Analyses, Research and Studies to Address the Impact of CMS’ Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries

To further CMS' mission and goals related to providing high quality health care to the American Indian/Alaska Native (AI/AN) community by providing research and analysis to increase the understanding of, access to, and impact of CMS' programs in Ind

To further CMS' mission and goals related to providing high quality health care to the American Indian/Alaska Native (AI/AN) community by providing research and analysis to increase the understanding of, access to, and impact of CMS' programs in Indian Country. Congress authorized AI/ANs to have access to Medicare and Medicaid services when provided through Indian Health Service (IHS) facilities located in tribal communities and amended titles XVIII and XIX of the Social Security Act to permit IHS facilities to bill Medicare and Medicaid for services provided to eligible AI/ANs. This authority was later extended to tribal facilities. Congress has also provided authority for Indian health care programs and beneficiaries to participate in the Children's Health Insurance program and the Health Insurance Marketplace. These changes have created a direct relationship between CMS and the Indian Health Service, The research conducted under this cooperative agreement is needed to help improve administration of CMS' programs given that CMS and IHS programs operate under different and sometimes competing authorities for CMS' programs, the Social Security Act and for IHS' programs, the Indian Health Care Improvement Act and the Indian Self Determination Education and Assistance Act, P.L. 93-638. To make CMS' programs work with Indian health program authorities, a crucial first is step is for CMS to understand the impact of its policies on Indian health care providers and tribal members so that the agency can provide the AI/AN community greater access to CMS' programs in an effective and efficient manner. The authority at Section 1110 of the Social Security Act permits CMS to enter into grants andcooperative arrangements with organizations and certain other entities in order to aid in improving administration and effectiveness of programs administered by the agency. To this end, the work conducted under this cooperative agreement will address the potential and actual impacts of CMS' programs on AI/ANs and the health care system serving these beneficiaries. CMS' understanding of the impact of its policies is vital to improving greater AI/AN access to and participation in CMS' programs; improving and ensuring that appropriate health care payments and resources are provided to IHS tribal, and urban Indian Health program providers; and contributing to overall improved health outcomes for Indian people. The information and activities produced or provided under the cooperative agreement will be used to develop culturally appropriate activities and strategies to improve how CMS' program operate and are administered in Indian country.

Eligibility is limited to the National indian Health Board, and this single source award was approved by the Chief Grants Management Officer. NIHB meets the definition of "tribal organization"under the Indian Health Care Improvement Act (IHCIA) 25 USC Section 1603(26), with significant historical experience in providing outreach and education and the provision of health care information for Indian Tribes and Tribal Organizations. NIHB is a legally established organization controlled and governed by Indians and includes the maximum participation of Indians in all phases if its activities. NIHB has 100 percent appointed or elected officers that comprise the Board of Directors. NIHB acts in a supportive role to ensure the dissemination of health care education and information to tribes. NIHB must submit a copy of the 501(c) (3) Non-profit Certifion as proof of non-profit status. Applicant must have an Employer Identification Number (EIN), otherwise known as a Taxpayer Identification Number (TIN), to apply. Applicant must have a Dun and Bradstreet (D & B) Data Universal Numbering System (DUNS) number. The DUNS number is a nine-digit identification number that uniquely identifies business entities. To obtain a DUNS number, access the following website: http://www.dnb.com/ or call -866-705-5711. This number should be entered in the block 8c (on the Form SF-424, Application for Federal Assistance). The organization name and addressed entered in block 8a and 8c should be exactly as given for the DUNS number. Applicant should obtain this DUNS number immediately to ensure all registration steps are completed in time. Applicant must also register in the Central Contractor Registration (CCR) database in order to be able to submit the application. Applicant should begin the CCR registration process immediately to ensure that it does not impair ability to meet required submission deadlines.

The primary beneficiaries of this effort are American Indians and Alaska Natives who are eligible for CMS' programs to get them educated about and enrolled in CMS' programs, as appropriate, ensure that Indian health care providers can participate and are enrolled in CMS programs ,and to reduce health disparities in tribal communities. By enrolling in CMS' programs, AI/ANs benefit by having greater access to services that may not be provided by their local Indian health care providers, and tribal communities benefit through increased resources to their Indian health care programs. The Federal government will benefit by obtaining information to help make more informed policies which will improve administration of CMS' programs in tribal communities and therereby provide AI/ANs access to quality health care. Federally Recognized Indian Tribal Governments and Native American Organizations would benefit because they can provide information and insight to help CMS understand the tribal provider and tribal beneficiary perspective so that CMS can make informed policies decisions that would permit CMS' programs to be administered and operate effectively and efficiently in tribal communities and not conflict with legislative/regulatory authority under which the Indian Health Service programs operates.

