State Exchange Modernization Grant Notice of Funding Opportunity - FINAL 6.21.2021.pdf

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

Center for Consumer Information and Insurance Oversight

State Exchange Modernization Grant Program

Notice of Funding Opportunity Type: New

Funding Opportunity Award Type: Cooperative Agreement

Notice of Funding Opportunity Number: IE-HBE-21-001

Federal Assistance Listings Number (CFDA): 93.525

Notice of Funding Opportunity Posting Date: June 21, 2021

Applicable Dates:

Letter of Intent to Apply Due Date: N/A

Electronic Application Due Date: July 20, 2021, 3:00 pm Eastern Standard Time

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

Anticipated Period of Performance: September 10, 2021 – September 9, 2022

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Table of Contents Executive Summary

A. Program Description

A1. Purpose

A2. Authority

A3. Background

A4. Program Requirements

A5. Technical Assistance and Information for Prospective Applicants

B. Federal Award Information

B1. Total Funding

B2. Award Amount

B3. Anticipated Award Dates

B4. Period of Performance

B5. Number of Awards

B6. Type of Award

B7. Type of Competition

C. Eligibility Information

C1. Eligible Applicants

C2. Cost Sharing or Matching

C3. Letter of Intent

C4. Ineligibility Criteria

C5. Single Application Requirement

C6. Continued Eligibility

C7. EIN, DUNS, and SAM Regulations

C8. Faith-Based Organizations

C9. Other Eligibility Requirements

D. Application and Submission Information

D1. Address to Request Application Package

D2. Content and Form of Application Submission

a. Application format

b. Standard forms

c. Application cover letter or cover page

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d. Project Narrative

e. Project Work Plan

f. Budget Narrative + Attestation

g. Business assessment of applicant organization (maximum 12 pages)

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

D4. Submission Dates and Times

D5. Intergovernmental Review

D6. Cost Restrictions

D7. Mandatory Disclosure

E. Application Review Information

E1. Criteria

E2. Review and Selection Process

E3. Federal Awardee Performance Integrity Information System (FAPIIS)

F. Federal Award Administration Information

F1. Federal Award Notices

F2. Administrative and National Policy Requirements

F3. Terms and Conditions

F4. Cooperative Agreement Terms and Conditions of Award

F5. Reporting

G. CMS Contacts

G1. Programmatic Questions

G2. Administrative/Budget Questions

H. Other Information

Appendix I. Guidance for Preparing a Budget Request and Narrative

Appendix II. Application and Submission Information

Appendix III. Business Assessment of Applicant Organization

Appendix IV: Accessibility Requirements

Appendix V. Review and Selection Process

Appendix VI. Application Check-Off List

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Executive Summary The American Rescue Plan Act of 2021 (P.L. 117-2) (ARPA) created a new grant program for Exchanges established by states under section 1311(b) of the Affordable Care Act (42 U.S.C.

18031(b)). The program directs the Secretary to award $20 million to State Exchanges for purposes of enabling such Exchange to modernize or update any system, program, or technology utilized by such Exchange to ensure such Exchange is compliant with all applicable requirements. Applicable requirements include an Exchange coming into compliance with reporting obligations under 45 CFR § 155.1200, including State-based Marketplace Annual Reporting Tool (SMART) requirements, or resolving outstanding SMART observations or open audit findings, as well as implementation of provisions of the ARPA, which increase financial assistance amounts available to certain taxpayers and consumers for Plan Years (PY) 2021 and 2022 who enroll in a qualified health plan through an Exchange.

This is a Limited Competition Notice of Funding Opportunity (NOFO) that is open only to eligible applicants. Eligible applicants are State Exchanges that, at the time of the application due date, have received approval or conditional approval from the U.S. Department of Health and Human Services (HHS) under 42 CFR §§ 155.105 and 155.106. An eligible State Exchange includes an Exchange that operates its own eligibility and enrollment platform or an Exchange provided for at 42 CFR § 155.106(c) that utilizes the Federal platform.

