Health Care Innovation Awards - Round Two Frequently Asked Questions

The frequently asked questions listed below are only applicable to the Health Care Innovation Awards Round Two Funding Opportunity Announcement (FOA).

 

On this page:

• Overview
• State Innovation Models Initiative relation
• Letter of Intent
• Applicant Eligibility
• Project Design, Scope and Restrictions
• Selection Process and Funding Questions
• Data and Technical Assistance

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Overview

What kinds of project proposals will the Health Care Innovation Awards Round Two fund?

Proposals should be focused on innovative approaches to improving health and lowering costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries. Projects should propose payment and service delivery models that aim to achieve better care for patients, better health for our communities, and lower costs through improvement for our health care system. The Centers for Medicare and Medicaid Services (CMS) is specifically seeking new payment and service delivery models in four broad Innovation Categories listed below:

1. 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.
2. 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 and adherence that lead to viral suppression), persons requiring long-term services and supports, 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.
3. 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.
4. 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.

For more information about the kinds of proposals being solicited by the Health Care Innovation Awards, please refer to the Funding Opportunity Announcement (FOA) (PDF).

 

Is the Center for Medicare and Medicaid Innovation planning any subsequent rounds of funding for the Health Care Innovation Awards?

No further rounds of the Health Care Innovation Awards have been announced at this time.

 

How quickly do awarded projects need to be operational?

Proposed models should be capable of rapid implementation. Awardees will be expected to complete the infrastructure and capacity related activities within six months of the award and start improving care as rapidly as possible. Preference will be given to models that can implement their care improvement activities faster than at six months.

 

What are the primary differences between the first round and second round of the Health Care Innovation Awards funding opportunities?

The first round of the Health Care Innovation Awards was a broad solicitation in CMS welcomed a broad range of proposals. In this second round, CMS is seeking to test new models in four categories:  models that will rapidly reduce costs for Medicare, Medicaid, and CHIP in outpatient settings; models that improve care for populations with specialized needs; financial and clinical models for specific types of providers and suppliers; and models that link clinical care delivery to preventative and population health.

 

What does it mean that “the Centers for Medicare & Medicaid Services (CMS) at its discretion and consistent with the requirements of Section 1115A of the Social Security Act, may further develop one or more of these payment and service delivery models and open them to participation through a subsequent solicitation?”  Can you please clarify what this may entail?

Section 1115A of the Social Security Act (added by Section 3021 of the Affordable Care Act) authorizes the Center for Medicare and Medicaid Innovation to test innovative health care payment and service delivery models that have the potential to lower Medicare, Medicaid, and CHIP spending while maintaining or improving the quality of beneficiaries’ care. Under the statute, models must address defined populations for which there are deficits in care leading to poor clinical outcomes or potentially avoidable expenditures. The Secretary of Health and Human Services (HHS) may expand the scope and duration of payment and service delivery models, including implementation on a nationwide basis.

 

State Innovation Models Initiative relation

How does Health Care Innovation Awards Round Two relate to the State Innovation Models Initiative? Is Health Care Innovation Awards Round Two an alternative to the State Innovation Models or is it complementary?

Health Care Innovation Awards Round Two is complementary to the State Innovation Models initiative. The State Innovation Models encompass broad statewide efforts to create multi-payer service delivery and payment reform with the goal of transforming a preponderance of care in the state to provide value based payment and service delivery models, with strong linkages to public health. Health Care Innovation Awards Round Two is a more focused initiative to identify new payment and service delivery models for Medicare, Medicaid, and CHIP enrollees. The Health Care Innovation Awards Round Two solicits proposals that are designed for models that do not primarily focus on acute hospital inpatient care, and are limited to the following four specific innovation categories: rapidly reducing Medicare, Medicaid, and/or CHIP costs in outpatient and/or post-acute care settings; improving care for populations with specialized needs; testing approaches for specific types of providers to transform their financial and clinical models; and improving the health of populations.

 

Should states speed up their State Innovation Models Initiative work to ensure that they have an innovation award application ready by the Health Care Innovation Awards Round two mid-August deadline for applications?

No, the State Innovation Models Initiative is on a different schedule and differs in its focus.

 

Can State Innovation Models Model Design, Pretest, and Test states apply to Health Care Innovation Awards Round Two?

Yes, although Health Care Innovation Awards Round Two proposals must be different than the state’s State Innovation Models proposal and should not be duplicative of other CMS or HHS activities.

