Accountable Health Communities

 

The Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (the Innovation Center), will assess whether systematically identifying the health-related social needs of community-dwelling Medicare and Medicaid beneficiaries, including those who are dually eligible, and addressing their identified needs impacts those beneficiaries’ total health care costs and their inpatient and outpatient utilization.
The Section 3021 provisions of the ACA authorize the Innovation Center to design, implement and evaluate innovative payment and service delivery models to improve quality and reduce costs. Rigorous evaluation requirements of the model’s impact influence model design parameters.

The Accountable Health Communities (AHC) Model is based on emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. This model will support community collaboration to systematically: (1) screen beneficiaries to identify unmet health-related social needs; (2) refer beneficiaries to increase awareness of community services; (3) provide person-centered navigation services to assist beneficiaries with accessing community services; and (4) align clinical and community services to ensure that community services are available and responsive to the needs of beneficiaries. The expectation is that these efforts will lead to a reduction in health care utilization and costs.
The funding announcement offers three interventions of varying intensity (each referred to as a “track”) to better link beneficiaries to community services: (1) Track 1—Awareness Intervention, (2) Track 2—Assistance Intervention, and (3) Track 3—Alignment Intervention. Prospective applicants may apply to up to two tracks (i.e., Tracks 1 and 2, Tracks 2 and 3, or Tracks 1 and 3). The Track 1—Awareness Intervention tests whether increasing beneficiary awareness of available community services through information dissemination and referral impacts total health care costs and inpatient and outpatient health care utilization of high-risk beneficiaries. Track 2—Assistance Intervention will test whether assisting beneficiaries with accessing services through community service navigation impacts total health care cost and inpatient and outpatient health care utilization. This intervention incorporates innovations from Track 1 (universal screening of health-related social needs and use of a community resource inventory to connect beneficiaries to available community services) with two additional features: (1) identifying high-risk beneficiaries as part of a smarter spending strategy to target additional resources where they are needed the most; and (2) community service navigation to assist high risk beneficiaries with resolving health-related social needs. Track 3—Alignment Intervention tests whether a combination of navigation services at the individual beneficiary level and partner alignment at the community level impacts ED visits and inpatient hospital admissions. This approach recognizes that there are significant barriers to effective integration of the health care delivery systems, governmental public health systems, and the community-based service system due to different cultures, funding streams and data systems. Effective and responsive infrastructures are needed to ensure that community services are available and address the health-related social needs of beneficiaries. This intervention incorporates innovations included in Tracks 1 and 2 and adds structural and financial support designed to foster community-wide realignment of resources to more effectively address beneficiaries’ health-related social needs.
Successful applicants will be selected to participate in a single track for the entire 5-year period. Although tracks share common design elements, each track’s intervention pathway and underlying hypothesis is distinct. Each track will be tested over a 5-year period.

General information about this opportunity
Last Known Status
Active
Program Number
93.650
Federal Agency/Office
Agency: Department of Health and Human Services
Office: Centers for Medicare and Medicaid Services
Type(s) of Assistance Offered
Formula Grants; Formula Grants (Cooperative Agreements)
Program Accomplishments
Not Applicable.
Authorization
Section 1115A of the Social Security Act (the Act), as amended by section 3021 of the ACA, authorizes the Innovation Center to test innovative payment and service delivery models to reduce Medicare, Medicaid, or CHIP expenditures, while preserving or enhancing the quality of beneficiaries’ care. The AHC is a service delivery model under section 1115A that tests whether systematic screening for health-related social needs in clinical settings, along with referral to community resources and navigation services, impacts overall health care cost and utilization.
Who is eligible to apply/benefit from this assistance?
Applicant Eligibility
-Community based organizations
-Individual and group provider practices
-Hospitals and health systems
-Institutions of Higher Education
-Local government entities and tribal organization from all 50 states, United States territories, and the District of Columbia.
Beneficiary Eligibility
Potential applicants are limited to the eligible entities described in the sections above. Successful applicants will provide intervention services to community-dwelling Medicare and Medicaid beneficiaries, including dually eligible beneficiaries. Community-dwelling beneficiaries include beneficiaries not residing in a correctional facility or long-term care institution (e.g., long stay nursing homes) when accessing clinical care at a participating clinical delivery site.The application will describe the target populations, geographic areas, and communities that will be the focus of the AHC intervention, the current quality and beneficiary experience outcomes, including current needs assessments of health-related social needs, and specific targets to be impacted by the AHC intervention.
Credentials/Documentation
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). The Grants Management Specialist assigned to monitor the sub-award and executive compensation reporting requirements is Iris Grady, who can be reached at divisionofgrantsmanagement@cms.hhs.gov.
*Applicants were previously required to register with the Central Contractor Registration (CCR). The CCR was a government-wide registry for organizations that sought to do business with the federal government. CCR collected, validated, stored, and disseminated data to support a variety of federal initiatives. This function is now fulfilled by SAM. SAM has integrated the CCR and will also incorporate seven other Federal procurement systems into a new, streamlined system. If an applicant had an active record in CCR prior to the rollout of SAM, an active record would be available in SAM. However, more than a year has passed since the rollout of SAM, so entities must ensure its registration with CCR (through SAM) is still active prior to applying under this funding opportunity. Please consult the SAM website listed above for additional information. 2 CFR 200, Subpart E - Cost Principles applies to this program.
What is the process for applying and being award this assistance?
Pre-Application Procedure
Preapplication coordination is not applicable. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.
Application Procedure
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. Letter of Intent to Apply: Required