The Centers for Medicare & Medicaid Services (CMS) will award up to 21 cooperative agreements, totaling $20,000,000 (pending availability of funds), to State Exchanges that submit a complete and successful application. CMS expects to award each successful applicant an apportionment of the $20,000,000, the level of which will be dependent on the applicant’s State Exchange model and the number of successful applicants. The period of performance for this grant program will be from the date of award through September 9, 2022.

CMS anticipates making awards to successful applicants on or after September 10, 2021. The application deadline for this funding opportunity is July 20, 2021.

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

State Exchange Modernization Grant

Authorization American Rescue Plan Act of 2021 (Public Law 117-2) (ARPA)

Federal Assistance Listings Number

(CFDA)

93.525

Funding Opportunity Type

New

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Funding Opportunity Number

IE-HBE-21-001

Type of Award Cooperative Agreement

Type of Competition Limited Competition

Letter of Intent A Letter of Intent is not required for this funding opportunity.

Application Due Date and Time

July 20, 2021 by 3:00 pm EST (Baltimore, MD)

Anticipated Issuance Notice(s) of Award

September 10, 2021

Period of Performance Start Date

September 10, 2021

Period of Performance End Date

September 9, 2022

Anticipated Total Available Funding

$20,000,000 (pending availability of funds)

Estimated Maximum Award Amount

$1,333,333

Estimated Maximum Number of Awardees

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A. Program Description A1. Purpose CMS, through its Center for Consumer Information and Insurance Oversight (CCIIO), seeks applications for the State Exchange Modernization Grant Program. The American Rescue Plan Act of 2021 (P.L. 117-2) (ARPA) makes $20 million available to American Health Benefits Exchanges established under section 1311(b) of the Affordable Care Act (42 U.S.C. 18031(b)) (ACA), for purposes of enabling such Exchange to modernize or update any system, program, or technology utilized by such Exchange to ensure such Exchange is compliant with all applicable requirements.

An American Health Benefits Exchange established under ACA section 1311(b), and not including Exchanges established by HHS under ACA section 1321(c), (referred to in this document as a State Exchange), is a marketplace established by a state to facilitate the purchase of qualified health plans (QHPs). This Notice of Funding Opportunity (NOFO) is open to State Exchanges that, at the time of the application due date, have received approval or conditional approval from the U.S. Department of Health and Human Services, in the manner described at 42 CFR §§ 155.105 and 155.106. An eligible State Exchange includes an Exchange that operates its own eligibility and enrollment platform or an Exchange provided for at 42 CFR § 155.106(c) that utilizes the Federal platform. The ARPA excludes an Exchange operated in a state by HHS under section 1321(c) of the ACA.

Eligible applicants may request funding to make system, program, or technology changes that would ensure an Exchange is compliant with all applicable federal Exchange requirements.

Applicable federal Exchange requirements include Exchange compliance with reporting obligations under 45 CFR § 155.1200, which includes State-based Marketplace Annual Reporting Tool (SMART) requirements, or resolving outstanding SMART observations or open audit findings. Federal Exchange requirements can also include implementation and operation of the amendments to the advance payments of premium tax credits (APTC) and cost-sharing reduction (CSR) programs made by sections 2305, 9661, and 9663 of the ARPA. These provisions make changes for PY 2021 and PY 2022 to financial assistance amounts available to certain taxpayers and consumers who enroll in a QHP through an Exchange. Please see A4.

Program Requirements for additional details.

CMS will award, through a limited competition process, cooperative agreements to up to 21 recipients. The funding available under this NOFO is available until September 9, 2022. Only one award will be made to each successful applicant via a Notice of Award.

A2. Authority Section 2801 of the American Rescue Plan Act of 2021 (P.L 117-2) authorizes the Secretary of Health and Human Services (HHS) to award funds to eligible State Exchanges to modernize or update any system, program, or technology utilized by such Exchange to ensure the Exchange is compliant with all applicable federal requirements.

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A3. Background The Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) (together referred to as the ACA) created new competitive private health insurance marketplaces – called American Health Benefits Exchanges – that give millions of eligible individuals access to affordable coverage. Exchanges help qualified consumers shop for, select, and enroll in quality, affordable health plans.

Exchanges also assist eligible consumers to receive premium tax credits and cost-sharing reductions, and help them enroll in other Federal and State health care programs, including Medicaid and the Children’s Health Insurance Program (CHIP).

