Flexible Alternatives for State Transformation Model

The Flexible Alternatives for State Transformation (FAST) Model will provide states with an opportunity to develop and implement payment reforms that are driven by state needs and enable local innovation to improve healthcare value and the health of populations.

Through FAST, the Innovation Center
will empower states to create transformative multi-payer models in which participating payers are aligned in how they incentivize healthcare value, quality, and outcomes.Together in partnership, states and CMS will support providers in their ongoing transformation to a value-based payment system.

Awardee states will have the flexibility to determine, based on state and community needs, the specific parameters of the proposed model, including the incentive structure and population and/or geographic region included in the model.

FAST provides states with the flexibility to pursue comprehensive and sustainable payment reform through one of two tracks that best meets their needs:
A. Transformation Track Support states to launch a new multi-payer model with Medicare, Medicaid, and commercial payer participation.

These models will meet the criteria outlined in the Innovation Center's 2017 Guidance for Medicare Participation in a state-based multi-payer model, as well as criteria to become an Advanced Alternative Payment Model .

States may request that CMS waive certain Medicare rules (e.g., the state sets ACO benchmarks for Medicare, the state has authority to set global budgets for hospitals) using 1115A Waiver Authority as part of the model.

Full implementation of models proposed under the Transformation Track would occur after the initial 2-year SLIM award, contingent upon successful negotiation of a signed agreement between CMS and the state, and OMB approval.

Receipt of a FAST award in no way guarantees approval of the proposed state-designed multi-payer model.

B. Alignment Track A: Support states that are interested in either modifying existing Medicaid and/or commercial payment and delivery innovations to qualify as Other Payer Advanced APMs ; or increasing Medicare provider participation in existing Advanced APMs, particularly to build on local innovations at the practice level, and to increase small and rural and specialty provider opportunities to participate in Advanced APMs.

Implementation of the proposed state-designed multi-payer model would occur after the initial 2-year FAST award, and may require CMS approval (e.g., for a Medicaid State Plan Amendment or waiver).

Alignment Track states may not propose an 1115A Medicare Waiver as part of the application to the Alignment Track A.
C. Alignment Track B: Support states to expand existing, or launch new, commercial and/or Medicaid alternative payment models, with an ultimate goal of building state and provider capacity to eventually participate in Advanced APMs.

Implementation of the proposed state-designed model would occur after the initial 2-year FAST award, and may require CMS approval (e.g., for a Medicaid State Plan Amendment or waiver).

Alignment Track B states may not propose an 1115A Medicare Waiver as part of the application to the Alignment Track B.

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.

Program Accomplishments

Not Applicable.

Uses and Use Restrictions

Funds will be used to refine the details of a state-based model and build state capacity to execute on that model, including investments in Data and Health IT, Metrics and Measurement, Stakeholder Engagement, Human Capital Development, Model Operations, and support negotiations with CMS for any needed new authorities (e.g., Medicaid state plan amendment, Medicaid waiver, Medicare FFS waiver, Medicaid Implementation Advance Planning Document Update).

Data and Health IT ? Awards may be used to fund technology, systems, and activities at the state, payer, and/or provider level to support SLIM health IT priorities: outcomes-focused service delivery, population health, and multi-payer models ready for Advanced APMs. Specific examples of systems and activities include: ? Development of shared governance, financing, and policy agreements, including convening activities and other activities associated with development of signed agreements associated with such agreements.

? Development and maintenance of multi-payer claims, clinical and non-clinical measurement reporting and analytics infrastructure, capability, and capacity.

This could include a statewide multi-payer database or related data center costs. ? Development and maintenance of multi-payer claims, clinical and non-clinical data extraction, transformation, aggregation, quality, use and dissemination capabilities, including health information exchange services and support for certified EHR technology use. ? Development, implementation and operations of an alert notification system.

? Identity management services, including Master Patient and/or Master Provider databases. ? Consent management, including the building of a consent registry. ? Analytics capabilities, including simulation and modeling of patient risk scores, predictive cost modeling, identification or prediction of gaps in care, and other functions that enhance clinical decision support.

? Infrastructure to support patient attribution and provider directories. ? Infrastructure to build or expand tele-health systems.

? Security mechanisms. ? Connections between behavioral health, public health, social services, and clinical data systems through shared health IT infrastructure. Metrics and Measurement: Award funds may be used to support measure alignment, including to develop and implement multi-payer core measure set with benchmarks, data collection and reporting framework and processes, including convening and other activities associated with getting payers? buy-in and commitment to measure alignment.

