PKG00252545-instructions.pdf

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

Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act: Section 1003

Demonstration Project to Increase Substance Use Provider Capacity

Notice of Funding Opportunity Type: New

Funding Opportunity Award Type: Cooperative Agreement

Notice of Funding Opportunity Number: CMS-2C2-19-001

CFDA: 93.664

Notice of Funding Opportunity Posting Date: June 25, 2019

Applicable Dates

Letter of Intent to Apply Due Date: July 18, 2019

Electronic Application Due Date: August 9, 2019

Anticipated Issuance Notice(s) of Award: September 30, 2019

Anticipated Period of Performance: September 30, 2019 to March 29, 2021

Table of Contents

EXECUTIVE SUMMARY

A. PROGRAM DESCRIPTION

A1. Purpose

A2. Authority

A3. Background

A4. Program Requirements

A5. Overview of Competitive Award Process for Planning Grants

A6. Technical Assistance and Information for Prospective Applicants

B. FEDERAL AWARD INFORMATION

B1. Award Amount

B2. Anticipated Award Dates

B3. Period of Performance

B4. Number of Awards

B5. Type of Award

C. ELIGIBILITY INFORMATION

C1. Eligible Applicants (select all that apply)

C2. Cost Sharing or Matching

C3. Letter of Intent

C4. Ineligibility Criteria

C5. Single Application Requirement

C6. Continued Eligibility

C7. EIN, DUNS and SAM Regulations

C8. Foreign and International Organizations

C9. Faith-Based Organizations

C10. Other Eligibility Requirements

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 Integrity Information System (FAPIIS)

F. FEDERAL AWARD ADMINISTRATION INFORMATION

F1. Federal Award Notices

F2. Administrative and National Policy Requirements

F3. Terms and Conditions

F4. Cooperative Agreement Terms and Conditions of Award

F5. Reporting

G. AGENCY CONTACTS

G1. Programmatic Questions

G2. Administrative Questions

Appendix A. Guidance for Preparing a Budget Request and Narrative

Appendix B. Application and Submission Information

Appendix C. Application Check List - Required Contents

Appendix D. Business Assessment of Applicant Organization

Appendix E. Review and Selection Process

Appendix F. 504 Compliance

Appendix G. Program Duplication Assessment

Appendix H. Glossary

Appendix I. Crosswalk between § 1003 and Selected Medicaid Opportunities Addressing the Opioid Epidemic

Appendix J. Relevant Medicaid Benefit Categories

Appendix K. Demonstration Project to Increase Substance Use Provider Capacity – Questions and Answers

APPENDIX L. Notice of Intent to Apply for Demonstration Project to Increase Substance Use Provider Capacity

EXECUTIVE SUMMARY

The Centers for Medicare & Medicaid Services, in consultation with the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Agency for Healthcare Research and Quality (AHRQ), is conducting a 54-month demonstration project to increase the treatment capacity of providers participating under the Medicaid State plan (or a waiver of such plan) to provide substance use disorder (SUD) treatment and recovery services. The purpose of this notice of funding opportunity is to solicit applications for participation in the Demonstration Project to Increase Substance Use Provider Capacity under the Medicaid program.

Item Description HHS Awarding Agency Centers for Medicare & Medicaid Services

CMS Awarding Center Center for Medicaid and CHIP Services

Notice of Funding Opportunity Title Demonstration Project to Increase Substance Use Provider Capacity

Authorization Section 1903 of the Social Security Act (42 U.S.C.

1396b) as amended by section 1003 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act

Funding Opportunity Type New

Funding Opportunity Number CMS-2C2-19-001

Type of Award Cooperative Agreement

Catalog of Federal Domestic Assistance 93.664

Letter of Intent to Apply Due Date (if applicable)

July 18, 2019

Application Due Date & Time August 9, 2019

Anticipated Issuance Notice(s) of Award September 30, 2019

Anticipated Period of Performance September 30, 2019 to March 29, 2021

Anticipated Total Available Funding $50 million

Estimated Number of Awards At least ten (10)

A. PROGRAM DESCRIPTION

A1. Purpose

The purpose of this notice of funding opportunity is to solicit applications for participation in the Demonstration Project to Increase Substance Use Provider Capacity under the Medicaid program.

A2. Authority

Section 1003 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act amended section 1903 of the Social Security Act (42 U.S.C. 1396b) in 2018 to include a new subsection that requires the Secretary of the Department of Health and Human Services, in consultation with the Assistant Secretary for Mental Health and Substance Use (SAMHSA) and the Director of the Agency for Healthcare Research and Quality (AHRQ) as appropriate, to conduct a 54-month demonstration project to increase the treatment capacity of providers participating under the Medicaid State plan (or a waiver of such plan) to provide substance use disorder (SUD) treatment or recovery services.

