Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges
The Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges (Funding Opportunity) will enable recipients to operate as Exchange Navigators in States with a Federally-facilitated Exchange (FFE), as authorized by the Patient Protection and Affordable Care Act (PPACA). Section 1311(i) of the PPACA requires Exchanges to establish a Navigator grant program. . The following duties are required of all recipients of funding under this Funding Opportunity, including but are not limited to: ? Conducting public education activities to raise awareness about the Exchange; ? Facilitating selection of a QHP; ? Providing information in a manner that is culturally and linguistically appropriate to the needs of the population served by the Exchange, including individuals with limited English proficiency, and ensuring accessibility and usability of Navigator tools and functions for individuals with disabilities; ? Providing referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under section 2793 of the Public Health Service Act, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; ? Complying with applicable training and conflict of interest standards; ? Obtaining the authorization of applicants for coverage available through an Exchange application prior to accessing their personally identifiable information; and ? Providing targeted assistance to serve underserved or vulnerable populations, as identified by the Exchange, within the Exchange service area. Change: The Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2020 Final Rule6 amended 45 C.F.R. ? 155.210(e)(9), effective June 24, 2019, to make the provision of certain types of assistance, including post-enrollment assistance, permissible for FFE Navigators instead of required. Accordingly, beginning with Navigator grants awarded through this Funding Opportunity, Navigators in FFEs may opt to continue providing the types of assistance listed at ? 155.210(e)(9), but will now have the flexibility to better prioritize their work according to consumer demand, community needs, and organizational resources.
General information about this opportunity
Last Known Status
Centers For Medicare and Medicaid Services, Department of Health and Human Services
Type(s) of Assistance Offered
B - Project Grants
Patient Protection and Affordable Care Act §§ 1311(d)(4)(K), 1311(i), and 1321(c)(1); 45 C.F.R. §§ 155.210 and 155.215.
Who is eligible to apply/benefit from this assistance?
Under section 1311(i)(2)(B) of the PPACA, eligible entities may include, but are not limited to, trade, industry and professional associations; commercial fishing industry organizations; ranching and farming organizations; community and consumer-focused nonprofit groups; and other entities capable of meeting program requirements. Eligible applicants may choose to partner with other entities and/or individuals to form a consortium of subrecipients in order to target a larger total portion of the "left behind" population. Funding through the cooperative agreement is open to individuals and private and public entities capable of carrying out the Navigator duties and other program requirements in a FFE, as outlined in statute, regulations, and this announcement, including community and consumer-focused nonprofit groups; faith-based organizations; trade, industry and professional associations; commercial fishing industry organizations; ranching and farming organizations; chambers of commerce; unions; resource partners of the Small Business Administration; licensed insurance agents and brokers; and other public or private entities. Other entities may include, but are not limited to, Indian Tribes, tribal organizations, urban Indian organizations, and State or local human services.
The following list, includes but is not limited to, the varying types of beneficiaries served under this cooperative agreement: Individual/Family, Minority group, Specialized group (e.g., LGBT, health professionals, students, veterans), Small business, Anyone/general public, Small Business Person, Black, American Indian, Spanish Origin, Other Non-White, Migrant, Immigrants, U.S. Citizen, Women, Disabled (e.g. Deaf, Blind, Physically Disabled), Physically Afflicted (e.g. TB, Arthritis, Heart Disease), Mentally Disabled, Unemployed, Low Income, Major Metropolis (over 250,000), Other Urban, Suburban, Rural.