Stakeholder Engagement: Awards may fund stakeholder engagement activities such as: ? Funding to facilitate consumer participation in state level stakeholder efforts. ? Develop and implement governance structures for multi-payer and multi-stakeholder work, including explicit data and health IT governance structures.

? Increase provider readiness to participate in Advanced APMs (e.g., CEHR adoption and use; prepare providers to participate in a model that includes more than nominal financial risk.

? Resources and activities to facilitate alignment on payment mechanisms, quality measures, data-sharing, and health IT infrastructure across payers Human Capital: In our experience working with states to launch multi-payer models, we have found that standing up state entities necessary for robust unique payment strategies, such as Maryland?s Health Services Cost Review Commission or Vermont?s Green Mountain Care Board, is essential to the success of the multi-payer model, but takes significant time and resources.

Award funds may support the following: ? Build leadership skills, administrative capacity, and subject matter expertise, including health IT, related to the multi-payer model. ? Develop state employee analytic and health IT capacity and capability.

? Staff resources associated with obtaining any needed Medicaid waivers or State Plan Amendments to support state-designed multi-payer model. ? Staff resources associated with finalizing financial, quality, access, and population health targets. ? Build public health capacity to assume financial accountability for population health outcomes. ? Prepare providers, payers, and Medicaid Managed care organizations to participate in Advanced APMs, including downside risk (e.g., analytics support for providers, quality improvement program development, health IT infrastructure). ? Staff resources associated with project management, including travel to SLIM trainings and conferences. ? Contract support for state personnel in operationalizing multi-payer model, including health IT. ? State agency personnel committed to developing and negotiating the terms of their state-designed multi-payer model with CMS. ? 100% FTE trained Federal grants management and administration staff to support SLIM, hired within first 3 months of award start. ? Staff that can represent the Governor?s Office. ? Staff and/or contractor support for developing and implementing alternative payment models (e.g., actuarial estimates, total cost of care benchmarking).

? Not to pay for any community services (e.g., housing, food, violence intervention programs, and transportation) ? To provide individuals with services that are already funded through any other source, including but not limited to Medicare, Medicaid, and CHIP. ? To match any federal funds ? To provide services, equipment, or supports that are the legal responsibility of another party under Federal, State, or Tribal 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 cover the costs to provide direct health care services to individuals. ? 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. ? For specific components, devices, equipment, or personnel that are not integrated into the entire service delivery model proposal. ? To provide goods or services not allocable to the approved project.

? To pay for construction. ? 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 (which is unallowable in accordance with 45 CFR ß 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.


Profit is considered to be any amount in excess of allowable direct and indirect costs. ? 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 lobby or advocate for changes in Federal and/or state law.

Eligibility Requirements

Applicant Eligibility

State Governor?s Offices, United States Territories Governors? Offices (American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the Virgin islands), and the Mayor?s Office of the District of Columbia are eligible to apply, with the exception of states that have a current SIM award, current multi-payer agreement in place with CMS, and/or states that have a current Delivery System Reform Incentive Payment (DSRIP) waiver in place.

Only one application from a Governor per state will be permitted.

A state cannot receive multiple awards. A state may propose that an outside organization focused on quality and state delivery system transformation, such as a non-profit affiliated with the state?s Department of Health/Medicaid single state agency or a public-private partnership supported by the Governor?s Office, receive and administer funds through a SLIM award.

Under such an approach, the Governor?s Office must provide a justification for the request and an attestation that the state will actively participate in all activities described in its proposal.

