Affordable Care Act Implementation Support for State Demonstrations to Integrate Care for Medicare-Medicaid Enrollees

Through this Funding Opportunity, Centers for Medicare & Medicaid Services (CMS) seeks to fund activities necessary to implement the demonstrations to integrate care for Medicare-Medicaid enrollees, especially those that promote beneficiary engagement and protection of beneficiary rights. The purpose of the cooperative agreement is to provide funding over a two-year period to states that previously had design contracts and also have a signed Memorandum of Understanding (MOU) with CMS to implement a CMS-approved demonstration.

Funding under this opportunity is only available to states that were previously awarded a State Demonstration to Integrate Care for Dual Eligible Individuals - Design Contract in 2011 and associated state designated entities (i.e., those entities designated by those state Medicaid agencies) that are authorized by law to administer cooperative agreements, grants, and contracts in support of state programs. Funding is only available once the state has signed a Memorandum of Understanding with CMS to implement their demonstration design.

Under this funding opportunity, interventions shall primarily target individuals enrolled in both Medicare and Medicaid.

Applicants must be states that were previously awarded a State Demonstration to Integrate Care for Dual Eligible Individuals - Design Contract in 2011 and associated state designated entities that are authorized by law to administer cooperative agreements, grants, and contracts in support of state programs. These States may submit applications, but funding is only available once the state has signed a Memorandum of Understanding with CMS to implement their demonstration design. Applications must include a cover letter expressing support from the state Medicaid director. If applicable, this letter shall express support for the state designated entity to apply and administer the cooperative agreement. In addition to this documentation, the application is expected to address how the applicant will implement the cooperative agreement program, including how the implementation activities are necessary to implement the demonstration.

Awardees will implement the Cooperative Agreement following CMS direction. CMS seeks to fund activities necessary to implement the demonstrations to integrate care for Medicare-Medicaid enrollees, especially those that promote beneficiary engagement and protection of beneficiary rights. Implementation tasks will vary, but could include: • Beneficiary and provider outreach and education; • Participant ombudsmen activities to support individual advocacy and independent systematic oversight with a focus on compliance with principles of community integration, independent living, and person-centered care in the home and community based care context; • Independent enrollment broker and information and assistance for beneficiaries; • Stakeholder engagement; • Provider training; • Ongoing monitoring of health plans, care coordination entities, and providers, including network adequacy; • Improvement to and execution of grievances and appeals; • Ongoing processes to confirm network adequacy; • Tracking claims and quality data; • Actuarial analysis and rate-setting; • State-level IT systems modifications to support beneficiary enrollment and data collection and reporting; and • Evaluation activities that do not duplicate those performed by the CMS' independent evaluator for the demonstration. Awardees will develop and submit implementation plans that describe how the awardee will manage the project. Awardees must submit regular progress reports to summarize progress against milestones identified in the implementation plans.

The project period of performance is two years. For the first 12-month period of performance, cooperative agreement funding may cover 100% of approved implementation activities during this period. In the second 12-month period of performance, cooperative agreement funding is available for 75% of the costs of approved implementation activities. The applicant must fund the remaining 25%.

See Award procedures (093)

The review process will include the following: • Applications will be screened to determine eligibility for further review using the criteria detailed in the solicitation. Applications received late or that fail to meet the eligibility requirements or do not include the required forms will not be reviewed. • Applications must include a cover letter of support from the state Medicaid director. If not, the applicant's submission will not receive further consideration and will not be eligible for award. • A team consisting of staff from HHS and potentially other outside experts will review all applications. The review panel will assess each application to determine the merits of the application and the extent to which the proposed program furthers the purposes of the program. CMS reserves the option to request that applicants revise or otherwise modify their applications and budget based on the recommendations of the panel. • Applications will be scored with a total of 100 points available. The following criteria will be used to evaluate applications received in response to this solicitation. More information about each criteria can be found in the funding opportunity announcement. o Proposed approach (40 points) o Organizational capacity and management plan (25 points) o Evaluation and reporting (10 points) o Budget and budget narrative (25 points) • The results of the objective review of the applications by qualified experts will be used to advise the approving HHS official. Final award decisions will be made by an HHS program official. In making these decisions, the HHS program official will take into consideration: recommendations of the review panel; the extent to which the requested resources directly support demonstration implementation efforts; any overlap with existing resources that support implementation; the extent to which the state is committing state resources to implementation efforts; the reasonableness of the estimated cost to the government and anticipated results; likelihood that the proposed project will result in the benefits expected; and availability of funding. • Successful applicants will receive one cooperative agreement per application issued under this announcement, pending the signing of an MOU with CMS to implement the demonstration design.

Applications are due January 28, 2012. A second round of applications is due April 15, 2013. A third round of applications is due May 29, 2013. The anticipated period of performance is two years from award. The anticipated funding period for the January 28, 2013 applicants is March 15, 2013 - March 14, 2015. The anticipated funding period for the April 15, 2013 applicants is May 29, 2013 to May 28, 2015. The anticipated funding period for the May 29, 2013 applicants is July 15, 2013 to July 14, 2015.

The anticipated notice of cooperative agreement dates are approximately March 15, 2013, May 29, 2013, and July 15, 2013.