SAMHSA and AHRQ will consult with CMS on three statutorily required reports to Congress:

an initial report; an interim report; and a final report. In addition, AHRQ, in consultation with CMS, will submit to Congress a statutorily required summary of experiences of states awarded planning grants and of states conducting demonstration projects.

A3. Background

Impact of SUD

Substance use disorders (SUD) impact the lives of millions of Americans including individuals enrolled in the Medicaid program. They occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, and/or home. In 2017, approximately 19.7 million people aged 12 or older had an SUD related to their use of alcohol or illicit drugs in the past year. An estimated 2.1 million people had an opioid use disorder (OUD), which includes 1.7 million people with a prescription pain reliever use disorder and 0.7 million people with a heroin use disorder.1

Over the past decade, the United States has experienced significant increases in rates of opioid-related emergency department visits and hospitalizations,2 neonatal abstinence syndrome (NAS), 1 SAMHSA. (2018) Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, SAMHSA. Retrieved March 15, 2019 from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm#summary 2 HHS. (2018) Testimony from Brett P. Giroir & Kimberly Brandt on Tracking Opioid and Substance Use Disorders in Medicare Medicaid, and Human Services Programs before Committee on Finance. Retrieved March 19, 2019 from https://www.hhs.gov/about/agencies/asl/testimony/2018-04/tracking-opioid-and-substance-use-disorders-medicare-medicaid-hhs-programs.html https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm#summary https://www.hhs.gov/about/agencies/asl/testimony/2018-04/tracking-opioid-and-substance-use-disorders-medicare-medicaid-hhs-programs.html https://www.hhs.gov/about/agencies/asl/testimony/2018-04/tracking-opioid-and-substance-use-disorders-medicare-medicaid-hhs-programs.html and pregnant women with OUD.3 Most alarming are the continued increases in overdose deaths, especially the rapid increase since 2013 in deaths involving illicitly made fentanyl and other highly-potent synthetic opioids.4 Medicaid beneficiaries have been disproportionately affected by the opioid epidemic, accounting for roughly half of all opioid-related overdose deaths in some states. The introduction of less expensive, more potent opioid alternatives, such as fentanyl, has also resulted in a higher risk of overdose for Medicaid beneficiaries.5

Treatment for SUD, including OUD, is mostly provided by specialty facilities that typically offer some combination of SUD services such as detoxification, pharmacotherapy, individual and/or group psychotherapy, and other psychosocial services in one or more settings (i.e. inpatient, residential, or outpatient).6 However, according to one recent study, 40 percent of counties in the United States do not have an addiction treatment facility that provides outpatient care and accepts Medicaid. This lack of treatment capacity is most prevalent in rural counties in southern and mid-western states and in areas with a higher proportion of racial and ethnic minorities.7

Over the past decade, new trends and approaches have emerged in the SUD treatment field.

Practitioners in generalist settings are beginning to screen for hazardous substance use patterns and potential disorders. Such screening now occurs in hospitals, emergency rooms, ambulatory clinics, and other medical and non-medical settings.8 States are integrating recovery models into SUD treatment approaches that incorporate person-centered planning, peer support,9 case management, and other home and community-based services and social supports that are used to address an individual’s environment and provide emotional and practical support to maintain recovery.10 Further, many states are implementing opioid prescribing guidelines and some states are making non-opioid pharmacologic and non-pharmacologic pain management therapies available within their Medicaid programs in order to prevent opioid use disorders while ensuring effective pain management for people with chronic pain.11

Recent SUD Initiatives

CMS has issued recent guidance and information on opportunities to design service delivery systems for individuals with SUD, including a new opportunity for demonstration projects approved under section 1115 of the Social Security Act (Act) to ensure that a continuum of care

3 CDC. (2018) Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid Use Disorder Documented at Delivery Hospitalization — United States, 1999–2014. MMWR Morbidity and Mortality Weekly Report: 67:845–849. Retrieved on May 28, 2019 from http://dx.doi.org/10.15585/mmwr.mm6731a1 4 See 2 5 MACPAC. (2018) Access to Substance Abuse Treatment in Medicaid. Retrieved on May 28, 2019 from https://www.macpac.gov/wp-content/uploads/2018/06/Access-to-Substance-Use-Disorder-Treatment-in-Medicaid.pdf 6 Cummings JR, Wen H, Ko M , et al, Race/Ethnicity and Geographic Access to Medicaid Substance Use Disorder Treatment Facilities in the United States, JAMA Psychiatry, 71(2): 190-196 (Feb 2014) 7 Cummings JR, Wen H, Ko M, et al, Race/Ethnicity and Geographic Access to Medicaid Substance Use Disorder Treatment Facilities in the United States, JAMA Psychiatry, 71(2): 190-196 (Feb 2014) 8 SAMHSA. (2006) Report to Congress: Addictions Treatment Workforce Development Retrieved on May 28, 2019 from https://www.samhsa.gov/sites/default/files/partnersforrecovery/docs/Report_to_Congress.pdf 9 For more information on Medicaid coverage of peer supports see: SMDL #07-011 10 SAMHSA. (2019) Recovery and Recovery Support. Retrieved on May 28, 2019 from https://www.samhsa.gov/find-help/recovery 11CMS. (2019) : Non-Opioid Pharmacologic and Non-Pharmacologic Chronic Pain Management” available at:

