This is a new grant demonstration with first year awards made in FY 2007.

Uses and Use Restrictions

Budget Neutrality: In conducting these demonstration projects, The Secretary of Health and Human Services shall ensure that the aggregate payments made by the Secretary under title XIX of the Social Security Act (42 U.S.C.

1396 et seq.) do not exceed the amount which the Secretary estimates would have been paid under the title, if the demonstration projects under Section 6063 had not been implemented.

Any funding allocated for the Federal match for home and community-based services provided under the demonstration for the first year of this grant that remain unspent will be carried over to the next year of the Grant.

Indirect Costs: The provisions of the OMB Circular A-87 govern reimbursement of indirect costs under this solicitation.

A copy of OMB Circular A-87 is available online at: http://www.whitehouse.gov/omb/circulars/a087/a087.html.

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Eligibility Requirements

Applicant Eligibility

Any single State Medicaid Agency, State Mental Health Agency, or instrumentality of the State may apply for this Demonstration Grant.

Only one application can be submitted for a given State.

By "State" we refer to the definition provided under 45 CFR 74.2 as "any of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State exclusive of local governments." By "territory or possession" we mean Guam, the U.S.

Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands.

Beneficiary Eligibility

The level of care for Medicaid eligible individuals for this demonstration at a minimum must be under the age of 21 and require the need for a PRTF as defined in the State's Medicaid State Plan. For the purposes of this demonstration, youth are defined as "any child, adolescent or young adult under the age of 21". States shall ensure that each participant under the demonstration meets this level of care criterion to participate in the demonstration. Further, States may elect to add additional criteria to carve out or target a specific sub-population to receive home and community-based services under this demonstration. As a part of the application process, States shall submit a copy of the level of care assessment used to assess eligibility for participation in this demonstration. PRTFs are defined as any non-hospital facility with a provider agreement with a State Medicaid Agency to provide the inpatient services benefit to Medicaid- eligible individuals under the age of 21 (CFR 42 441.150 - 441.182). The facility must be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or any other accrediting organization with comparable standards recognized by the State. Additionally PRTFs must comply with Conditions of Participation on the use of restraint and seclusion (CFR 483.350 - 483.376).

Credentials/Documentation

Each application for this Demonstration Grant must include a letter of endorsement from the Director of the Mental Health Authority and the State Medicaid Director, if the applicant is not the single State Medicaid Agency/State Agency.

Aplication and Award Process

Preapplication Coordination

Applicants are encouraged to submit a non-binding Notice of Intent to Apply.

Notices of Intent to Apply are not required and their submission or failure to submit a notice has no bearing on the scoring of proposals received.

But receipt of such notices enables CMS to better plan for the application review process.

This program is excluded from coverage under E.O.

12372.

Application Procedures

Applicants must submit their applications electronically through http://www.grants.gov. Please note when submitting your application electronically, you are required, additionally, to mail a signed SF 424 to Nicole Nicholson, Centers for Medicare & Medicaid Services, Office of Operations Management, Acquisition and Grants Group, C2-21-15 Central Building, 7500 Security Boulevard, Baltimore, MD 21244-1850. The mailed SF 424 form may be received at the Centers for Medicare & Medicaid Services within 2 business days of the application closing date.

Award Procedures

How the Merit of Applications Will Be Determined: CMS will employ a multiphase review process to determine the applications that will be reviewed and the merit of the applications that are reviewed. The multiphase review process includes the following: "Applications will be screened by Federal staff to determine eligibility for further review using the criteria detailed in the "Eligibility Information" section of the solicitation. Applications that are received late or fail to meet the eligibility requirements as detailed in the "Applicant Eligibility" section of this solicitation will not be reviewed." Applications will be objectively reviewed by a panel of experts, the exact number and composition of which will be determined by CMS at its discretion, but may include private sector subject matter experts, beneficiaries of Medicaid supports, and Federal and Applicant policy staff. The review panels will utilize the objective criteria described in the "Application Review Criteria Information" section of the solicitation to establish an overall numeric score for each application. The results of the objective review of applications will be used to advise the approving CMS official. Additionally, CMS staff will make final recommendations to the approving official after ranking applications using the scores and comments from the review panel and weighing other factors as described below. Factors Other than Merit that May be Used in Selecting Applications for Award: CMS may assure reasonable balance among the grants to be awarded in terms of key factors such as geographic distribution and broad target group representation. CMS may redistribute grant funds (as detailed in the "Award Information" section of the solicitation) based upon the number and quality of applications received. (e.g., to adjust the minimum or maximum awards permitted or adjust the aggregate amount of Federal funds allotted to a particular category of grants).

