NOFO Sec 9813 Final CGMO Cleared 7-12-2021 - 508 Compliant.pdf

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

Center for Medicaid and CHIP Services

American Rescue Plan Act (ARP) of 2021: Section 9813 State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services

Notice of Funding Opportunity Type: New

Funding Opportunity Award Type: Cooperative Agreement

Notice of Funding Opportunity Number: CMS-2I2-21-001

Federal Assistance Listings Number (CFDA): 93.639

Notice of Funding Opportunity Posting Date: July 13, 2021

Applicable Dates:

Letter of Intent to Apply Due Date: July 23, 2021

Electronic Application Due Date: August 13, 2021, 3:00 pm, Eastern Standard Time

Anticipated Issuance Notice(s) of Award: September 10, 2021

Anticipated Period of Performance: September 30, 2021 – September 29, 2022

Table of Contents Executive Summary

A. Program Description

A1. Purpose

A2. Authority

A3. Background

A4. Program Requirements

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, DUNS, and SAM Regulations

C8. Faith-Based Organizations

C9. Other Eligibility Requirements

D. Application and Submission Information

D1. Address to Request Application Package

D2. Content and Form of Application Submission

a. Application format

b. Standard forms

c. Application cover letter or cover page (optional)

d. Project Narrative (maximum 30 pages)

e. Budget Narrative (maximum 10 pages)

f. Business assessment of applicant organization (maximum 12 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

E. Application Review Information

E1. Criteria

E2. 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. Reporting

G. CMS Contacts

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

A. General Information

B. Accounting System

C. Budgetary Controls

D. Personnel

E. Payroll

F. Consultants (See appendix I in the NOFO for relevant information)

G. Property Management

H. Procurement

I. Travel

J. Internal Controls

Appendix IV: Accessibility Requirements

Appendix V. Review and Selection Process

Appendix VI: Application Check-Off List

Appendix VII. Notice of Intent to Apply for State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services

Executive Summary

The Centers for Medicare & Medicaid Services (CMS) is making available planning grants to state Medicaid agencies to support developing a new Medicaid option created by the American Rescue Plan Act of 2021: community-based mobile crisis intervention services for Medicaid beneficiaries in the community who are experiencing a mental health or substance use disorder (MH/SUD) crisis. The purpose of this notice of funding opportunity (NOFO) is to solicit applications for state planning grants to provide funding for developing state plan amendments (SPA), section 1115 demonstration applications, or section 1915(b) or 1915(c) waiver program requests (or amendment) to provide qualifying community-based mobile crisis intervention services under the Medicaid program. Eligible applicants are state Medicaid agencies.

Item Description

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

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

Notice of Funding Opportunity Title

State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services

Authorization The American Rescue Plan Act of 2021 (ARP) amended Title XIX of the Social Security Act (the Act) by adding a new section 1947:

State Option to Provide Qualifying Community-Based Mobile Crisis Intervention Services.

Federal Assistance Listings Number

93.639

Funding Opportunity Type

Cooperative Agreement

Funding Opportunity Number

CMS-2I2-21-001

Type of Award New

Type of Competition Competitive

Letter of Intent to Apply Due Date (if applicable)

July 23, 2021

Application Due Date and Time

August 13, 2021, by 3:00 pm EST (Baltimore, MD)

Anticipated Issuance Notice(s) of Award

September 10, 2021

Period of Performance Start Date

September 30, 2021

Period of Performance End Date

September 29, 2022

Anticipated Total Available Funding

$15 million (funds pending)

Estimated Maximum Award Amount

$300,000 to $1 million

Estimated Maximum Number of Awardees

Ten (10) to Twenty (20)

A. Program Description A1. Purpose CMS, through the Center for Medicaid and CHIP Services (CMCS), seeks applications for planning grants for the purpose of developing a State Plan Amendment (SPA), section 1115 demonstration application, or section 1915(b) or 1915(c) waiver request (or an amendment to such a waiver) to provide qualifying community-based mobile crisis intervention services. This NOFO is open to all state Medicaid agencies.

A2. Authority The American Rescue Plan Act of 2021 (ARP) amended Title XIX of the Social Security Act (the Act) by adding new section 1947 “State Option to Provide Qualifying Community-Based Mobile Crisis Intervention Services.” Section 1947(e) authorizes CMS to make funding available for implementing and administering, and to make planning grants available to states to prepare for implementing qualifying community-based mobile crisis intervention services.