 

Can states apply for Health Care Innovation Awards Round Two and also apply for a second round State Innovation Models Test Award?

Yes.

 

Letters of Intent

When is the Letter of Intent due?

The mandatory, non-binding Letter of Intent (LOI) is due by 3:00 pm EDT on Friday, June 28, 2013.

 

Is the Letter of Intent absolutely required in order to submit an application?

Yes, the Letter of Intent is required and must be received by the published deadline; otherwise you will not be able to submit an application.

 

What information is needed in the Letter of Intent?

The Letter of Intent is a web-based form that is available through the Health Care Innovation Awards page on our website. You will need to provide your contact information, an overview of your project, the innovation category that it best fits into, and information about the population that will be served by the project.

 

Do we need to submit forms like the SF 425 for the Letter of Intent (LOI)?

No. The SF 425 is a financial status report. It is not required for the Letter of Intent, but will be required as part of your application materials when you formally apply to the Health Care Innovation Awards Round Two.

 

How will I know that my Letter of Intent (LOI) has been received?

In response to submission of your Letter of Intent, you will be sent by e-mail an automatically generated LOI confirmation number. This number should be retained as it will be required in the application process. The application materials will include instructions on when and where to use the LOI confirmation number.

 

Will CMS provide feedback on Letters of Intent (LOIs)?

No. Organizations submitting LOIs will receive by e-mail an automated receipt notification confirming the date and time of submission. CMS is not able to provide feedback on individual LOIs.

 

Will CMS notify Letters of Intent (LOI) submitters of their eligibility to submit an application for the Innovation Awards?

No. All applicants having met the deadline for submitting the mandatory, non-binding LOIs are eligible to submit an application through grants.gov. Applicants who submitted their LOI(s) electronically using the online form will receive a confirmation number upon submission. Please retain the LOI confirmation number for your records. The LOI confirmation number is required for application submission.

 

Can potential applicants change the scope and other details of their proposed project between their Letter of Intent submission and their application for the Innovation Awards?

Yes. The Letter of Intent (LOI) is required to submit an application for the Innovation Awards; however, applicants are free to adjust their design, partnerships, and change the lead organization (assuming all organizations are in agreement and working in partnership with one another) in the period between submission of the LOI and submission of the application. In the event such changes to the proposal are made after the LOI submission, it is not necessary to update the LOI information.

However, if you submit an LOI before the deadline and realize that major changes or corrections are needed, we encourage you to submit a new LOI and obtain a new LOI confirmation number, so the content of the LOI will more closely match your eventual application. Due to the number of LOIs that we expect to receive, we will not be able to edit the original LOI for you. Note that if you choose to submit a corrected LOI, your application should include only the most up-to-date LOI confirmation number.

 

If an organization plans to submit multiple proposals, will it need to submit a separate Letter of Intent for each anticipated proposal?

Yes, if an organization anticipates submitting more than one proposal, it will need to submit a separate Letter of Intent for each planned proposal.

 

Applicant Eligibility

Who is eligible to apply for Round Two of the Health Care Innovation Awards?

Both not-for-profit and for-profit organizations that are recognized as a single legal entity by the State in which they are incorporated are eligible to apply. 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, the District of Columbia, academic institutions, research organizations, public-private partnerships, and for-profit organizations. 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. The organization must have a unique tax identification number (TIN) and a governing body that may enter into a cooperative agreement with CMS.

 

Are current Awardees from Health Care Innovation Awards Round One eligible to apply for Health Care Innovation Awards Round Two?

Yes. “Previous Awardees [from Health Care Innovation Awards Round One] may apply under this FOA, [however] organizations that received funding from CMS under Round One of the Health Care Innovation Awards may not receive additional funding to support models funded under Round One”.

 

Are territories eligible to apply for the Health Care Innovation Awards Round Two?

Yes. Territories and Commonwealths are eligible to apply. This includes the Commonwealths of Puerto Rico and the Northern Mariana Islands and the Territories of Guam, American Samoa, and the U.S. Virgin Islands.

 

Can an organization with one Tax identification Number submit multiple applications and/or receive multiple Innovation Awards?

Yes. However, the organization will need to submit a separate Letter of Intent for each application.

 

Can States apply for the Health Care Innovation Awards Round Two?

Yes. States are eligible to apply. By “state,” we refer to the definition provided under 45 CFR 74.2, which defines “state” 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.

 

Are other federal agencies eligible as conveners?

