PKG00246579-instructions.pdf

Department of Health and Human Services Centers for Medicare & Medicaid Services

Center for Medicaid and CHIP Services

HEALTHY KIDS Funding Opportunity:

Connecting Kids to Coverage (CKC)

HEALTHY KIDS 2019

Outreach and Enrollment Cooperative Agreements

Initial Announcement

Cooperative Agreement

Funding Opportunity Number: CMS-1Y1-19-001

CFDA: 93.767

Date: 11/30/2018

Applicable Dates:

FOA Posting Date: 11/30/18 Letter of Intent to Apply Due Date: 01/04/19 Electronic Cooperative Agreement Application Due Date: 01/28/2019 Anticipated Announcement of Awards: 06/01/2019 Anticipated Cooperative Agreement Period of Performance: 07/01/2019 – 06/30/2022 Applicant Teleconference: Wednesday, December 19, 2018

Conference Call Time: 2:00 PM - 3:30 PM ET Dial-in Number: 1-877-271-1828 Password: 79298811

(There are a limited number of phone lines for each call, please visit https://www.insurekidsnow.gov/ for all information regarding this nnouncement) https://www.insurekidsnow.gov/ http:https://www.insurekidsnow.gov

Table of Contents

I. EXECUTIVE SUMMARY

II. PROGRAM DESCRIPTION

1. Purpose ………………………………………………………………………..6

2. Authority ………………………………………………………………………..7

3. Background ………………………………………………………………………..7

4. Program Requirements

III. FEDERAL AWARD INFORMATION

1. Total Funding

2. Award Amount

3. Anticipated Award Dates

4. Period of Performance

5. Number of Awards

6. Type of Award

IV. ELIGIBILITY INFORMATION

1. Eligible Applicants

2. Cost Sharing/Matching and Maintenance of Outreach Funding

3. Mandatory Letter of Intent

4. Single Application Requirement

5. CMS/Grantee Collaboration

6. EIN, DUNS, and SAM Regulations

V. APPLICATION and SUBMISSON INFORMATION

1. Application Package

2. Submission Dates and Times

3. Intergovernmental Review

4. Cost Restrictions

VI. APPLICATION REVIEW INFORMATION

1. Criteria

2. Review and Selection Process

3. Anticipated Award Date

VII. AWARD ADMINISTRATION INFORMATION

1. Federal Award Notices

2. Administrative and National Policy Requirements

3. Terms and Conditions

4. Cooperative Agreement Terms and Conditions of Award

5. Reporting…………………………………………………………………………..39

VIII. AGENCY CONTACTS

IX. APPENDICES

APPENDIX A: Outreach Activities to Consider APPENDIX B: Using Parents of Medicaid or CHIP-enrolled Children as Mentors to

Parents of Uninsured Children APPENDIX C: Guidance for Preparing a Budget Request and Narrative APPENDIX D: Application and Submission Information APPENDIX E: Application Check-Off List Required Contents APPENDIX F: Definitions of Frequently Used Terms APPENDIX G: Letter of Intent to Apply APPENDIX H: 504 Compliance APPENDIX I: Business Assessment of Applicant Organization APPENDIX J: Review and Selection Process

I. EXECUTIVE SUMMARY

The Connecting Kids to Coverage HEALTHY KIDS 2019 Outreach and Enrollment Cooperative Agreements program provides funding opportunities to reduce the number of children who are eligible for, but not enrolled in, Medicaid and the Children’s Health Insurance Program (CHIP), and to improve retention of eligible children who are enrolled in the programs. This program is authorized under Section 2113 of the Social Security Act, as amended by Section 3004(a) of the Helping Ensure Access for Little Ones, Toddlers and Hopeful Youth by Keeping Insurance Delivery Stable Act (referred to as the HEALTHY KIDS Act and included in Pub. L. 115-120) and by Section 50103 of the Advancing Chronic Care, Extenders, and Social Services Act (referred to as the ACCESS Act and included in Pub. L. 115-123).

Funding Opportunity Title: Connecting Kids to Coverage HEALTHY KIDS 2019 Outreach and Enrollment Cooperative Agreements

Announcement Type: New

Funding Opportunity Number: CMS-1Y1-19-001 Catalog of Federal Domestic Assistance:

93.767

Letter of Intent to Apply Due Date: January 4, 2019

Cooperative Agreement Application Due Date:

01/28/2019 3:00 p.m. Eastern (Baltimore MD) Standard Time (EST)

Anticipated Notice of Award: June 1, 2019

Performance Period: 36 months

Anticipated Total Annual Available Funding:

$48,000,000

Estimated Number and Type of Awards:

35 Cooperative Agreements

Estimated Award Amount: $500,000 up to $1,500,000 Eligible Applicants: • A state with an approved child health plan under this title (42 U.S.C. Section 1397aa et seq.);

• A local government;

• An Indian tribe or tribal consortium, a tribal organization, an urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.), or an Indian Health Service provider;

• A federal health safety net organization;

• A national, state, local, or community-based public or nonprofit private organization, including organizations that use community health workers, community-based doula programs, or parent mentors;

• A faith-based organization or consortia, to the extent that a cooperative agreement awarded to such an entity is consistent with the requirements of Section 1955 of the Public Health Service Act (42 U.S.C. 300x-65) relating to a grant award to nongovernmental entities; and/or

• An elementary or secondary school.

