Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges

 

The Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges (Funding Opportunity) will enable recipients to operate as Exchange Navigators in states with a Federally-facilitated Exchange (FFE), as authorized by the Affordable Care Act (ACA). Section 1311(i) of the ACA requires Exchanges to establish a Navigator grant program. The Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Final Rule (2022 Payment Notice (PN)) amended 45 C.F.R. 155.210(e)(9) to reinstitute the requirement that Navigators in the FFEs provide information and assistance with regard to certain post-enrollment topics, such as the Exchange eligibility appeals process, the Exchange-related components of the Premium Tax Credit (PTC) reconciliation process, and the basic concepts and rights of health coverage and how to use it. The HHS Notice of Benefit and Payment Parameters for 2024 final rule at https://www.federalregister.gov/d/2023-08368/p-142, effective 6/18/2023, removed the prohibition, i.e., now allowed, for Navigators, non-Navigator assistance personnel, certified application counselors (CACs), and CAC Designated Organizations (CDOs) in FFEs from going door-to-door or using unsolicited means of direct contact to provide application or enrollment assistance.

Active 93.332 Centers For Medicare and Medicaid Services, Department of Health and Human Services B - Project Grants Not applicable. Affordable Care Act §§ 1311(d)(4)(K), 1311(i), and 1321(c)(1); 45 C.F.R. §§ 155.210 and 155.215. Under section 1311(i)(2)(B) of the ACA, eligible entities may include, but are not limited to, trade, industry and professional associations; commercial fishing industry organizations; ranching and farming organizations; community and consumer-focused nonprofit groups; and other entities capable of meeting program requirements. Eligible applicants may choose to partner with other entities and/or individuals to form a consortium of subrecipients in order to target a larger total portion of the underserved and vulnerable populations. Funding through the cooperative agreement is open to individuals and private and public entities capable of carrying out the Navigator duties and other program requirements in a FFE, as outlined in statute, regulations, and this announcement, including community and consumer-focused nonprofit groups; faith-based organizations; trade, industry and professional associations; commercial fishing industry organizations; ranching and farming organizations; chambers of commerce; unions; resource partners of the Small Business Administration; licensed insurance agents and brokers; and other public or private entities. Other entities may include, but are not limited to, Indian Tribes, tribal organizations, urban Indian organizations, and State or local human services. The following list, includes but is not limited to, the varying types of beneficiaries served under this cooperative agreement: Individual/Family, Minority group, Specialized group (e.g., LGBTQ, health professionals, students, veterans), Small business, Anyone/general public, Small Business Person, Black, American Indian, Spanish Origin, Other Non-White, Migrant, Immigrants, U.S. Citizen, Women, Disabled (e.g. Deaf, Blind, Physically Disabled), Physically Afflicted (e.g. TB, Arthritis, Heart Disease), Mentally Disabled, Unemployed, Low Income, Major Metropolis (over 250,000), Other Urban, Suburban, Rural. All of the instructions that an eligible applicant must follow to apply for the Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges (Funding Opportunity) are published on https://www.grants.gov. Consistent with 45 C.F.R. ? 155.215(a)(1)(i), all applicants (individuals, entities, and all members making up a consortium) should submit a brief statement (one or two short paragraphs) within the Cover Letter attesting that they, as Navigator cooperative agreement applicants, are not ineligible entities, and include attestations that all other Navigator entities (including subrecipients and contractors performing Navigator duties, the Navigator(s) including the Navigator's staff), do not have any of the prohibited relationships with health insurance or stop loss insurance issuers that are outlined above. As is explained in 45 C.F.R. ? 155.215 and the preamble language discussing that provision, some conflicts of interest (other than the prohibited relationships outlined above) would not be absolute bars to service as a Navigator, provided that the conflict of interest would not ultimately prevent the entity or individual from providing information and services in a fair, accurate, and impartial manner. In addition, in accordance with 45 C.F.R. ? 155.215(a)(1)(ii) and in compliance with the Standard Terms and Conditions that will be included in a Notice of Award, all successful applicants will be required to provide a written plan to remain free of conflicts of interest and to disclose to CMS, as operator of the FFE, certain non-disqualifying conflicts of interest as specified in 45 C.F.R. ? 155.215(a)(1)(iv). This award is subject to 45 C.F.R. Part 75, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS awards, which implements 2 C.F.R. Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards ("Uniform Guidance") effective December 26, 2014. Preapplication coordination is required. N/A 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. All of the instructions that an eligible applicant must follow to apply for the Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges (Funding Opportunity) are published on https://www.grants.gov. The information provided in this resource is only intended to highlight key steps in the federal grant and/or cooperative agreement submission process for individuals and entities who are new to or with limited experience applying for them. It is not intended to take the place of the requirements, information, statutes, regulations, and other guidance in the Funding Opportunity that it is based upon. In order to apply, all applicants are required to have a valid Employer Identification Number (EIN), otherwise known as a Taxpayer Identification Number (TIN); a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number; and be registered in the System for Award Management (SAM) database (https://www.sam.gov/portal/public/SAM/) to be able to submit an application at grants.gov (See Appendix II of the Funding Opportunity, Application and Submission Information, for descriptions of EIN, DUNS, and SAM). Successful applicants will receive a Notice of Award (NoA) available to the organization through the online grants management system used by CMS and awardee organizations.. The NoA is the document authorizing the cooperative agreement award and will be issued to the applicant as listed on the SF-424.. Any communication between HHS and applicants prior to issuance of the NoA is not an authorization to begin performance of a project. Unsuccessful applicants will be notified by letter, sent electronically or through the U.S. Postal Service to the applicant as listed on its SF-424, within 30 days of the award date. The deadline for applying and other related timelines are included in Section D. Application and Submission Information of the Funding Opportunity posted on www.grants.gov. The deadline to apply for this Funding Opportunity has closed. Notice of Awards for the 36-month period of performance were issued on August 27, 2021 and ends on August 26, 2024. Not applicable. Not applicable. For detailed information on the review and selection process, please refer to Appendix V, Review and Selection Process of the Funding Opportunity. o Applications will be screened to determine initial eligibility for further review using the criteria outlined in Section C. Eligibility Information, and Section D. Application and Submission Information (with cross reference to Appendix II, Application and Submission Information), of this Funding Opportunity. o An objective review panel will be convened to determine the merits of each application by reviewing and scoring the applications based on the criteria outlined in Section E1. Criteria. The objective review panel may include both Federal employees and non-Federal employees. CMS reserves the right to request that applicants revise or otherwise modify their proposals and budget based on CMS recommendations. o The objective review, the selection and award process may be separated into two stages. When making awards during both stages of the selection and award process discussed above, HHS reserves the right to reduce the budget requested, or only partially fund proposed activities, or not at all, based on the aforementioned criteria. o The results of the objective review of the applications by qualified experts will be used to advise the CMS approving official. Final award decisions will be made by the CMS approving official also based on a review of risks posed by an applicant prior to making an award as outlined in 45 C.F.R. ? 75.205. o The decision not to award a cooperative agreement, or to award a cooperative agreement at a particular funding level, is not subject to an appeal to any CMS, HHS, or any other federal official or board. Although the FFEs have been in operation since 2013 for the 2014 open enrollment period, Navigators continue to play a vital role as trusted community resources in assisting consumers with changing complex issues and educating, reaching, and assisting the underserved and vulnerable populations. Awarded entities must carry out the required statutory Navigator duties and the additional requirements laid out in Sections B. Award Information and E. Application Review Information of the corresponding Funding Opportunity posted on www.grants.gov.Funds are restricted from being used: • To cover the costs to provide direct health care services to individuals. • To match any other Federal funds. • To provide services, equipment, or support that are the legal responsibility of another party under Federal or State law (such as 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 funds provided under Funding Opportunity Announcement number CA-NAV-19-001, entitled “Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges. •To cover any pre-award costs. •To provide goods or services not allocable to the approved project. •To be used by local entities to satisfy state matching requirements •To pay for construction. • To carry out services that are the responsibility of the Marketplace, such as eligibility determinations and transferring enrollment information for consumers to a QHP. • To pay for capital expenditures for improvements to land, buildings, or equipment which materially increase their value or useful life as a direct cost, except with the prior written approval of the Federal awarding agency. • To pay for the cost of independent research and development, including their proportionate share of indirect costs (unallowable in accordance with 45 CFR 75.476). • To use as profit to any award recipient even if the award recipient is a commercial organization, (unallowable in accordance with 45 CFR 75.216(b)), except for grants awarded under the Small Business Innovative Research (SBIR) and Small Business Technology Transfer Research (STTR) programs (15 U.S.C. 638). Profit is any