No, other federal agencies cannot act as a convener for applicants.

 

Are other entities such as universities, community colleges, or 501(c)3 tax exempt organizations eligible to apply?

Yes, all such entities having a unique tax identification number and a governing body are eligible to apply.

 

Are Veterans Affairs (VA) or Department of defense (DoD) owned hospitals eligible to receive awards from the Health Care Innovation Awards Round Two?

VA or DOD owned hospitals and other Federal Government departments can be partners in a proposed project; however, no hospitals and other providers owned by U.S. Federal Government departments are eligible for Innovation Awards grant funding from CMS.

 

Is a national organizations eligible to receive a direct award?

National organizations may apply if they meet the other requirements stated in the FOA.

 

Can medical societies or trade associations apply as a primary awardee?

Yes, medical societies or trade associations may apply if they meet the other requirements stated in the FOA.

 

How does one find out whether a proposal would be duplicative of projects already announced or awarded by CMS or another federal agency?

Applicants can review information found on the official websites of the Centers for Medicare  & Medicaid Services (www.cms.gov), the Center for Medicare and Medicaid Innovation (https://www.cms.gov/priorities/innovation/overview), the U.S. Department of Health and Human Services (www.hhs.gov), the Centers for Disease Control and Prevention (www.cdc.gov), and the website for federal grants, www.grants.gov.  For more information on Innovation Center initiatives, please visit www.innovation.cms.gov.

 

Does the restriction on funding existing models extend to a test of an existing model funded by Health Care Innovation Awards Round One on a different population?

Organizations that received funding from CMS under Round One may not receive additional funding to support models funded under Round One.   Proposals to extend an existing model will not be considered, and CMS will not fund proposals that duplicate models that CMS or other HHS entities are currently testing.  CMS will consider applications proposing a test of an existing Round One model on a substantially different population. However, such applications will be reviewed against the criteria and approving official considerations outlined in the Round Two FOA.  Note approving official considerations include “whether the portfolio of awards adequately covers each or any of the priority areas and CMS program populations identified in this document, and is not duplicative to other CMS or HHS activities.”  Applicants submitting a Round One model test for a different population would need to demonstrate how the Round Two test is substantively different from the Round One test (that is, why the Round Two test would not be duplicative).

 

Do you have to have a commitment from a payer to submit an application or can you submit an application and then develop a relationship with the payer over the course of the demonstration?

Applications must include a feasible approach for securing the participation of multiple payers. 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.

 

Please define a “non-CMS payer.”  And, what do you mean by the “participation” of a non-CMS payer?

A non-CMS payer is an entity other than CMS or a state Medicaid program that pays for health care services on behalf of a group of patients. A non-CMS payer could include, but is not limited to, private insurers (including Medicare Advantage plans and Medicaid  Managed care organizations), employers, governments, and unions.

Participation means the implementation of the service delivery and payment model test in non-CMS patient populations served by the providers participating in the model test for CMS beneficiaries. As noted, CMS recognizes  providers may have more meaningful incentives to change their service delivery models if multiple payers are involved.

 

Please clarify if proposals that seek to test current service delivery models but with a new payment model are eligible or would they be considered duplicative?

Yes, proposals for payment models that are new and that apply to different populations of Medicare, Medicaid, and/or CHIP beneficiaries are eligible for funding, if they meet the criteria specified in the Funding Opportunity Announcement. CMS will not fund proposals that duplicate models that CMS or other HHS entities are currently testing in other initiatives. Payment models that propose new alternative approaches rather than simply expanding or supplementing fee-for-service payments will be preferred.

 

What role can a convener organization play?

Certain organizations may apply as conveners that assemble and coordinate the efforts of a group of participants.

Conveners for the Health Care Innovation Awards Round Two will be considered the primary applicant. Conveners will need to abide by the terms and conditions and assume direct risk for the award.

 

Project Design, Scope and Restrictions

Can we discuss our care model and payment design with someone at the Innovation Center to see if it might be a viable proposal for the Health Care Innovation Awards Round Two FOA or to determine how it might be improved?

To ensure the integrity and equity of this competitive funding opportunity, we are unable to meet with organizations applying for Health Care Innovation Awards Round Two funding during this procurement-sensitive time period. If you or your associates meet with CMS Innovation Center staff during this time period, you might be deemed ineligible for funding in Health Care Innovations Award Round Two.