A3. Background Qualifying community-based mobile crisis intervention services, as defined at section 1947 of the Act includes, “items and services for which medical assistance is available under the state plan under this title or a waiver of such plan that are furnished to an individual, otherwise eligible for medical assistance, who is outside of a hospital or other facility setting; and experiencing a mental health or substance use disorder crisis.”

States that submit and have approved by CMS, SPAs, section 1915(b) waiver programs with a corresponding authority for the services at issue, section 1915(c) home and community-based services waiver programs, or section 1115 demonstration applications meeting the conditions for the state option, may receive an 85 percent federal medical assistance percentage (FMAP) for expenditures on qualifying community-based mobile crisis intervention services, and for services furnished by qualifying mobile crisis intervention service providers, for the first 12 quarters within the five-year period beginning April 1, 2022, during which the state meets the conditions for the 85 percent FMAP. Further, section 1947 requires that for any quarter for which the 85 percent FMAP rate is claimed, states provide assurances satisfactory to the Secretary that any additional federal funds received by the state for qualifying community-based mobile crisis intervention services that are attributable to the increased FMAP under this section will be used to supplement, and not supplant, the level of state funds expended for such services in the federal fiscal year prior to April 2022, or the federal fiscal year prior to the first quarter that the state takes up this option.

A separate State Health Official Letter (SHO), aligning with this NOFO, will provide guidance on the state option to provide qualifying community-based mobile crisis intervention services.

States should refer to the SHO for specific details on the requirements for the state option. The information included in this NOFO on the state option is provided for informational purposes to assist states in developing their planning grant applications and does not supersede the information included in the SHO.

ARP section 9813 made available $15 million (funds pending) for the purposes of implementing, administering, and awarding planning grants to states. The planning grants awarded through this NOFO are designed to provide funds to support states in preparing to meet the requirements contained at section 1947(b) of the Act for furnishing qualifying community-based mobile crisis intervention services and to support the developing of SPAs, section 1115 demonstration applications, or section 1915(b) or 1915(c) waiver program requests (or amendments) that reflect such requirements. All state Medicaid agencies and territories are eligible to apply for the planning grants. We anticipate making from 10 to 20 awards; although, a maximum of 56 awards is possible. The maximum planning grant award amount per state is contingent upon the scope of the activities proposed in the state’s application and upon the total amount of funding ($15 million – funds pending) available under this funding opportunity. We anticipate the awards to range from $300,000 to $1,000,000 for each successful applicant. The period of performance is one year, from September 30, 2021, through September 29, 2022.

Through the planning grants, CMS will fund states to develop the Medicaid authority documentation and implement activities necessary for providing qualifying community-based mobile crisis intervention services.

A4. Program Requirements This is a new funding opportunity provided for in ARP section 9813. CMCS will award 12-month planning grants to states to support their efforts to develop qualifying community-based mobile crisis intervention services that meet the requirements contained in section 1947(b) of the Act, and would lead to submission and approval of a SPA, section 1115 demonstration application, or section 1915(c) or 1915(b) waiver request or amendment. Additionally, because states must demonstrate, to the satisfaction of the Secretary, that they will be able to support the provision of qualifying community-based mobile crisis intervention services, states may use planning grant funds for activities necessary for providing qualifying community-based mobile crisis intervention services that meet the conditions specified in section 1947(b) of the Act. (See examples below.)

States vary in provider and systems capacity to implement qualifying community-based mobile crisis services in a manner consistent with requirements at section 1947(b). Planning grant funding may support states in strengthening this capacity and funds can be put towards ensuring

• The provision of all required component services in community-based mobile crisis intervention services, which include screening and assessment, stabilization and de-escalation, coordination and referrals to health, social and other services, as needed, and health services as needed;

• Services are provided to individuals who reside in the community and outside of a hospital or other facility setting;

• Services are provided by a multi-disciplinary team that includes professionals and paraprofessionals who have appropriate expertise in behavioral health care and, at a minimum, includes one behavioral health care professional who is qualified to provide an assessment within scope of practice requirements under state law;

• All members of the multi-disciplinary team are trained in trauma informed care, de-escalation strategies and harm reduction;

• Community-based mobile crisis intervention services teams respond to crises in a timely manner;

• Community-based mobile crisis intervention services teams are maintaining relationships with relevant community partners, including medical and behavioral health providers, primary care providers, community health centers, crisis respite centers, and managed care plans (if applicable);

• Community-based mobile crisis intervention services are available 24 hours a day, 365 days a year; and

• Community-based mobile crisis intervention services programs maintain the privacy and confidentiality of beneficiary information consistent with federal and state requirements.

