PKG00251305-instructions.pdf

U.S. Department of Health and Human Services

Centers for Medicare & Medicaid Services

Center for Consumer Information and Insurance Oversight

Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges

Notice of Funding Opportunity

Invitation to Apply for 2019

Funding Opportunity Number: CA-NAV-19-001

CFDA: 93.332

Funding Opportunity Posting Date: May 23, 2019

Applicable Dates:

Mandatory Letter of Intent to Apply Due Date: N/A

Electronic Application Due Date: July 22, 2019 (3:00 p.m. EDT)

Anticipated Issuance Notices of Award: August 29, 2019

Anticipated Period of Performance: 24 months from the date of initial award with 12 month budget periods

Table of Contents

A. PROGRAM DESCRIPTION

A1. Purpose

A2. Authority

A3. Background

A4. Program Requirements

A5. Technical Assistance and Information for Prospective Applicants

B. FEDERAL AWARD INFORMATION

B1. Total Funding

B2. Award Amount

B3. Anticipated Award Date

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. Mandatory Letter of Intent

C4. Ineligibility Criteria

C5. Single Application Requirements

C6. Continued Eligibility

C7. EIN, DUNS, and SAM Regulations

C8. Foreign and International Organizations

C9. Faith-Based Organizations

D. APPLICATION AND SUBMISSION INFORMATION

D1. Address to Request Application Package

D2. Content and Form of Application Submission

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 and Integrity Information Systems (FAPIIS) ...55

F. FEDERAL AWARD ADMINISTRATION INFORMATION

F1. Federal Award Notices

F2. Administrative and National Policy Requirements

Audit Requirements

F3. Terms and Conditions

F4. Cooperative Agreement Terms and Conditions

F5. Reporting

G. CMS CONTACTS

G1. Programmatic Questions

G2. Grants Management Specialist/Business Administration Questions

H. APPENDICES

APPENDIX I. Guidance for Preparing a Budget Request and Narrative

APPENDIX II. Application and Submission Information

APPENDIX III. Business Assessment of Applicant Organization (Questions)

APPENDIX IV. Accessibility Provisions

APPENDIX V. Review and Selection Process

APPENDIX VI. List of States for which Funding is Available

APPENDIX VII. Application Check-Off List

Executive Summary

The Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges (Funding Opportunity) will enable recipients to operate as Exchange Navigators in States with a Federally-facilitated Exchange (FFE), as authorized by the Patient Protection and Affordable Care Act (PPACA)1. To view a current list of States that will have an FFE in benefit year 2020, see Appendix VI, List of States for which Cooperative Agreement Funding is Available.

When Exchanges were in their infancy, and public awareness and understanding of coverage options was low, the U.S. Department of Health and Human Services (HHS) encouraged Navigators to cast a wide net and to provide intensive face-to-face assistance to consumers. The FFEs have been in operation since 2013 for the 2014 open enrollment period, and the public is more aware of the options for private coverage available through them. Certified application counselors, direct enrollment partners, and Exchange-registered agents and brokers serve as additional resources to consumers. Beginning in 2018, the Navigator program was scaled down to reflect the enhanced public awareness of health coverage through the Exchanges and increased roles for private sector partners, including issuers and licensed health insurance agents and brokers, in serving consumers.

Even as the FFE Navigators’ role evolves, awarded entities must still carry out the required statutory Navigator duties and the additional requirements laid out in Sections B. Award Information and E. Application Review Information of this Funding Opportunity: 1) conduct public education activities to raise awareness of the availability of qualified health plans; 2) distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of premium tax credits under Section 36B of the Internal Revenue Code of 1986 and cost-sharing reductions under Section 1402 of the PPACA; 3) facilitate enrollment in qualified health plans; 4) provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under Section 2793 of the Public Health Service Act, or any other appropriate State agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and 5) provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the FFE.

This document describes how to submit proposals for available funding in fiscal years (FY) 2019 through 2021 and how the Centers for Medicare & Medicaid Services (CMS) will determine which proposals will be funded. This document should be read in its entirety, as some information has changed from the previous award cycles.

1 The Patient Protection and Affordable Care Act (Pub. L. 111–148) was enacted on March 23, 2010. The Health Care and Education Reconciliation Act of 2010 (Pub. L. 111–152), which amended and revised several provisions of the Patient Protection and Affordable Care Act, was enacted on March 30, 2010.