II. PROGRAM DESCRIPTION

This notice of funding opportunity (NOFO) seeks applications for the Connecting Kids to Coverage HEALTHY KIDS 2019 Outreach and Enrollment Cooperative Agreement grant funding (HEALTHY KIDS 2019 Cooperative Agreements). These HEALTHY KIDS 2019 Cooperative Agreements will support outreach strategies similar to those conducted in previous Connecting Kids to Coverage grant cycles, and participation in key outreach initiatives coordinated by the Connecting Kids to Coverage National Campaign (the National Campaign). The National Campaign provides outreach training and support for grantees and other partners who are working to help enroll eligible children in Medicaid and CHIP.

1. Purpose

The HEALTHY KIDS Act provides $120 million for activities aimed at reducing the number of children who are eligible for, but not enrolled in, Medicaid and CHIP, and improving retention of enrolled children. Of the total $120 million in funding, 10 percent will be set aside for outreach to American Indian/Alaska Native (AI/AN) children, 10 percent will be set aside for the National Campaign, and the remainder will be awarded for outreach and enrollment of uninsured children and their parents. This specific NOFO makes available $48 million in grants to states, local governments, Indian tribes, tribal consortium, urban Indian organizations receiving funds under title V of the Indian Health Care Improvement Act, federal health safety net organizations, community-based organizations, faith-based organizations, and schools. The list of eligible entities is in Section 1, Executive Summary, page 4, of this NOFO.

The HEALTHY KIDS Act funding for outreach and enrollment grants will build upon successful strategies facilitated by previous Connecting Kids to Coverage grant funding initiatives under the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 (Pub. L. 111-3), the Patient Protection and Affordable Care Act (ACA) of 2010 (Pub. L. 111-148), and the Medicare Access and CHIP Reauthorization Act (MACRA) (Pub. L. 114-10). To date, CHIPRA, the ACA, and MACRA provided the Centers for Medicare and Medicaid Services (CMS) with funding to award $162 million to eligible entities to support the enrollment and retention of eligible children in Medicaid and CHIP. This funding has been disbursed through four cycles of grants that were broadly targeted to eligible but unenrolled children, and three rounds of grants that were specifically targeted to AI/AN children.

Since 2009, enrollment grants have been awarded to over 230 community-based organizations, states, and local governments. Community-based organization awardees have included health care providers, schools, tribal organizations, and other types of nonprofits. Community-based organizations typically have access to and credibility with low-income families in their communities, making them indispensable partners for carrying out specialized strategies to target the hard-to-reach children who remain uninsured. State and local government agencies also play a critical role in helping to identify and enroll children. They are in a strong position to partner with other local and state run health and human services programs and agencies such as SNAP, child care agencies, and WIC to identify uninsured children and enroll them in coverage.

Grantees implemented a variety of outreach and enrollment strategies aimed at educating families about the availability of Medicaid and CHIP, identifying children likely to be eligible for these programs, and directly assisting families with the application and renewal process. For example, grantees used mobile enrollment strategies to provide one-on-one direct assistance to families living in rural areas, and worked closely with partners, often leveraging partners’ service sites, community relationships, and other resources to reach more children and families.

Beginning in 2016, applicants were encouraged to include parents in outreach and enrollment efforts because a large body of research suggests this is effective in increasing children’s enrollment and access to care. Grantees also participated in key initiatives coordinated by the National Campaign, such as back-to-school outreach efforts.

The National Campaign also continues under the HEALTHY KIDS Act to provide resources for outreach training and support for grantees and partner organizations. The National Campaign, led by CMS, provides a full range of outreach and enrollment materials including customizable posters and flyers, as well as radio and TV public service announcements, videos featuring successful outreach strategies, and outreach strategy guides that suggest effective ways to use the materials. Most materials are available in English and Spanish, and some are available in other languages as well. The National Campaign regularly conducts training webinars on key outreach and enrollment topics and also augments media outreach in selected target markets. All materials produced by the National Campaign, including recordings of all past webinars along with information about previous grantees, are available at https://www.insurekidsnow.gov/

2. Authority

The HEALTHY KIDS Act provides funding for the Children’s Health Insurance Program (CHIP) through federal fiscal year (FFY) 2023 and the ACCESS Act subsequently extended funding for an additional four years through FFY 2027.