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 an acknowledgement 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 receive acknowledgement 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 1:00 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.

Format Requirements for Applications:

Each 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 must be single-spaced and should follow the justifications and table formats provided in the FOA appendix. Sample Budget and Narrative Justifications.
•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 included in the FOA is restricted to a one-page summary which may be single-spaced.
•The following additional required documentation is excluded from the page limitations described in the FOA: Standard Forms, applicant’s copy of previously submitted Letter of Intent, Cover Letter, Project Abstract, Assessment of Program duplication and Implementation plan.

The application is expected to address how the applicant will carry out the implementation and planning work required to meet AHC goals. The application must address application components for the intervention track the applicant is proposing to implement.

Application Package:

The application components listed below are required and must be submitted with the application. Failure to submit these forms will result in an ineligible application that will not be reviewed.
-SF424: Official Application for Federal Assistance
-SF424A: Budget Information Non-Construction
-SF424B: Assurances- Non-Construction Programs
-SF LLL: Disclosure of Lobbying Activities
-Project Site Location Form
-Project Abstract
-Project Narrative
-Implementation Plan
-MOU with state Medicaid agency
-MOU with clinical delivery sites
-MOU with community service providers
-Assessment of Program Duplication
-Health Resource Equity Statement
-Budget Narrative
Award Procedure
Applications will be forwarded to a review panel. The review panel will evaluate the proposals based on how well they address 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 applicants 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. Applicants 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.
Deadlines
Contact the headquarters or regional office, as appropriate, for application deadlines.
Approval/Disapproval Decision Time
Anticipated Notice of Award date: August 27, 2016.
Appeals
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.
Renewals
The budget and project period for each Cooperative Agreement awarded will be 5 years from the date of award. The estimated project period for the first round of awards is September 01, 2016 – August 31, 2021. The grant period consists of five one-year budget periods. Please refer to 1. Executive Summary for periods of performance and budget.

Year one 12-month project and budget period: September 01, 2016 – August 31, 2017
Year two 12-month project and budget period: September 01, 2017 – August 31, 2018
Year three 12-month project and budget period: September 01, 2018 – August 31, 2019
Year four 12-month project and budget period: September 01, 2019 – August 31, 2020
Year five 12-month project and budget period: September 01, 2020 – August 31, 2021.
How are proposals selected?
Track 1 – Awareness: Eligible applicants that submit an application to Track 1 will be reviewed and scored based on the quality of their proposals. The Track 1 applicants receiving the highest scores, and meeting other criteria specified under the Review and Selection Process, will be offered cooperative agreements to test the Track 1 intervention. Part of the review process will include an analysis of the readiness of the applicant to implement a model within one year of the cooperative agreement award. The review criteria for Track 1 – Awareness applications are based on a total of 150 points allocated across the following areas:

-Project Narrative 85 points
-Implementation Plan 08 points
-MOU with state Medicaid agency 25 points
-MOUs with clinical delivery sites 15 points
-Health Resource Equity Statement 02 points
-Budget Narrative 15 points