In recent years a number of statutory changes have been made to CMS' programs and regulations have been developing to implement those changes. The assistance provided under this cooperative agreement will be used to: a) assess the ongoing impact of CMS' programs through an analysis of CMS regulations and CMS initiatives that have a potential impact or effect on IHS, Tribal and Urban Indian providers and AI/AN beneficiaries and use this information to monitor AI/AN participation in the CMS regulatory process to assess whether such participation contributes to the understanding of how CMS-related provisions in the Patient Protection and Affordable Care Act (ACA) impact the financing and delivery of health care in the Indian health care system; b) refine the inventory of AI/AN demographic, enrollment, and utilization data in order to develop strategies that make CMS data systems capable of reporting AI/AN enrollments, service utilization, health status and payment data from the Medicare, Medicaid and CHIP programs to facilitate program planning and evaluation, performance measurement, health status monitoring, and target enrollment efforts, identify gaps in data collection, propose and analyze approaches necessary to change and augment data collection systems and other information needed to support all reporting requirements under ACA, CHIPRA and ARRA, and propose reporting mechanisms and protocols for such reporting; c) update and revise the CMS Tribal Technical Advisory Group's 2013-2018 Strategic Plan (which is used to guide the administration of CMS' programs in Indian county) to incorporate legislative and regulatory changes resulting from the ACA; and d) Provide research support on the use and effectiveness of the CMS tribal consultation policy so that the agency can be assured to get appropriate tribal input when developing policies that will have a substantial direct effect on tribes. (e) Evaluate the effectiveness of outreach and enrollment efforts to AI/AN beneficiaries in CMS programs by conducting training on the basics of CMS programs to enrollment assisters and Indian health provider third party resource staff, learning and sharing best practices to increase AI/AN enrollment, and developing AI/AN culturally appropriate outreach materials based on feedback from training and outreach efforts. Provide quarterly reports summarizing outreach trainings and enrollment events, compilation of best practices utilized and lessons learned, and analysis of and recommendations to improve outreach efforts in Indian Country. Indirect Costs - If grantee requests indirect costs, an approved Indirect Cost Rate Agreement will be required to support those costs. The provisions of OMB Ciruclar A-87 govern reimbursement of indirect costs under this funding opportunity announcement. OMB Circulars are available on line at: http://www.whitehouse.ov/omb/circulars Direct Services - funds may not be used to provide individuals with services that are already funded through Medicare, Medicaid and/or CHIP. These services do not include expenses budgeted for provider and/or consumer task force member participation in conferences, provision of technical assistance, or attendance at technical assistance conferences sponsored by CMS or its national technical assistance providers for the benefit of awardees. The applicant's budget may not exceed a maximum funding level or project period of five years. Reimbursement of Pre-Award Costs-No funds awarded under this funding opportunity announcement may be used to reimburse pre-award costs. Other Prohibited Uses of Funds To match any other Federal funds. To provide services, equipment, or supports that are the legal responsibility of another party under Federal or State law (e.g., vocational rehabilitation or education services) or under any civil rights laws. Such legal responsibilities include, but are not limited to, modifications of a workplace or other reasonable accommodations that are a specific obligation of the employer or other party. To supplant existing state, local, or private funding of infrastructure or services, such as staff salaries, etc. To be used by local entities to satisfy state matching requirements. To pay for the use of specific components, devices, equipment, or personnel that are not integrated into the application. To pay for construction or alteration and renovation of real property (A & R). To pay for information technology (IT) equipment exceeding 10 percent of the total award. Any equipment, which includes IT, over $5,000 must be approved by CMS. To pay states for the use of any of their data made available for this initiative. Other limitations - A current recipient cannot be awarded a new, renewal, or competing continuation grant for any of the following reasons: The current project is not progressing in a satisfactory manner; The current project is not in compliance with program and financial reporting requirements; The applicant has an outstanding delinquent Federal debt; No award shall be made until the delinquent account is paid in full; or A negotiated repayment schedule is established nd at least one payment is received.

Application will be scored with at total of 100 points available. A minimum score of 90 points is required for funding. The following criteria will be used to evaluate the application received in response to the funding opportunity announcement. 1. Evaluation Criteria Part A: Program Information - Addresses Needs (15 points) Part B: Program Planning and Evaluations- Addresses project objectives, workplan and consultants) Program Plans - (40 points) Program Evaluation - (20 points) Part C: Program Report -- Addresses organizational capabilities and qualifications (15 points) Budget Narrative -- (10 points) The instructions for preparing the application narrative also constitute the evaluation criteria for reviewing and scoring the application. Weights assigned to each section are noted in parentheses. Points will be assigned to each evaluation criteria totaling 100 points. The ten-page narrative should include only the first year of activities, and information for multi-year projects should be included as an appendix.

The review process will include the following: NIHB's application will be reviewed to determine eligibility using the criteria detailed in the funding opportunity announcement. An application that is received late or that fails to meet the eligibility requirements as detailed in the FOA or does not include the required forms will not be reviewed. An independent, objective review of the application will be conducted. The review panel will assess the application based on the review criteria to determine the merits of the application and the extent to which it furthers the purposes of the research program. The review panel comments and recommendations will be condensed into a summary statement that will assist CMS in making the award decision. CMS will use the information to judge the likelihood that the project will be successfully implemented and will have tangible, beneficial outcomes. The applicant will receive written notification of the award decision. An award will be made to the successful applicant on or before September 29, 2017. The successful applicant will receive an official Notice of Award (NOA) signed by the CMS Grants Management Officer, OAGM, that will set forth the amount of the award and other pertinent information, including any specific terms conditions of the award required for the fulfillment of the grant. The NOA is a legal document issued to notify the grantee that the award has been approved and that funds are now available for draw down from the HHS Payment Management System (PMS). Any communication between CMS and an awardee prior to issuance of the NOA is not an authorization to begin implementation of a project.

Contact headquarters for approval information

Renewals for FY 2017-2021 will be provided each of these fiscal years based on the availability of funding and grantee's acceptable performance