3. Background

Since 2009, the nation has made substantial progress on reducing the number of uninsured children and enrolling eligible children in Medicaid and CHIP. A recent analysis of Census data found that the rate of uninsured children fell from

7.0 percent in 2013 to an all-time low of 4.3 percent in 2016, and just over 3.3 https://www.insurekidsnow.gov/ million children remain uninsured.1 In FFY 2017, Medicaid and CHIP served over 46 million children.2 That is more than 1 in every 2 children in America.

In addition to the decline in the percentage of uninsured children, Medicaid and CHIP participation rates increased, indicating that a greater proportion of eligible children were enrolling and gaining access to the health benefits that Medicaid and CHIP provide. A study by the Urban Institute, which has been tracking Medicaid and CHIP participation rates, found that nationally, participation rates have increased steadily from 81.7 percent in 2008 to 85.8 percent in 2010, and most recently 93.7 % in 2016.3 Participation rates have increased over time in every state, and a growing number of states in every region of the country have attained participation rates of 90 percent or higher.

The researchers attribute these achievements to the efforts states have made to streamline eligibility, verification, enrollment and renewal rules and procedures, and also to state and community-based outreach efforts. Since January 1, 2014, states have made significant changes to their Medicaid and CHIP eligibility determination policies, procedures and systems. Progress has been made to assure that application and enrollment processes and systems are seamless across insurance affordability programs, including Medicaid, CHIP, and Qualified Health Plans (QHP) through Exchanges.

States have also improved the renewal process for Medicaid and CHIP enrollees by using a data-driven redetermination process. States must use available data sources to determine eligibility without contacting enrollees, if possible per 42 CFR 435.916 and 457.343. If additional information is needed to determine eligibility, the state must send a renewal form pre-populated with information available to the agency. Other crucial components involve providing families and individuals applying for health insurance with reliable information and direct application assistance.

While this progress is significant, an Urban Institute analysis shows that there are still approximately 1.9 million children eligible for Medicaid and CHIP but not enrolled. 4 Recent improvements have narrowed gaps in coverage, yet coverage disparities persist. For example, AI/AN children continue to experience the highest uninsured rate, 8.0 percent, followed by Hispanic children with a rate of 7.1 percent uninsured. The Urban Institute analysis also shows that children in the

1 Haley, Jennifer, Genevieve Kenney, Robin Wang, Clare Pan, Victoria Lynch, and Matthew Buettgens. Uninsurance and Medicaid/CHIP Paritcipation among Children and Parents. September 2018. The Urban Institute.

https://www.urban.org/sites/default/files/publication/99058/uninsurance_and_medicaidchip_participation_among_chi ldren_and_parents_updated_1.pdf 2 https://www.medicaid.gov/chip/downloads/fy-2017-childrens-enrollment-report.pdf 3 Haley, Jennifer, Genevieve Kenney, Robin Wang, Victoria Lynch, and Matthew Buettgens. Medicaid/CHIP Participation Reached 93.7 Percent Among Eligible Children in 2016. August 2018. The Urban Institute.

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0417 4 Ibid.

https://www.urban.org/sites/default/files/publication/99058/uninsurance_and_medicaidchip_participation_among_children_and_parents_updated_1.pdf https://www.urban.org/sites/default/files/publication/99058/uninsurance_and_medicaidchip_participation_among_children_and_parents_updated_1.pdf https://www.medicaid.gov/chip/downloads/fy-2017-childrens-enrollment-report.pdf https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0417

South and in nonmetropolitan areas have higher rates of uninsurance, at 5.7 percent and 5.4 percent, respectively.5 In short, the nation is moving forward to ensure that children have the health coverage they need, but there is more work to be done.

Families and individuals continue to seek such help from organizations they know and trust – health care providers, their child’s school, familiar community-based organizations, and faith-based groups. In addition, state and local government agencies play a critical role in helping to identify and enroll children. These government agencies are in a strong position to partner with other local and state run health and human service programs and agencies such as Supplemental Nutrition Assistance Program (SNAP), child care, and WIC to identify uninsured children and enroll them in coverage. Government agencies also have relationships with local communities that can be leveraged to support outreach and enrollment efforts.

Thus, the services of Connecting Kids to Coverage (CKC) grantees remain fundamental to enrolling the hardest to reach children and adolescents and achieving the goal of reducing the number of children eligible for Medicaid and CHIP who are not enrolled and also helping children stay covered for as long as they are eligible.

4. Program Requirements

Planning Period

All awardees will be given a 90 day planning period to ensure that needed project leadership is engaged and the identified employees are fully trained and available to work on the cooperative agreement. CMS will allow grantees to use grant funds to employ individuals and begin operations during this time. However, full funding for the first year of the budget period will be restricted until the grantee demonstrates full staffing and readiness to begin operations. CMS will work with all awardees to evaluate their readiness and to provide full or conditional approval for further funding.