The ACA and its implementing regulations at 45 CFR Part 155 provide states with flexibility in the design and operation of their Exchanges to ensure states are implementing Exchanges that best meet consumer needs. States can choose to establish and operate a State Exchange or a State Exchange on the Federal Platform. States electing a State Exchange must implement and operate an eligibility and enrollment platform, among other functions, in order to verify eligibility for QHP enrollment, as well as calculate and verify a consumer’s eligibility for APTC. A State Exchange on the Federal Platform relies on the Federal HealthCare.gov platform to carry out eligibility and enrollment functions but operates other State Exchange functions, including consumer assistance and outreach. For states that elect not to operate either a State Exchange or a State Exchange on the Federal Platform, section 1321(c)(1) of the ACA provides for HHS to operate a Federally-facilitated Exchange (FFE) in those states.

Per 45 CFR §§ 155.105 and 155.106, states electing to operate a State Exchange or a State Exchange on the Federal Platform must complete and submit an Exchange Blueprint Application documenting that the Exchange will meet the legal and operational requirements associated with the Exchange model the state chooses to pursue. As part of its Blueprint submission, a state also agrees to demonstrate operational readiness to implement and execute the required Exchange activities described in the Blueprint. States electing a State Exchange or a State Exchange on the Federal Platform model coordinate closely with CMS on key transition activities and participate in frequent technical assistance sessions and operational readiness reviews with CMS subject matter experts. States meeting all transitional milestones must receive written approval or conditional approval from HHS to operate a State Exchange or State Exchange on the Federal Platform, generally at least three months prior to the Open Enrollment start date of November 1 for an ensuing plan year.

Since January 1, 2014, consumers in every state and the District of Columbia have had access to obtain health insurance coverage through Exchanges, operated by states through State Exchanges, or operated by the Federal government through FFEs. As of PY 2021, there are 15 conditionally approved State Exchanges that perform all Exchange functions, including operating their own eligibility and enrollment platforms. These states are California, Colorado, Connecticut, District of Columbia, Idaho, Massachusetts, Maryland, Minnesota, New Jersey, Nevada, New York, Pennsylvania, Rhode Island, Vermont, and Washington. There are also six conditionally approved State Exchanges on the Federal Platform. These states are Arkansas, Kentucky, Maine, New Mexico, Oregon, and Virginia. Three of these states with State Exchanges on the Federal Platform (Kentucky, Maine, and New Mexico) have also notified HHS of their intent to transition to a full State Exchange model that operates its own eligibility and

2021-06-21 Page 8 of 60 enrollment platform for PY 2022. These states have submitted a Blueprint application and are currently in the process of completing the transition activities and operational readiness reviews required to receive HHS approval.

All approved or conditionally approved State Exchanges are required to comply with reporting obligations under 45 CFR § 155.1200. This includes annually submitting to CMS a State-based Marketplace Annual Reporting Tool (SMART), which outlines Exchange-related policy and operational requirements as set forth in federal statute, regulations, and guidance. State Exchanges must also complete both an annual external independent programmatic audit and financial audit. CMS utilizes the annual reporting by State Exchange and the accompanying audits to monitor and oversee State Exchange compliance with applicable federal requirements.

The ARPA also contained new applicable federal Exchange requirements by temporarily increasing the amount of premium tax credits and cost-sharing reductions available to certain taxpayers and individuals who enroll in a QHP through an Exchange. Currently, applicable taxpayers with household incomes between 100 percent of the federal poverty level (FPL) and 400 percent FPL who enroll, or whose household members enroll, in a QHP on an Exchange can receive APTC to help offset the cost of premiums. For taxpayers who receive APTC, premium costs for a QHP are limited to a percentage of household income on a sliding scale. To provide increased access to, and affordability of, health insurance during the COVID-19 Pandemic, the ARPA implemented the following new provisions:

• Section 9661 of the ARPA increases the premium tax credits available for taxpayers in tax years 2021 and 2022 by modifying the “applicable percentages” for taxpayers with household incomes between 100 percent FPL and 400 percent FPL. The modified applicable percentage ranges from 0.0 percent to 8.5 percent of household income on a sliding scale. The provision also expands eligibility for premium tax credits to those above 400 percent FPL if the cost of the benchmark plan is greater than 8.5 percent of household income.

