One-Time Funding in Support of the Vermont All-Payer ACO Model

The purpose of this single source funding opportunity for the One-Time Funding in Support of Vermont's All-Payer ACO Model ("Model") cooperative agreement is to provide Vermont with the start-up costs of the Model to assist Vermont in accomplishing the health outcomes, financial, and ACO scale targets required of Vermont under the Model. A single-source award to the Agency for Human Services will enable CMS to expeditiously provide assistance to Vermont for the following specific activities: connect Medicare Fee-for-Service beneficiaries with community-based resources, coordinate transitions across care settings with appropriate involvement of the Medicare Fee-for-Service beneficiary's primary care provider, coordinate care across providers, support health promotion and self-management by Medicare Fee-for-Service beneficiaries, and support practice improvement and transformation. These activities are necessary for Vermont to achieve the goals of the Model. We note that the other components of the Model (e.g., Vermont-specific Medicare ACO initiative and statewide health outcomes, financial, and ACO scale targets) are governed by a separate State Agreement into which Vermont and CMS have entered.

This single source funding opportunity provides Vermont with the necessary start-costs of the Model and is open to Vermont's Agency for Human Services ("Agency"). The Agency is uniquely positioned to meet the objectives of this funding opportunity based on its existing knowledge of the Model, its regulatory authority over healthcare in Vermont and its role in administering the Vermont All-payer ACO Model, its existing partnerships and collaborations with Vermont providers, and its resources and ability to deploy the funding immediately. • Knowledge of the Model: the Agency is intimately familiar with the objectives of the Model. The Agency was a key member of the discussions between Vermont and CMS during the development of the Model; the Agency's Secretary and staff dedicated significant time, energy, and resources over the past year in partnering with CMS to establish the Model's financial, health outcomes, and ACO scale targets. This existing familiarity and knowledge of the Model will help the Agency to expediently deploy the upfront investment in the Model offered under this funding opportunity announcement. • Authority and role in administering the Model: The Agency is responsible for ensuring that changes in Vermont's health system improve the conditions and well-being of Vermonters. The Agency has broad Vermont healthcare authority to improve the health of Vermonters and control the rate of growth in healthcare costs. Additionally, the Agency is a signatory to the Vermont All-payer ACO Model's State Agreement and will be supporting the State in achieving its obligations under the State Agreement. The Agency can effectively complement this funding opportunity with its existing authority and role in administering the Model to ensure the funding is effectively used in achieving the Model's goals. • Existing partnership and collaboration: The Agency is located in Vermont and has existing relationships and a history of collaboration with Vermont providers and community-based resources that would benefit from this funding opportunity. The Agency has also been working with these stakeholders for their input through the development of the Model. • Resources and ability to implement immediately: The Agency has the staff to implement this award immediately to support providers engaging in care coordination and linking beneficiaries to community-based resources.

