Health Care Innovation Awards (HCIA)
The first round of the Health Innovation Awards (HCIA), announced on November 14, 2011, was a broad solicitation in which CMS welcomed a wide variety of proposals. In HCIA, Round One, CMS funded 107 Awardees who proposed compelling new models of service delivery/ payment improvements that showed substantial promise of delivering the Three-Part Aim of better health, better health care, and lower costs through improved quality for Medicare, Medicaid, and Children?s Health Insurance Program (CHIP) beneficiaries. Successful models included plans to rapidly develop and/or deploy the requisite workforce to support the proposed model. Awards recognized interventions that showed capability to improve care within the first 6 months of the award, while creating a sustainable pathway to net Medicare/Medicaid/CHIP savings within two to three years. These models of service delivery and payment improvement are now entering Year Two of the three-year period of performance for Round One of the HCIA. A second round of the Health Care Innovation Awards (HCIA) was announced on May 15, 2013. In HCIA Round Two, the Center for Medicare & Medicaid Services (CMS) will fund applicants who propose new service delivery models and design corresponding new payment models that show promise of providing better health, better health care, and lower costs through improved quality for Medicare, Medicaid, and Children?s Health Insurance Program (CHIP) enrollees. In Round Two, CMS is specifically seeking new payment and service delivery models in four broad Innovation Categories, as follows: ? Models that are designed to rapidly reduce Medicare, Medicaid, and/or CHIP costs in outpatient and/or post-acute settings. Priority areas are diagnostic services, outpatient radiology, high-cost physician-administered drugs, home based services, therapeutic services, and post-acute services. While preference will be given to submissions within these priority areas, CMS will consider submissions in other outpatient and/or post-acute areas within this Category. ? Models that improve care for populations with specialized needs. Priority areas are high-cost pediatric populations, children in foster care, children at high risk for dental disease, adolescents in crisis, persons with Alzheimer?s disease, persons living with HIV/AIDS (in particular, efforts to link and retain patients in care and improve medication adherence that lead to viral suppression), persons requiring long-term support and services, and persons with serious behavioral health needs. While preference will be given to submissions within these areas, CMS will consider submissions that improve care for other populations with specialized needs. ? Models that test approaches for specific types of providers to transform their financial and clinical models. Priority areas are models designed for physician specialties and subspecialties (for example, oncology and cardiology), and for pediatric providers who provide services to children with complex medical issues (including but not limited to care for children with multiple medical conditions, behavioral health issues, congenital disease, chronic respiratory disease, and complex social issues); and that include, as appropriate, shared decision-making mechanisms to engage beneficiaries and their families and/or caregivers in treatment choices. While preference will be given to submissions within these areas, CMS will consider submissions in other areas within this Category and from other specific types of non-physician providers. ? Models that improve the health of populations ? defined geographically (health of a community), clinically (health of those with specific diseases), or by socioeconomic class ? through activities focused on engaging beneficiaries, prevention (for example, a diabetes prevention program or a hypertension prevention program), wellness, and comprehensive care that extend beyond the clinical service delivery setting. These models may include community based organizations or coalitions and may leverage community health improvement efforts. These models must have a direct link to improving the quality and reducing the costs of care for Medicare, Medicaid, and/or CHIP beneficiaries. Priority areas are: models that lead to better prevention and control of cardiovascular disease, hypertension, diabetes, chronic obstructive pulmonary disease, asthma, and HIV/AIDS; models that promote behaviors that reduce risk for chronic disease, including increased physical activity and improved nutrition; models that promote medication adherence and self-management skills; models that prevent falls among older adults; and broader models that link clinical care with community-based interventions. While preference will be given to submissions within these areas, CMS will consider submissions in other areas within this Category. These categories were identified as gaps in the current Innovation Center portfolio and as areas that could result in potentially usable models for changes in Medicare, Medicaid, and CHIP payment methods. This round of Innovation Awards encourages a strong focus on Medicaid and CHIP populations. In addition, models that primarily focus on acute hospital inpatient care are excluded from this round and will not be reviewed. (Hospitals are eligible to apply for awards if they propose a model within one of the four Innovation Categories described below.) In Round Two ? in contrast to the first round ? CMS specifically seeks new payment models to support the service delivery models funded by this initiative. Awardees will be required to implement the service delivery models at the start of the three-year cooperative agreement period and submit a fully developed new Medicare, Medicaid, or CHIP payment model by the end of the cooperative agreement period. Successful applicants will demonstrate that they can implement a model that improves quality of care and reduces cost within the first six months of the award and delivers net savings to CMS within three years. At its discretion and consistent with the requirements of Section 1115A of the Social Security Act, CMS may further develop one or more of these payment and service delivery models and open them to participation through a subsequent solicitation. Do not rely on this Catalog of Federal Domestic Assistance announcement for complete and precise answers about the Health Care Innovation Awards. The final authority on all matters, including but not limited to application procedures, format of proposals, deadlines, criteria, eligibility, model test requirements, and the nature of the Funding Opportunity, is the appropriate Funding Opportunity Announcement itself, either for Round One or Round Two of the Health Care Innovation Awards. For specific details about Round Two of the initiative, see the Funding Opportunity Announcement at https://www.grantsolutions.gov/gs/preaward/previewPublicAnnouncement.do?id=17996.