• Section 9663 of the ARPA provides that a taxpayer who has received, or has been approved to receive, unemployment compensation for any week beginning during tax year 2021, for purposes of determining the premium tax credit, will be considered to be an applicable taxpayer and to have no household income in excess of 133 percent of the

FPL.

• Section 2305 of the ARPA provides that an individual who has received, or has been approved to receive, unemployment compensation for any week beginning during 2021, for purposes of determining reduced cost-sharing, will be considered to meet the requirement to have household income above 100 percent FPL and not exceeding 400 percent FPL, and to have no household income in excess of 133 percent of the FPL.

To provide these savings to consumers, State Exchanges must revise their systems, programs, and technology. State Exchanges using their own platform will need to make changes to their eligibility and enrollment systems to ensure that consumers have the ability to receive a correct eligibility determination. These Exchanges may also need to implement new business processes to apply the new subsidies to current enrollees outside of the normal annual enrollment process.

All State Exchanges, including those using the Federal Platform, may have new costs related to

2021-06-21 Page 9 of 60 providing assistance and education to enrollees and potential new consumers on the availability of these critical new supports for individuals and their families.

A4. Program Requirements The ARPA created a new grant program, which CMS calls the State Exchange Modernization Grant Program, to enable State Exchanges to modernize or update any system, program, or technology utilized by such Exchange to ensure the Exchange is compliant with all applicable federal requirements.

Eligible applicants may apply to use grant funds for modernization activities directly related to an Exchange coming into compliance with its reporting obligations under 45 CFR § 155.1200, including State-based Marketplace Annual Reporting Tool (SMART) requirements, or resolving outstanding SMART observations or open audit findings. The SMART and its accompanying audit requirements sets forth the federal statute, regulations, and guidance applicable to State Exchanges.

Eligible applicants may also apply to use grant funds to implement the premium tax credit and cost-sharing reduction statutes, as amended by sections 2305, 9661 and 9663 of the ARPA, which provide immediate relief to individuals and families facing economic hardships during the COVID-19 public health emergency.

Eligible activities could include:

1. Design, development, and implementation of necessary modifications to systems (applications, eligibility and verification, enrollment, privacy and security, reporting, etc.)

or technology infrastructure related to the implementation of applicable federal requirements.

2. Design, development, and implementation of program policies or procedures required for implementation of applicable federal requirements, including but not limited to consumer notifications, consumer assistance activities, stakeholder education or training, state and federal reporting, call center or appeal supports, staff training, and oversight and monitoring activities.

On March 19, 2021, the Office of Management and Budget (OMB) released memo M-21-20, Promoting Public Trust in the Federal Government through Effective Implementation of the American Rescue Plan Act and Stewardship of the Taxpayer Resources (https://www.whitehouse.gov/wp-content/uploads/2021/03/M_21_20.pdf). Pursuant to 2 CFR § 200.201, this memorandum provides possible administrative relief, by allowing Federal awarding agencies the authority to grant exceptions to financial assistance recipients affected by the pandemic as they deem appropriate and to the extent permitted by law. Such exceptions must also ensure sound financial management of the resources funding the relief, and minimize risk of waste, fraud, and abuse. In response to and as permitted by this memorandum, CMS will allow for necessary, reasonable, and allocable pre-award costs that are incurred (i) from March 15, 2021 through the end of the COVID-19 Public Health Emergency (PHE) Period declared by the Secretary,1 and (ii) prior to the effective date of the award (2 CFR § 200.210, 2 CFR § 200.458).

1 Secretary Azar declared a public health emergency under section 319 of the Public Health Service Act on January https://www.whitehouse.gov/wp-content/uploads/2021/03/M_21_20.pdf

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Recipients requesting funds reimbursement for pre-award costs must be able to demonstrate that the funds were utilized for eligible activities as described in A4. Program Requirements and consistent with allowable, reasonable, and allocable requirements outlined in HHS regulation 45 CFR §§ 75.403, 75.404, and 75.405. An applicant incurs pre-award costs at its own risk. If a State Exchange applicant does not receive a Cooperative Agreement award, CMS is not liable for costs incurred by the applicant. Please refer to D6. Cost Restrictions for more information on allowable pre-award costs and the maximum amount CMS will reimburse through this award.

