Analyses, Research and Studies to Address the Impact of CMS? Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries

To further CMS? mission and goals related to providing high quality health care to the American Indian/Alaska Native (AI/AN) community by providing research and analysis to increase the understanding of, access to, and impact of CMS? programs in Indian Country.



Congress authorized
AI/ANs to have access to Medicare and Medicaid services when provided through Indian Health Service (IHS) facilities located in tribal communities and amended titles XVIII and XIX of the Social Security Act to permit IHS facilities to bill Medicare and Medicaid for services provided to eligible AI/ANs.

This authority was later extended to tribal facilities.

Congress has also provided authority for Indian health care programs and beneficiaries to participate in the Children?s Health Insurance program and the Health Insurance Marketplace.


These changes have created a direct relationship between CMS and the Indian Health Service, The research conducted under this cooperative agreement is needed to help improve administration of CMS? programs given that CMS and IHS programs operate under different and sometimes competing authorities for CMS? programs, the Social Security Act and for IHS? programs, the Indian Health Care Improvement Act and the Indian Self Determination Education and Assistance Act, P.L.

93-638.

To make CMS? programs work with Indian health program authorities, a crucial first is step is for CMS to understand the impact of its policies on Indian health care providers and tribal members so that the agency can provide the AI/AN community greater access to CMS? programs in an effective and efficient manner.



The authority at Section 1110 of the Social Security Act permits CMS to enter into grants andcooperative arrangements with organizations and certain other entities in order to aid in improving administration and effectiveness of programs administered by the agency.

To this end, the work conducted under this cooperative agreement will address the potential and actual impacts of CMS? programs on AI/ANs and the health care system serving these beneficiaries.

CMS? understanding of the impact of its policies is vital to improving greater AI/AN access to and participation in CMS? programs; improving and ensuring that appropriate health care payments and resources are provided to IHS tribal, and urban Indian Health program providers; and contributing to overall improved health outcomes for Indian people.

The information and activities produced or provided under the cooperative agreement will be used to develop culturally appropriate activities and strategies to improve how CMS? program operate and are administered in Indian country.
Related Programs93.621 Affordable Care Act Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents

Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.

Office - See Regional Agency Offices.

Linda Gmeiner Grants Management Specialist Centers for Medicare & Medicaid Services Office of Acquisition and Grants Managemnet, AGG, DGM 7500 Security Boulevard, M/S B3-30-03 Baltimore, MD 21244-1850 410-786-9954 Linda.gmeiner@cms.hhs.gov.
Website Address

http://www.nihb.org




Selected Recipients for this Program


RecipientAmount Start DateEnd Date
National Indian Health Board $ 1,600,000   2017-09-292022-09-28
National Indian Health Board $ 3,950,000   2012-09-202018-09-19
$ 0   
$ 0   
$ 0   
$ 0   
$ 0   
$ 0   
$ 0   
$ 0   



Program Accomplishments

Not Applicable.

Uses and Use Restrictions

In recent years a number of statutory changes have been made to CMS? programs and regulations have been developing to implement those changes.

The assistance provided under this cooperative agreement will be used to: a) assess the ongoing impact of CMS? programs through an analysis of CMS regulations and CMS initiatives that have a potential impact or effect on IHS, Tribal and Urban Indian providers and AI/AN beneficiaries and use this information to monitor AI/AN participation in the CMS regulatory process to assess whether such participation contributes to the understanding of how CMS-related provisions in the Patient Protection and Affordable Care Act (ACA) impact the financing and delivery of health care in the Indian health care system; b) refine the inventory of AI/AN demographic, enrollment, and utilization data in order to develop strategies that make CMS data systems capable of reporting AI/AN enrollments, service utilization, health status and payment data from the Medicare, Medicaid and CHIP programs to facilitate program planning and evaluation, performance measurement, health status monitoring, and target enrollment efforts, identify gaps in data collection, propose and analyze approaches necessary to change and augment data collection systems and other information needed to support all reporting requirements under ACA, CHIPRA and ARRA, and propose reporting mechanisms and protocols for such reporting; c) update and revise the CMS Tribal Technical Advisory Group?s 2013-2018 Strategic Plan (which is used to guide the administration of CMS? programs in Indian county) to incorporate legislative and regulatory changes resulting from the ACA; and d) Provide research support on the use and effectiveness of the CMS tribal consultation policy so that the agency can be assured to get appropriate tribal input when developing policies that will have a substantial direct effect on tribes. (e) Evaluate the effectiveness of outreach and enrollment efforts to AI/AN beneficiaries in CMS programs by conducting training on the basics of CMS programs to enrollment assisters and Indian health provider third party resource staff, learning and sharing best practices to increase AI/AN enrollment, and developing AI/AN culturally appropriate outreach materials based on feedback from training and outreach efforts.