All of the instructions that an eligible applicant must follow to apply for the Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges (Funding Opportunity) are published on https://www.grants.gov. Consistent with 45 C.F.R. SS 155.215(a)(1)(i), all applicants (individuals, entities, and all members making up a consortium) should submit a brief statement (one or two short paragraphs) within the Cover Letter attesting that they, as Navigator cooperative agreement applicants, are not ineligible entities, and include attestations that all other Navigator entities (including subrecipients and contractors performing Navigator duties, the Navigator(s) including the Navigator's staff), do not have any of the prohibited relationships with health insurance or stop loss insurance issuers that are outlined above. As is explained in 45 C.F.R. SS 155.215 and the preamble language discussing that provision, some conflicts of interest (other than the prohibited relationships outlined above) would not be absolute bars to service as a Navigator, provided that the conflict of interest would not ultimately prevent the entity or individual from providing information and services in a fair, accurate, and impartial manner. In addition, in accordance with 45 C.F.R. SS 155.215(a)(1)(ii) and in compliance with the Standard Terms and Conditions that will be included in a Notice of Award, all successful applicants will be required to provide a written plan to remain free of conflicts of interest and to disclose to CMS, as operator of the FFE, certain non-disqualifying conflicts of interest as specified in 45 C.F.R. SS 155.215(a)(1)(iv). This award is subject to 45 C.F.R. Part 75, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS awards, which implements 2 C.F.R. Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards ("Uniform Guidance") effective December 26, 2014.
What is the process for applying and being award this assistance?
Preapplication coordination is required. N/A
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. All of the instructions that an eligible applicant must follow to apply for the Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges (Funding Opportunity) are published on https://www.grants.gov. The information provided in this resource is only intended to highlight key steps in the federal grant and/or cooperative agreement submission process for individuals and entities who are new to or with limited experience applying for them. It is not intended to take the place of the requirements, information, statutes, regulations, and other guidance in the Funding Opportunity that it is based upon. 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://www.sam.gov/portal/public/SAM/) to be able to submit an application at grants.gov (See Appendix II of the Funding Opportunity, Application and Submission Information, for descriptions of EIN, DUNS, and SAM).
Successful applicants will receive a Notice of Award (NoA) signed and dated by the HHS Grants Management Officer. The NoA is the document authorizing the cooperative agreement award and will be issued to the applicant as listed on the SF-424 and available to the organization through the online grants management system used by CMS and awardee organizations. Any communication between HHS and applicants prior to issuance of the NoA is not an authorization to begin performance of a project. Unsuccessful applicants will be notified by letter, sent electronically or through the U.S. Postal Service to the applicant as listed on its SF-424, within 30 days of the award date.
The deadline for applying and other related timelines are included in Section D. Application and Submission Information of the Funding Opportunity posted on www.grants.gov.
Approval/Disapproval Decision Time
Anticipated Notice of Awards is August 29, 2019
How are proposals selected?
For detailed information on the review and selection process, please refer to Appendix V, Review and Selection Process of the Funding Opportunity. o Applications will be screened to determine initial eligibility for further review using the criteria outlined in Section C. Eligibility Information, and Section D. Application and Submission Information (with cross reference to Appendix II, Application and Submission Information), of this Funding Opportunity. o An objective review panel will be convened to determine the merits of each application by reviewing and scoring the applications based on the criteria outlined in Section E1. Criteria. The objective review panel may include both Federal employees and non-Federal employees. CMS reserves the right to request that applicants revise or otherwise modify their proposals and budget based on CMS recommendations. o The objective review, the selection and award process may be separated into two stages. When making awards during both stages of the selection and award process discussed above, HHS reserves the right to reduce the budget requested, or only partially fund proposed activities, or not at all, based on the aforementioned criteria. o The results of the objective review of the applications by qualified experts will be used to advise the CMS approving official. Final award decisions will be made by the CMS approving official. o The decision not to award a cooperative agreement, or to award a cooperative agreement at a particular funding level, is not subject to an appeal to any CMS, HHS, or any other federal official or board.
How may assistance be used?