A5. Technical Assistance and Information for Prospective Applicants Prior to the application deadline, CMS will host a webinar to provide details about the State Exchange Modernization Grant Program, and to answer questions from potential applicants regarding this funding opportunity.

B. Federal Award Information CMS will award up to 21 cooperative agreements, totaling $20,000,000 (pending availability of funds), to State Exchanges that submit a complete and successful application. Each award will be no more than $1,333,333.

B1. Total Funding A total of $20,000,000 (pending availability of funds), as authorized by the ARPA. No additional funding is anticipated.

B2. Award Amount Each successful applicant will receive an apportionment, dependent on the applicant’s State Exchange model and the number of successful applicants, of the $20,000,000 (pending availability of funds). A State Exchange that operates its own eligibility and enrollment platform will receive up to $1,333,333 and a State Exchange on the Federal Platform will receive up to $800,000.

The funding amounts reflect the differences in responsibilities between the State Exchange models for implementation of the program activities described previously. Specifically, a State Exchange operating its own eligibility and enrollment platform would have costs associated with implementing necessary changes to its eligibility and enrollment platform IT systems. A State Exchange that does not operate an eligibility and enrollment system would not incur such costs, as the Federal Platform would be responsible for making any necessary changes.

Decisions regarding the specific funding levels for each cooperative agreement award will take into account total number of successful applicants within each Exchange model. If an applicant is unsuccessful, the applicant’s intended funding allotment may be split among successful applicants. CMS expects that successful applicants within their respective State Exchange model would receive the same funding level. However, CMS will also consider any anticipated changes to State Exchange models following the application due date, but that occur during the period of performance, which could result in differences in award amounts. For example, as noted previously in this NOFO, three State Exchanges on the Federal Platform have notified HHS of

31, 2020. The declaration was renewed on April 21, 2020, July 23, 2020, October 2, 2020, January 7, 2021, and by Secretary Becerra effective April 21, 2021.

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An eligible applicant must submit a successful and complete application package requesting the maximum award amount, including a budget that demonstrates the State Exchange’s need for that amount of funding to comply with applicable federal requirements.

B3. Anticipated Award Dates CMS anticipates awarding State Exchange Modernization Grants to successful applicants on or after September 10, 2021. The application deadline for this funding opportunity is July 20, 2021.

B4. Period of Performance The period of performance for this grant program will be from the date of notice of award through September 9, 2022.

B5. Number of Awards CMS anticipates making up to 21 awards for this grant program. All awards are subject to funding availability. In the absence of funding, CMS is under no obligation to make awards under this announcement.

B6. Type of Award The type of award issued under this NOFO is a cooperative agreement. The difference between grants and cooperative agreements is the degree of federal programmatic involvement rather than the type of administrative requirements imposed. A cooperative agreement differs from a grant in that it provides for substantial involvement between the federal awarding agency and the non-federal entity in carrying out the activity contemplated by the federal award. Therefore, statutes, regulations, and policies that are applicable to grants also apply to cooperative agreements, unless the award itself provides otherwise. References throughout this NOFO to grants also apply to cooperative agreements unless this NOFO states otherwise. Please refer to Section F4.

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

B7. Type of Competition This Notice of Funding Opportunity is a limited competition and is open only to State Exchanges approved or conditionally approved at the time of the application due date.

C. Eligibility Information C1. Eligible Applicants This funding opportunity is a limited competition open to only approved State Exchanges that, at the time of the application due date, have received approval or conditional approval from HHS, in the manner described at 42 CFR §§ 155.105 and 155.106. An eligible State Exchange includes an Exchange that operates its own eligibility and enrollment platform or an Exchange provided for at 42 CFR § 155.106(c) that utilizes the Federal platform. The ARPA excludes an Exchange operated in a state by HHS under section 1321(c) of the ACA.

The eligible applicants are State Exchanges in the following states: Arkansas, California, Colorado, Connecticut, District of Columbia, Idaho, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, and Washington.