CMS may waive or reduce the 90 day planning period, and the restriction of first year funding if the awardee’s outreach and enrollment efforts, as specified in this funding opportunity, and as detailed in the grantee’s approved application, are well established with all project leadership, staffing, and support already in place.

Special Considerations for Applicants that Represent Collaborative Efforts

Applicants that are collaboratives, and will use the strengths of each participating

5 Haley, Jennifer, Genevieve Kenney, Robin Wang, Clare Pan, Victoria Lynch, and Matthew Buettgens. Uninsurance and Medicaid/CHIP Paritcipation among Children and Parents. September 2018. The Urban Institute.

https://www.urban.org/sites/default/files/publication/99058/uninsurance_and_medicaidchip_participation_among_chi ldren_and_parents_updated_1.pdf https://www.urban.org/sites/default/files/publication/99058/uninsurance_and_medicaidchip_participation_among_children_and_parents_updated_1.pdf https://www.urban.org/sites/default/files/publication/99058/uninsurance_and_medicaidchip_participation_among_children_and_parents_updated_1.pdf group, should identify all member organizations and the roles and responsibilities of each under the grant. Proposals must designate a lead agency or organization.

Proposals from collaboratives will be considered on their strengths and merits in the same manner as proposals from individual states or other entities. Proposals should include a Letter of Commitment from the director (or other responsible person) of each organization participating in the collaborative. The letter should confirm the organization’s participation in the collaborative and the role it will play. Alternatively, applicants may include one Statement of Collaborative Effort (SCE) which lists each partner organization, the role each will play and the signature of the director of each organization (or other responsible person). Where applicable, Letters of Commitment or the SCE should provide information about past joint endeavors.

Project Activities

Grants awarded under the cooperative agreement will fund activities/strategies aimed at educating families about the availability of free or low-cost health coverage under Medicaid and CHIP, identifying children likely to be eligible for these programs, and assisting families, including parents, to apply for coverage.

Funds will also support efforts to assist families with the annual renewal process.

Applicants are encouraged to consider any of the following outreach strategies (See Appendix A for more information):

o Engaging schools and other programs serving young people in outreach, enrollment and retention activities;

o Bridging health coverage disparities by targeting subgroups of children with lower than average health coverage rates (e.g. teens, Hispanics, AI/AN or children in rural areas);

o Establishing and developing application assistance resources to provide high quality, reliable Medicaid/CHIP enrollment and renewal services in local communities; and o Using parent mentors to assist families with enrolling in Medicaid and CHIP, retaining coverage and finding resources for addressing social determinants of health.

Grantees will be required to participate in National Campaign activities and adopt strategies promoted by the National Campaign. In particular, grantees will be required to work with the National Campaign on two special initiatives each year. These initiatives are designed to capitalize on key opportunities for outreach that are expected to be particularly productive. The first will be focused on outreach during Back-to-School time. The second will take place after the annual Exchange open enrollment period ends and will feature the Medicaid/CHIP year-round application and enrollment messaging. This is critical as people can enroll in Medicaid and CHIP at any time and are not limited to an open enrollment period. Grants awarded under this cooperative agreement will remind families that they can apply for Medicaid and CHIP year-round.

The National Campaign will make outreach materials available that can be customized for local use. It will also host a robust series of training webinars to help guide grantees and others who will be conducting activities locally. During these initiatives, grantees will have the flexibility to tailor activities to the needs of their communities and to build on what they have been doing throughout the cooperative agreement period. The goal is to coordinate an intensive set of activities and a cohesive National Campaign during these two critical times of the year.

All applicants should take these additional factors into consideration when designing proposals:

o To be most effective, outreach efforts should link families to direct (one-on-one) enrollment and renewal support.

o Providing assistance with online applications and providing renewal support can make enrollment and retention more efficient, effective, and consumer-friendly.

o While the emphasis of the HEALTHY KIDS 2019 Outreach and Enrollment Cooperative Agreements remains focused on enrolling eligible children in Medicaid and CHIP, a large body of research finds that when eligible parents get enrolled in health insurance, their children are more likely to get enrolled and receive necessary preventive care.6 Appropriate messaging and strategies that help enroll eligible parents can also facilitate the enrollment of eligible children.

o In past cycles, a number of CKC grantees have also been Navigators, or coordinated closely with Navigators to ensure that a holistic approach is taken to provide coverage to all eligible members in the family.7 We continue to welcome applicants that are Navigators or coordinate closely with Navigators.

o Families often seek health insurance for their children at times when they are most attuned to needing health services for them, such as when they are sick or injured, need physical exams to enroll in school or summer programs, or need routine preventive care, including immunizations, vision and hearing tests, or asthma and allergy screenings. Organizations and institutions that provide such services – such as hospitals, health clinics, departments of health, and schools –