Provide quarterly reports summarizing outreach trainings and enrollment events, compilation of best practices utilized and lessons learned, and analysis of and recommendations to improve outreach efforts in Indian Country. Indirect Costs - If grantee requests indirect costs, an approved Indirect Cost Rate Agreement will be required to support those costs.

The provisions of OMB Ciruclar A-87 govern reimbursement of indirect costs under this funding opportunity announcement.

OMB Circulars are available on line at: http://www.whitehouse.ov/omb/circulars Direct Services - funds may not be used to provide individuals with services that are already funded through Medicare, Medicaid and/or CHIP.

These services do not include expenses budgeted for provider and/or consumer task force member participation in conferences, provision of technical assistance, or attendance at technical assistance conferences sponsored by CMS or its national technical assistance providers for the benefit of awardees. The applicant?s budget may not exceed a maximum funding level or project period of five years. Reimbursement of Pre-Award Costs?No funds awarded under this funding opportunity announcement may be used to reimburse pre-award costs. Other Prohibited Uses of Funds 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 application. To pay for construction or alteration and renovation of real property (A&R). To pay for information technology (IT) equipment exceeding 10 percent of the total award.

Any equipment, which includes IT, over $5,000 must be approved by CMS. To pay states for the use of any of their data made available for this initiative. Other limitations - A current recipient cannot be awarded a new, renewal, or competing continuation grant for any of the following reasons: The current project is not progressing in a satisfactory manner; The current project is not in compliance with program and financial reporting requirements; The applicant has an outstanding delinquent Federal debt; No award shall be made until the delinquent account is paid in full; or A negotiated repayment schedule is established nd at least one payment is received.

Indirect Costs - If grantee requests indirect costs, an approved Indirect Cost Rate Agreement will be required to support those costs.

The provisions of OMB Ciruclar A-87 govern reimbursement of indirect costs under this funding opportunity announcement.

OMB Circulars are available on line at: http://www.whitehouse.ov/omb/circulars Direct Services - funds may not be used to provide individuals with services that are already funded through Medicare, Medicaid and/or CHIP.

These services do not include expenses budgeted for provider and/or consumer task force member participation in conferences, provision of technical assistance, or attendance at technical assistance conferences sponsored by CMS or its national technical assistance providers for the benefit of awardees. The applicant?s budget may not exceed a maximum funding level or project period of five years. Reimbursement of Pre-Award Costs?No funds awarded under this funding opportunity announcement may be used to reimburse pre-award costs. Other Prohibited Uses of Funds 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 application. To pay for construction or alteration and renovation of real property (A&R). To pay for informaiton technology (IT) equipment exceeding 10 percent of the total award.

Any equipment, which includes IT, over $5,000 must be approved by CMS. To pay states for the use of any of their data made available for this initiative. Other limitations - A current recipient cannot be awarded a new, renewal, or competing continuation grant for any of the following reasons: The current project is not progressing in a satisfactory manner; The current project is not in compliance with program and financial reporting requirements; The applicant has an outstanding delinquent Federal debt; No award shall be made until the delinquent account is paid in full; or A negotiated repayment schedule is established nd at least one payment is received.

Eligibility Requirements

Applicant Eligibility

Eligibility is limited to the National indian Health Board, and this single source award was approved by the Chief Grants Management Officer.

NIHB meets the definition of ?tribal organization?under the Indian Health Care Improvement Act (IHCIA) 25 USC Section 1603(26), with significant historical experience in providing outreach and education and the provision of health care information for Indian Tribes and Tribal Organizations.

NIHB is a legally established organization controlled and governed by Indians and includes the maximum participation of Indians in all phases if its activities.

NIHB has 100 percent appointed or elected officers that comprise the Board of Directors.

NIHB acts in a supportive role to ensure the dissemination of health care education and information to tribes.