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(select all that apply) Government Organizations

State governments ☐ County governments ☐ City of Township governments ☐ Special District governments ☐ Native American tribal governments (Federally recognized) ☐ Native American tribal organizations (other than federally recognized tribal governments) Education Organizations ☐ Independent School Districts ☐ Public and State Controlled Institutions of Higher Education Private institutions of higher education Public Housing Organizations ☐ Public housing authorities ☐ Indian housing authorities Nonprofit Organizations

☐ Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education ☐ Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education ☐ For-profit Businesses (organizations other than small businesses) ☐ Small Businesses ☐ Individuals ☐ Others (if selected, required additional narrative information below) ☐ Unrestricted (if selected, required to include additional narrative information below)

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

C3. Letter of Intent A letter of intent is not required for this funding opportunity.

C4. Ineligibility Criteria Only one application will be accepted per State Exchange. Ineligible applicants are Exchanges operated in a state by HHS under section 1321(c) of the ACA.

C5. Single Application Requirement Applicants may submit only one application.

C6. Continued Eligibility

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Recipients must meet reporting and certification deadlines (as outlined in section F) to be eligible throughout the initial 12-month budget period and to remain eligible for a non-competing continuation award for subsequent budget periods in multi-year projects. In addition, recipients must demonstrate strong performance during the previous funding cycle(s) to be issued additional year funding; 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.

Continued funding is contingent on satisfactory progress, compliance with the terms and conditions, and the availability of funds. Satisfactory progress would be determined by the applicant’s adherence to the CMS approved detailed project work plan and timeline, other criteria for application approval, and in accordance with the terms and conditions at the time of the award.

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

C8. Faith-Based Organizations Faith-based organizations are not eligible to apply for this funding opportunity.

C9. Other Eligibility Requirements Not applicable.

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

D2. Content and Form of Application Submission

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

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

https://beta.sam.gov/ https://www.grants.gov/

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

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

• The Project Narrative must be double-spaced. The page limit for this document is 10 pages.

• The Budget Narrative may be single-spaced. The page limit for this document is 12 pages.

• The Project Work Plan may be single-spaced. The page limit for this document is 10 pages.

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

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

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

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

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

1. Project Abstract Summary

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

2. SF-424: Official Application for Federal Assistance

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

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

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

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

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

https://www.grants.gov/

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

• SF-424A: Budget Information Non-Construction

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

3. SF-LLL: Disclosure of Lobbying Activities

All applicants must submit this SF-LLL form. If your entity does not engage in lobbying, please insert “Non-Applicable” on the form and include the required AOR name, contact information, and signature. Please note that the application kit available online on the Grants.gov website is utilized for many programs and therefore Grants.gov may designate this form as optional to allow for flexibility amongst programs. However, this form is required as part of the application package and must be submitted for the application to be considered eligible for review.

4. Project Site Location Form(s)

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

c. Application cover letter or cover page An application cover letter or cover page is not required as part of this application.

d. Project Narrative The applicant must provide a Project Narrative that articulates in detail the proposed goals, measurable objectives, and milestones in accordance with the instructions and content requirements provided below, consistent with the criteria described in section A4. Program Requirements.

Below are the required and optional elements (sections) of the project narrative, including a brief description of the type of information required within each specific section. The project narrative must be double-spaced and cannot exceed 10 pages in length. This page limit does not include the budget narrative or project work plan.

The Project Narrative must include the following sections:

a. Organizational Capacity: Description of the entity that will perform the cooperative agreement activities under this Funding Opportunity, as well as a description of the

2021-06-21 Page 16 of 60 management controls and coordination mechanisms that will be used to ensure the timely and successful execution and operation of the proposed activities.

b. Exchange Modernization: Discussion of the State Exchange’s proposed approach to modernize or update Exchange systems, programs, or technology to implement applicable federal requirements. This could include a description of the State Exchange’s proposed approach to come into compliance with State-based Marketplace Annual Reporting Tool (SMART) requirements, resolve outstanding SMART observations or open audit findings, and/or how the Exchange will implement the premium tax credit and cost-sharing reduction statutes as amended by sections 2305, 9661, and 9663, as applicable, of the ARPA.