Item Description

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

CMS Awarding Center Center for Consumer Information and Insurance Oversight (CCIIO)

Notice of Funding Opportunity Title Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges

Authorization Patient Protection and Affordable Care Act (PPACA), Sections 1311(d)(4)(K), 1311(i), and 1321(c)(1)

Funding Opportunity Type New

Funding Opportunity Number CA-NAV-19-001

Type of Award Cooperative Agreement

Catalog of Federal Domestic Assistance 93.332

Letter of Intent to Apply Due Date (if applicable)

Not Applicable

Application Due Date & Time

July 22, 2019 3:00 PM Eastern U.S. Time

Anticipated Issuance Notice(s) of Award August 29, 2019

Anticipated Period of Performance 24 months from the date of award with 12-month budget periods

Anticipated Total Available Funding $10 million allotted per 12-month budget period; $20 million total for 24-month period of performance, pending funding availability

Estimated Number of Awards 25-50

A. PROGRAM DESCRIPTION

A1. Purpose

The Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges (Funding Opportunity) will enable recipients to operate as Exchange Navigators in States with a Federally-facilitated Exchange (FFE), as authorized by the PPACA. To view a current list of eligible States that will have an FFE in benefit year 2020, see Appendix VI, List of States for which Cooperative Agreement Funding is Available.

A2. Authority

This Cooperative Agreement is being issued by the Secretary of HHS pursuant to Sections 1311(d)(4)(K), 1311(i), and 1321(c)(1) of the PPACA. Section 1311(i) of the PPACA states that an Exchange “shall establish a program under which it awards grants” to entities which facilitate education about and enrollment in qualified health plans (QHPs) through Exchanges. These entities are known as “Navigators.”

Please visit the following link to view the full list of relevant regulations that HHS has published under Title 45 of the Code of Federal Regulations: https://ecfr.io/Title-45/cfr155_main

A3. Background

Section 1311(i) of the PPACA requires Exchanges to establish a Navigator grant program. This Funding Opportunity is open to eligible entities and individuals (described in Section 1311(i)(2) of the PPACA and 45 C.F.R. §155.210(a) and (c)) applying to serve consumers in States with a FFE. Entities and individuals cannot serve as federally certified Navigators without receiving federal cooperative agreement funding to perform Navigator duties. This is the fifth Funding Opportunity since 20132 provided for Navigators serving FFE consumers.

A4. Program Requirements

Entities or individuals eligible to apply for this Funding Opportunity must be capable of carrying out, at a minimum, all Navigator duties required by the PPACA and HHS regulations. The primary regulations that establish requirements for awardees under this Funding Opportunity are

2 For more information on the previous Navigator Funding Opportunity announcements and awardees, please see https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance.html.

https://ecfr.io/Title-45/cfr155_main https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance.html

45 C.F.R. §§ 155. 2103 and 155.2154. These regulations establish duties that are required of all recipients of funding under this Funding Opportunity, including, but not limited to:

• Conducting public education activities to raise awareness about the Exchange;

• Facilitating selection of a QHP;

• Providing information in a manner that is culturally and linguistically appropriate to the needs of the population served by the Exchange, including individuals with limited English proficiency, and ensuring accessibility and usability of Navigator tools and functions for individuals with disabilities;

• Providing referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under section 2793 of the Public Health Service Act, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage;

• Complying with applicable training and conflict of interest standards;

• Obtaining the authorization of applicants for coverage available through an Exchange application prior to accessing their personally identifiable information; and

• Providing targeted assistance to serve underserved or vulnerable5 populations, as identified by the Exchange, within the Exchange service area. Throughout this Funding Opportunity, we refer to these populations as the “left behind” populations.

For purposes of this Funding Opportunity, the FFEs will consider “left behind” populations to include those individuals who are disproportionately without access to health insurance coverage or care and who may be unaware of the full range of the different types of coverage options available to them, including coverage options in addition to QHPs, such as association health plans and short-term, limited-duration insurance.

• Examples of “left behind” populations may include: hourly wage workers (restaurant and retail workers); variable income workers (workers with unpredictable annual incomes who fluctuate in and out of eligibility for financial assistance when purchasing health insurance); and persons who did not get health insurance because of a lack of affordable

3 See 45 C.F.R. § 155.210, at https://ecfr.io/Title-45/se45.1.155_1210

4 See 45 C.F.R. § 155.215, at https://ecfr.io/Title-45/se45.1.155_1215

5 See 45 C.F.R. § 155.210(e)(8) https://ecfr.io/Title-45/se45.1.155_1210 https://ecfr.io/Title-45/se45.1.155_1215 coverage options in their area, or because they lacked a general knowledge about affordable health insurance options and how to enroll.

• Applicants may propose additional “left behind” populations in their applications for the FFE’s approval.

The Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2020 Final Rule6 amended 45 C.F.R. § 155.210(e)(9), effective June 24, 2019, to make the provision of certain types of assistance, including post-enrollment assistance, permissible for FFE Navigators instead of required. Accordingly, beginning with Navigator grants awarded through this Funding Opportunity, Navigators in FFEs may opt to continue providing the types of assistance listed at § 155.210(e)(9), but will now have the flexibility to better prioritize their work according to consumer demand, community needs, and organizational resources.