Examples of activities for which planning grant funds may be requested include:

• Technical assistance in meeting the purpose of the planning grants: developing SPAs, demonstration applications, waiver program requests, and other amendments, including the writing and submission of documents for implementing community-based mobile crisis intervention services under the Medicaid program;

• Technical assistance on planning emergent intervention and crisis services and the integration with crisis call centers, crisis intervention centers, and longer-term post-crisis care coordination programs and resources such as community-based recovery supports;

• Technical assistance to Medicaid providers on developing person-centered plans of care responsive to individuals’ social, financial, family and caregiving needs;

• Conducting a statewide needs assessment for community-based mobile crisis intervention services, including such factors as provider capacity, provider qualifications, scope of services furnished, equity strategies, and privacy protections;

• Enrolling prospective Medicaid providers and making technical assistance available for meeting Medicaid claiming requirements for furnishing community-based mobile crisis intervention services;

• Training Medicaid providers on trauma informed care, lethal means safety planning, treatment modalities listed in section 9813 and the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care, and supporting the safety of individuals experiencing violence;

• Training Medicaid providers on sex and gender responsive approaches, engagement of social and other services responsive to LGBTQIA+ communities, approaches responsive across the life course (e.g., tailored crisis intervention for teens and older adults), and connections and referrals to long-term, ongoing, post-crisis, SUD and mental health services;

• Training and development of protocols for law enforcement and first responders;

• Building linkages and developing collaborations of community-based mobile crisis intervention services with National Suicide Prevention Lifeline crisis call centers and first responders;

• Building and strengthening partnerships with relevant state and local partners (e.g., Single State Agencies for substance abuse and mental health);

• Assessment of state information systems to identify options for improving interagency communication and data sharing for facilitating individuals’ access to on-going treatment and to prevent recurring crises; and

• Technical assistance to identify the need for and to implement state information systems edits and changes to support data-driven decisions related to quality, sustainability, and expansion of community-based mobile crisis intervention services.

Applications must include, at a minimum, a work plan, a budget, and timeline describing the planning grant activities and how the funds will be used.

A5. Technical Assistance and Information for Prospective Applicants Prior to the application deadline, CMS will hold a webinar to provide details about the Section 9813 State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services and to answer questions from potential applicants regarding this funding opportunity.

Information about the webinar will be posted at https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/state-planning-grants-for-qualifying-community-based-mobile-crisis-intervention-services/index.html

A webinar will be held on:

• July 15, 2021 1:00 pm to 2:00 pm (ET)

Administrative questions about the State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services under the Medicaid Program may be directed to:

PlanninggrantsMCIS@cms.hhs.gov.

B. Federal Award Information B1. Total Funding http://at/ https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/state-planning-grants-for-qualifying-community-based-mobile-crisis-intervention-services/index.html https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/state-planning-grants-for-qualifying-community-based-mobile-crisis-intervention-services/index.html mailto:PlanninggrantsMCIS@cms.hhs.gov

CMS will award a maximum of $15 million (funds pending) total divided among approximately ten to twenty states for purposes of the 12-month State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services. These discretionary grants will be awarded using a competitive process.

B2. Award Amount The total award amount per recipient of an award under this program will range from $300,000 to $1,000,000. The maximum planning grant award per state is contingent upon the scope of the activities proposed in the state’s application and upon the total amount of funding ($15 million (funds pending) available under this funding opportunity.

B3. Anticipated Award Dates September 10, 2021

B4. Period of Performance September 30, 2021 – September 29, 2022

B5. Number of Awards The anticipated number of awards is between 10 and 20 awards; although, a maximum of 56 awards is possible.

B6. Type of Award The planning grant awards issued under this Notice of Funding Opportunity will be structured as cooperative agreements. 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 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, and policies that are applicable to grants also apply to cooperative agreements, unless the award itself provides otherwise. References to grants throughout this NOFO 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.