In this section, applicants should describe proposed implementation and operational plans, including measurable objectives and milestones, where applicable. Applicants should note any system, program, or technology modernization activities that are in progress or complete as of the date of application submission.

CMS recognizes that applicants requesting funding to implement new federal requirements under the amendments in sections 2305, 9661, and 9663 of the ARPA may incur costs prior to the effective date of this award directly pursuant to the negotiation and in anticipation of this award where such costs are necessary for efficient and timely performance of the scope of work. Such costs are allowable only to the extent that they would have been allowable if incurred after the date of this Federal award and only with the written approval of CMS. Refer to D6. Cost Restrictions for more information on allowable pre-award costs and the maximum amount CMS will reimburse through this award.

e. Project Work Plan Each applicant must submit a detailed Project Work Plan outlining the State Exchange’s proposed implementation activities (maximum of 10 pages). The Project Work Plan should document key milestones the applicant must carry out over the entire project period. For each milestone, the applicant should identify the months and years in which they start, are carried out, and are completed. The Project Work Plan should identify, by name and title, the individual responsible for accomplishing each goal.

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

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

Recipients may request reimbursement for pre-award costs of up to 40% of the total award and must justify that such costs are directly pursuant to the negotiation and in anticipation of this award where such costs are necessary for efficient and timely performance of the scope of work.

Such costs are allowable only to the extent that they would have been allowable if incurred after

2021-06-21 Page 17 of 60 the date of this Federal award and only with the written approval of CMS. Applicants must separately outline pre-award costs in the budget submitted.

CMS will not approve pre-award costs for travel or supplies. In order to receive reimbursement of pre-award costs incurred for contracts, consultants, equipment, or other technology or service costs, a recipient must attest and demonstrate compliance with state procurement policies, procedures, and regulations. When procuring property and services under a Federal award, a state must follow the same policies and procedures it uses for procurements from its non-Federal funds. The state will comply with 45 CFR §75.331 and ensure that every purchase order or other contract includes any clauses required by 45 CFR §75.335. All other non-Federal entities, including subrecipients of a state, will follow 45 CFR §§75.327 through 75.335. The non-Federal entity must use its own documented procurement procedures which reflect applicable State, local, and tribal laws and regulations, provided that the procurements conform to applicable Federal law and the standards identified in this part of the regulation.

The recipient must also attest that it has sufficient resources, whether as a budget request through this grant or other financial resources, to ensure administrative oversight of grant requirements in addition to the following Exchange reporting obligations under 45 CFR § 155.1200 for the performance period of this award, including:

• completion and submission of State-based Marketplace Annual Reporting Tool (SMART) within required timelines, and

• completion and timely submission of both an annual external independent programmatic audit and financial audit within required timelines.

To ensure administrative oversight, the Budget Narrative must identify a Project Director who is an employee of the applicant organization. This narrative must provide assurances that this individual will dedicate sufficient time to this award, funded through this award or in-kind, to perform the required roles and responsibilities and ensure effective monitoring of funds under this award. The percentage FTE proposed by the applicant must ensure effective monitoring by the Project Director and is subject to review by CMS.

Applicant must include an attestation in the budget narrative that addresses the following:

(1) pre-award costs (if applicable) were incurred no earlier than March 15, 2021 and prior to the effective date of this award;

(2) as stated above, that pre-award procurement costs (if applicable) were incurred consistent with its own documented procurement procedures which reflect applicable State, local, and tribal laws and regulations, and that the procurements conform to applicable Federal law and the standards identified in this part of the regulation (45 CFR §§75.327 through 75.335).

(3) that it has sufficient resources, whether as a budget request through this grant or other financial resources, to ensure administrative oversight of grant requirements in addition to the Exchange reporting obligations under 45 CFR § 155.1200 for the performance period of this award.

Refer to D6. Cost Restrictions for more information on allowable pre-award costs.