amount in excess of allowable direct and indirect costs. • To carry out any functions already funded by HHS, including through federal Marketplace Establishment grants under section 1311(a) of the Affordable Care Act or through federal Consumer Assistance Program grants under section 2793 of the Public Health Service Act, including to make payments to recipients of funds provided to states under those authorities for activities that are funded under those authorities. • To assist consumers residing in a state with a State-based Marketplace that the Navigator is not funded to serve. (See Section VIII. 2, State Reference List) or in a state the Navigator does not serve. FFE Navigators may provide these consumers with basic information about Marketplace, but should refer them to Navigators, the Marketplace Call Center, and other resources within the state where the consumer resides for more in-depth assistance. • To expend funds related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or Executive order proposed or pending before the Congress or any state government, state legislature or local legislature or legislative body. • To fund staff retreats or promotional giveaways. • To purchase gifts or gift cards, or promotional items that market or promote the products or services of a third party, that would be provided to any applicant or enrollee. Not applicable. Awardees must comply with audit requirements outlined in HHS regulation 45 C.F.R. Part 75 (implementing 2 C.F.R. Part 200). See Subpart F - Audit Requirements of the Funding Opportunity. Recipient must maintain expenditures and other financial records detailing the use of cooperative agreement funds for three years from the day on which the grantee submits the last financial status report for the grant period unless there is an open investigation in which case the records must be maintained during the duration of the investigation. Recipient should submit these reports to CMS on a quarterly basis along with their quarterly progress reports. 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. Project period is 36 months from the notice of award and ends on August 26, 2024. Funding will be awarded in 12-month increments called budget periods based on funding availability. Continued funding throughout the 36-month period of performance will be contingent on a timely submission of a non-competing continuation application 90 days prior to the start of the second and third years of the period of performance, strong performance during the prior budget period, funding availability, and the awardee’s ability to continue meeting all eligibility requirements laid out in this Funding Opportunity, including continuing to serve in a state(s) with a FFE. Method of awarding/releasing assistance: • Once an award is made, the funds are posted in recipient accounts established in the Department of Health and Human Services, Division of Payment Management, Payment Management System (PMS). Grantees may then access their funds by using the PMS funds request process. Upon notification of award, recipients under this announcement will be able to drawdown funds for approved start-up costs. The remaining funds will be reimbursable upon meeting required milestones. Method of awarding/releasing assistance. • Once an award is made, the funds are posted in recipient accounts established in the Department of Health and Human Services, Division of Payment Management, Payment Management System (PMS). Grantees may then access their funds by using the PMS funds request process. Upon notification of award, recipients under this announcement will be able to drawdown funds for approved start-up costs. The remaining funds will be reimbursable upon meeting required milestones. Programmatic Questions: Navigatorgrants@cms.hhs.gov. Administrative or Financial Questions: Grants@cms.hhs.gov Christopher Clark
7501 Wisconsin Avenue
Bethesda, MD 20814 US
Grants@cms.hhs.gov
Phone: 301-492-4319 https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance.html 75-0511-0-1-551 (Cooperative Agreements) FY 22$98,855,586.00; FY 23 est $98,592,225.00; FY 24 est $98,592,225.00; FY 21$82,077,310.00; FY 20 FY 19$10,000,000.00; FY 18$10,000,000.00; FY 17$36,108,220.00; FY 16$643,000,000.00; - Current Fiscal Year: 2023 Projection: up to $111,500,000 For a complete list of requirements, please see Section F2. Administrative and National Policy Requirements of the Funding Opportunity. o All equipment, staff, and other budgeted resources and expenses must be used exclusively for the projects identified in the Applicant's original cooperative agreement application or agreed upon subsequently with HHS, and may not be used for any prohibited uses. o Consumers and other stakeholders must have meaningful input into the planning, implementation, and evaluation of the project. o This award is subject to 45 C.F.R. Part 75, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS awards [available at https://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75], which implements 2 C.F.R. Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards ("Uniform Guidance") effective December 26, 2014. See below for more information. All awardees receiving awards under this cooperative agreement program must comply with all applicable Federal statutes relating to nondiscrimination, including, but not limited to: a. Title VI of the Civil Rights Act of 1964, b. Section 504 of the Rehabilitation Act of 1973, c. The Age Discrimination Act of 1975, d. Title II, Subtitle A of the Americans with Disabilities Act of 1990, and e. Section 1557 of the Patient Protection and Affordable Care Act. Not applicable.