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; Z - Salaries and Expenses
Section 1115A of the Social Security Act (added by Section 3021 of the Affordable Care Act)
Who is eligible to apply/benefit from this assistance?
Round One of HCIA sought to attract a wide variety of health care innovators and organizations, including: provider groups, health systems, payers and other private sector organizations, faith-based organizations, local governments, and public-private partnerships. In addition, certain organizations (such as professional associations) were eligible to apply as conveners assembling and coordinating the efforts of a group of participants. Conveners could serve as facilitators or could be direct award recipients. States were not eligible to apply to HCIA Round One. HCIA Round Two seeks to engage with a wide variety of innovators. Welcome to apply are interested parties that meet the eligibility requirements specified in the Funding Opportunity Announcement, have developed innovations that will drive significant improvement in population health, quality of care, and total cost of care, and can create a clear pathway to an alternate payment model based on their innovation. Examples of the types of organizations expected to apply are: provider groups, health systems, payers and other private sector organizations, faith-based organizations, state and/or local governments, territories or possessions, academic institutions, research organizations, public-private partnerships, and for-profit organizations. By "state," we refer to the definition provided under 45 CFR 74.2 as "any of the several States of the U.S., the District of Columbia, the Commonwealth of Puerto Rico, (or) any territory or possession of the U.S." By "territory or possession," we mean Guam, the U.S. Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands. In addition, certain organizations may apply as conveners that assemble and coordinate the efforts of a group of participants. Unsuccessful applicants from prior CMS funding competitions are eligible to apply. Technology-based models need to reflect the actual use, not the development, of a product in a broader service delivery or payment model. For specific details on eligibility, see the Funding Opportunity Announcement at https://www.grantsolutions.gov/gs/preaward/previewPublicAnnouncement.do?id=17996.
The Health Care Innovation Awards initiative will fund applicants who propose the most compelling new service delivery and payment models that will drive system transformation and deliver better outcomes for Medicare, Medicaid, and CHIP beneficiaries. Proposals should be focused on innovative approaches to improving health and lowering costs for high risk/high opportunity populations, including Medicare, Medicaid, and CHIP beneficiaries. In Round Two, proposals should focus, in particular, on beneficiary care and payment in the four Innovation Categories described under the heading, "Objectives (050)," above. Round Two of the Innovation Awards encourages a strong focus on Medicaid and CHIP populations. However, CMS recognizes that in order for providers to have meaningful incentives to change their service delivery models they must engage multiple payers. Therefore, applications must include a feasible approach for securing participation of multiple payers for their proposed models. This could include demonstrable commitments from current payer partners, current contracts, letters of support or commitment from private insurers, state governments, or local governments. Preference will be given to applications that include participation by non-CMS payers at the outset of the model's implementation. Funding from CMS can only be used to provide care for beneficiaries of Medicare, Medicaid, and CHIP. For specific details, see the Funding Opportunity Announcement at https://www.grantsolutions.gov/gs/preaward/previewPublicAnnouncement.do?id=17996.
Applicants should review the solicitation criteria to determine the required documentation. OMB Circular No. A-87 applies to this program.
What is the process for applying and being award this assistance?
Preapplication coordination is not applicable.