6 Hudson, Julie, Asako Moriya, “Medicaid Expansion for Adults Had Measureable ‘Welcome Mat’ Effects on Their Children,” Health Affairs, 36 no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0347 7 A Navigator is an individual or organization that's trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Exchange, including completing eligibility and enrollment forms. These individuals and organizations are required to be unbiased and their services are free to consumers.

https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0347 are in a good position to conduct outreach and help families get their eligible children enrolled. They may also be more likely to have the infrastructure to sustain and track progress of outreach and enrollment efforts.

o States and local government agencies play key roles in helping to identify and enroll children. They can partner with other local and state health and human service programs and agencies such as SNAP, child care agencies, and WIC to identify uninsured children and enroll them in coverage because of their relationships with local communities that can be leveraged to support outreach and enrollment efforts. Applicants that are not one of these types of organizations or institutions may wish to consider partnering with one or more of these entities.

o Parents who have at least one Medicaid or CHIP-enrolled child can serve as mentors to parents of uninsured children during the application and renewal process. Parent mentors educate families with uninsured children about health insurance coverage, and assist with completing and submitting applications for health insurance coverage.

They can also provide guidance on identifying medical and dental homes and community pharmacies for children, provide assistance and referrals to successfully address social determinants of children’s health, and act as a liaison between the families and the state. One study showed that the use of parent mentors was more effective than traditional methods in insuring children, achieving faster coverage, and renewing coverage.8 Applicant organizations may wish to work with parent mentors as a strategy to increase the participation of eligible, particularly hard-to-reach, children in Medicaid and CHIP (Please see Appendix B for more information).

Data and Reporting Requirements

Grantees will be required to collect and report to CMS data related to their goals and accomplishments for this funding opportunity. Such data will demonstrate the outcomes that result directly from this funding opportunity, and will also be used to help evaluate the success of outreach and enrollment strategies and identify areas that need improvement or mid-course corrections. All grantees will be responsible for collecting and reporting particular data elements (presented below). In addition, applicants may identify additional metrics that could be used to evaluate the efforts of the grantee’s work. All required data must be reported to CMS by adhering to a detailed data dictionary and uploading the required data to a web-based portal provided by CMS. Grantees will be provided with reporting tools for the submission of all required data and reporting elements. Grantees

8 Flores G., Lin H., Walker C, et al. Parent Mentors and Insuring Uninsured Children: A Randomized Controlled Trial. Pediatrics. 2016; 137(4): e 0153519; Flores G., Lin H., Walker C, et al. Parent Mentoring Program Increases Coverage Rates for Uninsured Latino Children. Health Affairs. 2018; 37(3); 403–412.

may also report additional data that illustrates their progress in increasing the participation of eligible children in Medicaid and CHIP.

The required data that all grantees must report on a monthly basis include:

o Number of children for whom an application for health coverage has been submitted as a direct result of CKC funding o Number of children verified to be newly enrolled in Medicaid or CHIP as a direct result of CKC funding o Number of children for whom the grantee submitted a renewal form for Medicaid or CHIP coverage o Number of children verified to be renewed in Medicaid or CHIP as a direct result of CKC funding o The outreach and enrollment activities completed during the month

The following data must be reported on a monthly basis only if the applicant proposes to target parents with CKC funds:

o Number of parents for whom an application for health coverage has been submitted as a direct result of CKC funding o Number of parents verified to be newly enrolled in Medicaid as a direct result of CKC funding o Number of parents for whom the grantee submitted a renewal form for Medicaid coverage o Number of parents verified to be renewed in Medicaid as a direct result of CKC funding

CMS may require the reporting of additional data elements over the course of the cooperative agreement in order to fully assess grantee performance.

Grantees will be required to verify which children are enrolled or renewed in coverage as a result of CKC funding. To the extent possible, the best way to verify new enrollments and successful renewals is with the state or county Medicaid and/or CHIP agencies. This would typically require the establishment of a detailed Memorandum of Understanding (MOU) or other data-sharing agreement between the grantee and the relevant state or county Medicaid/CHIP agencies that allows grantees to submit detailed identifying information about the people they have assisted and receive verifications in response. Non-state applicants must describe their plans to secure an MOU or other data-sharing agreement with the state or county Medicaid/CHIP agencies within 90 days after the cooperative agreement is awarded.

CMS recognizes that it may not always be possible to obtain data from state or county sources. Therefore, all non-state applicants must also describe alternative methods for verifying new enrollments and renewals that do not depend on cooperation by state or county agencies and that can be implemented with the requested funding. If the grantee does not obtain an MOU, or create and implement a well-designed and effective alternative data methodology within 120 days from the date of the award, CMS may terminate the award for failing to have a process in place to collect and report the required data elements.

Please note, all applications, enrollments, and renewals reported should be directly attributable to this cooperative agreement. For example, if a HEALTHY KIDS 2019 grantee is also a Navigator grant recipient, only enrollment and renewal data directly attributed to CKC HEALTHY KIDS 2019 funding should be reported.