Deadlines

Please visit http://www.grants.gov for application deadline. For information on how to get started with Grants.gov, please visit http://www.grants.gov/applicants/get_registered.jsp. We strongly recommend that you do not wait until the application deadline date to begin the application process through Grants.gov. We recommend you visit Grants.gov at least 30 days prior to filing your application to fully understand the process and requirements. We encourage applicants to submit well before the closing date.

Authorization

Section 6063, Deficit Reduction Act of 2005, Public Law 109-171.

Range of Approval/Disapproval Time

Successful applicants will receive a Financial Assistance Award (FAA) signed and dated by the CMS Grants Management Officer. The FAA is the document authorizing the grant award and will be sent through the U.S. Postal Service to the applicant organization as listed on its SF 424. Any communication between CMS and applicants prior to issuance of the FAA is not an authorization to begin performance of a project.

Appeals

Appeals are governed by Title 45--Public Welfare. SUBTITLE A--DEPARTMENT OF HEALTH AND HUMAN SERVICES PART 16--PROCEDURES OF THE DEPARTMENTAL GRANT APPEALS BOARD.

Renewals

Any funding allocated for the Federal match for home and community-based services provided under the demonstration for the first year of this grant that remain unspent will be carried over to the next year of the Grant. Funding for years 2008 - 2011 will be awarded on a Continuation Grant to each State based on their approved Financial Neutrality Formula and updated Implementation Plan. Any funding allocated for the Federal match for home and community-based services provided under the demonstration that remains unspent will be carried over to the next year of the Grant.

Assistance Considerations

Formula and Matching Requirements

A State receiving an award under this solicitation will receive reimbursement for home and community-based services provided under the demonstration on a quarterly basis at a rate equal to the State's Federal Medical Assistance Percentage (FMAP). Administrative costs will be reimbursed according to the requirements of CFR 42, Section 433.15.

Length and Time Phasing of Assistance

The demonstration period is five years. Budget Period: The budget period is from FY 2007 through FY 2011.

Post Assistance Requirements

Reports

Financial Status Report, form (SF-269), will be required to be submitted semi-annually.

This financial status report will account for all uses of grant monies during each reporting period.

During the pre-implementation period, CMS will work with the grantees to determine if additional reporting requirements imposed.

At the end of each demonstration grant year, States will be required to produce documentation that they have not exceeded the determined budget ceiling and meet all CMS financial requirements.

The format of this financial report will be determined during the IP phase of the Demonstration Semi- Annual Progress Reports: Web-based reports in a pre-determined format will be required to be submitted semi-annually.

The submission of the finalized IP will be due no later than 9 months after receipt of the Notice of Financial Assistance Award.

The IP will be considered the First report due under this demonstration.

Audits

In accordance with the provisions of OMB Circular No. A- 133 (Revised, June 24, 1997).

Records

Required to follow 45 CFR 74.53.

Financial Information

Account Identification

75-0516-0-1-551.

Obigations

FY 07 $21,325,721; FY 08 $37,168,000; and FY 09 est $49,168,000.

Range and Average of Financial Assistance

Floor: $21 million; Ceiling $21 million for FY 07; $37 million for FY 08.