Track 2 – Assistance: Eligible applicants that submit an application to Track 2 will be reviewed and scored based on the quality of their proposals. The Track 2 applicants receiving the highest scores, and meeting other criteria specified under the Review and Selection Process, will be offered cooperative agreements to test the Track 2 intervention. Part of the review process will include an analysis of the readiness of the applicant to implement a model within one year of the cooperative agreement award. Applications will be scored with a total of 175 points allocated across the following areas:

-Project Narrative 110 points
-Implementation Plan 08 points
-MOU with state Medicaid agency 25 points
-MOUs with clinical delivery sites 15 points
-Health Resource Equity Statement 02 points
-Budget Narrative 15 points

Track 3 – Alignment: Eligible applicants that submit an application to Track 3 will be reviewed and scored based on the quality of their proposals. The Track 3 applicants receiving the highest scores, and meeting other criteria specified under the Review and Selection Process, will be offered cooperative agreements to test the Track 3 intervention. Part of the review process will include an analysis of the readiness of the applicant to implement a model within one year of the cooperative agreement award. Applications will be scored with a total of 220 points allocated across the following areas:

-Project Narrative 145 points
-Implementation Plan 08 points
-MOU with state Medicaid agency 25 points
-MOUs with clinical delivery sites 15 points
-MOUs with community partners 10 points
-Health Resource Equity Statement 02 points
-Budget Narrative 15 points.
How may assistance be used?
The FOA provides three different funding opportunities; eligible entities may apply for a Track 1 –Awareness, Track 2- Assistance, or Track 3- Alignment award.

Track 1 – Awareness employs an evidence-based intervention to test whether increasing awareness of available community services through information dissemination and referral impacts total health care cost and inpatient and outpatient health care utilization for Medicare and Medicaid beneficiaries. These cooperative agreements will support systematic screening of community dwelling Medicare and Medicaid beneficiaries for health-related social needs and the referral of beneficiaries who screen positive for health-related social needs to community resources. Funding for Track 1 – Awareness will support the required work to implement this intervention. CMMI expects successful applicants to: (1) offer to systematically screen all community-dwelling Medicare and Medicaid beneficiaries for health-related social needs; (2) prepare a community referral summary for each beneficiary who is screened and randomized to the intervention group that addresses the health-related social needs identified through the screening; (3) review the community referral summary with each beneficiary who has agreed to be screened and has been randomized to the intervention group; and (4) distribute a copy of the community referral summary to the beneficiary.

Track 2 – Assistance, through a randomized design, will test whether assisting beneficiaries with accessing community services through community service navigation impacts total health care costs and inpatient and outpatient health care utilization. These cooperative agreements will support systematic screening and referral and community service navigation. Funding for Track 2 – Assistance will support the required work to implement this intervention. CMMI expects successful applicants to: (1) offer to systematically screen all community-dwelling Medicare and Medicaid beneficiaries for health-related social needs; (2) prepare a community referral summary for each beneficiary with a health-related social need and a minimum number of ED visits that addresses the health-related social needs identified through the screening tool; (3) review the community referral summary with each beneficiary with an identified health-related social need; (4) distribute a copy of the community referral summary to each beneficiary with an identified health-related social need; (5) identify high-risk beneficiaries with health-related social needs based on ED utilization history; and (6) provide community service navigation services to high-risk beneficiaries in the intervention group, including an in-depth personal interview, development of a person-centered action plan and follow-up to address health-related social needs.

Track 3 – Alignment will determine whether a combination of referrals to community service providers and community service navigation at the individual beneficiary level and partner alignment at the community level impacts total health care costs and inpatient and outpatient health care utilization. These cooperative agreements will support: systematic screening and referral; community service navigation; and partner alignment. Funding for Track 3 – Alignment will support the required work to implement this intervention. CMMI expects successful applicants to: (1) offer to systematically screen all community-dwelling Medicare and Medicaid beneficiaries for health-related social needs; (2) prepare a community referral summary for each beneficiary that addresses the health-related social needs identified through the screening tool; (3) review the community referral summary with each beneficiary with an identified health-related social need and a minimum number of ED visits; (4) distribute a copy of the community referral summary to each beneficiary with an identified health-related social need; (5) identify high-risk beneficiaries with health-related social needs based on ED utilization history; (6) provide community service navigation services to high-risk beneficiaries in the intervention group, including an in-depth personal interview, development of a person-centered action plan and follow-up to address health-related social needs; and (7) implement a community-level quality improvement approach whereby the award recipient delineates a geographic target area and assumes certain integrator functions, including convening and working with an Advisory Board, collecting data and using those data to conduct gap analyses, and developing quality improvement plans to inform community decision-making and coordination between clinical delivery sites, community service providers, local government and other partners such as MA plans and MCOs that cover community-dwelling beneficiaries in the geographic target area.