B7. Type of Competition This NOFO is competitive and open to all eligible applicants.

C. Eligibility Information C1. Eligible Applicants All state Medicaid agencies may apply. Only one application may be submitted for a given state.

The term “state Medicaid agency” means the single state agency for medical assistance provided under Title XIX of the Social Security Act (the Act). A Territory or Tribal organization, if interested, must come under the auspices of and work with the state Medicaid agency in the implementation of this initiative. The state Medicaid agency or designee must be the signatory and oversee implementation of the grant but may apply in conjunction with other co-applicant(s) including any other state agencies and/or Territory, Tribes, or Tribal organizations operating mental health or substance use disorder (SUD) treatment or recovery programs.

Government Organizations

State governments County governments City of Township governments Special District governments Native American tribal governments (Federally recognized) Native American tribal organizations (other than federally recognized tribal governments)

Education Organizations Independent School Districts Public and State Controlled Institutions of Higher Education

Private institutions of higher education Public Housing Organizations

Public housing authorities Indian housing authorities

Nonprofit Organizations

Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education For-profit Businesses (organizations other than small businesses) Small Businesses Individuals Others Unrestricted

C2. Cost Sharing or Matching Cost Sharing is not applicable for this program.

C3. Letter of Intent A non-binding, letter of intent to apply must be submitted by the State Medicaid Agency to PlanninggrantsMCIS@cms.hhs.gov by July 23, 2021. A copy of the letter of intent should also be included with the final application. Entities that do not submit a letter of intent by this deadline will be ineligible to apply. CMS will provide confirmation of receipt of the letter of intent to each prospective applicant that submits such a letter.

See Appendix VII for submission instructions.

C4. Ineligibility Criteria CMS will consider the following criteria as potential reasons for applicant disqualification for award:

• Incomplete application. A non-exhaustive list of circumstances that constitute an incomplete application includes:

o Failure to meet application requirements as described.

o Omission of required application elements as described.

o Insufficient supporting detail provided in the application. CMS will not review applications that merely restate the text within the NOFO. Applicants must detail their approach to achieving program goals and milestones. Reviewers will note evidence of how effectively the applicant includes these elements in its application.

• Program Integrity concerns. CMS may deny selection to an otherwise qualified applicant on the basis of information found during a program integrity review regarding the organization, community partners, or any other relevant individuals or entities.

• Disregard of maximum page limits stipulated in the Notice of Funding Opportunity.

• Late submission of an application (see Section D)

• Overlap with another model, demonstration, or program, which may result in duplication.

C5. Single Application Requirement CMS intends to award one cooperative agreement per selected state. Applicants must be the State Medicaid Agency.

C6. Continued Eligibility Recipients must meet reporting and certification deadlines (as outlined in section F) to be eligible throughout the 12-month budget period. Continued funding is contingent on satisfactory progress, compliance with the terms and conditions, and the availability of funds. Satisfactory progress would be 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.

C7. EIN, DUNS, and SAM Regulations In order to apply, all applicants are required to have a valid Employer Identification Number (EIN), otherwise known as a Taxpayer Identification Number (TIN), a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number, and be registered in the System for Award Management (SAM) database (https://sam.gov/content/home) to be able to submit an application in Grants.gov. See Appendix II. Application and Submission Information for descriptions of EIN, DUNS, and SAM.

C8. Faith-Based Organizations Faith-based organizations are not eligible to apply.

C9. Other Eligibility Requirements https://sam.gov/content/home

Non-applicable.

D. Application and Submission Information D1. Address to Request Application Package Competitive Funding Opportunities Application materials are available at https://www.grants.gov. Please note that CMS requires electronic submission of applications for all Notice of Funding Opportunities through the grants.gov website. Refer to Appendix II. Application and Submission Information for additional requirements and instructions.

D2. Content and Form of Application Submission

a. Application format Applications determined to be ineligible, incomplete, and/or nonresponsive based on the initial screening may be eliminated from further review. However, in accordance with HHS Grants Policy, the CMS, Office of Acquisition and Grants Management (OAGM), Grants Management Officer in his/her sole discretion, may continue the review process for an ineligible application if it is in the best interests of 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” letter-size pages (one side only) with 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 this document is 30 pages.