Regulations, Guidelines, and Literature

(CFR 42, 441.150 - 441.182) PRTFs are defined as any non-hospital facility with a provider agreement with a State Medicaid Agency to provide the inpatient services benefit to Medicaid-eligible individuals under the age of 21. The facility must be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or any other accrediting organization with comparable standards recognized by the State. (CFR 483.350 - 483.376) Conditions of Participation on the use of restraint and seclusion). Under this demonstration States are granted the same waiver provisions provided to States who operate a section 1915 (c) waiver program. The three waiver provisions of Title XIX of the Social Security Act (the Act) are as follows: 1902 (a)(10)(B) (Comparability) The waiver of this provision of the Act permits a State to limit the provision of waiver services to Medicaid beneficiaries who require the level of care in an institutional setting, are in the target group(s) specified in the waiver, and offer services to waiver participants that are not provided to other Medicaid beneficiaries. 1902(a) (1) (State- wideness). The Secretary may grant a waiver of this provision of the Act in order to permit a State to limit the operation of a waiver to specified geographic areas of the State; and 1902(a) (10) (C) (i) (III) (Income and Resources for the Medically Needy). A State may request a waiver of this provision in order to apply institutional income and resources rules for the medically needy to persons in the community who otherwise qualify for waiver services. Additionally, States program design under this demonstration shall comply with existing Medicaid statutory and regulatory requirements governing the administration and operation of a section 1915 (c) waiver program, especially the six statutory assurances that are located in 42 CFR 441.302. HCBS waiver application for more detailed guidance on this subject found at: http://www.cms.hhs.gov/HCBS/02_QualityToolkit.asp#TopOfPage. By "State" we refer to the definition provided under 45 CFR 74.2 as "any of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State exclusive of local governments. By "territory or possession" we mean Guam, the U. S. Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands. CMS will reimburse States for home and community-based services provided under the demonstration on a quarterly basis at a rate equal to the State's Federal Medical Assistance Percentage (FMAP). (See Attachment 6 in the solicitation materials, for a list of home and community-based service categories). Administrative costs will be reimbursed according to the requirements of CFR 42, 433.15. A complete electronic application package, including all required forms, for this demonstration grant is available at https://apply.grants.gov/forms_apps_idx.html Standard application forms and related instructions are available online at http://gsa.gov/forms. Standard forms are available as detailed in, Section V.A, Address to Request Application Package. The following standard forms must be completed with an original signature and enclosed as part of the proposal: SF 424: Official Application for Federal Assistance (see Note below*) SF 424A: Budget Information SF 424B: Assurances Non-Construction Programs SF LLL: Disclosure of Lobbying Activities PHS-5161-1 (7/00) Additional Certifications - can be found at the following website: http://apply.grants.gov/forms/sample/SSA_additionalassurances_VI.0.pdf Usual Requirements that must be adhered to by law and regulation: A. Specific administrative and policy requirements of grantees as outlined in 45 CFR 74 and 45 CFR 92, apply to this grant opportunity.B. All grantees receiving awards under thesegrantprogramsmustmeettherequirements of: Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, The Age Discrimination Act of 1975, Hill-Burton Community Service nondiscrimination provisions, and Title II Subtitle A of the Americans with Disabilities Act of 1990.

Information Contacts

Regional or Local Office

None.

Headquarters Office

Program Contact: Ronald Hendler, Centers for Medicare & Medicaid Services, Center for Medicaid and State Operations, 7500 Security Boulevard, Mail Stop S2-14- 26, Baltimore, MD 21244. Telephone: (410) 786-2267. E-mail address: ronald.hendler1@cms.hhs.gov .

Criteria for Selecting Proposals

The Application submission will include a systems assessment, demonstration design and Financial Neutrality Form, following the application instructions in Section IV of the solicitation. Through a competitive process, 10 applications will receive awards. The 10 States receiving awards will be required to submit an Implementation Plan. States receiving an award under this solicitation will have nine months to complete the Implementation Plan for Centers for Medicare & Medicaid Services (CMS) review and approval. CMS will employ a multiphase review process to determine the applications that will be reviewed and the merit of the applications that are reviewed. The multiphase review process includes the following: Applications will be screened by Federal staff to determine eligibility for further review using the criteria detailed in the Eligibility Information section of this solicitation. Applications that that are received late or fail to meet the eligibility requirements as detailed in the Applicant Eligibility section of this solicitation will not be reviewed. Applications will be objectively reviewed by a panel of experts, the exact number and composition of which will be determined by CMS at its discretion, but may include private sector subject matter experts, beneficiaries of Medicaid supports, and Federal and Applicant policy staff. The review panels will utilize the objective criteria described in the Application Review Criteria Information section of this solicitation to establish an overall numeric score for each application. The results of the objective review of applications will be used to advise the approving CMS official. Additionally, CMS staff will make final recommendations to the approving official after ranking applications using the scores and comments from the review panel and weighing other factors as described below. Factors Other than Merit that May be Used in Selecting Applications for Award: CMS may assure reasonable balance among the grants to be awarded in terms of key factors such as geographic distribution and broad target group representation. CMS may redistribute grant funds (as detailed in the Award Information section of this solicitation) based upon the number and quality of applications received. (e.g., to adjust the minimum or maximum awards permitted or adjust the aggregate amount of Federal funds allotted to a particular category of grants).