This change will apply to the following topics7:

• Understanding the process of filing Exchange eligibility appeals;

• Understanding and applying for exemptions from the individual shared responsibility payment that are granted through the Exchange, understanding the availability of exemptions from the requirement to maintain minimum essential coverage and from the individual shared responsibility payment that are claimed through the tax filing process and how to claim them, and understanding the availability of IRS resources on this topic8;

• The Exchange-related components of the premium tax credit reconciliation process, and understanding the availability of IRS resources on this process;

• Understanding basic concepts and rights related to health coverage and how to use it; and

• Referrals to licensed tax advisers, tax preparers, or other resources for assistance with tax preparation and tax advice related to consumer questions about the Exchange application and enrollment process, exemptions from the requirement to maintain minimum essential

6 See Federal Register 84 FR 17454: https://www.govinfo.gov/content/pkg/FR-2019-04-25/pdf/2019-08017.pdf

7 See 45 C.F.R. § 155.210(e)(9)

8 The elimination of the shared responsibility payment applies to months beginning after December 31, 2018. More information can be found here: https://www.irs.gov/affordable-care-act/individuals-and-families/individual-shared-responsibility-provision.

https://www.govinfo.gov/content/pkg/FR-2019-04-25/pdf/2019-08017.pdf https://www.congress.gov/bill/115th-congress/house-bill/1/text https://www.irs.gov/affordable-care-act/individuals-and-families/individual-shared-responsibility-provision https://www.irs.gov/affordable-care-act/individuals-and-families/individual-shared-responsibility-provision coverage and from the individual shared responsibility payment, and premium tax credit reconciliations.

Applicants should be creative, proposing innovative strategies for meeting the statutory and regulatory requirements outlined in this Funding Opportunity (See Section E. Application Review Information). For example, with respect to consumer outreach and education activities, innovative cost-effective strategies might include: distributing educational flyers, posting information on an organization’s website, or other cost-effective approaches to sharing information with consumers. Applicants are also encouraged to think critically about their proposed work plan and outline strategies that maximize their impact on the community and that use federal cooperative agreement funds efficiently —such as through strategic partnerships with public and private organizations, coordinating outreach activities with local CHIP outreach or other similar outreach programs, or providing more virtual or mobile assistance to consumers.

Prohibitions:

The regulations at 45 C.F.R. §§ 155. 210 and 155.215 establish prohibitions that apply to all recipients of funding under this Funding Opportunity (see Section D6. Cost Restrictions for additional prohibitions). These include, but are not limited to:

• Receiving any consideration directly or indirectly from any health insurance issuer or issuer of stop loss insurance in connection with the enrollment of any individuals or employees in a QHP or a non-QHP;

• Charging any applicant for or enrollee in coverage available through the Exchange for application or other assistance related to Navigator duties;

• Compensating individual Navigators on a per-application, per-individual-assisted, or per-enrollment basis;

• Providing gifts9 of any value to any applicant or potential enrollee as an inducement for enrollment;

• Providing gifts to any applicant or potential enrollee for a reason other than as an inducement for enrollment that exceed $15, either individually or in the aggregate, when provided to that individual during a single encounter.

9 See 45 C.F.R. 155.201(d)(6) for definition of gifts: https://ecfr.io/Title-45/se45.1.155_1210 https://ecfr.io/Title-45/se45.1.155_1210

• Using Exchange funds to purchase gifts or gift cards, or promotional items that market or promote the products or services of a third party, that would be provided to any applicant for or potential enrollee in coverage available through the Exchange;

• Soliciting any consumer for application or enrollment assistance by going door-to-door or through other unsolicited means of direct contact, except in cases where the individual has a pre-existing relationship with the individual Navigator or Navigator entity and other applicable state and federal laws are otherwise complied with; and

• Initiating any telephone call to a consumer using an automatic telephone dialing system or an artificial or prerecorded voice, except in cases where the individual Navigator or Navigator entity has a relationship with the consumer and other applicable state and federal laws are otherwise complied with.

Required Training:

All entities and individuals carrying out Navigator functions under cooperative agreements awarded through this Funding Opportunity must successfully complete an HHS-developed training program and pass an online exam to ensure appropriate understanding of relevant Exchange-related information and must be federally certified before carrying out any Navigator functions. After initial certification, all entities and individuals carrying out Navigator functions must obtain continuing education and be recertified on at least an annual basis. Navigator entities awarded cooperative agreement awards must also comply with any state-specific requirements, so long as these state-specific requirements do not prevent application of the provisions of Title I of the PPACA. Navigators will receive technical assistance from HHS to complete the required federal certification/recertification training in the Marketplace Learning Management System.

Referrals and Consumer Assistance:

Navigators will be required to assist any consumer seeking assistance, even if that consumer is not a member of the “left behind” population or is otherwise not a member of the community(ies) or group(s) the applicant expects to target, as outlined in its funding proposal.

There may be some instances where a Navigator does not have the immediate capacity to help an individual. In such cases, the Navigator should make every effort to provide assistance in a timely manner, but could also refer consumers seeking assistance to other resources, such as the toll-free Exchange call center or certified application counselors. Although Navigators should not refer consumers to specific agents and brokers, they may refer consumers to general resources they can use to search for an agent or broker near where they live, such as the Help On

Demand tool10 available through Find Local Help on HealthCare.gov. Additionally, if a Navigator in a FFE is approached by a consumer who lives in a state with a State-based Exchange, or in a state with an FFE in which the Navigator has not been funded to serve, the Navigator must refer the consumer to a Navigator or other Exchange-approved assister in the consumer’s state.