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. For HCIA Round Two, Letters of Intent to Apply must be received by 3:00 pm Eastern Daylight Time on June 28, 2013. Failure to submit a Letter of Intent to Apply will disqualify the application from that organization from being reviewed. The information specified for the Letter of Intent to Apply must be provided through an online form. In addition to required Standard Forms, as described in the Funding Opportunity Announcement, applications for HCIA Round Two should include a Cover Letter (to be enclosed with the project narrative), a Project Abstract, and a Project Narrative that includes the following sections: o Model Design. o Organizational Capacity. o Return on Investment, which should include a Financial Plan signed by the chief financial officer of the applicant organization, a Model Sustainability Plan, and if $10 million or more is requested an Actuarial Review. Applicants requesting less than $10 million are encouraged but not required to submit an external actuarial review. o Monitoring, Reporting, and Evaluation. o Funding and Sustainability, including a Budget Narrative that gives a yearly breakdown of costs for the 3-year model period. o Supplementary Materials, including an Operational Plan, an Executive Overview, and documentation related to financial projections, profiles of participating organizations, relevant letters of endorsement, etc. For more detail about application requirements, including required registrations and the format, size, structure, and content of the application package, consult the Funding Opportunity Announcement, available online at https://www.grantsolutions.gov/gs/preaward/previewPublicAnnouncement.do?id=17996.
There are a number of differences between the criteria and review processes for Round One and Round Two of the HCIA. In Round One, the Innovation Center made 107 awards ranging from approximately $1 million to $26.5 million for a three-year period. Cooperative agreements were awarded with consideration to: (1) available funding; (2) geographic diversity; and (3) the quality of each application and the ability to meet the goals of the project. In the first round, less than 5% percent of applications were funded. Profiles of Awardees are available on the CMS website at http://innovation.cms.gov/ The CMS Innovation Center announced cooperative agreements for Round One of HCIA in two batches, with the first batch of awardees for Round One of HCIA announced on May 8, 2012 and the second (final) batch for Round One announced on June 15, 2012. Applications in Round One were scored with a total of 100 points available. The following criteria were used to evaluate Round One applications received in response to this solicitation. Round One Criteria Design of Project (30 points) Organizational Capacity and Management Plan (25 points) Workforce Goals (15 points) Budget, Budget Narrative, Financial Plan and Sustainability (20 points) Evaluation and Reporting (10 points) In Round Two, 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. Round Two Criteria Design of Proposed Model (25 points) Organizational Capacity and Management Plan (25 points) Return on Investment (20 points) Budget, Budget Narrative, and Model Sustainability (20 points) Monitoring and Reporting (10 points) For specific details about criteria for evaluation being used for Round Two of the initiative, see the Funding Opportunity Announcement at https://www.grantsolutions.gov/gs/preaward/previewPublicAnnouncement.do?id=17996. Review Process: A team consisting of HHS staff from outside CMMI and other outside experts will review all eligible applications. The review process will include the following steps: o Prior to submission of the application to the review panel, a preliminary eligibility screen will be conducted by CMS staff or CMS contractors to ensure that the technical requirements of the application are met. o Applications will be screened again to determine eligibility for further review using criteria detailed in this solicitation and in applicable law, including 2 CFR Parts 180 and 376. o The review panel will assess each application to determine the merits of the proposal and the extent to which the proposed model furthers the purposes of Health Care Innovation Awards Round Two. Reviewers will award points in each area to determine scores. CMS reserves the right to request that applicants revise or otherwise modify their proposals and budget based on the recommendations of the panel. o Concurrently, the CMS Office of the Actuary will assist the GMO in review of the reasonableness of the estimated cost to the government, and will review the potential for federal savings. This review will be one of the criteria for the CMS Approving Official to consider during the application review process. The CMS Approving Official may utilize information provided by the CMS Actuary's assessment of applicants' potential for savings in determining award recipients. 