III. FEDERAL AWARD INFORMATION

1. Total Funding

The total amount of federal funds available is anticipated to be $48,000,000.

2. Award Amount

The amount of each cooperative agreement award made to eligible applicants may range from $500,000 up to $1,500,000, with the award amount commensurate with enrollment and renewal targets.

3. Anticipated Award Dates

The anticipated award date may vary depending on agency circumstances but is projected to be up to four months after the application deadline to allow for adequate application review and grantee selection.

4. Anticipated Period of Performance

The project period of performance for each Cooperative Agreement awarded will be three years from the date of notice of award. There will be three one-year budget periods for the period of performance from 07/01/2019 to 06/30/2022.

5. Number of Awards

CMS has no way to know the actual number of applicants and quality of award submission at this time. However, based on previous grant experience we anticipate awarding approximately 35 cooperative agreements.

6. Type of Award

These awards will be structured as Cooperative Agreements. The Federal Grant and Cooperative Agreement Act of 1977, 31 U.S.C. 6301, defines the cooperative agreement as an alternative assistance instrument to be used in lieu of a grant whenever substantial federal involvement with the recipient during performance is anticipated. The difference between grants and cooperative agreements is the degree of federal programmatic involvement rather than the type of administrative requirements imposed. Therefore, statutes, regulations, policies, and the information contained in the HHS Grants Policy Statement that are applicable to grants also apply to cooperative agreements, unless the award itself provides otherwise.

IV. ELIGIBILITY INFORMATION

1. Eligible Applicants

This cooperative agreement opportunity is open to the following individual eligible entities, or collaboratives of eligible entities:

a. A state with an approved child health plan under this title [42 U.S.C. Section1397aa et seq.];

b. A local government;

c. An Indian tribe or tribal consortium, a tribal organization, an urban

Indian organization receiving funds under title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.), or an Indian Health Service provider;

d. A federal health safety net organization;

e. A national, state, local, or community-based public or nonprofit private organization, including organizations that use community health workers, community-based doula programs, or parent mentors;9

f. A faith-based organization or consortia, to the extent that a cooperative agreement awarded to such an entity is consistent with the requirements of Section 1955 of the Public Health Service Act (42 U.S.C. 300x-65) relating to a grant award to nongovernmental entities; and/or

g. An elementary or secondary school.

Former and current Connecting Kids to Coverage grantees (from Cycles I, II, III, or IV) or AI/AN grantees (from Rounds I, II, or III) submitting proposals under this NOFO must be or have been grantees in good standing, meaning they must be meeting or have met all reporting requirements and other contractual obligations under their grants.

Applicants that had Cycle I, II, III, or IV or AI/AN grants may apply for a Connecting Kids to Coverage (HEALTHY KIDS 2019) cooperative agreement if

9 Please see Appendix B for more information.

their proposal meets one of the following:

o New and distinct activities: A Cycle I, Cycle II, Cycle III, Cycle IV or AI/AN grantee may submit a proposal for activities that are new and distinct from those previously funded under the Cycle I, Cycle II, Cycle III, Cycle IV or AI/AN grant, OR o Continuation of successful activities: A Cycle I, Cycle II, Cycle III, Cycle IV or AI/AN grantee that wishes to continue activities it is currently or previously conducted, may submit a proposal for a HEALTHY KIDS 2019 grant, but must present data demonstrating that the activities it wishes to continue have proved successful in enrolling and/or retaining eligible children in Medicaid and CHIP and warrants further funding.

Ineligible Applicants

Foreign and International Organizations and for-profit entities are not eligible to apply. Applicants must be public and/or not-for-profit entities.

Threshold Criteria o Application deadline: Applications not received electronically through www.grants.gov by the application deadline will not be reviewed.

o Applications will be considered for funding only if the application meets the requirements as outlined in IV. Eligibility Information, and V. Application Information.

Applicants are strongly encouraged to use the review criteria information provided in Section VI. Application Review Information, Section V. Application Information, and Appendix D, Application and Submission Information, to ensure that the application proposal adequately addresses all the criteria.

2. Cost Sharing/Matching and Maintenance of Outreach Funding

Awardees, including states, are not required to provide a matching contribution.

However, any outside funding that will be contributed to the outreach and enrollment effort by other entities must be mentioned in the Budget Narrative. In the case of a state that is awarded a grant, the state funds expended for outreach and enrollment activities during the grant project period shall not be less than the level of such funds expended in the federal fiscal year proceeding the first fiscal year for which the grant is awarded.

3. Mandatory Letter of Intent http://www.grants.gov/

Applicants are required to submit a non-binding Letter of Intent to Apply (See Appendix F). CMS reserves the right to consider an applicant ineligible without a timely Letter of Intent (LOI). The Letter of Intent enables CMS to better plan for the application review process. Letters of Intent to Apply should be submitted by email to CMS at healthykids@grantreview.org by January 4, 2019 3:00 p.m. Eastern (Baltimore) time.