Multi-State Awardees:

An applicant may propose to serve populations in multiple FFEs through the submission of one application. However, the applicant must submit separate Budget Narratives and project (metric) goals for each FFE it proposes to serve (See Section D. Application and Submission Information for additional information). If an applicant is proposing to serve in more than one FFE, the applicant should be prepared to revise its project scope and budget upon award if it is not funded to serve in all proposed FFEs and/or at the full amount requested.

Continued Funding:

Continued funding throughout the 24-month period of performance will be contingent on timely submission of the non-competing continuation application, strong performance during the previous budget period, funding availability, and the awardee’s ability to continue meeting all eligibility requirements laid out in this Funding Opportunity, including continuing to serve in a state(s) with a FFE.

Strong performance during the previous budget period will be measured by looking at a) the awardee’s ability to meet the self-imposed performance metrics laid out in its original application, b) the quality and timeliness of required report submissions, as determined by CMS,

c) the awardee’s compliance with the terms and conditions provided with its Notice of Award, including compliance with all applicable statutory and regulatory requirements, and d) the awardee’s ability to communicate with and respond in a timely manner to requests from its Project Officer and Grants Management Specialist throughout the period of performance.

Information about reporting and certification will be provided with the Notice of Award for the Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges.

Additionally, HHS could terminate a cooperative agreement for poor performance, or alternatively the awardee might withdraw from the cooperative agreement program before the end of the 24-month period of performance. Should the FFE in a state (or, in the case of a multi-state award, all applicable states) in which a Navigator awardee has received funding through this Funding Opportunity transition from a FFE to a State-based Exchange (SBE) or State-based

10 Help On Demand is a consumer assistance and referral service used to connect consumers seeking assistance with Exchange-registered, state licensed agents and brokers in their area who can provide assistance with Exchange plans and enrollments.

Exchange on the Federal Platform (SBE-FP) before the 24-month project period ends, the Navigator cooperative agreement would end and any unused funds would be returned to HHS. In accordance with 45 C.F.R. §155.106, any state seeking approval from HHS to operate a SBE or SBE-FP must coordinate with HHS on a jointly-developed transition plan, including a process and timeline for ending this cooperative agreement.. In the case of a multi-state award, the Navigator cooperative agreement would remain in place for any FFE in a state that remains a

FFE.

Multi-Year Project Period and Funding Structure:

The period of performance under this specific Funding Opportunity will be for 24 months, funded in 12-month increments known as budget periods. Continued funding will be contingent on the awardee continuing to meet all Navigator program requirements, current program priorities, and the availability of funds. This multi-year funding structure is designed to provide greater consistency for Navigator awardee organizations and their staff from year to year, reducing yearly start up time and providing for a more efficient use of cooperative agreement funds.

Applicants must submit a proposal which covers the full 24-month period of performance.

Although initial funding awarded through this Funding Opportunity will cover only the first 12-month budget period of the 24-month period of performance, applicants must still submit an estimated budget for each budget period (years 1 and 2) using the funding allocations provided for the first budget year (See Section B2. Award Amount). For Year 2, awardees will be able to revise their budgets, based on actual11 funding available from HHS, as part of their non-competing continuation applications which will be required from all awardees prior to the end of the first budget period.

A non-competing continuation application is a financial assistance request (in the form of an application or performance/progress report) for a subsequent budget period within a previously approved period of performance for which a recipient does not have to compete with other applicants. Approval of this application will allow the awardee to continue implementing its project plan and to receive its next 12-month increment of funding. Non-competing continuation applications should be submitted no later than 90 days before the end of the current budget period (e.g., if the budget period will end on August 10, submit the non-competing continuation application by May 10). Exact requirements for the non-competing continuation application as

11 Actual funding available to awardees from HHS during year 2 of this 24-month project period will be determined based on the total amount of funding made available to the Navigator program for the 12-month budget period, as well as each awardee’s performance during the prior budget period, as outlined in Section A4. Continued Funding.

As a result, individual award amounts during year 2 may be higher or lower than the amount awarded for the first 12-month budget period.

well as due dates will be laid out in the terms and conditions that accompany each awardee’s Notice of Award and guidance provided by the CMS Project Officer.

Due to their non-competitive nature, continuation applications will not be reviewed or scored by an objective review panel. Instead, all continuation applications will be reviewed by CMS staff.

A5. Technical Assistance and Information for Prospective Applicants

HHS will hold two sessions designed to provide technical assistance for potential applicants.

These sessions will provide applicants with an overview of this project, budget guidance, and review the instructions for applying outlined in this Funding Opportunity. Applicants are encouraged to submit questions in advance of each session to Navigatorgrants@cms.hhs.gov.