CMS is committed to achieving better care for individuals, better health for populations, and reduced expenditures for Medicare, Medicaid, and CHIP. Through the Innovation Center, CMS strives towards these goals by testing innovative payment and service delivery models. CMS believes that states can be critical partners of the federal government and other health care payers to facilitate the design, implementation, and evaluation of community-centered health systems that can deliver significantly improved cost, quality, and population health performance results for all state residents, including Medicare, Medicaid, and CHIP beneficiaries. States have policy and regulatory authorities, as well as ongoing relationships with commercial healthcare payers, health plans, and providers that can accelerate delivery system reform. CMS has previously partnered with states to accelerate delivery system reform through initiatives such as the State Innovations Model (SIM). SIM provides state-based healthcare transformation efforts with funding to test the ability of states to utilize policy and regulatory levers to accelerate multi-payer health care transformation. Selected states have been working with state-based payers, including Medicaid and commercial payers, and providers to design and implement care delivery and payment reform. States participating in SIM were selected through two rounds of public Funding Opportunity Announcements released on August 23, 2012 (Round 1) and May 22, 2014 (Round 2). Additionally, CMS has released guidance to SIM state participants in which CMS indicated that in certain instances it will consider state proposals for Medicare's alignment with state multi-payer payment and care delivery models. According to that guidance, CMS indicated that CMS would assess such proposals with consideration of the following principles: 1) patient-centered, 2) accountable for total cost of care, 3)transformativee, 4) broad-based, 5) feasible to implement, and 6) feasible to evaluate. Vermont was one state that approached CMS with a desire for Medicare's alignment with the state's payment and care delivery model, and Vermont publicly released its proposal on January 25, 2016 . CMS reviewed Vermont's proposal and determined that it met the requirements necessary to explore in detail a potential Vermont-specific model. In October 2016, CMS and the State of Vermont entered into a State Agreement on the Vermont All-payer ACO Model. Under the Model, CMS will test whether health and care delivery for Vermont residents improve and healthcare expenditures for beneficiaries across payers (including Medicare fee-for-service, Vermont Medicaid, Vermont Commercial Plans, and Vermont Self-insured Plans) decrease if a) the aforementioned payers offer Vermont ACOs risk-based arrangements tied to health outcomes and healthcare expenditures; b) the majority of Vermont providers and/or suppliers enter into such risk-based arrangements; and c) the majority of Vermont residents across payers are aligned to an ACO bound by such arrangements. Start-up funding through a Cooperative Agreement will assist Vermont in achieving the above goals of the Model. As part of the Model, Vermont providers will participate in a Vermont-specific Medicare ACO initiative (the "Vermont Medicare ACO Initiative"), and CMS will provide $9.5M in start-up costs to assist Vermont providers with care coordination and bolster their collaboration with community-based resources. In return, Vermont commits to achieving statewide health outcomes, financial, and ACO scale (percentage of Vermont residents aligned to an ACO) targets - both for Medicare and across all significant healthcare payers. CMS believes that care coordination and collaboration with community-based resources will be necessary in order to achieve the financial, health outcomes, and ACO scale targets required under the Model. The start-up costs of the Model that CMS is providing to Vermont through a Cooperative Agreement will support such care coordination and collaboration with community-based resources, and will better enable Vermont to achieve the Model's financial, health outcomes, and ACO scale targets.

Employer Identification Number: All applicants must have a valid Employer Identification Number (EIN) assigned by the Internal Revenue Service. Dun and Bradstreet (D & B) Data Universal Numbering System (DUNS number): All applicants must have a Dun and Bradstreet (D & B) Data Universal Numbering System (DUNS) number in order to apply. The DUNS number is a nine-digit identification number that uniquely identifies business entities. Obtaining a DUNS number is free. To obtain a DUNS number, access the following website: www.dunandbradstreet.com or call 1-866-705-5711. See Section IV, Application and Submission Information, for more information on obtaining a DUNS number. System for Award Management (SAM) All applicants must register in the System for Award Management (SAM)* database (https://www.sam.gov/portal/public/SAM/) in order to be able to submit an application at http://www.grants.gov. In order to register, applicants must provide their DUNS and EIN numbers. Each year, organizations and entities, registered to apply for Federal grants through Grants.gov must renew their registration with SAM. Each year organizations and entities must renew their registration with SAM. Failure to renew SAM registration prior to application submission will prevent an applicant from successfully applying via Grants.gov. Similarly, failure to maintain an active SAM registration during the application review process can prevent CMS from issuing your agency an award under this program. Applicants should begin the SAM registration process as soon as possible after the announcement is posted to ensure that it does not impair your ability to meet required submission deadlines. Applicants must successfully register with SAM prior to submitting an application or registering in the Federal Funding Accountability and Transparency Act Sub-award Reporting System (FSRS) as a prime awardee user; awardees may make sub-awards only to entities that have DUNS numbers. Organizations must report executive compensation as part of the registration profile at https://www.sam.gov/portal/public/SAM/ by the end of the month following the month in which this award is made, and annually thereafter (based on the reporting requirements of the Federal Funding Accountability and Transparency Act (FFATA) of 2006 (Pub. L. 109-282), as amended by Section 6202 of Public Law 110-252 and implemented by 2 CFR Part 170).