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, guided by recommendations of the review panel and by programmatic concerns. CMS intends to fund models in communities with a wide variety of geographic and socio- economic characteristics, including underserved urban and rural areas. CMS reserves the right to approve or deny any or all proposals for funding. Note that section 1115A of the Social Security Act states that there is no administrative or judicial review under sections 1869 or 1878 of the Act for the selection of organizations, sites, or participants to test models under section 1115A of the Act. Interviews may be conducted with applicants prior to selection in order to clarify Application and Submission Information as needed. CMS reserves the right to request that applicants revise or otherwise modify their proposals and budget based on the recommendations of the panel and the review of the CMS Approving Official. Successful applicants will receive one cooperative agreement award issued under this announcement. Unsuccessful applicants may request reviewer's comments. For specific details about the Review Process for Round Two of the initiative, see the Funding Opportunity Announcement at https://www.grantsolutions.gov/gs/preaward/previewPublicAnnouncement.do?id=17996. The Announcement and Award dates for Round Two are: Funding Opportunity Announcement: May 15, 2013 Anticipated Awardee Announcements: Phase 1 - January 15, 2014; Phase 2 - January 31, 2014 Anticipated Notice of Cooperative Agreement Award: Phase 1 and Phase 2 - February 28, 2014 Award Notices for Round Two of the HCIA: The Authorized Official of successful applicants will receive an electronic 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, and may also include additional specific cooperative agreement terms and conditions. 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 review panel. The NoA is the legal document issued to notify the awardee that an award has been made and that funds may be requested from the HHS payment system. Any communication between CMS and awardees prior to issuance of the NoA is not an authorization to begin performance of a model. Unsuccessful applicants will be notified by letter, sent through the U.S. Postal Service to the applicant organization as listed on its SF 424, within 30 days of announcement of Notices of Award. The award procedures for Round Two are revised versions of those stipulated for Round One. For more details, see the Funding Opportunity Announcement at https://www.grantsolutions.gov/gs/preaward/previewPublicAnnouncement.do?id=17996.
June 28, 2013 to August 15, 2013 The deadlines for Round One were: Required Letter of Intent was due: December 19, 2011. Proposals for Round One were due: January 27, 2012. The deadlines for Round Two are: Required Letter of Intent Due Date: June 28, 2013, by 3:00 p.m. Eastern Daylight Time Application Due Date: August 15, 2013, by 3:00 p.m. Eastern Daylight Time.
Approval/Disapproval Decision Time
For Round One: The CMS Innovation Center announced cooperative agreements for Round One of HCIA in two batches, with the first batch of awardees for Round One of HCIA announced on May 8, 2012 and the second (final) batch for Round One announced on June 15, 2012. For Round Two: Anticipated Notice of Cooperative Agreement Award: Phase 1 and Phase 2 - February 28, 2014
CMS reserves the right to approve or deny any or all proposals for funding. Note that section 3021 of the Affordable Care Act establishes title XI, section 1115A of the Social Security Act, which creates the Center for Medicare and Medicaid Innovations (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.
How are proposals selected?
See Award Procedures (093) Above
How may assistance be used?
The funds shall be used to implement models that support system transformation toward higher quality care at lower costs, and to plan and develop complementary payment models. Award dollars may be used for specific components, devices, equipment, software, analytical tools, or personnel provided that are integrated into the service delivery and payment model. Award dollars cannot be used to make permanent improvements to property not owned by the federal government; minor alterations and renovations are permissible under certain circumstances that will be described in the Financial Plan template (to be provided on or about June 14, 2013 on the Innovation Center website at http://innovation.cms.gov). CMS will not fund proposals that duplicate models that CMS is currently testing in other initiatives (see Section I.4) or other proposals being investigated elsewhere in HHS. CMS will not fund the provision of services to non-CMS beneficiaries. CMS will not fund applicants that cannot monitor, self-evaluate, and report on the progress and impact of their model in a timely manner. In Round Two, CMS will not fund models that focus primarily on acute hospital inpatient care.
All equipment, staff, other budgeted resources, and expenses must be used exclusively for the project identified in the awardee’s original cooperative agreement application or agreed upon subsequently with HHS, and may not be used for any prohibited uses.
Award dollars cannot be used
• For specific components, devices, equipment, software, or personnel that are not integrated into the entire service delivery and payment model proposal.
• 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 entire service delivery and payment model proposal. Award dollars cannot be used for specific components, devices, equipment, or personnel that are not integrated into the entire service delivery and payment model proposal. CMS will not fund proposals that replicate models that CMS is currently testing in other initiatives. Finally, given the breadth of models that could be submitted, CMS will not fund proposals that cannot monitor, evaluate, and report on the progress and impact of their program in a timely manner.