• The Budget Narrative may be single-spaced. The page limit for this document is 10 pages.

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

• Tables included within any portion of the application must have a font size of at least 12-point with a 14 CPI and may be single-spaced. Tables are counted towards the applicable page limits.

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

• The following required application documents are excluded from the page limitations described previously: Standard Forms, Application Cover Letter/Cover Page (if applicable), copy of the Letter of Intent, Project Site Location Form, and Indirect Cost Rate Agreement.

b. Standard forms The following forms must be completed with an electronic signature and enclosed as part of the application:

1. Project Abstract Summary https://www.grants.gov/

A one-page abstract serves as a succinct description of the proposed project and includes the goals of the project, the total budget, and a description of how the funds will be utilized. The abstract is often distributed to provide information to the public and Congress, so please write the abstract so that it is clear, accurate, concise, and without reference to other parts of the application. Exclude personal identifying information from the abstract. In the Grants Application Package at https://www.grants.gov , select the Project Abstract Summary and complete the form.

2. SF-424: Official Application for Federal Assistance

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

• On Item 15 “Descriptive Title of Applicant’s Project,” state the specific grant or cooperative agreement opportunity for which you are applying.

• Check “No” to item 19c, as Review by State Executive Order 12372 does not apply to this cooperative agreement funding opportunity.

• The Authorized Organizational Representative (AOR) completes and 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.

The AOR is the designated representative of the applicant/Recipient organization with authority to act on the organization’s behalf in matters related to the award and administration of grants. In signing a grant application, the AOR agrees that the organization will assume the obligations imposed by applicable Federal statutes and regulations and other terms and conditions of the award, including any assurances, if a grant is awarded. These responsibilities include accountability both for the appropriate use of funds awarded and the performance of the grant-supported project or activities as specified in the approved application.

• SF-424A: Budget Information Non-Construction

• SF-424B: Assurances-Non-Construction Programs

3. SF-LLL: Disclosure of Lobbying Activities

All applicants must submit this SF-LLL form. If your entity does 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 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.

4. Project Site Location Form(s)

All applicants must submit this Project Site Location 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 https://www.grants.gov/ 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 or cover page (optional) A cover letter is optional. The applicant may choose to include a cover letter or cover page to detail its interest in participation in Section 9813 State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services.

d. Project Narrative (maximum 30 pages)

The applicant provides a project narrative that includes a work plan, budget, and timeline describing the planning grant activities and how the funds will be used. The project narrative should be consistent with the criteria described in section A4. Program Requirements.

Below are the required and optional elements (sections) of the project narrative including a brief description of the type of information required within each specific section. The project narrative is double-spaced and cannot exceed 30 pages in length. This page limit does not include resumes for key personnel, job descriptions, budget narrative, or organizational charts.

Work Plan and Timeline: Proposed goals, measurable objectives, activities and timeline Qualifying community-based mobile crisis intervention services must meet the requirements contained in section 1947(b) of the Act and necessitate the successful submission and approval of a SPA, section 1115 demonstration application, or section 1915(c) or 1915(b) waiver program request or amendment. In this section, describe your plans for activities necessary for preparing to provide qualifying community-based mobile crisis intervention services that meet the requirements specified in section 1947(b) of the Act.

Provide a work plan describing your goals, measurable objectives, activities, and milestones, under the planning grant, related to meeting each requirement:

• The provision of all required component services in community-based mobile crisis intervention services, which include screening and assessment, stabilization and de-escalation, coordination and referrals to health, social and other services, as needed;

• Services are provided to individuals who reside in the community and outside of a hospital or other facility-based setting;

• Services are provided by a multi-disciplinary team that includes professionals and paraprofessionals who have appropriate expertise in behavioral health care and, at a minimum, includes one behavioral health care professional who is qualified to provide an assessment within scope of practice requirements under state law;

• All members of the multi-disciplinary team are trained in trauma informed care, de-escalation strategies, and harm reduction;

• Community-based mobile crisis intervention services teams respond to crises in a timely manner;

• Community-based mobile crisis intervention services teams are maintaining relationships with relevant community partners, including medical and behavioral health providers, primary care providers, community health centers, crisis respite centers, and managed care plans (if applicable);

• Community-based mobile crisis intervention services are available 24 hours a day, 365 days a year; and

• Community-based mobile crisis intervention services programs maintain the privacy and confidentiality of beneficiary information consistent with federal and state requirements.