Beneficiary Eligibility

The Centers for Medicare & Medicaid Services (CMS) has worked to promote efficiency and quality of health care, particularly under value-based payment models in the Medicare program. CMS has invested in a number of initiatives to achieve these goals, including the Medicare Shared Savings Program, Comprehensive Primary Care (CPC) Initiative, Comprehensive Primary Care Plus (CPC+), Next Generation ACO Model, and Bundled Payments for Care Improvement (BPCI) Initiative. These efforts were bolstered by the 2015 Medicare Access and CHIP Reauthorization Act (MACRA). MACRA directed the Secretary to create the QPP, which creates new provider incentives to promote adoption of Advanced Alternative Payment Models (APMs), not just in Medicare but also among Medicaid and private payers as well. CMS has also recognized the importance of state flexibility, because states can accelerate healthcare transformation. The Innovation Center has invested in partnerships with states under several models, including the State Innovation Model (SIM). The SIM initiative tests the ability of state governments to use their policy and regulatory levers to accelerate health care transformation that results in better care, smarter spending, and healthier people.. This Funding Announcement for the Flexibility and Accountability in State Transformation Model FAST builds upon important lessons from the SIM Initiative, but is substantively different, providing direct federal investment in states to support innovative payment reforms that are driven by state needs, but is structured to give states more accountability to achieve milestones than has been present in SIM. States will be held accountable in two ways. First, grant funds will be released incrementally, contingent upon the state's progress in achieving annual and quarterly milestones that demonstrate tangible progress in building the infrastructure and capacity needed to implement its proposed state-designed model at the conclusion of the FAST award period. Second, progression to Year 2 will be contingent upon a fundamental demonstration of the state?s commitment to the model beyond the FAST award period (e.g., evidence of future budget allocations to support the model, proposed legislation to ensure the state has necessary authorities to execute the model, submission of Medicaid SPA, etc.). We believe such investments will empower our state partners to design new approaches and to execute these strategies well, and will eventually lead to long term, sustainable improvements in quality and reductions in cost trends.


Employer Identification Number: All applicants must have a valid Employer Identification Number (EIN) assigned by the Internal Revenue Service. Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS number): All applicants must have a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number in order to apply. The DUNS number is a nine-digit identification number that uniquely identifies business entities. Obtaining a DUNS number is free. To obtain a DUNS number, access the following website: www.dunandbradstreet.com or call 1-866-705-5711. See Section IV, Application and Submission Information, for more information on obtaining a DUNS number. System for Award Management (SAM) All applicants must register in the System for Award Management (SAM)* database (https://www.sam.gov/portal/public/SAM/) in order to be able to submit an application at http://www.grants.gov. In order to register, applicants must provide their DUNS and EIN numbers. Each year, organizations and entities, registered to apply for Federal grants through Grants.gov must renew their registration with SAM. Each year organizations and entities must renew their registration with SAM. Failure to renew SAM registration prior to application submission will prevent an applicant from successfully applying via Grants.gov. Similarly, failure to maintain an active SAM registration during the application review process can prevent CMS from issuing your agency an award under this program. Applicants should begin the SAM registration process as soon as possible after the announcement is posted to ensure that it does not impair your ability to meet required submission deadlines. Applicants must successfully register with SAM prior to submitting an application or registering in the Federal Funding Accountability and Transparency Act Sub-award Reporting System (FSRS) as a prime awardee user; awardees may make sub-awards only to entities that have DUNS numbers. Organizations must report executive compensation as part of the registration profile at https://www.sam.gov/portal/public/SAM/ by the end of the month following the month in which this award is made, and annually thereafter (based on the reporting requirements of the Federal Funding Accountability and Transparency Act (FFATA) of 2006 (Pub. L. 109-282), as amended by Section 6202 of Public Law 110-252 and implemented by 2 CFR Part 170). 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.