Funding Restrictions – Indirect Costs
• Indirect costs will be capped at 20% or the applicant’s Federally negotiated indirect cost rate or the applicant’s provisional rate, whichever of these is lowest. Applicants may elect to waive their Federally negotiated indirect cost rate. If requesting indirect costs, a Federally negotiated Indirect Cost Rate Agreement will be required.
Funding Restrictions – Direct Services
• Cooperative Agreement funds may not be used to provide individuals with services that are already funded through Medicare, Medicaid and/or CHIP. In compliance with the OMB Circulars, which define allowed cost, funding from the Innovation Center may not supplant funding for services that are currently authorized through the Medicaid State Plan. This also applies to funding provided through waivers or other grants, including federal grants. Travel or participation in conferences may require CMS approval.
Funding Restrictions – Reimbursement of Pre-Award Costs
• No cooperative agreement funds awarded under this solicitation may be used to reimburse pre-award costs.
The following standard requirements apply to applications and awards under this FOA:
• Specific administrative requirements, as outlined in 2 CFR Part 225 and 45 CFR Part 92, apply to cooperative agreement awarded under this announcement.
• All awardees under this project must comply with all applicable Federal statutes relating to nondiscrimination including, but not limited to:
o Title VI of the Civil Rights Act of 1964,
o Section 504 of the Rehabilitation Act of 1973,
o The Age Discrimination Act of 1975,
o Hill-Burton Community Service nondiscrimination provisions, and
o Title II Subtitle A of the Americans with Disabilities Act of 1990.
What are the requirements after being awarded this opportunity?
CMS plans to collect data elements to be part of monitoring for all of the different models, and these monitoring and surveillance elements will feed into the evaluation. All awardees will be required to cooperate in providing the necessary data elements to CMS or a CMS contractor. 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 program, 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 program model. Data for monitoring will be collected both from awardees and or CMS claims data sources. The program monitoring aspect of this initiative will balance the examination of the extent to which awardees demonstrate fidelity to their proposed models of care and the potential need to make mid-course corrections that improve the models of care based on feedback from the monitoring and evaluation findings. Moreover, the evaluation will assess whether there is evidence of harm or unintended consequences as a result of the intervention.
See "Reports (111)" above.
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
For Round One, the anticipated period of performance for the 3-year project period is July 1, 2012 through June 30, 2015. For Round Two, the anticipated period of performance for the 3-year model period is April 1, 2014 to March 31, 2017. The budget period is 12 months. Awards will be made through Cooperative Agreements.
Who do I contact about this opportunity?
Regional or Local Office
All programmatic questions about the Health Care Innovation Awards Round Two must be directed to the initiative email address: InnovationAwards@cms.hhs.gov. Responses to Frequently Asked Questions will be posted on http://innovation.cms.gov
7500 Security Blvd.
Baltimore, MD 21207 US
(Salaries and Expenses) FY 18$0.00; FY 19 est $0.00; FY 20 est $0.00; FY 17$26,715,516.00; FY 16$119,108,914.00; -
Range and Average of Financial Assistance
In Round Two of the Health Care Innovation Awards, the Innovation Center expects to make up to $900 million in funding available to support a diverse portfolio of new and innovative payment and service delivery models that will reduce the cost of health care and improve its quality in Medicare, Medicaid, and/or CHIP. CMS intends to fund the best qualified applications within the scope of available funds. CMS estimates that there will be approximately 100 awards, with a range of approximately $1 million to $30 million per award; however CMS is not obligated to fund a minimum number of applicants, or to distribute a minimum amount of funds available for the second round of Health Care Innovation Awards. Cooperative agreements will be awarded with consideration to the criteria listed above under Award Procedure (093). Awardees might not receive the award amount requested and might be asked to adjust the service delivery model, payment model, work plan, budget, or other application deliverable. For specific details, see the Funding Opportunity Announcement at https://www.grantsolutions.gov/gs/preaward/previewPublicAnnouncement.do?id=17996. In Round One, the Innovation Center made 107 awards ranging from approximately $1 million to $26.5 million for a three-year period. Cooperative agreements were awarded with consideration to: (1) available funding; (2) geographic diversity; and (3) the quality of each application and the ability to meet the goals of the project. In the first round, less than 5% percent of applications were funded. Profiles of Awardees are available on the CMS website at http://innovation.cms.gov/
Regulations, Guidelines and Literature
Examples of Funded Projects