https://www.medicaid.gov/federal-policy-guidance/downloads/cib022219.pdf http://dx.doi.org/10.15585/mmwr.mm6731a1 https://www.macpac.gov/wp-content/uploads/2018/06/Access-to-Substance-Use-Disorder-Treatment-in-Medicaid.pdf https://www.samhsa.gov/sites/default/files/partnersforrecovery/docs/Report_to_Congress.pdf https://www.samhsa.gov/find-help/recovery https://www.samhsa.gov/find-help/recovery https://www.medicaid.gov/federal-policy-guidance/downloads/cib022219.pdf is available to individuals with SUD.12,13 Some states that have received CMS approval for an SUD section 1115 demonstration under this initiative are using this demonstration as an opportunity to reexamine and significantly increase Medicaid reimbursement rates for SUD treatment providers, which may significantly increase the number of SUD providers participating in Medicaid and beneficiaries’ access to treatment. For instance, during the first year of implementation for the Virginia demonstration, the number of outpatient practitioners billing for SUD services increased by 173 percent, the number of Medicaid beneficiaries accessing SUD services increased 57 percent, treatment rates for beneficiaries with SUD increased by 64 percent, and the number of beneficiaries who received medication assisted treatment (MAT) increased 34 percent. In addition, the number of emergency department visits related to SUD decreased by 14 percent, while the number of emergency department visits related to OUD decreased by 25 percent.14 Additional information on the opportunity available to states under section 1115 demonstrations, as well as several other sections of the SUPPORT Act, is provided in Appendix I, “Crosswalk between § 1003 and Selected Medicaid Opportunities Addressing the Opioid Epidemic.”

Need for Increased SUD Provider Capacity

Increasing Medicaid provider capacity is essential to expanding access to SUD treatment for Medicaid beneficiaries. The need for SUD providers with expertise and skills to provide SUD prevention, early detection, and whole-person treatment and recovery services is evident. In 2017, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) published a final report that summarized financing and workforce policies that can be used by states to expand treatment access and capacity for OUD, focusing on MAT.15 The report described five workforce barriers: 1) Not enough physicians with a U.S. Department of Justice Drug Enforcement Administration registration and a buprenorphine waiver; 2) Provider access in rural areas; 3) Lack of support for small, non-specialist physicians; 4) Lack of infrastructure to support treatment; and 5) Stigma and knowledge gaps among providers related to recognizing and treating SUD, including a belief among some providers that MAT is a replacement addiction treatment rather than a treatment.

While section 1003 of the SUPPORT Act focuses on increasing the treatment capacity of providers participating under the state Medicaid program to provide SUD treatment or recovery services, we recognize that Medicaid providers’ willingness to treat individuals with SUD may also be a barrier to treatment. There are many providers who could provide treatment for SUD but may be unwilling to do so. The 2017 ASPE Report indicates that, although providers recognize the dangers of the opioid epidemic, many providers do not recognize OUD in their patient population, have significant misunderstanding about treating SUD, and may believe

12CMS. (2017), SMD #17-003 Strategies to Address the Opioid Epidemic. Retrieved on May 28, 2019 from https://www.medicaid.gov/federal-policy-guidance/downloads/smd17003.pdf 13 CMS. (2019) Medicaid Innovation Accelerator Program (IAP), Opioid Data Analytics Cohort Retrieved on May 28, 2019 from https://www.medicaid.gov/state-resource-center/innovation-accelerator-program/program-areas/reducing-substance-use-disorders/index.html 14 Virginia Department of Medical Assistance Services,VCU. (2018) Addiction and Recovery Treatment Services Evaluation Report. Retrieved on May 28, 2019 from https://hbp.vcu.edu/media/hbp/policybriefs/pdfs/ARTSone-yearreport_8.9.18_Final.pdf 15 ASPE. (2017), State and Local Policy Levers for Increasing Treatment to Address the Opioid Epidemic Final Report.