Key Personnel

• Identify key personnel including one individual to serve as Project Director. Include a resume or curriculum vitae for each individual identified as key personnel in the organizational chart. Include this information as an appendix to the application submitted in response to this NOFO. If key personnel have not yet been hired, applicants should provide a hiring strategy and job descriptions should be included as an appendix.

Management Controls

• Describe the management controls and coordination mechanisms that will be used to ensure the timely and successful execution and operation of the planning grant and submission of the SPA, section 1115 demonstration application, or section 1915(c) or 1915(b) waiver program request or amendment for qualifying community-based mobile crisis intervention services under the Medicaid program.

Description of the Entity

• Describe the entity or entities who will perform the cooperative agreement activities under this funding opportunity. Include an organizational chart, to be included as an appendix, clearly identifying the reporting relationships of key personnel assigned to implement the planning grant and to implement the qualifying community-based mobile crisis intervention services under the Medicaid program.

e. Budget Narrative (maximum 10 pages) Applicants supplement Form SF-424A with a Budget Narrative that includes a yearly breakdown of costs, for each line item outlined in the SF-424A, according to a 12-month period. Applicants include a clear description of the proposed set of services covered with award funds for each activity/cost within the line item. The application clearly defines the proportion of the requested funding designated for each activity and justifies the applicant’s readiness to receive funding.

The budget separates out funding administered directly by the lead agency from funding subcontracted to other partners.

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

If applicable, the budget narrative should also identify non-CMS funding sources and the value of such funding, and describe how the applicant will integrate other sources of funding into the project.

Detailed justifications must be provided for each activity/cost proposed to be funded under this award along with full computations for budget estimates. Applicants must also clearly link each activity to the goals of this NOFO and be consistent with program requirements. Overhead and administrative costs must be reasonable and are only reimbursable in accordance with HHS grants policy.

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

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

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

i. be registered in SAM before submitting its application;

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

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

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

D4. Submission Dates and Times All applications must be submitted electronically and be received through www.grants.gov by the date and time set forth below. Applications received after 3:00 pm, Eastern Time, of the date set forth below will not be reviewed or considered for award.

Due Date for Applications August 13, 2021, 3:00 PM Eastern U.S. Time (Baltimore, MD)

D5. Intergovernmental Review Program is not subject to Executive Order 12372, “Intergovernmental Review of Federal Programs” (45 CFR 100). Please check box “C” on item 19 of the SF 424 (Application for Federal Assistance) as Executive Order 12372 does not apply to these cooperative agreements.

D6. Cost Restrictions Applicants will not be allowed to receive reimbursement of pre-Federal award costs. Note: Pre-award costs are included in the prohibited list of costs below.

https://grants.gov/

Direct Costs

Funding under this NOFO can only cover functions, described in the Program Requirements, related to the completion of the application for Section 9813 State Planning Grants for Mobile Crisis Intervention Services, and cannot be used to duplicate or supplant other funding sources.

Indirect Costs

If the applicant entity has a current negotiated indirect cost rate agreement (NICRA), and is requesting indirect costs, a copy of the current NICRA must be submitted with the application. Any non-Federal entity that has never received a negotiated indirect cost rate, except for those non-Federal entities described in Appendix VII(D)(1)(b) to 45 CFR part 75, may elect to charge a de minimis rate of 10% of Modified Total Direct Costs (MTDC) which may be used indefinitely. See also section F2. Administrative and National Policy Requirements of this NOFO for more information on indirect costs.

Prohibited Uses of Award Funds

CMS prohibits funds under this award for any of the activities/costs outlined below unless an exception is specifically authorized by statute.

• To reimburse for pre-award costs.

• To match any other Federal funds.

• To provide services, equipment, or supports that are the legal responsibility of another party under Federal, State, or Tribal law (e.g., vocational rehabilitation or education services) or under any 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 goods or services not allocable to the approved project.

• To supplant existing State, local, Tribal or private funding of infrastructure or services, such as staff salaries, etc.

• To be used by local entities to satisfy state matching requirements.

• To pay for construction.

• To pay for capital expenditures for improvements to land, buildings, or equipment which materially increase their value or useful life as a direct cost, except with the prior written approval of the Federal awarding agency.