NIHB must submit a copy of the 501(c) (3) Non-profit Certifion as proof of non-profit status. Applicant must have an Employer Identification Number (EIN), otherwise known as a Taxpayer Identification Number (TIN), to apply.

Applicant must have a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number.

The DUNS number is a nine-digit identification number that uniquely identifies business entities.

To obtain a DUNS number, access the following website: http://www.dnb.com/ or call -866-705-5711.

This number should be entered in the block 8c (on the Form SF-424, Application for Federal Assistance).

The organization name and addressed entered in block 8a and 8c should be exactly as given for the DUNS number.

Applicant should obtain this DUNS number immediately to ensure all registration steps are completed in time. Applicant must also register in the Central Contractor Registration (CCR) database in order to be able to submit the application.

Applicant should begin the CCR registration process immediately to ensure that it does not impair ability to meet required submission deadlines.

Beneficiary Eligibility

The primary beneficiaries of this effort are American Indians and Alaska Natives who are eligible for CMS? programs to get them educated about and enrolled in CMS? programs, as appropriate, ensure that Indian health care providers can participate and are enrolled in CMS programs ,and to reduce health disparities in tribal communities. By enrolling in CMS? programs, AI/ANs benefit by having greater access to services that may not be provided by their local Indian health care providers, and tribal communities benefit through increased resources to their Indian health care programs. The Federal government will benefit by obtaining information to help make more informed policies which will improve administration of CMS? programs in tribal communities and therereby provide AI/ANs access to quality health care. Federally Recognized Indian Tribal Governments and Native American Organizations would benefit because they can provide information and insight to help CMS understand the tribal provider and tribal beneficiary perspective so that CMS can make informed policies decisions that would permit CMS? programs to be administered and operate effectively and efficiently in tribal communities and not conflict with legislative/regulatory authority under which the Indian Health Service programs operates.

Credentials/Documentation

NIHB must submit its 501c(3) Nonprofit Certification as proof of nonprofit status. 2 CFR 200, Subpart E - Cost Principles applies to this program.

Aplication and Award Process

Preapplication Coordination

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 Procedures

This program is excluded from coverage under 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. This program is excluded from coverage under 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. A complete application should consist of the following documents organized in the following sequence: Cover letter SF-424 Application for Federal Assistance SF-424A Budget Information A budget narrative not to exceed 15 single spaced pages Abstract of project A research project narrative that describes each of the five separate project objectives (the entire narrative not to exceed 40 single spaced pages) SF424B Assurances Health Board resolution 501(c)(3) Non-profit Certification Resumes for all key personnel Position descriptions Disclosure of lobbying activities (SFLLL) (if not applicable, then annotate the form) Copy of approved indirect cost (IDC) rate agreement (if applicable) Documentation of current OMB A-133 required financial audit (if applicable) Acceptable forms of documentation include: e-mail confirmation form Federal Audit Clearinghouse (FC) that audits were submitted; or Face sheets from audit reports. These can be found at: http://harvester.census.gov/sac/ or http://harvester.census.gov/sac/dissem/entity.html:submit=Ret urn+tp+Entity+Search Project Narrative: Separate Project Narratives are required for each of the five projects: Each narrative should be a separate Word document that does not exceed 8 pages with consecutively numbered pages If the individual project narrative exceeds the page limits noted above, only the first 8 pages will be reviewed. The total number for pages submitted should not exceed 40 pages?8 pages for each of the five projects. There are three parts to the narrative for each of the five projects: Part A?Program Information (1 page limitation) Section 1: Needs Part B ? Program Planning and Evaluation (6 page limitation); and Section I: Program Plans Section 2: Program Evaluation Part C?Program report. (1 page limitation) Section I: Describe major accomplishments over the last 24 months Section 2: Describe major activities over the last 24 months. Budget Narrative A separate budget narrative is required for each project. Each narrative must describe the budget amount(s) requested and match the corresponding scopes of work described in the project narrative. The total page limitation for the budget is three pages for each project for a total of 15 pages. The applicant should provide a detailed breakdown of the aggregate number for the budget recorded on standard form 424 (SF 424) ?application for Federal Assistance,? including allocations for each major set of activities or proposed tasks. The proposed budget justification must clearly describe each cost element in the related budget category. The budget must clearly identify what funds will be administered directly by the lead agency and what will be subcontracted to other partners. The designated lead agency is solely responsible for the fiscal management of the project. NIHB must supplement Budget Form SF424A with a Budget Narrative. The narrative must include a yearly breakdown of costs for the five-year grant period of performance. Specifically, the Budget Narrative should provide a detailed cost breakdown for each line item outlined in the SF 424A by year including a breakdown of costs for each activity/cost with the line item. The proportion of grant funding designed for each activity should be clearly outlined and justify the institutions readiness to receive funding through 2021 including complete explanations and justifications for the proposed grant activities. The budget must separate out funding that is administered directly by the awardee from any funding that will be subcontracted. The following budget categories should be addressed (as applicable): Personnel (Note: none of the funds shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II ($179,700) Fringe benefits Contractual costs, including subcontracts Equipment Supplies Travel Indirect charges, Indirect costs shall be supported by an approved Indirect cost rate agreement. Other costs, including those not otherwise associated with training and education. The Budget Narrative must outline the strategies and activities of the program, and provide cost breakdowns for any subcontracts that will be implemented to achieve anticipated outcomes. The Budget Narrative shall also clearly distinguish the funding source for any given activity/cost, as either Federal or Non-Federal. The applicant should pinpoint those costs funded through in ?kind contributions. Applicant must include detailed salary and fringe benefit costs for staff dedicated to the project through an in-kind contribution, to include yearly salary costs and the percentage of time dedicated to the project (for any given year). The total budget should include both direct and indirect costs, if applicable.