 

If we currently have meetings with the Innovation Center about another ongoing model test and are planning to apply for Health Care Innovation Awards Round Two, can we continue to meet with the Innovation Center?

Organizations can meet with Innovation Center officials about other funded projects, as long as the conversation does not address Health Care Innovation Awards Round Two.

 

My proposed model seems to fit one of the four Innovation Categories outlined in the FOA for the Health Care Innovation Awards Round Two, but I’m not entirely sure. How can I confirm that my proposal appropriately addresses one of the four Innovation Categories?

The Innovation Center hosted a series of webinars that addressed in detail the four Innovation Categories, providing background and examples. We suggest you visit the Health Care Innovation Awards Round Two web page and review the webinar slides and transcripts that are posted as well as review the FOA. Your application should detail how your proposal addresses the targeted innovation area and priorities.

 

My model of care and payment improvement seems to fit more than one of the four Innovation Categories. To be considered, does a proposal need to address only one of the Innovation Categories? Or can it address two or more of the innovation areas?

Proposals should identify and focus on one primary Innovation Category, but can also address other Innovation Categories, insofar as this is justified by the design of the proposed model.

 

What is the difference between models designed to serve patients with special needs and models designed to serve populations, including populations with special needs? For example, what is the difference between a model designed to serve people living with HIV as “patients with special needs” and a model designed to serve a “population” of beneficiaries living with HIV?

The primary difference is that “models that improve care for patients with specialized needs” are expected to be primarily focused on clinical care, while “models that improve the health of populations” should be focused on engaging beneficiaries,  prevention, wellness, and comprehensive care in ways “that extend beyond the clinical service delivery setting”.

 

Will “submissions in other areas within” the specified categories have the same chance of being awarded as submissions which directly address priority areas mentioned in the FOA?

All submissions will be evaluated on the basis of the same criteria. As long as a submission clearly falls within the four Innovation Categories described in the FOA, it will receive the same consideration as proposals that address identified “Priority Areas,” though “preference will be given to submissions within these Priority Areas.” Applications will be scored against the criteria outlined in the FOA. The CMS authorizing official will consider additional factors as outlined in the FOA. In developing your application, applicants should carefully consider these criteria and considerations.

 

Are applications expected to include a completely finished and fully explained payment model?

“All applicants must submit, as part of their application, the design of a payment model that is consistent with the new service delivery model” proposed.  “Applicants have the option to submit . . . a detailed and fully developed payment model as well as a list of payers interested in testing the new payment and service delivery model”. Note that “If they have not already done so as part of the application, awardees must deliver, during or by the conclusion of the cooperative agreement period, a detailed and fully developed version of the payment model” design.

 

Is the involvement of multiple payers a requirement for proposals?

All applications “must include a feasible approach for securing participation of multiple payers for their proposed models,” which could include “demonstrable commitments from current payer partners, current contracts, letters of support or commitment from private insurers, state governments, or local governments”.

 

Are proposals required to include payers in addition to Medicare, Medicaid, and/or the Children’s Health Insurance Program?

No. However, “Preference will be given to applications that include participation by non-CMS payers at the outset of the model’s implementation”.

 

CMS expresses a preference for involvement of the payer community in the development and testing of new payment models. Are there protections relating to antitrust that can be provided as payers come together around new care delivery and payment models?

Applicants continue to be subject to all applicable laws and regulations and should consult their legal counsel in that regard.

 

If multiple partners are involved in developing a proposed model test, should they apply jointly or should one partner take the lead?

One partner should be the lead applicant and all communication about the proposal, including the Letter of Intent (LOI) and the application itself, should only come from the lead applicant. There should be only one LOI per application, regardless of how many partners are involved.

 

Can we propose innovations that improve care and lower costs for Medicare Part D?

Yes, applications related to Medicare part D are eligible.

 

Is a list of Health Care Innovation Awards Round One Awardees available?

Yes. A list of Awardees and descriptions of their model tests are available on the Health Care Innovation Awards Project Profiles page.

 

Applicants requesting $10 million or more in funding are required “to obtain and submit an external actuarial certification of their Financial Plan with their Application”. Are the funding limits for actuarial certification based on the yearly award or the total award?

The requirement for actuarial certification is based on the total award amount.

 

Can the certifying actuary be an employee of the applicant’s organization or provided to the organization through an ongoing contractual relationship?

No, the certifying actuary needs to be external to the applicant.

 

Would it be advisable for an organization requesting less than $10 million in funding to obtain and submit an external actuarial certification of their Financial Plan?