Allowable costs associated with the AHC intervention include:
-Data collection (including at the clinical delivery sites), analysis, and reporting cost associated with program performance and continuous quality improvement;
-Coordination with CMS rapid cycle evaluation, and costs for collecting and preparing data for CMS evaluator;
-Staff resources associated with model management and project management, including travel to AHC workshops and conferences;
-Intervention service delivery costs;
-Tracking system for collecting and reporting metrics required by CMS;
-Infrastructure costs related to providing: systematic screening and referrals (Track 1, Track 2 and Track 3), community service navigation (Track 2 and Track 3), and partner alignment (Track 3);
-Model beneficiary assignment or reconciliation costs;
-Web and internet collaborative learning and communication costs;
-Project management and reporting costs;
-Business operations associated with the model; and
-Model management and administration for consortia and clinical delivery site relationships.

CMS will not fund proposals that duplicate models for populations that are already being funded and tested as part of other CMS or federal government initiatives. CMS will not pay directly for community service provision (e.g., housing, food, violence intervention programs, and transportation) in any of the three tracks. Rather, award money will fund systems change interventions to connect beneficiaries with community services. Costs that are not over and above financing provided for existing Medicaid State plans or waivers series will not be considered. No cooperative agreement funds awarded under this solicitation may be used to reimburse pre-award costs.

ŹProhibited Uses of Cooperative Agreement funds also include the use of funds to:
-Match any other federal funds;
-Provide services, equipment, or support that are the legal responsibility of another party under Federal or state law or under any civil rights laws;
-Supplant existing federal, state, local, or private funding of infrastructure or services;
-Pay for the use of specific components, devices, equipment, or personnel that are not integrated into the proposed AHC intervention; and
-Lobby or advocate for changes in federal and/or state law.

Terms and Conditions:

Cooperative agreements issued under this FOA are subject to the Department of Health and Human Services Grants Policy Statement (HHS GPS) at http://www.hhs.gov/asfr/ogapa/aboutog/hhsgps107.pdf. The standard terms and conditions in the HHS GPS will apply as indicated unless there are statutory, regulatory, or award-specific requirements to the contrary. Standard and program specific terms of award will accompany the Notice of Award. Potential applicants 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 in the application by the CMS review panel. The recently released Uniform Guidance (2 CFR Part 200) and HHS regulations (45 CFR Part 75) supersedes information on administrative requirements, cost principles, and audit requirements for grants and cooperative agreements included in the current HHS Grants Policy Statement where differences are identified. Awardees must also agree to respond to requests, from CMS, that are necessary for the evaluation of national efforts and provide data on core elements of their own cooperative agreement activities.
Cooperative Agreement (Special) Terms and Conditions of Award:
The following categories of special terms of award are in addition to, and not in lieu of, otherwise applicable HHS grant administration policies. CMS reserves the right to include any of these in the cooperative agreement with an appropriate level of specific details, some of which are provided below:
-Reporting (financial, quality, progress)
-Learning and Diffusion (training)
-Stakeholders (public notice, tribal consultation)
-Beneficiaries (related to AHC services)
-Providers (training related to AHC)
-Project monitoring
-Data collection
-Evaluation
-Termination
-Funding
-Financial arrangements
-Operations
-Program Integrity. CMS will not fund proposals that duplicate models for populations that are already being funded and/or tested as part of other CMS or federal government initiatives. CMS will not pay directly for community service provision (e.g., housing, food, violence intervention programs, and transportation) in any of the three tracks. Rather, award money will fund systems change interventions to connect beneficiaries with community services. Costs that are not over and above financing provided for existing Medicaid State plans or waivers series will not be considered. No cooperative agreement funds awarded under this solicitation may be used to reimburse pre-award costs.