Retrieved on May 28, 2019 from https://aspe.hhs.gov/system/files/pdf/259511/SLlevers.pdf https://www.medicaid.gov/federal-policy-guidance/downloads/smd17003.pdf https://www.medicaid.gov/state-resource-center/innovation-accelerator-program/program-areas/reducing-substance-use-disorders/index.html https://www.medicaid.gov/state-resource-center/innovation-accelerator-program/program-areas/reducing-substance-use-disorders/index.html https://hbp.vcu.edu/media/hbp/policybriefs/pdfs/ARTSone-yearreport_8.9.18_Final.pdf https://aspe.hhs.gov/system/files/pdf/259511/SLlevers.pdf

MAT is a replacement addiction treatment rather than a treatment.15

In a recent report to Congress, SAMHSA highlighted a major challenge to expanding the SUD treatment capacity in any setting (that is, an SUD specialty facility or other health care setting)— the shortage of providers with sufficient experience, certification, and/or education to serve individuals with SUD.16 This finding was further evidenced in a June 2018 HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief on Substance Use Disorder Workforce that identified workforce barriers to accessing SUD treatment services that also included a lack of institutional and clinician peer support, provider stigma, and inadequate or burdensome reimbursement.17 In addition, there is geographic variability in the training, qualifications, and licensure of SUD treatment providers. States and localities have varying requirements with respect to clinical staffing in SUD treatment programs. SUD licenses and certificates tend to be state-specific. States may also have additional specific continuing education course requirements for credentialing and licensing.18

Key Terms

This Notice of Funding Opportunity (NOFO) uses many acronyms throughout. All acronyms are defined at first mention in the text and can be referenced in the Glossary (Appendix H).

Throughout this NOFO, “applicant” refers to the state applying for the funding opportunity, and “recipient” refers to the state selected to receive the cooperative agreement.

Section 1003 refers to “behavioral health treatment.” In this NOFO, we use this term to refer to services or treatment to address substance use and mental health disorders. In addition, we consider the term “provider capacity” to include training, education, payment, and Medicaid providers’ willingness to furnish services to address SUD including OUD.

A4. Program Requirements

Planning Phase

The funding opportunity described in this NOFO is for the planning grants required by section 1903(aa)(3) of the Act. Consistent with section 1903(aa)(3) of the Act, CMCS will award 18-month planning grants to at least 10 states for the purposes of preparing an application to participate in a 36-month demonstration project and for carrying out the activities set forth below. This 18-month period is referred to as the Planning Phase.

Initial Assessment

17 ASPE. (2018), Substance Use Disorder Workforce. Retrieved on May 28, 2019 from https://aspe.hhs.gov/basic-report/substance-use-disorder-workforce-issue-brief 18 SAMHSA, Addiction Technology Transfer Center National Office. (2017) , National Workforce Report 2017, Strategies for Recruitment, Retention, and Development of the Substance Use Disorder Treatment and Recovery Services Workforce: A National Qualitative Report, Retrieved on June 24, 2019 from https://www.drugsandalcohol.ie/28384/1/ATTC_Network_Natl_Report2017.pdf https://aspe.hhs.gov/basic-report/substance-use-disorder-workforce-issue-brief https://aspe.hhs.gov/basic-report/substance-use-disorder-workforce-issue-brief https://www.drugsandalcohol.ie/28384/1/ATTC_Network_Natl_Report2017.pdf

During the Planning Phase, grantees will conduct an initial assessment of the behavioral health treatment needs of the state to determine the extent to which providers are needed to address the SUD treatment and recovery needs of Medicaid beneficiaries (including the types of such providers, geographic area of need, and sources of state data). The assessment will include information on which to base efforts for improving the network of Medicaid-participating providers that provide SUD treatment and/or recovery services including the following:

- An estimate of the number and percentage of individuals enrolled in Medicaid who have

SUD;

- Information on the capacity, qualifications, and willingness of Medicaid providers to provide SUD treatment and/or recovery services to Medicaid-eligible individuals;

- Information on the gap in Medicaid-covered SUD treatment and recovery services relative to the estimated number of individuals enrolled in Medicaid who have SUD; and

- Information on the level and amount of coordination between primary care, mental health care, and SUD treatment and recovery services for Medicaid beneficiaries

Development of State Infrastructure

Grantees will conduct activities that, taking into account the results of the state’s needs assessment described above, support the development of state infrastructure. These activities can include recruiting prospective providers and providing training and technical assistance to providers. In addition, grantees will conduct activities to improve reimbursement, training, and education to expand Medicaid provider capacity to deliver SUD treatment and recovery services.

Grantees will also develop projections regarding the extent to which the state would increase the number and capacity of Medicaid providers offering SUD treatment or recovery services, as well as the willingness of Medicaid providers to offer SUD treatment or recovery services, during the demonstration project.

Post-Planning Phase

As required by section 1903(aa)(4) of the Act, CMCS will select not more than 5 states to participate in a demonstration and receive payment, as specified in section 1903(aa)(5) of the Act and described below, for 36 months following the 18-month Planning Phase. This 36-month period is referred to as the Post-Planning Phase. The funding opportunity described in this NOFO is not for the Post-Planning Phase. There will be a separate application for participation in the Post-Planning Phase.