Technical Assistance Session #1

Wednesday, June 5, 2019 from 3:00 to 4:00 pm Eastern Daylight Time Link: https://goto.webcasts.com/starthere.jsp?ei=1245655&tp_key=1bbf4a3c51

Technical Assistance Session #2

Tuesday, July 9, 2019 from 3:00 to 4:00 pm Eastern Daylight Time Link: https://goto.webcasts.com/starthere.jsp?ei=1245656&tp_key=47021aff2e

B. FEDERAL AWARD INFORMATION

B1. Total Funding

HHS expects to award up to $20,000,000 over the 24-month period of performance and up to $10,000,000 during the first 12-month budget period of this multi-year award depending on the availability of funds and current program priorities.

Applicants selected for award under this Funding Opportunity will be issued funding for the first 12-month budget period of the multi-year award and will be required to submit a non-competing continuation application for continued funding of their award during the 24-month project period. Cooperative agreement award amounts may vary annually12 and all awards issued under this Funding Opportunity are subject to the availability of funds and current program priorities.

12 Actual funding available to awardees from HHS during year 2 of this 24-month project period will be determined based on the total amount of funding made available to the Navigator program for the 12-month budget period, as well as each awardee’s performance during the prior budget period(s), as outlined in Section A4. Program Requirements, Continued Funding. As a result, individual award amounts during year 2 may be higher or lower than the amount awarded for the first 12-month budget period and is not appealable.

mailto:Navigatorgrants@cms.hhs.gov https://goto.webcasts.com/starthere.jsp?ei=1245655&tp_key=1bbf4a3c51 https://goto.webcasts.com/starthere.jsp?ei=1245656&tp_key=47021aff2e

In the absence of funding, HHS is under no obligation to make awards under this Funding Opportunity or can change the award amount prior to the issuance of a Notice of Award.

B2. Award Amount

HHS expects to award up to $20,000,000 over the 24-month project period, with up to $10,000,000 awarded for the first 12-month budget period of this multi-year award. Although initial funding awarded through this Funding Opportunity will cover only the first 12-month budget period of the 24-month project period, applicants must still submit an estimated budget for each budget period (years 1 and 2), using the funding tier allocations provided in Table 1 below. For Year 2 of the period of performance, awardees will be able to revise their budgets, based on actual funding available to HHS and current program priorities, as part of their non-competing continuation applications, which will be required from all awardees for continued funding of their award during the 24-month project period.

For the first 12-month budget period, the $10,000,000 in total available funding is allocated among the 34 FFE states (See Appendix VI, List of States for which Cooperative Agreement Funding is Available) based on the size of the remaining, eligible uninsured (legal residents under age 65) population in each FFE state, with a minimum of $100,000 available for awards in each FFE. As was the case in 2018, the 34 FFE states have been sorted into funding tiers, outlined in the below table, based on their state’s total number of remaining, eligible uninsured (legal residents under age 65) consumers.

Once again, those FFEs with the highest number of remaining uninsured, and therefore the FFEs that are the most likely to have the highest number of consumers who have been “left behind” for Navigators to reach, are in the tier with the highest available funds—tier 6. On the contrary, those FFE states with the lowest number of remaining uninsured consumers are in the tier with the minimum amount of available funding – tier 1. In subsequent budget periods, the funding allocation formula and funding tier table will continue to be updated based on funding availability and new data (if available). Updates to the funding allocation formula and funding tier table will be communicated to recipients as a part of the Non-Competing Continuation Application process.

The amount of funding being requested by an applicant within a FFE for the first 12-month budget period should be proportional to the scope and breadth of the activities being proposed and the portion of the FFE they plan to target. For example, an applicant proposing to serve the entire State of Alaska could apply for a maximum of $100,000 for the first 12-month budget year. Alternatively, an applicant only proposing to serve part of the State of Alaska could apply for $50,000 for the first 12-month budget year, allowing multiple applicants (if available) to be selected for award in the State of Alaska. When making awards, HHS reserves the right to reduce the budget requested, or only partially fund proposed activities, based on its review of the expected activities, the reasonableness of the budget submitted by the applicant, and the availability of remaining funds for the FFE for which an award is made.

Table 1. Funding Allocation Tiers for 2019-2020 Budget Period, Per FFE State ($10,000,000 in total funding will be allocated among the 34 FFE states, per 12-month budget period)

Funding Allocation Tier 1 Uninsured population less than 200,000 per FFE

States with a FFE 2017 Total Number of

Eligible Uninsured (under Age 65) 13

State Funding Allocation

Alaska 97,000 $100,000 Delaware 50,000 $100,000

Hawaii 52,000 $100,000

Iowa 144,000 $100,000

Maine 107,000 $100,000

Montana 87,000 $100,000

Nebraska 155,000 $100,000

New Hampshire 76,000 $100,000

North Dakota 55,000 $100,000

South Dakota 77,000 $100,000

West Virginia 108,000 $100,000

Wyoming 70,000 $100,000

13 Numbers represent civilian, noninstitutionalized population. For information on confidentiality protection, sampling error, non-sampling error, and definitions, see https://www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2017.pdf. For complete data by state, see Health Insurance in the United States: 2017, Table HI-05. Health Insurance Coverage Status and Type of Coverage by State and Age for All People: 2017, US Census Bureau, September 12, 2018.