Application Procedures

2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. Applications will be submitted electronically through GrantSolutions in response to the Funding Opportunity Announcement (FOA). Application Materials; Application materials will be available for download at http://www.grants.gov. Please note that HHS requires applications for all announcements to be submitted electronically through http://www.grants.gov. For assistance with http://www.grants.gov, contact support@grants.gov or 1-800-518-4726. At Grants.gov, applicants will be able to download a copy of the application packet, complete it off-line, and then upload and submit the application via the Grants.gov website. Specific instructions for applications submitted via http://www.grants.gov: ? You may access the electronic application for this project at http://www.grants.gov. You must search the downloadable application page by the CFDA number. ? At the http://www.grants.gov website, you will find information about submitting an application electronically through the site, including the hours of operation. HHS strongly recommends that you do not wait until the application due date to begin the application process through http://www.grants.gov because of the time needed to complete the required registration steps. ? The applicant must be registered in the System for Award Management (SAM) database in order to be able to submit the application. Applicants are encouraged to register early, and must have their DUNS and EIN/TIN numbers in order to do so. ? Authorized Organizational Representative: The Authorized Organizational Representative (AOR) who will officially submit an application on behalf of the organization must register with grants.gov for a username and password. AORs must complete a profile with Grants.gov using their organization?s DUNS Number to obtain their username and password at http://grants.gov/applicants/get_registered.jsp. AORs must wait one business day after successful registration in SAM before entering their profiles in Grants.gov. Applicants should complete this process as soon as possible after successful registration in SAM to ensure this step is completed in time to apply before application deadlines. ? When an AOR registers with Grants.gov to submit applications on behalf of an organization, that organization?s E-Biz POC will receive an email notification. The email address provided in the profile will be the email used to send the notification from Grants.gov to the E-Biz POC with the AOR copied on the correspondence. ? The E-Biz POC must then login to Grants.gov (using the organization?s DUNS number for the username and the special password called ?M-PIN?) and approve the AOR, thereby providing permission to submit applications. ? Any files uploaded or attached to the Grants.Gov application must be PDF file format and must contain a valid file format extension in the filename. Even though Grants.gov allows applicants to attach any file formats as part of their application, CMS restricts this practice and only accepts PDF file formats. Any file submitted as part of the Grants.gov application that is not in a PDF file format, or contains password protection, will not be accepted for processing and will be excluded from the application during the review process. In addition, the use of compressed file formats such as ZIP, RAR, or Adobe Portfolio will not be accepted. The application must be submitted in a file format that can easily be copied and read by reviewers. It is recommended that scanned copies not be submitted through Grants.gov unless the applicant confirms the clarity of the documents. Pages cannot be reduced in size, resulting in multiple pages on a single sheet, to avoid exceeding the page limitation. All documents that do not conform to the above specifications will be excluded from the application materials during the review process. ? After you electronically submit your application, you will receive an acknowledgement from Grants.gov that contains a Grants.gov tracking number. CMS will retrieve your application package from Grants.gov. Please note that applicants may incur a time delay before they receive acknowledgement that the application has been accepted by the Grants.gov system. Applicants should not wait until the application deadline to apply because notification by Grants.gov that the application is incomplete may not be received until close to or after the application deadline, eliminating the opportunity to correct errors and resubmit the application. Applications submitted after the deadline, as a result of errors on the part of the applicant, will not be accepted. ? After CMS retrieves your application package from Grants.gov, a return receipt will be emailed to the applicant contact. This will be in addition to the validation number provided by Grants.gov. Applications cannot be accepted through any email address. Full applications can only be accepted through http://www.grants.gov. Full applications cannot be received via paper mail, courier, or delivery service. All grant applications must be submitted electronically and be received through http://www.grants.gov by 3:00 pm Eastern Daylight Time on the applicable due date. Applications not successfully submitted to Grants.gov by the due date and time will not be eligible for review. All applications will receive an automatic time stamp upon submission and applicants will receive an email reply acknowledging the application?s receipt. Please be aware of the following: 1) Search for the application package in Grants.gov by entering the CFDA number. This number is shown on the cover page of this announcement. 2) If you experience technical challenges while submitting your application electronically, please contact Grants.gov Support directly at: www.grants.gov/customersupport or (800) 518-4726. Customer Support is available to address questions 24 hours a day, 7 days a week (except on Federal holidays). 3) Upon contacting Grants.gov, obtain a tracking number as proof of contact. The tracking number is helpful if there are technical issues that cannot be resolved. To be considered timely, applications must be received by the published deadline date. However, a general extension of a published application deadline that affects all State applicants or only those in a defined geographical area may be authorized by circumstances that affect the public at large, such as natural disasters (e.g., floods or hurricanes) or disruptions of electronic (e.g., application receipt services) or other services, such as a prolonged blackout. This statement does not apply to an individual entity having internet service problems. In order for there to be any consideration there must be an effect on the public at large. Grants.gov complies with Section 508 of the Rehabilitation Act of 1973. If an individual uses assistive technology and is unable to access any material on the site including forms contained with an application package, they can email the Grants.gov contact center at support@grants.gov or call 1-800-518-4726. Form of Application Submission The application must include all contents described below, in the order indicated, and conform to the following specifications: o Use 8.5? x 11? letter-size pages (one side only) with 1? margins (top, bottom, and sides). Other paper sizes will not be accepted. This is particularly important because it is often not possible to reproduce copies in a size other than 8.5? x 11?. o All pages of the project and budget narratives must be paginated in a single sequence. o Font size must be at least 12-point with an average of 14 characters per inch (CPI). o The Project Narrative must be double-spaced. o The Budget Narrative may be single-spaced and should follow the justifications and table formats provided in Appendix A, Guidance for Preparing a Budget Request and Narrative in Response to SF 424A. o Tables included within any portion of the application should have a font size of at least 12-point with a 14 CPI and may be single spaced. o The project abstract is restricted to a one-page summary which may be single-spaced. o The application may not exceed 55 pages. Although tables are counted towards the page limitation, the additional required documentation, including Standard Forms and Project Abstract is excluded from the page limitation The following standard forms are found in the Grants Application Package at www.grantsolutions.gov and must be completed with an electronic signature and submitted as part of the proposal: o Project abstract summary o SF-424: Official Application for Federal Assistance (see note below) o SF-424A: Budget Information Non-Construction o SF-424B: Assurances-Non-Construction Programs o SF-LLL: Disclosure of Lobbying Activities ? Project Site Location Form(s)