• To pay for the cost of independent research and development, including their proportionate share of indirect costs (unallowable in accordance with 45 CFR 75.476).

• To expend funds related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or Executive Order proposed or pending before the Congress or any state government, state legislature or local legislature or legislative body.

D7. Mandatory Disclosure Submission is required for all applicants, in writing, to the awarding agency and to the HHS Office of Inspector General (OIG), all information related to violations of federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the federal award.

Disclosures must be sent in writing to:

U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services Office of Acquisition and Grants Management Attn: Director, Division of Grants Management 7500 Security Blvd, Mail Stop B3-30-03 Baltimore, MD 21244-1850

AND

U.S. Department of Health and Human Services Office of Inspector General ATTN: Mandatory Grant Disclosures, Intake Coordinator 330 Independence Avenue, SW, Cohen Building Room 5527 Washington, DC 20201

URL: https://oig.hhs.gov/fraud/report-fraud/index.asp

(Include “Mandatory Grant Disclosures” in subject line)

Fax: (202) 205-0604 (Include “Mandatory Grant Disclosures” in subject line) or

Email: MandatoryGranteeDisclosures@oig.hhs.gov

Materials should be scanned and emailed to the Grants Management Specialist assigned to this

NOFO.

E. Application Review Information E1. Criteria Applications must be submitted in the required format, no later than the deadline. If an applicant does not submit all of the required documents and does not address each of the topics described in D2. Content and Form of Application Submission Information (with cross reference to E1. Criteria), the applicant risks not being eligible and/or awarded. Applications are reviewed in accordance with criteria outlined below.

In preparing applications, applicants should review the requirements detailed in Section A4.

Program Requirements. Technical review panelists will assess and score applicants’ responses in accordance with the criteria below, using a scale of 100 total base points.

All applicants must submit the following:

• Standard Forms;

• A Cover Letter, if applicable;

• A Project Narrative (including Work Plan and Timeline);

• A Budget Narrative;

https://oig.hhs.gov/fraud/report-fraud/index.asp mailto:MandatoryGranteeDisclosures@oig.hhs.gov

• Business Assessment of Applicant Organization;

• Federally Negotiated Indirect Cost Rate Agreement (if applicable);

• Resumes or Curriculum Vitae for Key Personnel;

• Job Descriptions, if applicable; and

• An Organization Chart.

Project Narrative Below are the review criteria for the Project Narrative. Qualifying community-based mobile crisis intervention services must meet the requirements contained in section 1947(b) of the Act and as a result lead to the successful submission and approval of a SPA, section 1115 demonstration application, or section 1915(c) or 1915(b) waiver program request or amendment.

In this section, describe your plans for activities necessary for preparing to provide qualifying community-based mobile crisis intervention services that meet the requirements in section 1947(b) of the Act.

Incomplete, unclear, and confusing proposals will receive point deductions. Project Narratives with significant content deficiencies may receive a score of zero. Proposals that merely restate the content of the NOFO, without responding to the Program Requirements and Application Review Criteria, will receive a score of zero. Each component of the Project Narrative is weighted as indicated below. The scoring criteria breakdown is reflective of the total possible number of points available, but each item is scored on a range starting from zero. Points are awarded based on the quality of the applicant’s response.

Section Topics Total

Available Points

Scoring Criteria Breakdown

Project Narrative

I. Work Plan, Organization, Administration, and Capacity

80 (See section D. Application and Submission Information) Work Plan: Proposed goals, measurable objectives, activities and timeline (40 points)

Provide a work plan describing your goals, measurable objectives, activities, and timeline, under the planning grant, related to meeting each requirement:

• The provision of all required component services in community-based mobile crisis intervention services, which include screening and assessment, stabilization and de-escalation, coordination and referrals to health, social and other services, as needed;

Points

Scoring Criteria Breakdown

• Services are provided to individuals who reside in the community and outside of a hospital or other facility-based setting;

• Services are provided by a multi-disciplinary team that includes professionals and paraprofessionals who have appropriate expertise in behavioral health care and, at a minimum, includes one behavioral health care professional who is qualified to provide an assessment within scope of practice requirements under state law;

• All members of the multi-disciplinary team are trained in trauma informed care, de-escalation strategies, and harm reduction;

• Community-based mobile crisis intervention services teams respond to crises in a timely manner;

• Community-based mobile crisis intervention services teams are maintaining relationships with relevant community partners, including medical and behavioral health providers, primary care providers, community health centers, crisis respite centers, and managed care plans (if applicable);

• Community-based mobile crisis intervention services are available 24 hours a day, 365 days a year; and

• Community-based mobile crisis intervention services programs maintain the privacy and confidentiality of beneficiary information consistent with federal and state requirements.