https://www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2017.pdf https://www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2017.pdf

Funding Allocation Tier 2 Uninsured population between 200,000 and 450,000 per FFE

States with a FFE 2017 Total Number of

Eligible Uninsured (under Age 65)

State Funding Allocation

Alabama 446,000 $200,000

Kansas 248,000 $200,000

Louisiana 379,000 $200,000

Mississippi 350,000 $200,000

Utah 279,000 $200,000

Wisconsin 306,000 $200,000

Funding Allocation Tier 3 Uninsured population between 500,000 and 700,000 per FFE

States with a FFE 2017 Total Number of

Eligible Uninsured (under Age 65)

State Funding Allocation

Arizona 685,000 $300,000

Indiana 531,000 $300,000

Michigan 502,000 $300,000

Missouri 544,000 $300,000

New Jersey 674,000 $300,000

Ohio 677,000 $300,000

Oklahoma 541,000 $300,000

Pennsylvania 682,000 $300,000

South Carolina 538,000 $300,000

Tennessee 625,000 $300,000

Funding Allocation Tier 4 Uninsured population between 700,000 and 900,000 per FFE

States with a FFE 2017 Total Number of

Eligible Uninsured (under Age 65)

State Funding Allocation

Illinois 841,000 $450,000

Virginia 718,000 $450,000

Funding Allocation Tier 5 Uninsured Population between 900,000 and 1.5 million per FFE

States with a FFE 2017 Total Number of

Eligible Uninsured (under Age 65)

State Funding Allocation

Georgia 1,365,000 $550,000

North Carolina 1,069,000 $550,000

Funding Allocation Tier 6 Uninsured Population over 2 million per FFE

States with a FFE 2017 Total Number of

Eligible Uninsured (under Age 65)

State Funding Allocation

Florida 2,627,000 $1,300,000

Texas 4,755,000 $1,300,000

Continued funding throughout the 24-month period of performance will be contingent on the following:

• Timely and complete submission of the non-competing continuation application,

• Strong performance (see below) during the previous budget period,

• Funding availability,

• Current program priorities, and

• The awardee’s ability to continue meeting all eligibility requirements laid out in this

Funding Opportunity, including continuing to serve in a state(s) with a FFE.

Strong performance during the period of performance will be measured by looking at:

• The awardee’s ability to meet the self-imposed performance metrics laid out in its original application,

• The quality and timeliness of required report submissions, as determined by CMS,

• The awardee’s compliance with the terms and conditions provided with its Notice of

Award, including compliance with all applicable statutory and regulatory requirements14, and

• The awardee’s ability to communicate with and respond in a timely manner to requests from their Project Officer throughout the period of performance. Information about reporting and certification will be provided with the Notice of Award for the Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges.

Additionally, in subsequent funding cycles, awardees could receive decreased funding or their cooperative agreement could be terminated due to poor performance. This Funding Opportunity provides detailed information on the cooperative agreement requirements related to these activities and instructions for application submission.

Individual cooperative agreement award amounts will vary annually depending on:

• The total funding available to the Navigator program,

• Annual rate of uninsured,

• Current program priorities,

• The number and quality of eligible Navigator cooperative agreement applicants for a given FFE, 14 Failure to comply with the terms and conditions of this cooperative agreement, including compliance with all statutory and regulatory requirements, may result in placement on a formal corrective action plan. Awardees placed on a formal corrective action plan during the course of the 24-month period of performance may not receive additional Navigator cooperative agreement funding for the subsequent 12-month budget period, depending on their progress in following the corrective action plan.

• The size and scope of the “left behind” population a Navigator cooperative agreement applicant proposes to reach, and

• Whether funds requested are for allowable costs.

When making awards, HHS reserves the right to reduce the budget requested, or only partially fund proposed activities, or not at all, based on its review of:

• The expected scope of the proposed targeted FFE service area,

• The performance metric goals laid out in the application,

• Target population(s) served by the applicant,

• Scope and breadth of the activities being proposed and the size of the population to be targeted,

• Proposed budget submitted by the applicant,

• Other awarded Navigator recipients in a given FFE, and

• The availability of remaining funds for the Exchange service area or areas which an award is made.

CMS decisions regarding funding levels for each of the FFEs, as established in the aforementioned Table 1, and decisions regarding the specific funding levels for each cooperative agreement award, are not appealable. The decision not to award a cooperative agreement is also not appealable15. Please also note that awardees cannot receive more funding than requested in their application.