Award Procedures

? Applications will be screened for completeness and adherence to eligibility requirements for the track states have applied for: Transformation or Alignment. Applications received late or that fail to meet the eligibility requirements detailed in this solicitation or do not include the required forms will not be reviewed. ? An objective review panel will determine the merits of the proposal and the extent to which the proposed model furthers the purpose of SLIM, in accordance with the information outlined in the FOA. The objective review panel may include federal employees and/or non-federal employees. ? Applicants will be required to present their proposals to HHS leadership as part of the selection process. The purpose(s) of the presentation is(are) to: o Determine the extent to which the proposed model furthers the purpose of SLIM, in accordance with the information outlined in the FOA. o Determine the commitment of the state in implementing the proposal. o Determine the level of commitment and investment by stakeholders. o Assist CMS in its assessment of factors such as proposal feasibility, stakeholder engagement and state leadership. o Assist CMS in understanding the number of individuals impacted by the proposal. The state?s presentation must be led by a cabinet-level health official, such as a state Secretary of Health, and include providers and commercial payers who have committed to participate in the model. In the case of public-private partnership entities applying for a State-led Innovation Model award, senior leaders from the private and public sector, including senior leaders of the applicant entity, shall be present. Specifically, CMS expects applicants to address the criteria set forth in this FOA. CMS will also consider the number and nature of participation by stakeholders, including providers and payers, in the presentation. CMS may require further discussions with states regarding their proposals. The result of the review processes described above will be used in conjunction with the other factors noted in the FOA to determine the technical merit of the application and advise the approving HHS official. Final award decision will be made by a HHS program official. In making this decision, the HHS program official will take into consideration: reviews for programmatic and grants management compliance; pre-award business and risk assessment review (see below for information); the reasonableness of the estimated cost to the federal government and anticipated results; and the likelihood the proposed cost will result in the benefits expected. As noted in 45 CFR Part 75, CMS will do a review of risks posed by Applicant prior to award. In evaluating risks posed by Applicant, CMS will consider the below factors as part of the risk assessment (Applicant should review the factors in their entirety at http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=30572eb720fd047981e26dcf89370678&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1205, which includes: ? Financial stability; ? Quality of management systems and ability to meet the management standards prescribed in 45 CFR Part 75; o History of performance (including, for prior recipients of Federal awards: timeliness of compliance with applicable reporting requirements, conformance to the terms and conditions of previous federal awards, extent to which previously awarded amounts will be expended prior to future awards); o Reports and findings from audits performed under Subpart F of 45 CFR Part 75 and findings of any other available audits; and o Applicant?s ability to effectively implement statutory, regulatory, and other requirements imposed on non-federal entities. If successful, the Applicant will receive one cooperative agreement award. If unsuccessful, the Applicant will be advised by letter or electronic mail (sent to the AOR) that the application will not be held for further consideration or be funded. If an applicant is not selected for a SLIM Cohort 1 award, the applicant may apply for a later SLIM Cohort award.


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


Social Security Act, section 1115A.

Range of Approval/Disapproval Time

Anticipated Notice of Award date is 90 days after application submission.


CMS reserves the right to approve or deny any or all proposals for funding. Note that section 1115A of the Social Security Act, which creates the Center for Medicare and Medicaid Innovation (CMMI). Section 1115A(d)(2) states that there is no administrative or judicial review of the selection of organizations, sites, or participants to test models.



Assistance Considerations

Formula and Matching Requirements

This program has no statutory formula. Matching requirements are not applicable to this program. MOE requirements are not applicable to this program.

Length and Time Phasing of Assistance

The period of performance will be 24 months from the date of award with two 12 month budget periods. See the following for information on how assistance is awarded/released: The period of performance will be 24 months from the date of award with two 12 month budget periods.

Post Assistance Requirements


Awardees must agree to cooperate with any federal evaluation of the model and performance results and provide required quarterly, annual, and final (at the end of the cooperative agreement period) reports in a form prescribed by CMS.

Reports will be submitted electronically.

These reports will include how cooperative agreement funds were used, describe project or model progress, and describe any barriers, delays, and measurable outcomes.