Key Personnel (10 points) Description of key personnel including identifying one individual to serve as Project Director Include a resume or curriculum vitae for each individual identified as key personnel in the organizational chart included as an appendix to the application submitted in response to this NOFO. If key personnel have not yet been hired, applicants should provide a hiring strategy and job descriptions should be included as an

Points

Scoring Criteria Breakdown appendix.

Management Controls (20 points) Description of the management controls and coordination mechanisms that will be used to ensure the timely and successful execution and operation of the planning grant and submission of the SPA, section 1115 demonstration application, or section 1915(b) or 1915(c) waiver request.

Description of the Entity (10 points) Description of the entity that will perform the cooperative agreement activities under this funding opportunity. Include an organizational chart to be included as an appendix clearly identifying the reporting relationships of key personnel assigned to implementing the planning grant and to implementing the qualifying community-based mobile crisis intervention services under the Medicaid program.

Budget Narrative

Budget

Narrative 20 Detailed budget, adhering to the format outline in Appendix I, Guidance for Preparing a Budget Request and Narrative, for the period of performance. (10 points)

Reasonableness of requested funding according to tasks proposed: (10 points) (5 of 10 points) Funds requested are reasonable based on the total available funding and each activity is linked to the goals of this NOFO;

and

(5 of 10 points) Funds requested are reasonable based on proposed project goals. Identification of any non-CMS funding sources, the value of such funding, and a description for how the funding will be integrated into the project.

Total Available Points 100

E2. Review and Selection Process CMS will consider the scale of all applications when making final award determinations.

Awards may be adjusted to a lower amount if the applicant fails to meet program requirements (refer to section F5. Reporting). The application itself is not a legally binding contract and does not require any applicant or CMS to enter into a cooperative agreement. CMS will select Recipients at CMS’s sole discretion. Such selection will not be subject to administrative or judicial review, per Section 1115A(d)(2)(B) of the Act. Please refer to Appendix V. Review and Selection Process for more information on the review and selection process.

E3. Federal Awardee Performance Integrity Information System (FAPIIS) In accordance with 45 CFR Part 75:

i. CMS, prior to making a Federal award with a total amount of Federal share greater than the simplified acquisition threshold,1 is required to review and consider any information about the applicant that is in the designated integrity and performance system accessible through SAM (currently FAPIIS) (see 41 U.S.C. 2313);

ii. An applicant, at its option, may review information in the designated integrity and performance systems accessible through SAM and comment on any information about itself that the HHS awarding agency previously entered and is currently in the designated integrity and performance system accessible through SAM.

iii. CMS will consider any comments by the applicant, in addition to the other information in the designated integrity and performance system, in making a judgment about the applicant’s integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicant as described in §75.205.

F. Federal Award Administration Information F1. Federal Award Notices If successful, the applicant will receive a Notice of Award (NoA) signed and dated by the CMS Grants Management Officer. The NoA is the legal document authorizing the cooperative agreement award and issued to the applicant as listed on the SF-424 and available to the applicant organization through the online grants management system used by CMS and recipient organizations. Any communication between CMS and applicant prior to issuance of the NoA is not an authorization to begin performance of a project.

If unsuccessful, CMS notifies the applicant electronically to the email address as listed on its SF- 424, within 30 days of the award date.

1 Simplified acquisition threshold means the dollar amount below which a non-Federal entity may purchase property or services using small purchase methods. Non-Federal entities adopt small purchase procedures in order to expedite the purchase of items costing less than the simplified acquisition threshold. The simplified acquisition threshold is set by the Federal Acquisition Regulation at 48 CFR Subpart 2.1 (Definitions) and in accordance with 41 U.S.C.

1908.

F2. Administrative and National Policy Requirements A. National/Public Policy Requirements

By signing the application, the authorized organizational official certifies that the organization will…