“Applicants are encouraged but not required to submit an external actuarial review of their Financial Plan”.

 

Do organizations that receive external actuarial certification of their Financial Plans also need to have their Financial Plans reviewed by their chief financial officer?

Yes, the Financial Plans for all applicants, regardless of the amount of the funding request, “must be reviewed and certified by the chief financial officer of the applicant organization”.

 

Will CMS be providing a list of recommended actuaries?

No, applicants should consult actuaries who are members of The American Academy of Actuaries.

 

Can an organization submit more than one proposal?

Yes, an organization can submit multiple proposals.

 

If an organization is working on two different service delivery models, will it need to submit two separate Letters of Intent (LOIs) and a full application for each?

Yes. Different models of care and payment must be submitted separately, with a different LOI for each and a full application for each.

 

If an organization submits more than one application, can it be considered for more than one award?

Yes. Organizations can submit more than one application and be considered for more than one award.

 

The FOA states that models primarily focused on acute hospital inpatient care are excluded from this round and will not be reviewed. Can you clarify?

This funding opportunity is focused on innovative payment and service delivery models in non-inpatient settings. We do expect, however, that proposals falling within any of the four given Innovation Categories may result in improved outcomes and reduced costs in the inpatient setting.

 

If our proposal projects that most or all of savings to the total cost of care will accrue from reduced inpatient costs due to our proposed outpatient care model, are we still eligible to apply for this round?

Yes. The Funding Opportunity Announcement indicates that we are not seeking applications primarily focused on service and payment reforms occurring in the inpatient setting. We do expect that proposals falling within any of the four given Innovation Categories may result in improved outcomes and lower costs in the inpatient setting. Reductions in inpatient costs may be counted in projecting total cost of care savings.

 

Are hospitals eligible to apply for funding in Round Two of the Health Care Innovation Awards?

Yes, Hospitals are eligible to apply for awards if they propose a model within one of the four Innovation Categories.

 

Can dually eligible enrollees (beneficiaries eligible for both Medicare and Medicaid) be considered as participants?

Yes, dually eligible enrollees can be considered and addressed in the proposed care delivery and payment design model.

 

Can patients belong to a Medicare Advantage program?

Yes. Patients enrolled in a Medicare Advantage program can be participants in a proposed care and payment design model.

 

Can proposers ask for claims data to help with their applications?

No. During the application process, we cannot make individual claim level data available; however, during HCIA Round Two webinars we will direct applicants to various publicly available sources online where cost estimates may be obtained. Once awards have been made, there will be an opportunity for Awardees to receive Medicare fee-for-service data through the program. It is important to note there are cost limits to the amount of claims data we can provide. Applicants should have an alternative plan for obtaining needed data.

 

How many Medicare, Medicaid and/or CHIP beneficiaries should models propose to target if the proposed project directly or indirectly improves the quality of care and lowers costs for an additional population?

No specific number or percentage of Medicare, Medicaid and/or CHIP beneficiaries are required in proposals. However, the project should be designed so interventions contribute to improving the health and lowering the total cost of care for the targeted populations.

 

Can proposed projects for the Innovation Awards involve multiple geographic areas?

Yes.

 

Can Innovation Awards funds be used to replace existing funding under State Medicaid programs?

No. The Health Innovation Awards Round Two is seeking to solicit new innovative approaches towards better care, better health and lower costs through improvement. Projects that propose to use funds to replace existing or expiring funding sources will not be considered favorably.

 

What is the difference between the design of a payment model and a detailed and fully-developed payment model?

The design of a payment model is described in the Funding Opportunity Announcement in 4(b) (2) Payment Model. A detailed and fully-developed payment model builds on the payment model design, and contains more detailed components on the implementation of the payment model and how the payment model can be made available to other providers and potentially serve as a basis for a subsequent solicitation by CMS.  The fully developed payment model should define a clear pathway to ongoing sustainability through the creation of a fully developed Medicare, Medicaid, and/or CHIP payment model. This fully developed payment model may be submitted at the option of applicants as part of the application, and if not so submitted, must be submitted by awardees either during or by the end of the three-year cooperative agreement. This payment model should result in savings for Medicare, Medicaid, and/or CHIP.

 

Can you clarify the explanation for the return on investment requirements for applicants?

CMS will require applicants to complete budget form SF 424A and a Financial Plan demonstrating their ability to achieve both a reduction in total cost of care and a strong Return on Investment (ROI) over the three-year performance period for the award.  More details on what is required to demonstrate an ROI to CMS can be found in Section Three of the Funding Opportunity Announcement.