The states selected to participate in the Post-Planning Phase will, for each quarter of the Post- Planning Phase, be paid an amount equal to 80 percent of the qualified sums expended during the quarter. Qualified sums are the amount expended by the state during the quarter that is attributable to SUD treatment or recovery services furnished by providers participating under the State plan (or a waiver of such plan), that exceeds one-quarter of the sums expended by the state during fiscal year 2018 that was attributable to SUD treatment or recovery services. Information on how CMCS will calculate payments to states during the Post-Planning Phase is provided in Appendix K.

The application for states to participate in the Post-Planning Phase is expected to include the following:

- A proposed process for carrying out an ongoing assessment of the state’s behavioral health treatment needs, taking into account the results of the initial assessment;

- A review of reimbursement methodologies and other policies related to SUD treatment or recovery services under the State plan (or waiver of such plan) that may create barriers to increasing the number of providers delivering such services;

- An analysis of the prevalence of SUD among Medicaid-enrolled and eligible beneficiaries comparing state prevalence with the national average (as measured by per capita opioid drug overdoses and/or Medicaid substance use and opioid-related diagnoses);

- A plan that will result in long-term and sustainable provider networks under the Medicaid program that will offer a continuum of care for SUD. The plan shall include the following:

Specific activities to increase the number of providers (including providers that specialize in providing SUD treatment or recovery services, hospitals, health care systems, Federally Qualified Health Centers, and, as applicable, Certified Community Behavioral Health Clinics) that offer evidence-based SUD treatment. Evidence-based SUD treatment includes, but is not necessarily limited to: the use of FDA-approved pharmacotherapies for OUD (e.g., injectable naltrexone, buprenorphine products, methadone) or other SUD (including tobacco and alcohol use disorders, recovery, or support services), short-term medical withdrawal or detoxification services (which for OUD must include the provision of injectable naltrexone following completion of the medical withdrawal procedure), outpatient SUD services, and evidence-based peer recovery services;

Strategies that will incentivize providers to obtain the necessary training, education, and support to deliver SUD treatment or recovery services in the state;

Milestones and timeframes for implementing the activities set forth in the plan; and Specific measurable targets for increasing the number and capacity of providers in the

SUD treatment and recovery provider network under the State plan (or a waiver of such plan) or the willingness of such providers to provide SUD treatment or recovery services to Medicaid beneficiaries in the state.

- A proposed process for reporting the information required, including the following information to assess the effectiveness of the efforts of the state to expand the capacity of providers to deliver SUD treatment or recovery services during the period of the demonstration project:

The financial impact of the demonstration project on the state;

A description of all funding sources available to the state to provide SUD treatment or recovery services in the state;

A plan for how the state will sustain any increase in the capacity of providers to deliver

SUD treatment or recovery services resulting from the demonstration project after the termination of the demonstration project; and

A description of how the State will coordinate the goals of the demonstration project with any waiver of such plan granted (or submitted by the state and pending) pursuant to section 1115 for the delivery of SUD services under the State plan, as applicable.

States will also be required to consult with relevant stakeholders, including beneficiaries, families, and caregivers; Medicaid managed care plans; health care providers; Medicaid beneficiary advocates; Indian health care providers and tribal governments; and Medicare providers for dually-eligible beneficiaries. States will be required to include a description of this consultation in their application. States will also be required to provide assurance that they will comply with SUPPORT Act section 1006(b).

A5. Overview of Competitive Award Process for Planning Grants

CMS invites applications for this solicitation from states that are seeking to increase the treatment capacity of Medicaid providers to furnish SUD treatment and recovery services through an approved State plan (or waiver of such plan). CMS will use a competitive award process to award 18-month planning grants to at least 10 states.

A synopsis of the award process and timeline is as follows:\

CMS publishes competitive solicitation for SUPPORT Act section 1003 planning grant: June 25, Applicant teleconferences with CMS occur: July 10, 2019 3:30pm to 4:30pm (ET); July 31, 2019 3:00pm to 4:00pm (ET) State submits, as part of the application process, required Letter of Intent: July 18, 2019 States submit applications any time prior to due date: August 9, 2019 CMS awards planning grants: September 30, 2019

A6. Technical Assistance and Information for Prospective Applicants

Prior to the planning grant application deadline, CMS will host one or more teleconferences or webinars to provide details about the Demonstration Project to Increase Substance Use Provider Capacity under the Medicaid Program and to answer questions from states. Information about the forums will be posted on the following website:

https://www.medicaid.gov/medicaid/benefits/bhs/support-act-provider-capacity-demos/index.html

These will be held:

• July 10, 2019 3:30pm to 4:30pm (ET)

• July 31, 2019 3:00pm to 4:00pm (ET)

A third specific webinar is also scheduled for the 37 states with AI/AN populations, Indian health care providers, and AI/AN Medicaid beneficiaries.