Award Procedures

The review process will include the following: NIHB?s application will be reviewed to determine eligibility using the criteria detailed in the funding opportunity announcement. An application that is received late or that fails to meet the eligibility requirements as detailed in the FOA or does not include the required forms will not be reviewed. An independent, objective review of the application will be conducted. The review panel will assess the application based on the review criteria to determine the merits of the application and the extent to which it furthers the purposes of the research program. The review panel comments and recommendations will be condensed into a summary statement that will assist CMS in making the award decision. CMS will use the information to judge the likelihood that the project will be successfully implemented and will have tangible, beneficial outcomes. The applicant will receive written notification of the award decision. An award will be made to the successful applicant on or before September 29, 2017. The successful applicant will receive an official Notice of Award (NOA) signed by the CMS Grants Management Officer, OAGM, that will set forth the amount of the award and other pertinent information, including any specific terms conditions of the award required for the fulfillment of the grant. The NOA is a legal document issued to notify the grantee that the award has been approved and that funds are now available for draw down from the HHS Payment Management System (PMS). Any communication between CMS and an awardee prior to issuance of the NOA is not an authorization to begin implementation of a project.

Deadlines

Contact the headquarters or regional office, as appropriate, for application deadlines.

Authorization

The Social Security Act, Section 1110, codified at 42 U.S.C., Section 1310. This authority permits the obligation of funding for CMS to enter into grants and cooperative arrangements with organizations and certain other entities in order to aid in improving the administration and effectiveness of programs carried out by the agency. For purposes of this award, CMS is accepting an application from the National Indian Health Board (NIHB) under a single-source cooperative agreement. Approval to award this cooperative agreement to NIHB under a single-source award was granted by the Chief Grants Management Officer, dated April 6, 2017.

Range of Approval/Disapproval Time

Contact headquarters for approval information.

Appeals

Not Applicable.

Renewals

Renewals for FY 2017-2021 will be provided each of these fiscal years based on the availability of funding and grantee?s acceptable performance.

Assistance Considerations

Formula and Matching Requirements

This program has no statutory formula. Matching Requirements: Section 1110 of the Social Security Act requires cost sharing by the applicant. To comply with this requirement, CMS requires that the applicant provide cost sharing equal to at least one percent (1%) of the amount of the award. This cost sharing requirement may be satisfied through in-kind contributions. This program does not have MOE requirements.

Length and Time Phasing of Assistance

N/A. Method of awarding/releasing assistance: quarterly.

Post Assistance Requirements

Reports

The grantee must submit the following required reports through the period of performance: 1) quarterly progress reports, 2) annual report, and 3) final report.