 

Medicare, Medicaid, and CHIP serve specific populations that are unlike those covered by private insurers.  Could you please clarify the expected involvement of other payers?  How would a payment model tested by a private payer be assumed to demonstrate cost savings for the populations served by Medicare, Medicaid or CHIP?

CMS is not specifically requiring cost savings accruing to private payers participating in testing a  payment model. As noted, CMS recognizes providers may have more incentive to change their service delivery models if multiple payers are involved.

 

Can the proposed new payment model address only Medicare as a payer, and not address other payers?

The payment model design must include Medicare, Medicaid, and/or CHIP – any one or more of these programs – though it should ideally include other payers as well. As noted previously, applications must include a feasible approach for securing the participation of multiple payers for their proposed models.  We are primarily interested in model designs that focus on Medicaid and/or CHIP.

 

Since applicants will be testing (or at least developing) a payment model in the private sector that is supposed to be applicable for the public sector, should the application (or proposed evaluation) address the feasibility of replicating the payment model in the public sector?

Payment model feasibility is addressed in two ways in the Funding Opportunity Announcement:

The payment model must be operationally feasible for CMS and applications must include a feasible approach for securing participation of multiple payers.

 

What guidance can you provide on how to handle indirect costs related to our application?  For example, our university has overhead expenses for projects taking place under its auspices.  This is common for some grants.  How do we handle these costs for an HHS grant?

If requesting indirect costs in the budget, a copy of the federally negotiated indirect cost rate agreement is required.  Indirect costs will be capped at 20 percent or the applicant’s federally negotiated indirect cost rate or the applicant’s provisional rate, whichever of these is lower.  Applicants may elect to waive their federally negotiated indirect cost rate.

 

What is the page length requirement?

A total of 50 pages are allowed for all four supplemental templates (list) and any letters of support. An additional 50 pages for the application narrative section will be allowed.

 

I was not able to provide all the letters of support I wanted and still meet the page limit. Can I send the letters of support separately?

No. Please prioritize your letters of support and send only the letters that you believe are most likely to convey the successful implementation of your project.  To save space but still convey the breadth of support for your proposal, you might consider  listing (but not including the actual letters) any additional partners and payers who have indicated their support.

 

Do I have to adhere to the margins and spacing requested for the application narrative in the supplemental forms?

You must use the supplemental form templates as is, that is, with the existing margins and page spacing. Please be mindful of page restrictions for the supplemental materials.

 

Where can I get copies of the standard forms (SF-425, etc.) for grants.gov?

These forms are available on the Grants.Gov website.

 

Can you please confirm/clarify that both a financial plan narrative and a budget narrative are required as part of the Project Narrative?

The financial plan and budget narrative are separate documents and each is required as explained in the Funding Opportunity Announcement in sections three and five.

 

How should I name the file before uploading it to grants.gov?

Please save using the existing file name.

 

Is there an error in the financial plan Excel template on the Innovation Center website? Could there be a programming error, as there appears to be a calculation error for Estimated Total Cost of Care Expenditures After Savings applied  YR -3 Total?

Thank you for alerting us to this issue.  We have provided instructions to correct the calculation in your own version below. The cells in question are not used elsewhere in the financial plan.  There will be no penalty for submitting this calculation incorrectly as presented on the template. There will be likewise no additional benefit for providing this field correctly.

O47 calculation should be    =sum(L47:N47)
O48 calculation should be     =sum(L48:N48)
O49 calculation should be     =sum(L49:N49)
O50 calculation should be     =sum(L50:N50)

 

The Financial Plan Template on the Innovation Center’s website lists the baseline year as 4/1/2013 through 3/31/2014.  This would be the year for the cost comparisons.  The application, as I understand it, requires a baseline cost computation to compare with the three years of the award—the application of the innovation.  As this baseline year is in the future, are we to use a different baseline year than the one on the financial form for purposes of the application?

The financial plan pivots around the start of the performance period in 4/1/2014. The baseline at that time will be 4/1/2013- 3/31/2014. We ask that you estimate the costs for this period even though some portion of it is in the future.

 

Where can I find definitions for the cost categories on the plan?

Please reference the application guide on the Health Care Innovation Awards Round Two web page.

 

How should I name the file before uploading to grants.gov?

Please save using the existing file name.