• July 16, 2019 1:00pm to 2:00pm (ET)

Administrative questions about the Demonstration Project to Increase Substance Use Provider Capacity under the Medicaid Program may be directed to:

SubstanceUseProviderCapacity@cms.hhs.gov.

CMS expects to award one support contract for evaluation. Planning grantees will be required to work with the national evaluation contractor and participate in all evaluation activities including the collection of data and reporting of grant activities.

https://www.medicaid.gov/medicaid/benefits/bhs/support-act-provider-capacity-demos/index.html https://www.medicaid.gov/medicaid/benefits/bhs/support-act-provider-capacity-demos/index.html mailto:SubstanceUseProviderCapacity@cms.hhs.gov

This includes completion of a semi-annual CMS web-based report detailing implementation progress, challenges, barriers, solutions, outputs and outcomes.

States may also choose to conduct their own independent evaluation to assist in the establishment of a formative learning process and/or to serve as the interface between the grant applicant and the CMS national evaluation contractor. The grant applicant and its evaluation contractor (if the grant applicant chooses to engage one) will be required to cooperate with CMS and the national evaluation contractor, including in the use of standard data sets such as T-MSIS.

The national evaluation will include an analysis of the impact, outcomes, and processes of the grant program, including identifying the elements that were critical to successful expansion of SUD treatment and recovery service capacity, as well as the barriers that impede states’ success.

The evaluation will include both qualitative and quantitative methods to (1) assess whether the demonstration achieved its stated goals, (2) describe the strengths and limitations of the demonstration project, and (3) propose a plan for the sustainability of the project. The evaluation will also address the impact of the states’ initiatives to expand the number, capacity, and willingness of providers to deliver SUD treatment and recovery services. In addition, the evaluation will assess the impact of the states’ initiatives on the number of individuals enrolled in Medicaid who receive SUD treatment or recovery services under the demonstration and on the outcomes of Medicaid beneficiaries with SUD. The states’ results will be assessed related to: (1) impact, benefits, barriers, and outcomes; (2) evidence of improved coordination and efficiencies in the SUD treatment and recovery system; (3) experiences of the beneficiaries and providers;

and (4) SUD treatment and recovery services access and utilization.

B. FEDERAL AWARD INFORMATION

B1. Award Amount

CMS will award a maximum of $50 million total divided among at least 10 states for the purposes of the 18-month planning grant under the Demonstration Project to Increase Substance Use Provider Capacity. All state Medicaid agencies are eligible to compete for a planning grant. Grants will be awarded using a competitive process. We expect awards to range from between $2 million and $5 million per state.

B2. Anticipated Award Dates

State applications for participation in the Demonstration Project to Increase Substance Use Provider Capacity under the Medicaid Program will be due 45 days from the date of the NOFO posting. CMS expects to announce awardees within 52 days after the application deadline date.

B3. Period of Performance

The period of performance for the planning grants is 18 months. States have the flexibility to propose the scope and focus of their programs within this timeframes, as long as their approach includes the completion of the required activities by dates specified by CMS, where appropriate

(e.g., demonstration applications) and within the period of performance. CMS plans to award the planning grants by September 30, 2019.

B4. Number of Awards

CMS anticipates awarding at least 10 planning grant awards. The maximum planning grant award per state is contingent upon the scope of the activities proposed in the state’s application and upon the total amount of funding available under this funding opportunity.

B5. Type of Award

The planning grant awards issued under this Notice of Funding Opportunity will be structured as cooperative agreements.19 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 award recipient during performance is anticipated. 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 states otherwise.

CMS may request an amendment of the applicant’s proposals following award selection, including for the purposes of incorporating best practices or new national regulations and/or policies related to grants, coverage, payment, and delivery of services. CMS will monitor and evaluate recipients’ activities performed under the cooperative agreement, including monitoring, measuring and evaluating achievement of states awarded planning grants through the Demonstration Project to Increase Substance Use Provider Capacity under the Medicaid Program. On at least a monthly basis, CMS anticipates informal communication with recipients.

Continued funding is dependent on satisfactory progress towards meeting the goals and performance expectations delineated in the grant’s terms and conditions. CMS reserves the right to terminate the grant if it is determined to be in its best interests. At any point during the program if a state fails to meet the terms and conditions of award under this grant, CMS may suspend funding until the necessary benchmarks are met or terminate the award.

C. ELIGIBILITY INFORMATION

C1. Eligible Applicants

State governments

Any State Medicaid Agency may apply. Only one application can be submitted for a given state.

The term “State Medicaid Agency” means the single state agency for medical assistance provided under Title XIX of the Social Security Act (the Act). A Territory or Tribal organization, if interested, must come under the auspices of and work with the State Medicaid Agency in the implementation of this demonstration program. The State Medicaid Agency or designee must be the signatory and oversee implementation of the grant but may apply in

19 https://blog.grants.gov/2016/07/19/what-is-a-cooperative-agreement/ https://blog.grants.gov/2016/07/19/what-is-a-cooperative-agreement/ conjunction with other co-applicant(s) including any other state agencies and/or Territory, Tribes, or Tribal organizations operating SUD treatment and recovery programs.