CMS will provide the format for these reports in the terms and conditions. Research and analysis of impact of CMS Regulations/Initiatives on the Indian health care system?quarterly and annual reports to summarize the impacts of the CMS-related regulations and initiatives on provision of health care in the I/T/U system and AI/AN beneficiaries. Data Research and Analysis Project-Prepare Medicare and Medicaid/CHIP annual reports that include: findings from the analysis of the Medicare, Medicaid, and CHIP data; identifies gaps in data collection; identifies shortcomings in system interactions; proposes CMS/IHS/SSA data interface protocols; and makes specific recommendations on additional data systems improvements.

No cash reports are required.

In order for CMS to monitor the grantee?s efforts toward reaching the goals of the grant program, the grantee must agree to provide CMS with information it may require to assess the functioning and effectiveness of the program and to ensure that the grant monies are expended for the purposes for which they were awarded.

The grantee must submit the following required reports through the period of performance: 1) quarterly progress reports, 2) annual report, and 3) final report.

CMS will provide the format for these reports in the terms and conditions.

Federal financial reporting-- submit the SF-425 Federal Financial Report on an annual, semi-annual, or quarterly basis.

More details are outlined in the Notice of award Terms and Conditions. Transparency Act Reporting Requirements? 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 surecipients?s five most highly compensated executives as outlined in Appendix A and 2 CFR Part 170 (on line at www.fsrs.gov ).

A performance report is required quarterly and annually.

Audits

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. Guidelines within OMB Circular No. A-133

Records

The recipient must maintain expenditures and other financial records detailing the use of cooperative agreement funds and the progress reports 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.

Financial Information

Account Identification

05-0101-2-0-141.

Obigations

(Cooperative Agreements (Discretionary Grants)) FY 16 $860,000; FY 17 est $800,000; and FY 18 est $800,000

Range and Average of Financial Assistance

FY 2014 - $635,000 FY 2015 - $635,000 FY 2016 - $860,000 Approximate average award -- $800,000.

Regulations, Guidelines, and Literature

Not Applicable.

Information Contacts

Regional or Local Office

See Regional Agency Offices. Linda Gmeiner Grants Management Specialist Centers for Medicare & Medicaid Services Office of Acquisition and Grants Managemnet, AGG, DGM 7500 Security Boulevard, M/S B3-30-03 Baltimore, MD 21244-1850 410-786-9954 Linda.gmeiner@cms.hhs.gov.

Headquarters Office

Linda Gmeiner 7500 Security Blvd. M/S B3-30-03, Baltimore, Maryland 21244 Email: Linda.gmeiner@cms.hhs.gov Phone: 410-786-9954

Criteria for Selecting Proposals

Application will be scored with at total of 100 points available. A minimum score of 90 points is required for funding. The following criteria will be used to evaluate the application received in response to the funding opportunity announcement. 1. Evaluation Criteria Part A: Program Information ? Addresses Needs (15 points) Part B: Program Planning and Evaluations? Addresses project objectives, workplan and consultants) Program Plans ? (40 points) Program Evaluation ? (20 points) Part C: Program Report -- Addresses organizational capabilities and qualifications (15 points) Budget Narrative -- (10 points) The instructions for preparing the application narrative also constitute the evaluation criteria for reviewing and scoring the application. Weights assigned to each section are noted in parentheses. Points will be assigned to each evaluation criteria totaling 100 points. The ten-page narrative should include only the first year of activities, and information for multi-year projects should be included as an appendix.



Social Entrepreneurship
Spotlight



Ethical Fashion Social Enterprise Empowers a Generation of African Women

Ethical Fashion Social Enterprise Empowers a Generation of African Women
Dsenyo, founded and designed by Marissa Perry Saints, seeks to help women and artisans working...



Social Services Jobs

  Social Work Jobs
  Foundation Related Jobs
  Education Jobs
  Social Services Employment
  Executive Director Jobs





More Federal Domestic Assistance Programs


Regional Innovation Clusters | Burial Expenses Allowance for Veterans | Teacher and School Leader Incentive Grants (formerly the Teacher Incentive Fund) | Pre-existing Condition Insurance Program (PCIP)  | Community Forest and Open Space Conservation Program (CFP) |  Site Style by YAML | Grants.gov | Grants | Grants News | Sitemap | Privacy Policy


Edited by: Michael Saunders

© 2004-2018 Copyright Michael Saunders