 

Is this my final operational plan for the life of the award?

No.  This operational plan captures the first six months of the award.  Operational plans will need to be revised after the notice of award to reflect any changes resulting from post application negotiations and final contracting.

 

Can I include other relevant visuals in this document to further illustrate our plans?

You may insert relevant visuals as needed.  Due to page length restrictions you may have to insert these additional visuals within the application narrative.

 

Do my measures need to align exactly with my driver diagram?

Strong alignment is highly recommended.

 

Is my list of self-monitoring measures final?

No, it will be reviewed and refined in consultation with your project officer if awarded.

 

If I was not able to provide all my measures, will there be an opportunity to submit a new operational plan if awarded?

Yes, however, please also use the application narrative to discuss any measures that you could not fit into or were not yet ready to provide in the submitted operational plan.

 

How should I name the file before uploading to grants.gov?

Please save as the existing file name.

 

Who should sign the application, if our organization does not have a Chief Financial Officer?

Please use the authorizing official or other representative responsible for fiscal oversight.

 

Does the actuary have to be external if my organization is applying for a grant over $10 million?

Yes, the actuary providing signature should be external to the applicant and key partners, if the applicant is requesting more than $10 million.

 

How should I name the Executive Overview file before uploading to grants.gov?

Please save using the existing file name.

 

Can the information differ from what I provided in my LOI?

We expect that at least some of the information in the Executive Summary may change between the LOI and application phases.

 

What happens, if I cannot find my LOI number?  Where can I find it to fill out my Executive Overview?

The LOI number was distributed to you when you completed the Letter of Intent process online.  If you are unable to retrieve your LOI number please send an email to InnovationAwards@cms.hhs.gov to request it.

 

Is it acceptable if some of the content falls onto the next page?

Yes.  The forms are designed to expand as necessary but you still need to be mindful of the page limit.

 

Does the total page count of my Executive Overview count toward the 50 page supplemental material total?

Yes.

 

If my project covers more than one innovation category, how should I capture that on my Executive Overview?

The Executive Overview has a question to identify the primary innovation category your project will address.  You should indicate all other applicable innovation categories on the question “Additional Innovation Category Type(s)”.  Application narratives should adequately provide support for these additional innovation categories.

 

The brief summary section does not allow me enough space to describe my project.  What options do I have?

The summary sections on the Executive Overview are designed to capture the most salient points.  All other context should be provided in the longer, more descriptive narrative portion of the application.

 

Is the Executive Overview form compatible with older Microsoft Word versions?

The Executive Overview is designed to work best with Word 2010 and should be compatible with prior versions.

 

Will the lack of a detailed and fully developed payment model at the time of my application impact my selection chances?

The Funding Opportunity Announcement (FOA) states all applicants must submit, as part of their application, the design of a payment model that is consistent with the new service delivery model funded by this second round of Health Care Innovation Awards. Alternatively, applicants may choose to submit, as part of their application, a detailed and fully developed payment model as well as a list of payers interested in testing the new payment and service delivery model.

If they have not already done so as part of the application, awardees must deliver, during or by the conclusion of the cooperative agreement period, a detailed and fully developed version of the payment model required above, as well as a list of payers interested in testing the  payment and service delivery model.

All applications that comply with the instructions in the FOA will be reviewed and considered equally. CMS encourages but does not require payment models that are implemented within the award performance period. Applications will be reviewed against criteria and approving official considerations as stated in the FOA. Approving official criteria include “the potential for implementation of the proposed payment model, the speed with which the payment model could be introduced and result in a solicitation of other participants, and the likelihood of success of sustainability.”

 

What should I do, if I do not know how to calculate my net savings after deducting in-kind costs?

Please reference the Financial Plan template as that should help in identifying and calculating net savings.  Then report those numbers on the Executive Overview’s applicable fields.

 

When I enter values for the various years (Year 1, etc.) the total column is not updating. Should it?

No, the form has limited functionality and does not total automatically.  Please make sure your totals are accurate.

 

My estimates for target number of participants and sites are rough at this point.  Is it acceptable to submit these estimates?

We do want to obtain estimates that are as accurate as possible but understand there is an inherent element of error for any forecast.

 

My organization participated in a demonstration model a few years ago.  Should I still indicate any involvement?

Yes.  If prior demonstration involvement applies to your current application/project, you should do your best to indicate any learning and/or experience that will help in the application narrative.