Multi-State Awardees:

An applicant may propose to serve populations in multiple FFEs through the submission of one application. However, the applicant must submit separate Budget Narratives and project (metric) goals for each FFE it proposes to serve (See Section D. Application and Submission Information for additional information). If an applicant is proposing to serve in more than one FFE, the applicant should be prepared to revise its project scope and budget upon award if it is not funded to serve in all proposed FFEs and/or at the full amount requested.

B3. Anticipated Award Date

The anticipated award date is August 29, 2019.

15 See https://cfda.gov/ https://cfda.gov/

B4. Period of Performance

The period of performance, also known as the project period, is 24 months from the date of the notice of award and funded in 12-month increments called budget periods.

B5. Number of Awards

HHS estimates the number of awards to be between 25 and 50. All awards are subject to funding availability. In the absence of funding, HHS is under no obligation to make awards under this announcement.

B6. Type of Award

These awards will be structured as cooperative agreements. Under the Federal Grant and Cooperative Agreement Act of 1977, 31 U.S.C. 6301, et seq., and implementing regulations at 45 C.F.R. part 75, a cooperative agreement is 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 Statement16 that are applicable to grants also apply to cooperative agreements, unless the award itself provides otherwise (see also F4. Cooperative Agreement Terms and Conditions).

B7. Type of Competition

This will be a competitive Funding Opportunity open to all eligible applicants identified in C1.

Eligible Applicants.

C. ELIGIBILITY INFORMATION

C1. Eligible Applicants

This Funding Opportunity is open to individuals and private and public entities capable of carrying out the Navigator duties and other program requirements in a FFE, as outlined in statute, regulations, and this announcement (See particularly Section A. Program Description).

Under section 1311(i)(2)(B) of the PPACA, eligible entities may include, but are not limited to, trade, industry and professional associations; commercial fishing industry organizations;

ranching and farming organizations; community and consumer-focused nonprofit groups;

16 The HHS regulation (45 C.F.R. Part 75) effective December 26, 2014, supersedes information on administrative requirements, cost principles, and audit requirements for grants and cooperative agreements included in the current (2007) HHS Grants Policy Statement where differences are identified.

chambers of commerce; unions; resource partners of the Small Business Administration; other licensed insurance agents and brokers17 and other entities capable of meeting program requirements. Eligible applicants may choose to partner with other entities and/or individuals to form a consortium of subrecipients18 in order to target a larger total portion of the “left behind” population. In the case of an application from more than one entity or individual (i.e., a consortium), applicants must designate a lead applicant to serve as the primary contact for, and recipient of, federal funding, and that will serve as the pass-through entity for making federal funds awarded under the Funding Opportunity available to other consortium members.

To receive a cooperative agreement, applicants will be expected to:

• Demonstrate that they have existing relationships with employers and employees, consumers (including uninsured and underinsured consumers), or self-employed individuals likely to be eligible for enrollment in a QHP in the communities they expect to target, or that they could readily establish those relationships19, with a particular emphasis on those populations which the Exchange has identified as being “left behind” (See Section A4. Program Description).

For purposes of this Funding Opportunity, the Exchange will consider “left behind” populations to include those individuals who are disproportionately

17 PPACA 1311(i)(4) prohibits a Navigator from being “a health insurance issuer and from “receiv[ing] any consideration directly or indirectly from any health insurance issuer in connection with the enrollment of any qualified individuals or employees of a qualified employer in a [QHP].” CMS regulations at 45 C.F.R.

155.210(d)(1)-(4) and 155.215(a)(1) implement this statutory provision. In guidance, CMS has explained that agents and brokers who sell lines of insurance other than health insurance or stop loss insurance (for example, auto, life, and homeowners’ policies) would not be prohibited from receiving consideration from the sale of those other lines of insurance while serving as a Navigator. However, agents and brokers that sell lines of insurance other than health insurance or stop loss insurance, and that opt to become Navigators, would have to disclose these non-prohibited lines of business to the FFE and (in plain language) to each consumer assisted, per 155.215(a)(1)(i)(iv)(A).

18 A consortium for the purposes of this Funding Opportunity refers to two or more individuals, two or more private or public organizations, or a combination of individual(s) and private or public organization(s) that have identified a lead entity to serve as the primary applicant for, and recipient of, federal funding, and that will serve as the pass-through entity for making federal funds awarded under the funding opportunity available to other consortium members. The lead applicant should demonstrate through its application a plan to establish subawards and contracts with other consortium members to fulfill all the requirements of this Funding Opportunity. Applicants should be aware that if they intend to transfer performance of any portion of the substantive programmatic work under a CMS Navigator cooperative agreement, they must indicate this information, to the extent known, at the time of the application. CMS prior approval is required for the transfer of substantive programmatic work from a recipient to a subaward or contract once the period of performance has commenced. CMS would consider activities that Navigators are required or authorized to perform under CMS Navigator program regulations to be substantive programmatic work subject to this prior approval requirement. See related CMS guidance and citations at https://marketplace.cms.gov/technical-assistance-resources/delegating-navigator-duties-faqs.pdf.