* Connect patients with community-based resources. Examples include the following. * Develop and maintain up-to-date local information about formal and informal resources beyond those covered by Medicare, including peer and community-based programs. * Assist and support access to community resources based on individual patient needs and goals. Community resources include transportation services for patients with restricted mobility, nutritional counseling and support, housing subsidies, and food assistance. * Coordinate transitions across care settings with appropriate involvement of the patient's primary care provider. Examples include the below. * Develop and maintain collaborative relationships between providers such as hospital emergency departments, hospital discharge departments, and primary care providers. * Reconcile medication. * Plan follow-up with primary care provider and other necessary providers. * Review post-discharge care management plan with patient. * Coordinate care across providers. Examples include the following. * Schedule appointments and perform outreach to support attendance at scheduled treatment and human services appointments. * Monitor treatment progress, implementation of the care management plan, and medication adherence. * Coordinate with other providers to monitor individuals' health status and participation in treatment. * Support health promotion and self-management by patients. Examples include the following. * Provide health education specific to a patient's chronic conditions * Identify health and life goals and develop of self-management plans with the patient. * Provide health promoting lifestyle interventions including but not limited to nutritional counseling, obesity reduction, and increasing physical activity. * Teach patients to use their durable medical equipment. * Review medications. * Ensure patients are following self-management plans. * Support practice improvement and transformation. Examples include the below. * Meet nationally recognized patient medical home standards. * Respond to data to reduce variation and improve care Collaborate with community-based care coordinators to identify and link community-based services for high risk patients.

The period of performance will be 12 months from the date of award with one 12 month budget period.

Application Materials; Application materials will be available for download at http://www.grants.gov. Please note that HHS requires applications for all announcements to be submitted electronically through http://www.grants.gov. For assistance with http://www.grants.gov, contact support@grants.gov or 1-800-518-4726. At Grants.gov, applicants will be able to download a copy of the application packet, complete it off-line, and then upload and submit the application via the Grants.gov website. Specific instructions for applications submitted via http://www.grants.gov: * You may access the electronic application for this project at http://www.grants.gov. You must search the downloadable application page by the CFDA number. * At the http://www.grants.gov website, you will find information about submitting an application electronically through the site, including the hours of operation. HHS strongly recommends that you do not wait until the application due date to begin the application process through http://www.grants.gov because of the time needed to complete the required registration steps. * The applicant must be registered in the System for Award Management (SAM) database in order to be able to submit the application. Applicants are encouraged to register early, and must have their DUNS and EIN/TIN numbers in order to do so. * Authorized Organizational Representative: The Authorized Organizational Representative (AOR) who will officially submit an application on behalf of the organization must register with grants.gov for a username and password. AORs must complete a profile with Grants.gov using their organization's DUNS Number to obtain their username and password at http://grants.gov/applicants/get_registered.jsp. AORs must wait one business day after successful registration in SAM before entering their profiles in Grants.gov. Applicants should complete this process as soon as possible after successful registration in SAM to ensure this step is completed in time to apply before application deadlines. * When an AOR registers with Grants.gov to submit applications on behalf of an organization, that organization's E-Biz POC will receive an email notification. The email address provided in the profile will be the email used to send the notification from Grants.gov to the E-Biz POC with the AOR copied on the correspondence. * The E-Biz POC must then login to Grants.gov (using the organization's DUNS number for the username and the special password called "M-PIN") and approve the AOR, thereby providing permission to submit applications. * Any files uploaded or attached to the Grants.Gov application must be PDF file format and must contain a valid file format extension in the filename. Even though Grants.gov allows applicants to attach any file formats as part of their application, CMS restricts this practice and only accepts PDF file formats. Any file submitted as part of the Grants.gov application that is not in a PDF file format, or contains password protection, will not be accepted for processing and will be excluded from the application during the review process. In addition, the use of compressed file formats such as ZIP, RAR, or Adobe Portfolio will not be accepted. The application must be submitted in a file format that can easily be copied and read by reviewers. It is recommended that scanned copies not be submitted through Grants.gov unless the applicant confirms the clarity of the documents. Pages cannot be reduced in size, resulting in multiple pages on a single sheet, to avoid exceeding the page limitation. All documents that do not conform to the above specifications will be excluded from the application materials during the review process. * After you electronically submit your application, you will receive anacknowledgmentt from Grants.gov that contains a Grants.gov tracking number. CMS will retrieve your application package from Grants.gov. Please note that applicants may incur a time delay before they receiveacknowledgmentt that the application has been accepted by the Grants.gov system. Applicants should not wait until the application deadline to apply because notification by Grants.gov that the application is incomplete may not be received until close to or after the application deadline, eliminating the opportunity to correct errors and resubmit the application. Applications submitted after the deadline, as a result of errors on the part of the applicant, will not be accepted. * After CMS retrieves your application package from Grants.gov, a return receipt will be emailed to the applicant contact. This will be in addition to the validation number provided by Grants.gov. Applications cannot be accepted through any email address. Full applications can only be accepted through http://www.grants.gov. Full applications cannot be received via paper mail, courier, or delivery service. All grant applications must be submitted electronically and be received through http://www.grants.gov by 3:00 pm Eastern Daylight Time on the applicable due date. Applications not successfully submitted to Grants.gov by the due date and time will not be eligible for review. All applications will receive an automatic time stamp upon submission and applicants will receive an email reply acknowledging the application's receipt. Please be aware of the following: 1) Search for the application package in Grants.gov by entering the CFDA number. This number is shown on the cover page of this announcement. 2) If you experience technical challenges while submitting your application electronically, please contact Grants.gov Support directly at: www.grants.gov/customersupport or (800) 518-4726. Customer Support is available to address questions 24 hours a day, 7 days a week (except on Federal holidays). 3) Upon contacting Grants.gov, obtain a tracking number as proof of contact. The tracking number is helpful if there are technical issues that cannot be resolved. To be considered timely, applications must be received by the published deadline date. However, a general extension of a published application deadline that affects all State applicants or only those in a defined geographical area may be authorized by circumstances that affect the public at large, such as natural disasters (e.g., floods or hurricanes) or disruptions of electronic (e.g., application receipt services) or other services, such as a prolonged blackout. This statement does not apply to an individual entity having Internet service problems. In order for there to be any consideration there must be an effect on the public at large. Grants.gov complies with Section 508 of the Rehabilitation Act of 1973. If an individual uses assistive technology and is unable to access any material on the site including forms contained with an application package, they can email the Grants.gov contact center at support@grants.gov or call 1-800-518-4726. Form of Application Submission The application must include all contents described below, in the order indicated, and conform to the following specifications: * Use 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 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 Budget Narrative may be single-spaced and should follow the justifications and table formats provided in Appendix A, Guidance for Preparing a Budget Request and Narrative in Response to SF 424A. * Tables included within any portion of the application should have a font size of at least 12-point with a 14 CPI and may be single spaced. * The project abstract is restricted to a one-page summary which may be single-spaced. * The application may not exceed 45 pages. Although tables are counted towards the page limitation, the additional required documentation, including Standard Forms and Project Abstract is excluded from the page limitation The following standard forms are found in the Grants Application Package at www.grantsolutions.gov and must be completed with an electronic signature and submitted as part of the proposal: * Project abstract summary * SF-424: Official Application for Federal Assistance (see note below) * SF-424A: Budget Information Non-Construction * SF-424B: Assurances-Non-Construction Programs * SF-LLL: Disclosure of Lobbying Activities * Project Site Location Form(s)