CMS will provide the format for project and model reporting and technical assistance necessary to complete required report forms. Quarterly progress reports are due within 30 days of the end of each calendar quarter.

The annual (or final as applicable) progress reports are due 90 days following the end of each performance year.

Awardees must also agree to respond to requests that are necessary for the evaluation of the Model effort and provide data on key elements of Model performance and on results from the cooperative agreement activities.

CMS will continue to make requests for data related to its evaluation beyond the end of the state?s performance period.

The period for which CMS may continue to make such requests will be further clarified in the terms and conditions of award.

The Federal Financial Report (FFR or Standard Form 425) has replaced the SF-269, SF- 269A, SF-272, and SF-272A financial reporting forms.

All grantees must utilize the FFR to report cash transaction data, expenditures, and any program income generated.

Recipients must report on a quarterly basis cash transaction data via two separate systems: the Payment Management System (PMS) and GrantSolutions.

As detailed above, award recipient must agree to cooperate with any federal evaluation of the model and performance results and provide required quarterly, annual, and final reports in a form prescribed by CMS.

Reports will be submitted electronically.

These reports will include how cooperative agreement funds were used, describe project or model progress, and describe any barriers, delays, and measurable outcomes.

CMS will provide the format for project or model reporting and technical assistance necessary to complete required report forms.

Successful applicant must also agree to respond to requests that are necessary for the evaluation of the Model efforts and provide data on key elements of model performance and on results from the cooperative agreement activities.

As detailed above.

Successful applicants must submit reports to Federal Funding Report and meet Payment Management System reporting requirements.

HHS will have substantial involvement in this cooperative agreement award, as outlined below: o Program Evaluation ? HHS will work with recipients to implement lessons learned.

o Project Officer and Monitoring ? A Project Officer(s) will be assigned to this cooperative agreement award to support and monitor Recipients throughout the period of performance.

HHS Grants Management Officer(s), Grants Management Specialists, and Project Officer(s) will monitor, on a regular basis, progress of Recipients.

This monitoring may be by phone, document review, on-site visit, meeting, and by other appropriate means, such as reviewing program progress reports and Federal Financial Reports (FFR or SF-425).

This monitoring will help determine compliance with programmatic and financial requirements. o Communication ? Project Officer will conduct progress report calls to collect updates on how the Model is being implemented, including the formation of the RHRC, Model operations, global budget administration, data analytics, technical assistance, and quality assurance, and other updates as needed.


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.


Award recipient is required to maintain proper records ? including financial records, supporting documents, statistical records, and all other records pertinent to the program ? for the duration of the award, and retain these for a minimum of three years. If any litigation, claim, negotiation, audit, or other action involving the award has been started before the expiration of the three years, the records should be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular three year period, whichever is later.

Financial Information

Account Identification



(Cooperative Agreements) FY 16 $0; FY 17 est $47,000,000; and FY 18 est $88,000,000

Range and Average of Financial Assistance

The anticipated total funding is up to $240 million for up to 12 states, with an anticipated average award size of $20 million per state over a 24-month budget period.

Regulations, Guidelines, and Literature

This solicitation is subject to the Health and Human Services Grants Policy Statement (HHS GPS) at http://www.hhs.gov/asfr/ogapa/aboutog/hhsgps107.pdf. The general terms and conditions in the HHS GPS will apply as indicated unless there are statutory, regulatory, or award-specific requirements to the contrary. Standard and program specific terms of award will accompany the NoA. Applicant should be aware that special requirements could apply to cooperative agreement awards based on the particular circumstances of the effort to be supported and/or deficiencies identified in the application by the HHS review panel. The recently released HHS regulation (45 CFR Part 75) supersedes information on administrative requirements, cost principles, and audit requirements for grants and cooperative agreements included in the current HHS Grants Policy Statement where differences are identified.

Information Contacts

Regional or Local Office


Headquarters Office

Christina Crider 7500 Security Blvd, Baltimore, Maryland 21244 Email: Christina.Crider@cms.hhs.gov Phone: 410-786-3900

Criteria for Selecting Proposals

The Applicant must produce a detailed and fully developed proposal exemplifying the applicant?s readines to participate in the Flexibility and Accountability in State Transformation Model. Each proposal must include the following core elements: 1. Project Abstract 2. Signed Memorandums of Understanding 3. Project Narrative (addressing the following subject areas): ? Core Proposal Requirements ? Track-specific Proposal Requirements ? Health IT Strategy ? Operational Plan ? Statewide Performance Targets 4. Budget and Budget Narrative.

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