When Exchanges were in their infancy, and public awareness and understanding of coverage options was low, the U.S. Department of Health and Human Services (HHS) encouraged Navigators to cast a wide net and to provide intensive face-to-face assistance to consumers. The FFEs have been in operation since 2013 for the 2014 open enrollment period, and the public is more aware of the options for private coverage available through them. Certified application counselors, direct enrollment partners, and Exchange-registered agents and brokers serve as additional resources to consumers. Beginning in 2018, the Navigator program was scaled down to reflect the enhanced public awareness of health coverage through the Exchanges and increased roles for private sector partners, including issuers and licensed health insurance agents and brokers, in serving consumers. Even as the FFE Navigators’ role evolves, awarded entities must still carry out the required statutory Navigator duties and the additional requirements laid out in Sections B. Award Information and E. Application Review Information of the corresponding Funding Opportunity posted on www.grants.gov.
What are the requirements after being awarded this opportunity?
Awardees must agree to cooperate with any Federal evaluation of the program and must provide required weekly, monthly, quarterly, and final (at the end of the cooperative agreement period) reports in a form prescribed by CMS.
Awardees must comply with audit requirements outlined in HHS regulation 45 C.F.R. Part 75 (implementing 2 C.F.R. Part 200). See Subpart F - Audit Requirements of the Funding Opportunity.
Recipient must maintain expenditures and other financial records detailing the use of cooperative agreement funds for three years from the day on which the grantee submits the last financial status report for the grant period unless there is an open investigation in which case the records must be maintained during the duration of the investigation. Recipient should submit these reports to CMS on a quarterly basis along with their quarterly progress reports.
Other Assistance Considerations
Formula and Matching Requirements
Statutory formula is not applicable to this assistance listing.
Matching requirements are not applicable to this assistance listing.
MOE requirements are not applicable to this assistance listing.
Length and Time Phasing of Assistance
Project period is 24 months from the notice of award. Funding will be awarded in 12 month increments based on funding availability. Continued funding throughout the 24-month period of performance will be contingent on a timely submission of a non-competing continuation application 90 days prior to the start of the second year of the period of performance, strong performance during the first budget period, funding availability, and the awardee’s ability to continue meeting all eligibility requirements laid out in this Funding Opportunity, including continuing to serve in a state(s) with a FFE. • Once an award is made, the funds are posted in recipient accounts established in the Department of Health and Human Services, Division of Payment Management, Payment Management System (PMS). Grantees may then access their funds by using the PMS funds request process. Upon notification of award, recipients under this announcement will be able to drawdown funds for approved start-up costs. The remaining funds will be reimbursable upon meeting required milestones.
Who do I contact about this opportunity?
Regional or Local Office
Programmatic Questions: Navigatorgrants@cms.hhs.gov Administrative Questions: Grants@cms.hhs.gov
7501 Wisconsin Avenue
Bethesda, MD 20814 US
(Cooperative Agreements) FY 18$10,000,000.00; FY 19 est $10,000,000.00; FY 20 est $10,000,000.00; FY 17$36,108,220.00; FY 16$643,000,000.00; -
Range and Average of Financial Assistance
Current Fiscal Year: 2019 Projection: up to $10,000,000
Regulations, Guidelines and Literature
For a complete list of requirements, please see Section F2. Administrative and National Policy Requirements of the Funding Opportunity. o All equipment, staff, and other budgeted resources and expenses must be used exclusively for the projects identified in the Applicant's original cooperative agreement application or agreed upon subsequently with HHS, and may not be used for any prohibited uses. o Consumers and other stakeholders must have meaningful input into the planning, implementation, and evaluation of the project. o This award is subject to 45 C.F.R. Part 75, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS awards [available at https://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75], which implements 2 C.F.R. Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards ("Uniform Guidance") effective December 26, 2014. See below for more information. All awardees receiving awards under this cooperative agreement program must comply with all applicable Federal statutes relating to nondiscrimination, including, but not limited to: a. Title VI of the Civil Rights Act of 1964, b. Section 504 of the Rehabilitation Act of 1973, c. The Age Discrimination Act of 1975, d. Title II, Subtitle A of the Americans with Disabilities Act of 1990, and e. Section 1557 of the Patient Protection and Affordable Care Act.
Examples of Funded Projects