19 See PPACA Section 1311(i)(2): https://sites.google.com/site/healthreformnavigator/ppaca-sec-1311, and CMS regulations at 155.210(c).

https://marketplace.cms.gov/technical-assistance-resources/delegating-navigator-duties-faqs.pdf https://sites.google.com/site/healthreformnavigator/ppaca-sec-1311 without access to health insurance coverage or care and who may be unaware of the full range of coverage options available to them, including coverage options in addition to QHPs, such as association health plans and short-term, limited-duration insurance. Examples of “left behind” populations include: hourly wage workers (restaurant and retail workers); variable income workers (workers with unpredictable annual incomes who fluctuate in and out of eligibility for financial assistance when purchasing health insurance); and persons who did not get health insurance because of a lack of affordable coverage options in their area, or because they lacked a general knowledge about affordable health insurance options and how to enroll.

Applicants may propose additional “left behind” populations in their applications for the FFE’s approval.

• Describe their previous work with consumers, including “left behind” groups, and how their experience working with consumers will support their work as a Navigator awardee, including how it will support their efforts to facilitate enrollment in QHPs and Medicaid/CHIP through an FFE, or, in the alternative, describe how they are in a position to readily establish relationships with consumers in the community(ies) they propose to target and with “left behind” groups.

• Demonstrate their experience and expertise in meeting the linguistic and cultural needs of diverse communities.

Previous awardees should describe their success with achieving previous project goals under any of the prior CMS Navigator funding opportunities.

All applicants should indicate in the cover letter if they, or any of their consortium members if applicable, were ever on a formal corrective action plan, including receiving a warning letter, and for how long and when they successfully completed the corrective action plan, while serving as an HHS Navigator awardee or subawardee/contractor of an HHS Navigator awardee (or as an awardee of any other federal grant/cooperative agreement) and a description of how the issue(s) was resolved. In addition, CMS regulations, at 45 C.F.R. § 155.210(c)(1)(iii), require that entities that wish to become Navigators must meet any applicable State licensing, certification, or other standards, so long as such standards do not prevent the application of the provisions of title I of the PPACA.

C2. Cost Sharing or Matching

Cost sharing or matching is not a requirement of this Funding Opportunity.

C3. Mandatory Letter of Intent

A letter of intent is not a requirement of this Funding Opportunity.

C4. Ineligibility Criteria

Each award made under this Funding Opportunity should not be used for activities funded by other CMS or federal grant/cooperative agreement awards. In the budget request, applicants should distinguish between activities that will be funded under this application and similar activities funded with other CMS or federal sources, if applicable.

The following entities are ineligible to apply under this Funding Opportunity:

• Health insurance issuers;

• Subsidiaries of health insurance issuers;

• Issuers of stop loss insurance and their subsidiaries;

• Associations that include members of, or lobby on behalf of, the insurance industry; or

• Recipients of any direct or indirect consideration from any health insurance issuer or issuer of stop loss insurance in connection with the enrollment of any individuals or employees in a QHP or non-QHP. CMS has clarified in regulation that no health care provider shall be ineligible to operate as a Navigator in an FFE solely because it receives consideration from a health insurance issuer for health care services provided.

Consistent with 45 C.F.R. § 155.215(a)(1)(i), all applicants (individuals, entities, and all members making up a consortium) should submit a brief statement (one or two short paragraphs) within the Cover Letter attesting that they, as Navigator cooperative agreement applicants, are not ineligible entities, and include attestations that all other Navigator entities (including subrecipients and contractors performing Navigator duties, the Navigator(s) including the Navigator's staff),20 do not have any of the prohibited relationships with health insurance or stop loss insurance issuers that are outlined above.

As is explained in 45 C.F.R. § 155.215 and the preamble language discussing that provision, some conflicts of interest (other than the prohibited relationships outlined above) would not be

20 See the conflict of interest regulations at https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&rgn=div5&view=text&node=45:1.0.1.2.70&idno=45#se45.1.155_1215 https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&rgn=div5&view=text&node=45:1.0.1.2.70&idno=45#se45.1.155_1215 https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&rgn=div5&view=text&node=45:1.0.1.2.70&idno=45#se45.1.155_1215 absolute bars to service as a Navigator, provided that the conflict of interest would not ultimately prevent the entity or individual from providing information and services in a fair, accurate, and impartial manner. In addition, in accordance with 45 C.F.R. § 155.215(a)(1)(ii) and in compliance with the Standard Terms and Conditions that will be included in a Notice of Award, all successful applicants will be required to provide a written plan to remain free of conflicts of interest and to disclose to CMS, as operator of the FFE, certain non-disqualifying conflicts of interest as specified in 45 C.F.R. § 155.215(a)(1)(iv).

C5. Single Application Requirements

An applicant may propose to serve populations in multiple FFE service areas through the submission of one application, by submitting separate budget narratives and project (metric) goals for each Exchange service area it proposes to serve (See Sections A4. Program Requirements and B2. Award Amount).

C6. Continued Eligibility

An awardee must…