4. Single Application Requirement

Only one application may be submitted by any given lead eligible entity for funding of a Connecting Kids to Coverage HEALTHY KIDS 2019 cooperative agreement; however, an eligible entity may be a member of multiple applicant collaboratives. Entities working together as a collaborative shall submit one application. Only one HEALTHY KIDS 2019 cooperative agreement will be awarded to a single eligible entity or to the lead agency of a collaborative.

If an eligible entity submits more than one application, only the last eligible application submitted, before the stated deadline, will be accepted for review. All awardees must attest that they will not finance the same scope of work under more than one HEALTHY KIDS 2019 cooperative agreement award or other federal or non-federal funding stream.

5. CMS/Grantee Collaboration

Grantees will agree to fulfill all cooperative agreement requirements including requirements to collaborate with CMS. They must agree to:

a. Participate in key grantee training activities as identified by

CMS;

b. Participate in the Connecting Kids to Coverage National Campaign outreach initiatives described in this NOFO;

c. Participate in monthly conference calls with the CMS Project Officer. The Project Director for the grant is required to participate in these monthly calls.

d. Submit, in a timely manner, semi-annual reports to include all required data elements using the progress reporting tool provided by CMS (see Section II(3) for a description of the required data reporting process);

e. Submit, in a timely manner, monthly reports to include data on current and upcoming activities, number of applications submitted on behalf of the targeted populations, etc.

f. Submit timely, accurate Federal Financial Status Reports (SF-425);

g. Participate on conference calls, with CMS or its contractors, to provide updates on enrollment and renewal data, implementation status and other updates as needed;

h. Work collaboratively with CMS to identify successful strategies and share information about cooperative agreement mailto:healthykids@grantreview.org mailto:CMS_TA@grantreview.org activities;

i. Share best practices and lessons learned with other grantees via peer-to-peer learning opportunities provided by CMS;

j. Cooperate fully with the independent evaluation of the cooperative agreement program conducted by the CMS evaluator; and;

k. Cooperate fully with CMS and all CMS contractors associated with this cooperative agreement.

6. EIN, DUNS, and SAM Regulations

In order to apply, all applicants are required to have a valid Employer Identification Number (EIN), otherwise known as a Taxpayer Identification Number (TIN); a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number;

and be registered in the System for Award Management (SAM) database (https://www.sam.gov/SAM/) to be able to submit an application at grants.gov.

See Appendix B for descriptions of EIN, DUNS, and SAM.

V. APPLICATION and SUBMISSON INFORMATION

1. Application Package

This solicitation serves as the application package for this grant and contains all the instructions that a potential applicant requires to apply for cooperative agreement funding. The application should be written primarily as a narrative with the addition of standard forms required by the federal government for all grants and cooperative agreements.

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

For assistance with Grants.gov, contact Support@Grants.gov or call

(800) 518-4726. HHS strongly recommends that you do not wait until the application due date to begin the application process (through http://www.grants.gov) because of the time needed to complete the required registration steps.

Content and Format of Application

Please note that applications that fail to follow the strict formatting requirements outlined below regarding formatting, font size, and page limitations will be deemed ineligible and their applications will not be considered for review. The application must include all contents described below and must not exceed 28 pages.

https://www.sam.gov/SAM/ http://www.grants.gov/ mailto:Support@Grants.gov http://www.grants.gov/ http:Grants.gov http:Grants.gov http:Grants.gov http:grants.gov

Please note that some items must be double-spaced and other items may be single-spaced. Proposals that do not adhere to this strict page limitation will not be reviewed and will be rejected.

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 described below, in the order indicated, and conform to the following specifications:

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

o All pages of the project and budget narratives must be paginated in a single sequence.

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

o The Project Narrative will be double-spaced.

o The Budget Narrative may be single-spaced and should follow the justifications and table formats provided in Appendix B, Sample Budget and Narrative Justifications.

o Tables included within any portion of the application should 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.

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

o The additional required documentation, including Standard Forms, copies of the previously submitted Letter of Intent, Cover Letter, and Project Abstract are excluded from the page limitations.

504 Compliance - Recipients of federal financial assistance (FFA) from Health and Human Services (HHS) must administer their programs in compliance with federal civil rights laws. This means that recipients of HHS funds must ensure equal access to their programs without regard to a person’s race, color, national origin, disability, age and, in some circumstances, sex and religion. It is HHS’ duty to ensure access to quality, culturally competent care, including long-term services and supports, for vulnerable populations.

HHS provides guidance to recipients of FFA on meeting their legal obligation to take reasonable steps to provide meaningful access to their programs by persons with limited English proficiency. In addition, recipients of FFA have specific legal obligations for serving qualified individuals with disabilities by providing information in alternate formats.