Only applications received by the specified deadline will be reviewed and scored. An application will not be funded if the application fails to meet any of the requirements as outlined in Section C. Eligibility Information and Section D. Application and Submission Information. Applicants are strongly encouraged to use the review criteria information provided in Section E. Application Review Information to help ensure that all of the criteria that will be used in evaluating the proposals are adequately addressed.

C2. Cost Sharing or Matching

Cost sharing/match is not required for the planning grant.

C3. Letter of Intent

Mandatory

A non-binding letter of intent to apply must be submitted by the State Medicaid Agency to SubstanceUseProviderCapacity@cms.hhs.gov by July 18, 2019. A copy of the letter of intent should also be included with the final application. Entities that do not submit a letter of intent by this deadline will be ineligible to apply. CMS will provide confirmation of receipt of the letter of intent to each prospective applicant that submits such a letter.

C4. Ineligibility Criteria

CMS will consider the following criteria as potential reasons for applicant disqualification for award.

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

o Failure to meet application requirements as described.

o Omission of required application elements as described.

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

• Inability or unwillingness to collect and share monitoring and evaluation data with CMS or its contractors.

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

mailto:SubstanceUseProviderCapacity@cms.hhs.gov

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

• Late submission of an application (see Section D)

• Overlap with another model: demonstration or program, including a CMMI model, which may result in duplication.

C5. Single Application Requirement

CMS intends to award one cooperative agreement per selected state. Applicants must be the State Medicaid Agency. An applicant must demonstrate through its application that it is partnering with the state agency responsible for enrolling Medicaid providers and furnishing Medicaid-covered SUD treatment or recovery services, public health, and other relevant state agencies. A state or the District of Columbia cannot receive more than one award over the duration of the Section 1003 Demonstration Project to Increase Substance Use Provider Capacity.

C6. Continued Eligibility

Award recipients must meet reporting and certification deadlines to be eligible throughout the initial 18-month planning budget period and to remain eligible for a non-competing continuation award for subsequent budget periods in multi-year projects. In addition, recipients would need to demonstrate strong performance during the previous funding cycle(s) before additional year funding is awarded or, in the case of awards where all funding is issued in the first year, to ensure continued access to funding. At any time in the award cycle, recipients could receive decreased funding or their award could be terminated if they fail to perform the requirements of the award.

C7. EIN, DUNS and SAM Regulations

To be able to submit an application at grants.gov, 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/portal/public/SAM/). See Appendix B. Application and Submission Information for descriptions of EIN, DUNS, and SAM.

C8. Foreign and International Organizations

Foreign and international organizations are not eligible to apply.

C9. Faith-Based Organizations

Faith-based organizations are not eligible to apply. Only the single State Medicaid Agency in each state is qualified to address this solicitation.

https://www.sam.gov/portal/public/SAM/

C10. Other Eligibility Requirements

Not Applicable

D. APPLICATION AND SUBMISSION INFORMATION

D1. Address to Request Application Package

Application materials will be available at http://www.grants.gov. Please note that CMS requires applications for all announcements to be submitted electronically through Grants.gov. Applicants will be able to download a copy of the application packet, complete it offline, and then upload and submit the application via the Grants.gov website. Refer to Appendix B. Application and Submission Information for specific instructions on how to apply.

D2. Content and Form of Application Submission

a. Application Format

Applications determined to be ineligible, incomplete, and/or nonresponsive based on the initial screening may be eliminated from further review. However, in accordance with HHS Grants Policy, the CMS Office of Acquisition and Grants Management (OAGM) Grants Management Officer, in his/her sole discretion, may continue the review process for an ineligible application if it is in the best interests of the government to meet the objectives of the program. Each application must include all contents of the application package, in the order indicated, and conform to the following formatting specifications:

• The following page size must be used: 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”.

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

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

• The Project Narrative must be double-spaced. The page limit for the Project Narrative is 60 pages.

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

• The Business Assessment of Applicant Organization may be single spaced. The page limit for this document is 10 pages. The total page limit is 120 pages.

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

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

• The following required application documents are excluded from the page limitations described above: Standard Forms, Copy of Letter of Intent, Project Work Plan (including a timeline for proposed activities), and Memoranda of Understanding/Letters of Support with key state agencies and other partners (if applicable). Application Cover Letter/Cover Page (if applicable), Project Site Location Form, and Indirect Cost Rate Agreement. See text below http://www.grants.gov/ for other exclusions.

b. Standard forms

The following forms must be completed with an original signature and enclosed as part of the application:

• Project Abstract Summary

A one-page abstract should serve as a succinct description of the proposed project and must include the goals of the project, the total budget, and a description of how the funds will be used.