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

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

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

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

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

i. be registered in SAM before submitting its application;

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

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

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

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

Due Date for Applications July 20, 2021 by 3:00 PM Eastern U.S. Time (Baltimore, MD) https://grants.gov/

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

D6. Cost Restrictions Direct Costs Funding under this NOFO can only cover approved State Exchange modernization activities, and cannot be used to duplicate or supplant other funding sources. Additionally, this cooperative agreement funding cannot be used for the following:

• Construction

• Travel

Pre-award Costs On March 19, 2021, the Office of Management and Budget (OMB) released memo M-21-20, Promoting Public Trust in the Federal Government through Effective Implementation of the American Rescue Plan Act and Stewardship of the Taxpayer Resources (https://www.whitehouse.gov/wp-content/uploads/2021/03/M_21_20.pdf). Pursuant to 2 CFR § 200.201, this memorandum provides possible administrative relief, by allowing Federal awarding agencies the authority to grant exceptions to financial assistance recipients affected by the pandemic as they deem appropriate and to the extent permitted by law. Such exceptions must also ensure sound financial management of the resources funding the relief, and minimize risk of waste, fraud, and abuse. In response to and as permitted by this memorandum, CMS will allow for necessary, reasonable, and allocable pre-award costs that are incurred (i) from March 15, 2021 through the end of the COVID-19 Public Health Emergency (PHE) Period declared by the Secretary,2 and (ii) prior to the effective date of the award (2 CFR § 200.210, 2 CFR § 200.458).

As outlined in 2 CFR § 200.458, pre-award costs are those incurred prior to the effective date of this award directly pursuant to the negotiation and in anticipation of this award where such costs are necessary for efficient and timely performance of the scope of work. Such costs are allowable only to the extent that they would have been allowable if incurred after the date of this Federal award and only with the written approval of CMS. A recipient may not reimburse for pre-award costs without this written approval.

Under this program, an applicant may request up to 40% of the total award in pre-award costs that occurred no earlier than March 15, 2021 and prior to the effective date of this award. CMS will not approve pre-award costs for travel or supplies. In order to receive reimbursement of pre-award costs incurred for contracts, consultants, equipment, or other technology or service costs, a recipient must attest and demonstrate compliance with state procurement policies, procedures, and regulations. When procuring property and services under a Federal award, a state must follow the same policies and procedures it uses for procurements from its non-Federal funds. The state will comply with 45 CFR §75.331 and ensure that every purchase order or other contract includes any clauses required by 45 CFR §75.335. All other non-Federal entities, including

2 Secretary Azar declared a public health emergency under section 319 of the Public Health Service Act on January 31, 2020. The declaration was renewed on April 21, 2020, July 23, 2020, October 2, 2020, January 7, 2021, and by Secretary Becerra effective April 21, 2021.

https://www.whitehouse.gov/wp-content/uploads/2021/03/M_21_20.pdf

2021-06-21 Page 20 of 60 subrecipients of a state, will follow 45 CFR §§75.327 through 75.335. The non-Federal entity must use its own documented procurement procedures which reflect applicable State, local, and tribal laws and regulations, provided that the procurements conform to applicable Federal law and the standards identified in this part of the regulation.

The recipient must also attest that it has sufficient resources, whether as a budget request through this grant or other financial resources, to ensure administrative oversight of grant requirements in addition to meeting the following Exchange reporting obligations under 45 CFR § 155.1200 for the performance period of this award, including:

• completion and submission of State-based Marketplace Annual Reporting Tool (SMART) within required timelines, and

• completion and timely submission of both an annual external independent programmatic audit and financial audit within required timelines.

Recipients requesting funds reimbursement for pre-award costs must be able to demonstrate that the funds were utilized for eligible activities as described in A4. Program Requirements and consistent with allowable, reasonable, and allocable requirements outlined in HHS regulation 45 CFR §§ 75.403, 75.404, and 75.405. An applicant incurs pre-award costs at its own risk. If a State Exchange applicant does not receive a Cooperative Agreement award, CMS is not liable for costs incurred by the applicant.

Indirect Costs

If the applicant entity has a current negotiated indirect cost rate agreement (NICRA), and is requesting indirect costs, a copy of the current NICRA must be submitted with the application.

Any non-Federal entity that has never received a negotiated indirect cost rate, except for those non-Federal entities described in Appendix VII(D)(1)(b) to 45 CFR Part 75, may elect to charge a de minimis rate of 10% of…