ŹProhibited Uses of Cooperative Agreement funds also include the use of funds to:
-Match any other federal funds;
-Provide services, equipment, or support that are the legal responsibility of another party under Federal or state law or under any civil rights laws;
-Supplant existing federal, state, local, or private funding of infrastructure or services;
-Pay for the use of specific components, devices, equipment, or personnel that are not integrated into the proposed AHC intervention; and
-Lobby or advocate for changes in federal and/or state law.
What are the requirements after being awarded this opportunity?
Reporting
ll successful applicants under this announcement must comply with the following reporting and review activities:
Progress Reports

Award recipients must agree to cooperate with any Federal evaluation of Accountable Health Communities and at a minimum provide quarterly and final (at the end of the performance period) reports, as required, in the format prescribed by CMS. To facilitate programmatic involvement of CMS, additional information on program progress may be requested in written or verbal formats during monthly progress meetings. Programs not meeting programmatic milestones may be required to provide progress updates as frequently as weekly. Reports will be submitted electronically. Programs should be prepared to report quarterly on each intervention element and their program’s progress towards goals. The first quarterly report is estimated to be due November 31, 2016. The program progress narrative report elements include but are not limited to:

i.Program Name;
ii.Program Leader Name;
iii.Reporting Period;
iv.Budget Status - include amounts for planned expenditure, actual expenditure, and deficit/surplus;
v.Work Plan Chart/Timeline status;
vi.Project description - short summary;
vii.Milestones - Milestones are high-level goals that often define the phases of a project. Record here milestones that have been reached at this point in the project;
viii.Accomplishments - Tasks that were accomplished during this reporting period;
ix.Projected Goals - Goals projected to be completed during the next reporting period; and
x.Issues - Issues that must be addressed for the project to be successful.

The anticipated due date for the first year-end narrative reports is October 31, 2017. Annual project reports for future budget periods will be due within 90 days of each 12-month budget period with the submission of the non-compete continuation award application.

The anticipated due date for the final progress report is October 31, 2021, 90 days after the end of the project period. Payment Management Requirements

States must submit a quarterly electronic SF-425 via the payment management system. The report identifies cash expenditures against the authorized funds for the cooperative agreement. Failure to submit the report may result in the inability to access funds.

Federal Financial Report (FFR)

Additional information on financial reporting will be provided in the terms and conditions of award.

Federal Funding Accountability and Transparency Act Reporting Requirements

New awards issued under this funding opportunity announcement are subject to the reporting requirements of the Federal Funding Accountability and Transparency Act of 2006 (Pub. L. 109–282), as amended by section 6202 of Public Law 110–252 and implemented by 2 CFR Part 170. Grant and Cooperative Agreement recipients must report information for each first-tier sub-award of $25,000 or more in Federal funds and executive total compensation for the recipient’s and sub-recipient’s five most highly compensated executives as outlined in
Appendix A to 2 CFR Part 170 (available online at https://www.fsrs.gov/). As detailed above, award recipients must agree to cooperate with any federal evaluation of the model and performance results and provide required quarterly, semi-annual (every 6 months), annual and final (at the end of the 5 year performance period) reports in a form prescribed by CMS. Reports will be submitted electronically. These reports will include how cooperative agreement funds were used, describe project or model progress, and describe any barriers, delays, and measurable outcomes. CMS will provide the format for project or model reporting and technical assistance necessary to complete required report forms. Successful applicants must also agree to respond to requests that are necessary for the evaluation of the Model Design, pre-testing assistance, or Model Testing efforts and provide data on key elements of model performance and on results from the cooperative agreement activities. As detailed above. Successful applicants must submit reports to Federal Funding Report and meet Payment Management System reporting requirements. CMS will enlist a third party entity to assist us in monitoring the model implementation and testing performance results and outcomes. CMS plans to collect data elements to be part of monitoring for all of the AHC cooperative agreement recipients, and these monitoring and surveillance elements will feed into the evaluation. All award recipients will be required to cooperate in providing the necessary data elements to CMS or a CMS contractor. The contractor would assist CMS in developing a cost, quality, beneficiary experience, population health monitoring, and review model performance to ensure model design requirements are met; tracking performance across awardees and providing for rapid cycle evaluation and early detection of model performance issues; developing a system to collect, store, and analyze data to assess health care cost and utilization, quality performance, beneficiary experience, and population health improvements and assisting with state implementation, including coordination between states and CMS and its other contractors.

