?Transforming Clinical Practice Initiative (TCPI) ? Support and Alignment Network (SAN) 2.0?

Applicants that are continuing as SAN 2.0 cooperative agreement awardees will work to leverage primary and specialist care transformation work and learning in the field.

SAN 2.0 awardees add a valuable technical assistance asset to TCPI that will catalyze the accelerated adoption of Alternative
Payment Models (APMs), prior to 2019, at very large scale, and with very low cost.

By implementing accelerated practice transformation strategies, the SAN 2.0 awardees provide expertise needed to spread transformation knowledge to the entire TCPI community and support the 6 goals of TCPI.

SAN 2.0 represents a significant enhancement to the TCPI network expertise and capability to align with delivery system reform programs recently authorized under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Agency - Department of Health and Human Services

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

Office - See Regional Agency Offices.
Website Address


Program Accomplishments

Fiscal Year 2016: Fiscal Year 2016-SAN 2.0s have developed infrastructure within their networks, hired key personnel; and continue to enroll and assess practices/clinicians nationally; and provide technical assistance to enrolled clinicians in practice transformation. Fiscal Year 2017: N/A. Fiscal Year 2018: N/A.

Uses and Use Restrictions

Funds shall be used to implement and evaluate models that support system transformation toward higher quality care at lower costs.

Additionally, the funds shall further healthcare design improvements to support both primary and specialty care.

This includes innovations that have been tested and shown to reduce unnecessary testing and eliminate other inefficiencies in specialty care that are of primary interest in the SAN?s work.

Award dollars cannot be used for specific components, devices, equipment, or personnel that are not integrated into the entire service delivery model proposal.

Funds shall not be used to build or purchase health information technology or other information technology that exceed more than 10% of total costs of the applicant?s proposed budget.

Award dollars cannot be used to make permanent improvements to property not owned by the federal government; minor alterations and renovations are permissible under certain circumstances that are described in the financial plan template.

Eligibility Requirements

Applicant Eligibility

Applications will be screened for completeness and adherence to eligibility.

Applications received late or that fail to meet the eligibility requirements or do not include the required forms will not be reviewed.

Beneficiary Eligibility

The Beneficiary eligibility includes the list as noted above with the exception of: -Federal, Interstate -Intrastate -Student/Trainee and Graduate Students -Artist/Humanist -Engineer/Architect, Builder/Contractor/Developer -Farmer/Rancher/Agriculture Producer -Industrialist/Business Person -Small Business Person -Homeowner -Property Owner -Anyone/General Public.


No Credentials or documentation are required. This program is excluded from coverage under 2 CFR 200, Subpart E - Cost Principles.

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

This program is excluded from coverage under 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.

Award Procedures

Successful applicants will receive a Notice of Award (NoA) signed and dated by the CMS Grants Management Officer that will set forth the amount of the award and other pertinent information. The award will also include standard Terms and Conditions, and may also include additional specific cooperative agreement terms and conditions. Potential applicants should be aware that special requirements could apply to cooperative agreement awards based on the particular circumstances of the effort to be supported and/or deficiencies identified in the application by the review panel. The NoA is the legal document issued to notify the awardee that an award has been made and that funds may be requested from the HHS payment system. The NoA will be sent electronically to the Authorized Official and awardee organization as listed on its SF 424. Any communication between CMS and awardees prior to issuance of the NoA is not an authorization to begin performance of a project.


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


Section 1115A of the Social Security Act (the Act), as added by ž 3021 of the Affordable Care Act.

Range of Approval/Disapproval Time

Awards: Anticipated date of awards for Transforming Clinical Practice Initiative - Support and Alignment Network (SAN) 2.0 is September 2017.





Assistance Considerations

Formula and Matching Requirements

Statutory formulas are not applicable to this program. Matching requirements are not applicable to this program. This program has MOE requirements, see funding agency for further details.

Length and Time Phasing of Assistance

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

Post Assistance Requirements


The CMS Center for Clinical Standards and Quality and the CMS Innovation Center will take an active and substantial role in the management, implementation, evaluation, and monitoring of SAN awards.

The activities funded under the cooperative agreement and their resulting recipient responsibilities will be part of performance tracking, measuring, and evaluation responsibilities of CMS.

CMS will examine how the organizations that receive SAN funds used the money.

Quality data will be collected from the SAN and reported to a CMS contractor on a quarterly basis, but should be maintained by the SAN with monthly results.

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. Grantees must report on a quarterly basis cash transaction data via the Payment Management System (PMS) using the FFR in lieu of completing a SF-272/SF272A.

The FFR, containing cash transaction data, is due within 30 days after the end of each quarter.

The quarterly reporting due dates are as follows:, 7/30, 10/30, 1/30, 4/30.

A Quick Reference Guide for completing the FFR in PMS is at: www.dpm.psc.gov/grant_recipient/guides_forms/ffr_quick_reference.aspx.

In addition to submitting the quarterly FFR to PMS, Grantees must also provide, on an annual basis, a report to be uploaded into Grant Solutions which includes their expenditures and any program income generated in lieu of completing a Financial Status Report (FSR) (SF269/269A).

Expenditures and any program income generated should only be included on the annually submitted FFR, as well as the final FFR.

Annual hard-copy FFRs should be mailed and received within 30 calendar days of the applicable year end date.

The final FFR should be uploaded in Grants Solutions within 90 calendar days of the project period end date.

Awardees must agree to cooperate with any Federal evaluation of the model and performance results and provide required monthly, quarterly, semi-annual (every six months), 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 in transitioning clinicians to APMs, 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.

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

Awardees must submit a quarterly electronic SF 425 via the Payment Management System.

The report identifies cash expenditures against the authorized funds for the cooperative agreement.

Failure to submit the report may result in the inability to access funds.

CMS will enlist a third party entity to assist CMS in monitoring the SAN 2.0 performance results and outcomes.

CMS plans to collect data elements to be part of monitoring for all of the different SANs, and these monitoring and surveillance elements will feed into the evaluation.

All awardees will be required to cooperate in providing the necessary data elements to CMS or a CMS contractor.

The contractor would assist CMS in developing appropriate monitoring protocols and tracking performance across awardees and providing for rapid cycle evaluation and early detection of model performance problems, including coordination between awardees and CMS and its other contractors.



This program is excluded from coverage under 2 CFR 200, Subpart F - Audit Requirements. Awardees must comply with the audit requirements of Office of Management and Budget (OMB) Circular A-133. Information on the scope, frequency, and other aspects of the audits can be found on the Internet at www.whitehouse.gov/omb/circulars.


Awardees must comply with the audit requirements of Office of Management and Budget (OMB) Circular A-133. Information on the scope, frequency, and other aspects of the audits can be found on the Internet at www.whitehouse.gov/omb/circulars.

Financial Information

Account Identification



(Formula Grants (Cooperative Agreements)) FY 16 $1,394,273; FY 17 est $1,710,440; and FY 18 est $1,872,668

Range and Average of Financial Assistance

Budget Fiscal Year 2017: $700,000 - $110,000.

Regulations, Guidelines, and Literature

Please see Appendix (Review and Research) of the ICIP

Information Contacts

Regional or Local Office

See Regional Agency Offices.

Headquarters Office

Fred Butler, Jr. 7500 Security Blvd, Baltimore, Maryland 21207 Email: fred.butler@cms.hhs.gov Phone: 410-786-8834

Criteria for Selecting Proposals

See section VI. of FOA.

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