The applicant must produce a detailed and fully developed proposal exemplifying the applicant's readiness to participate in the One-Time Funding in Support of the Vermont All-Payer ACO Model. Each proposal must include the following core elements: Description of Need - 20 points Statement of Project Goals - 10 points Capacity to implement the project - 30 points Implementation Plan - 20 points Data Collection and Reporting Plan - 10 points Budget and Budget Narrative - 10 points

Application will be forwarded to a review panel. The review panel will evaluate the proposal based on how well applicant addresses the evaluation criteria outlined in the FOA. Based on the advice of the review panel, the CMS selection official will approve the selected application and issue a Notice of Award. Successful applicant will receive a Notice of Award (NoA) signed and dated by the CMS Grants Management Officer that will set forth the amount of the award and other pertinent information. The award will also include standard Terms and Conditions. Applicant should be aware that special requirements could apply to cooperative agreement awards based on the particular circumstances of the effort to be supported and/or deficiencies identified by the review panel.

Pending OMB approval of the Funding Opportunity Announcement (FOA), applications are due November 30, 2016. Anticipated Notice of Award date: January 30, 2017

CMS reserves the right to approve or deny any or all proposals for funding. Note that section 1115A of the Social Security Act, which creates the Center for Medicare and Medicaid Innovation (CMMI). Section 1115A(d)(2) states that there is no administrative or judicial review of the selection of organizations, sites, or participants to test models.