The abstract is often distributed to provide information to the public and Congress, so 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 http://www.grants.gov/ (or alternatively http://www.GrantSolutions.gov/ for single-source applications), select the Project Abstract Summary and complete the form.

• Application for SF-424: Official Application for Federal Assistance

Please note the following on SF-424:

o On Item 15 “Descriptive Title of Applicant’s Project,” state the specific cooperative agreement opportunity for which you are applying (Section 1003 Demonstration Project to Increase Substance Use Provider Capacity).

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

• SF-424A: Budget Information Non-Construction

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

• SF-LLL: Disclosure of Lobbying Activities.

All applicants must submit this document. Federal law prohibits the use of appropriated funds for publicity or propaganda purposes or for the preparation, distribution, or use of the information designed to support or defeat legislation pending before Congress or state legislatures. For more information, please see Current Provisions and Restrictions at this link:

https://www.hhs.gov/grants/grants/grants-policies-regulations/lobbying-restrictions.html.) If your entity does not engage in lobbying with funds from any source, 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 on the Grants.gov website is utilized for many programs and therefore Grants.gov may designate this form as optional to allow for flexibility amongst programs. However, this form is required as part of your application package and must be submitted for your application to be considered eligible for review.

http://www.grants.gov/ http://www.grantsolutions.gov/

• 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.

c. Application Cover Letter or Cover Page

Cover letter or cover page not required.

d. Project Narrative (Maximum 60 pages)

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 Section E1. Criteria.

Please include the title “Project Narrative” at the beginning of the Project Narrative. The Project Narrative must include the following information:

1. Proposed activities to support the development of an initial assessment of the mental health and SUD treatment needs of the state to determine the extent to which providers are needed to address the SUD treatment and recovery needs of Medicaid beneficiaries, including:

estimates of the number and percentage of individuals enrolled in Medicaid who have SUD;

the capacity, qualifications, and willingness of Medicaid providers to provide SUD treatment and/or recovery services to Medicaid-eligible individuals; the gap in Medicaid-covered SUD treatment and recovery services; and the level and amount of coordination between primary care, mental health care, and SUD treatment and recovery providers. Applicants are encouraged to focus on the following Medicaid subpopulations in their assessments: pregnant women, postpartum women, infants (including those with neonatal abstinence syndrome), adolescents and young adults between the ages of 12 and 21, AI/ANs, people living in rural areas, and Medicare-Medicaid dual-eligibles. States may also focus on other subpopulations of specific interest to the state in their assessments.

2. Proposed activities that, taking into account the results of the assessment, would support the development of state infrastructure, including to recruit prospective providers and provide training and technical assistance to providers who deliver SUD treatment or recovery services to Medicaid beneficiaries.

3. Proposed activities to improve reimbursement, training, and education to expand Medicaid provider capacity to deliver SUD treatment and recovery services.

4. Proposed activities to develop projections regarding the extent to which the state would increase the number and capacity of Medicaid providers offering SUD treatment or recovery services, as well as the willingness of Medicaid providers to offer SUD treatment or recovery services, during the demonstration project; and

5. An analysis comparing the state’s SUD prevalence with the national average, as measured by per capita opioid drug overdoses and the prevalence of substance use and opioid-related diagnoses among Medicaid enrollees. Applicants are encouraged to also provide information on the prevalence of SUD among Medicaid subpopulations, including but not necessarily limited to, pregnant women, postpartum women, infants, adolescents and young adults between the ages of 12 and 21, AI/ANs, people living in rural areas, and Medicare-Medicaid dual-eligibles (or other subpopulations of specific interest to the state), as well as information on the prevalence of neonatal abstinence syndrome.

Applicants are encouraged to include information on current activities that relate to or will support the applicant’s proposed activities, as well as help to inform CMS’s review of the application. The projective narrative should also include information describing the following:

staffing; state infrastructure; data sharing; reporting; and organizational structure.

e. Budget Narrative (Maximum 10 pages)

Applicants must supplement Form SF-424A with a Budget Narrative. The Budget Narrative must include a yearly breakdown of costs according to a 12-month period. See Section B.

Federal Award Information for more information on the performance period. Applicants must include a clear description of the proposed set of activities that will be covered with grant funds.

The Budget Narrative should provide a detailed cost breakdown for each line item outlined in the SF-424A by grant year, including a breakdown of costs for each activity/cost within the line item. The proportion of the requested funding designated for each activity should be clearly defined and should justify the applicant’s readiness to receive funding. The budget must separate out funding that will be administered directly by the lead agency from funding that will be administered by sub-awardees. For more specific information and instructions for completing the SF-424A and Budget Narrative, please refer to Appendix A. Guidance for Preparing a Budget Request and Narrative.

f. Business Assessment of Applicant Organization (Maximum 10 pages)

As required by 45 CFR §75.205 for…