Data for monitoring will include process, safety, and performance measures. It will include, but will not be limited to, data on the background characteristics of the target population and target area, data characterizing the activities of the model testing and a battery of follow-up data describing relevant characteristics of the target population or target area and metrics at selected intervals after commencement of the delivery system and/or payment model. This will include detailed information on participant characteristics and outcomes reported in a standard format. Data for monitoring will be collected from awardees and/or CMS claims data, electronic health records, public health data or other sources. The model monitoring aspect of this initiative will balance the examination of the extent to which awardees demonstrate fidelity to their proposed delivery system and payment models and the potential need to make mid-course corrections that improve or optimize performance of the delivery system or payment models based on feedback from the monitoring and rapid cycle evaluation findings. The evaluation will also assess whether there is evidence of harm or unintended consequences as a result of the models or testing methods.
Auditing
In accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements, non-Federal entities that expend financial assistance of $750,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Non-Federal entities that expend less than $750,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in 2 CFR 200.503.
Records
Awardees are required to maintain proper records – including financial records, supporting documents, statistical records, and all other records pertinent to the program – for the duration of the award, and retain these for a minimum of three years. If any litigation, claim, negotiation, audit, or other action involving the award has been started before the expiration of the three years, the records should be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular three year period, whichever is later.
Other Assistance Considerations
Formula and Matching Requirements
This program has no statutory formula.
Matching requirements are not applicable to this program.
MOE requirements are not applicable to this program.
Length and Time Phasing of Assistance
The budget and project period for each Cooperative Agreement awarded will be 5 years from the date of award. The estimated project period for the first round of awards is September 01, 2016 – August 31, 2021. The grant period consists of five one-year budget periods. Please refer to 1. Executive Summary for periods of performance and budget.

Year one 12-month project and budget period: September 01, 2016 – August 31, 2017
Year two 12-month project and budget period: September 01, 2017 – August 31, 2018
Year three 12-month project and budget period: September 01, 2018 – August 31, 2019
Year four 12-month project and budget period: September 01, 2019 – August 31, 2020
Year five 12-month project and budget period: September 01, 2020 – August 31, 2021. See the following for information on how assistance is awarded/released: The grant period consists of five one-year budget periods. Please refer to 1. Executive Summary for periods of performance and budget.
Who do I contact about this opportunity?
Regional or Local Office
None. Chisara Asomugha (Chisara.Asomugha@cms.hhs.gov) Director, Division of Health Incentives and Infrastructure, Preventative and Population Health Care Models Group, CMMI.
Headquarters Office
Chisara Asomugha 7500 Security Blvd, MS WB-06-05
Baltimore, MD 21244
, Baltimore, Maryland 21244 Email: Chisara.Asomugha@cms.hhs.gov Phone: 410-786-8033
Website Address
http://www.innovation.cms.gov
Financial Information
Account Identification
75-0522-0-1-551.
Obligations
(Formula Grants) FY 14 $0; FY 15 est $0; and FY 16 est $55,700,000
Range and Average of Financial Assistance
The anticipated total funding per award, per budget period is $200,000 - $450,000.

The total amount of federal funds available is anticipated to be up to $12 million to 12 award recipients to implement Track 1—Awareness Intervention, $30.84 million to 12 award recipients to implement Track 2—Assistance Intervention, and $90.20 million to 20 award recipients to implement Track 3—Alignment Intervention.
Regulations, Guidelines and Literature
Cooperative agreements issued under this FOA are subject to the Health and Human Services Grants Policy Statement (HHS GPS) at http://www.hhs.gov/asfr/ogapa/aboutog/hhsgps107.pdf. The general terms and conditions in the HHS GPS will apply as indicated unless there are statutory, regulatory, or award-specific requirements to the contrary. Standard and program specific terms of award will accompany the NoA. Potential applicants 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 in the application by the CMS review panel. The recently released Uniform Guidance (2 CFR Part 200) and HHS regulations (45 CFR Part 75) supersedes information on administrative requirements, cost principles, and audit requirements for grants and cooperative agreements included in the current HHS Grants Policy Statement where differences are identified. Awardees must also agree to respond to requests from CMS that are necessary for the evaluation of national efforts and provide data on core elements of their own cooperative agreement activities.
Examples of Funded Projects
Not Applicable.

 



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