 

My organization is scheduled to roll out an Electronic Health Record system during the period of performance.  How should I indicate this on the Executive Overview?

If the Electronic Health Record system is not in place at the time of application, please indicate “no” on the Executive Overview.  The question is designed to estimate the data and information sharing capabilities for applicants.

 

Would an applicant be permitted to alter payment policies and possibly eligibility requirements for one or all of these public insurance programs?

Payment model designs may propose changes to payment policies and eligibility. However, only CMS and states may implement payment policy changes in Medicare, Medicaid, and/or CHIP programs. CMS is under no obligation to implement such changes.

 

May a state Medicaid agency apply to test a new payment model?  May Managed Medicaid providers apply? What are the applicable restrictions?

Yes, states and their components may apply, as may Managed Medicaid parties that meet the eligibility requirements of the Funding Opportunity Announcement (FOA). Restrictions contained in the FOA apply. Note that funding from the Innovation Center may not supplant funding for services that are currently authorized through the Medicaid State Plan.

 

Does the financial plan count against the page limits?

Yes, the financial plan is set to print to three pages, and counts against the page limits in the supplementary materials.  That is, three of the 50 pages are for the financial plan.

 

Our application proposes a model focused on foster children, where Medicaid is the only payer serving this population.  How can we meet the requirement to “include a feasible approach for securing participation of multiple payers” when Medicaid is the only payer?

We encourage potential applicants wishing to focus on foster children to submit an application. CMS recognizes that a single payer that encompasses the preponderance of care and service for a particular population may, under certain circumstances, provide strong incentives for care redesign. In these circumstances, we would encourage models to include all payers serving the target population, however small their participation. Please note that Medicaid Managed Care is considered a non-CMS payer for purposes of this initiative. CMS will assess participation of non-CMS payers based on the facts and circumstances described in each application.

CMS will assess all  timely applications against the criteria and considerations listed in the Funding Opportunity Announcement. The preferences described in the FOA are factors in our review, but are not necessarily determinative.

 

Will the Indirect Cost Rate Agreement count toward our page limits?

No, the Indirect Cost Rate Agreement will not count toward any page limits for this Funding Opportunity Announcement.

 

Since Medicaid managed care organizations are considered non-CMS payers, will a proposal that targets Medicaid and CHIP beneficiaries who are provided Medicaid services exclusively through a single MMCO count as a multiple payer proposal?

A proposal by a Medicaid managed care organization plan that targets only the Medicaid and/or CHIP beneficiaries that it serves under contract to a state Medicaid organization is not considered a multiple payer proposal. However, if the applicant can secure participation by additional payers covering non-CMS patient populations served by the providers participating in the model test, it would be considered multiple payer participation.

 

Are Medicaid managed care organizations prohibited from applying because they are considered non-CMS payers?

No. Medicaid managed care organizations – like other non-CMS payers – are eligible to apply for funding under the Health Care Innovations Awards Round Two, provided they meet the eligibility requirements under the FOA.

Note that some questioners may confuse the requirement relating to the participation of non-CMS payers with the prohibition against funding the provision of services to non-CMS beneficiaries. With regard to Medicaid managed care organizations, these organizations are considered non-CMS payers, but their members are considered CMS beneficiaries.

 

Selection Process and Funding Questions

Do Health Care Innovation Awards Round One Awardees have any advantage in Round Two of the Health Care Innovation Awards?

Round One Awardees do not have any advantage in Round Two. All Health Care Innovation Round Two applications will go through the same eligibility screening process and all eligible proposals will be evaluated by independent review panels on the basis of the same criteria.

 

Data and Technical Assistance

What types of technical assistance will CMS provide to awardees?

In order to support a broad range of models, CMS is prepared to offer technical assistance to awardees on a case-by-case basis. CMS anticipates contracting with an entity or entities to provide technical assistance, as needed, to awardees as they develop and implement their respective models. The technical assistance contractor(s) will be available to assist awardees to design, develop, rapidly implement, and sustain their models to meet this initiative's programmatic goals.

 

Will CMS provide data to awardees to help successfully implement their proposed model?

CMS is open to discussing data needs with awardees and may provide data if appropriate to the particular care model or infrastructure activity. Applications should include information regarding project data needs.

 

Will CMS provide Medicare data to organizations that receive Round Two Health Care Innovation Awards?

Proposals that require data from CMS should explicitly specify this need. CMS is under no obligation to provide requested data. Please review pages 14-15 in the FOA, Award Information, for additional detail.