Several sources of guidance provided below:

o https://www.hhs.gov/ocr/index.html o http://www.hhs.gov/ocr/civilrights/resources/laws/summaryguidance.ht ml o http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53 o http://www.hhs.gov/ocr/civilrights/understanding/section1557/index.ht ml o HHSAR 352.270-1 o http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html

Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under federal civil rights laws at at https://www.hhs.gov/ocr/index.html or call 1-800-368-1019 or TDD 1-800-537- 7697.

Overview of Cooperative Agreement Application Structure and Content

Standard Forms

The following standard forms are found in the Grants Application Package at Grants.gov and must be completed with an electronic signature and submitted as part of the proposal:

Project abstract summary A one-page abstract should serve as a succinct description of the proposed project and should include the goals of the project, the total budget, the number of projected clinician participants, projected total cost of care savings, and a description of how the funds will be used. 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.

Personal identifying information should be excluded from the abstract. In the Grants Application Package that can be found at www.Grants.gov, select the Project Abstract Summary and complete the form.

SF-424: Official Application for Federal Assistance

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

o On Item 15 “Descriptive Title of Applicant’s Project”, state the specific cooperative agreement opportunity for which you are applying: Connecting Kids to Coverage Outreach and Enrollment Cooperative Agreements.

https://www.hhs.gov/ocr/index.html https://www.hhs.gov/ocr/index.html http://www.hhs.gov/ocr/civilrights/resources/laws/summaryguidance.html http://www.hhs.gov/ocr/civilrights/resources/laws/summaryguidance.html http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53 http://www.hhs.gov/ocr/civilrights/understanding/section1557/index.html http://www.hhs.gov/ocr/civilrights/understanding/section1557/index.html https://www.hhs.gov/grants/contracts/contract-policies-regulations/hhsar/part-352-solicitation-provisions-contract-clauses/index.html#352.270-1Accessibilityofmeetingsconferencesandseminarstopersonswithdisabilities.

http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html https://www.hhs.gov/ocr/index.html o Check “No” to item 19c, as Review by State Executive Order 12372 does not apply to this cooperative agreement funding opportunity.

o SF-424A: Budget Information Non-Construction o SF-424B: Assurances-Non-Construction Programs o SF-LLL: Disclosure of Lobbying

Activities.

All applicants must submit this document. If your entity does not engage in lobbying, please insert “Non-Applicable” on the document and include the required Authorized Organizational Representative (AOR) name, contact information, and signature. Please note that the application kit available online in Grants.gov is used for many programs and therefore Grants.gov may designate this form as optional to allow for flexibility amongst programs. The specific funding opportunity announcement will provide final, binding guidance. This form is required as part of your application package and must be submitted for your application to be considered eligible for review.

o Project Site Location Form(s)

All applicants must submit this 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. This form is required as part of your application package and must be submitted for your application to be considered eligible for review.

Project Narrative Requirement

The applicant must provide a Project Narrative that articulates in detail the proposed goals, measurable objectives, and milestones to be completed in accordance with the instructions and content requirements provided below and the specific criteria described in E1. Criteria. Please include the title “Project Narrative’ at the beginning of the Project Narrative.

In the Grants Application Package that can be found at www.Grants.gov, select the Project Narrative Attachment Form and “Add Mandatory Project Narrative File”.

Budget Narrative Requirement

For more information on completing the budget narrative, please see Appendix B, Sample Budget and Narrative Justifications. This Appendix provides detailed instructions and examples of how the information in the budget narrative should be presented. Detailed explanations must be provided for each activity as well as full computations. Applicants must also clearly link each activity to the goals of this funding opportunity announcement and that are consistent with HEALTHY

KIDS 2019 cooperative agreement requirements. Overhead and administrative costs must be reasonable.

Awardees must submit budget estimates for one in-person meeting, for up to two individuals, who directly work on the cooperative agreement to attend a two-day face-to-face meeting in the Baltimore area.

Detailed costs and breakdown for each SF-424A, Section B line items are as follows:

1. Personnel (itemized)

2. Fringe benefit costs

3. Travel and training cost

4. Equipment

5. Supplies

6. Contractual

7. Construction (unallowable)

8. Other

9. Indirect Cost

10. Totals

The Budget Narrative Attachment Form can be found in the Grants Application Package at www.Grants.gov; select the Budget Narrative Attachment Form and “Add Mandatory Budget Narrative”. Completion of the Standard form, SF- 424A, is also required and is an important part of our proposal and will be reviewed carefully by HHS staff.

For detailed application content, format and submissions instruction, please refer to Appendix C. Application and Submission Information.

Business assessment of applicant organization (maximum 10 pages) An applicant must review, answer, and submit the business assessment questions outlined in Appendix I.

Unique Entity Identifier and System for Award Management (SAM) – Required 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 and, 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.

2. Submission…