describe how the grant awards will be used to fund specific initiatives and investments in the SBS infrastructure. In doing so, recipients must identify whether specific initiatives and investments are eligible to be matched with federal Medicaid administrative match, or mirror current Medicaid administrative activities the State is currently engaged in, as authorized in section 1903(a) of the Act, so as to ensure that the grant activities are eligible under the provisions of section 11003(b) of the BSCA. Where such matching funds are otherwise available in Medicaid, those funding opportunities should be pursued as the grant funding is intended to be used for activities that CMS could not otherwise fund.

Recipients must provide plans for maintaining and submitting accurate billing information

(e.g., school district accountants, third-party billers, etc.) during the grant award and post-grant award period. For example, this may include hiring contracted billing providers for schools within the State or hiring dedicated billing staff within the State school district. To support the application, the applicant should thoroughly discuss the current practices regarding State, SEA, and LEA10 staffing specifically working on SBS issues related to

7 For Medicaid-enrolled students with an IEP, Medicaid is payer of first resort of Medicaid-covered services included in the IEP (see section 1903(c) of the Act and IDEA sections 612(e) and 640(c), codified at 20 USC

1412(e) and 1440(c); 34 C.F.R. § 300.154(h); and 42 C.F.R. § 433.139) 8 20 U.S.C. § 1412(a)(12) & 34 C.F.R. § 300.154(a)-(c).

9 34 C.F.R. § 300.154(d).

10 LEAs are public boards of education or other public authorities legally constituted within a State for either administrative control or direction of, or to perform a service function for, public elementary or secondary schools in a city, county, township, school district, or other political subdivision of a State. 34 C.F.R. § 300.28

2024-01-24 Page 22 of 80 billing and documentation, and the improvements that would be gained through grant funding.

4. Sustainability. Recipients must submit proposals describing how initiatives funded through the grant will be sustained in the immediate post-grant award period (first 2 years), up to and including plans to submit SPA and any other relevant documents as needed (e.g., Medicaid Administrative Claiming (MAC) plan, PACAP, TSIP, etc.). As noted above, the initial investment of grant funding toward infrastructure improvements that are not otherwise matchable with Medicaid funds, should lead to State expenditures that are in fact eligible for federal matching funds under the Medicaid statute which is where applicants should indicate sustainability of their grant activities. Recipients should also describe the process related to how the State might reinvest federal financial participation (FFP) related to Medicaid claims for SBS down to the LEAs and State SEAs. The expectation is that applicants present post-grant sustainability plans for the future of the State’s SBS program, and the ongoing availability of Medicaid or CHIP services in schools within the State by describing long-term service goals (up to at least 5 years post-grant) for the program.

5. Technical Assistance Center Participation. Recipients must include plans and intentions to participate and engage with the CMS Technical Assistance Center and disseminate the information, in terms of lessons learned, best practices and implementation of SBS, to the schools and LEAs. All Recipients will be required to participate in regular meetings with

CMS and our contractors to discuss State strategies and implementation of the State’s efforts.

Applications must also describe, if applicable, any State actions or policy changes undertaken due to the recent CMS guidance related to SBS, including any updates the Medicaid Billing

Manuals to Align Best Practices to Recommended Guidance11 and how the interventions have been put into practice.

6. Rural, Tribal and remote areas. Recipients must describe in detail any challenges related to delivering SBS in rural, Tribal and remote areas of the State, as applicable. These areas present much different administrative issues and access issues than non-rural and non-remote areas.

7. Data. Recipients must present current procedures and proposed process improvements for statewide tracking, documenting, and maintaining Medicaid and CHIP service data, including claims for Medicaid or CHIP services provided to Medicaid- or CHIP-enrolled students in school settings through the Medicaid or CHIP programs.

Activities for Recipients Qualifying under the Implementation of SBS

8. Applicants must present plans for the collection of evidence of increased service utilization in school settings. Applicants must also provide plans to monitor the participation of new and existing Medicaid or CHIP SBS provided through LEAs within the State. For example, some LEAs lack resources to simply bill Medicaid or CHIP (e.g., billing software, 11 CMS School Based Services Comprehensive Guide: https://www.medicaid.gov/medicaid/financial-management/downloads/sbs-guide-medicaid-services-administrative-claiming.pdf https://www.medicaid.gov/medicaid/financial-management/downloads/sbs-guide-medicaid-services-administrative-claiming.pdf https://www.medicaid.gov/medicaid/financial-management/downloads/sbs-guide-medicaid-services-administrative-claiming.pdf

2024-01-24 Page 23 of 80 accounting staff, etc.) and therefore do not bill for SBS. Applicants must be prepared to develop plans to:

• Encourage, such as through the development of guidance, resources and technical assistance, participation of schools and LEAs in billing Medicaid and CHIP for SBS provided to enrolled children and adolescents.

• Through the schools and LEAs, inform and educate the public of SBS services and activities in accessible and linguistically inclusive ways (e.g., town hall meetings, information webinars, school website postings etc.)

Activities for Recipients Qualifying under the Expansion of SBS

9. Applicants must include:

• Details about whether services currently are IDEA-only (IEP/IFSP) plus any Medicaid or CHIP services beyond IEP/IFSP services the State provides in schools.

• Plans for, or active submission of all materials (e.g., SPA(s)- coverage,…