Webinar: State Innovation Models Initiative Round Two - Model Design Proposal Requirements
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The State Innovation Models Initiative Round 2 provides funding between $1 million to $3 million for up to 15 states to design and implement healthcare delivery system transformation models. Eligible applicants include U.S. states, territories, and the District of Columbia, with application requirements covering project narratives, budgets, and operational plans, and a scoring process focusing on proposal quality. Key limitations include disallowing the duplication of existing models and the supplanting of funds, with a project period set for one year starting January 1, 2015.
Webinar: State Innovation Models Initiative Round Two - Model Design Proposal Requirements
- 1. State Innovation Models Initiative Round 2: Model Design Application & Proposal Requirements Tuesday, June 10, 2014 3:00-4:00pm EDT
- 2. • Purpose of the State Innovation Models Initiative • Eligibility • Funding and Performance Period • Application Review and Selection Process • Design Award Proposal Requirements • Design Award Limitations • Scoring • Contacts/Next Steps Agenda
- 3. • Premise of the State Innovation Models Initiative: – Broad stakeholder input and engagement – State governments will accelerate delivery system transformation – Public and private sector collaboration for states’ payment and healthcare delivery system transformation State Innovation Models
- 4. • Who may apply: – All U.S. States and Territories, District of Columbia (Mayor), including Round 1 State Innovation Model Design and Pre-Test states – One application per state (for Model Design or Model Test Award) – Cannot receive Model Design and Test Award – Current State Innovation Model Round 1 Model Test awardees are NOT eligible for Round 2 funding – Outside organizations focused on quality and state delivery system transformation Eligibility
- 5. • CMS will award between $1 million -$3 million per state to up to 15 Model Design cooperative agreements through this Funding Announcement. • States receiving Model Design awards have 12 months from the award start date to complete their State Health System Innovation Plans and Model Designs. • The project period for Model Design awards will be one year: January 1, 2015, through December 31, 2015. Funding and Performance Period
- 6. • Model Design applications will be reviewed and scored based on the quality of the proposal. • In-person presentations are not required for Model Design applicants. • Applications will be screened for completeness and adherence to eligibility requirements. • Objective review panel will determine merits of the proposal and extent to which the proposed model furthers the purpose of SIM Application Review and Selection Process
- 7. • Model Design applications must address the following required areas: – Model Design Project Narrative – Budget Narrative – Financial Analysis – Operational Plan Model Design Proposal Requirements
- 8. Model Design Project Narrative • Plan for Improving Population Health • Health Care Delivery System Transformation Plan • Payment and/or Service Delivery Model • Leveraging Regulatory Authority • Health Information Technology • Stakeholder Engagement • Quality Measure Alignment • Monitoring and Evaluation Plan • Alignment with State and Federal Innovation Model Design Proposal Requirements (1 of 4): Model Design Project Narrative
- 9. • Explanation of requested budget • Submit Standard Form-424A (SF-424A) • Overhead and administrative (indirect) costs limited to 10% • Indicate other funding sources • Attestation that Innovation Center funds will not supplant funding from other sources • Personnel costs (itemized) • See page 34 of the FOA Model Design Proposal Requirements (2 of 4): Budget Narrative
- 10. • At a minimum, the financial analysis must: – Describe the populations being addressed and their respective total medical and other services costs • Total medical/other costs (PMPM/total population total) – Anticipated cost savings resulting from specified interventions – Expected total savings and Return on Investment (ROI) for the overall state model and basis for expected savings. Model Design Proposal Requirements (3 of 4): Financial Analysis
- 11. • Describe activities and budget for performance period • Timeline for design process • Major milestones • Key personnel roles/responsibilities • Governor’s role • Lead agencies/departments • Assumptions made, risks to operation timeline, projected strategies for mitigation of identified risks. Model Design Proposal Requirements (4 of 4): Operational Plan
- 12. The following areas are considered out of scope: – Medicare eligibility changes; – Coverage/benefits reductions in Medicare/Medicaid or any changes that would have the effect of rationing care; – Increases in premiums or cost sharing; – Increases in net federal spending under Medicare, Medicaid or CHIP programs; – Medicaid FMAP formula changes; – Changes to the EHR incentive program for eligible professionals and eligible hospitals; – Changes in State Financial Alignment Models; – Reductions in Medicare beneficiary choice of provider or health plan, or Medicaid choice of provider or health plan beyond those allowed today, or changes to maintenance of effort requirements; – Changes to CMS sanctions, penalties, or official denial of participation currently in effect. Model Design Award Limitations
- 13. • CMS will not fund proposals that: – Duplicate models for population that are already being funded and tested as part of any other CMS and/or HHS initiatives. – Supplant existing federal or state funding – Use funds to substitute for currently funded Medicaid or CHIP services or administrative activities. Design Award Limitations (cont.)
- 14. • Scoring is based on proposals’ quality in the following 5 areas: – Model Design Strategy (30 Points) – Provider Engagement Strategy (15 Points) – Payer/Other Stakeholder Strategy (15 Points) – Operational Plan (10 Points) – Model Design Budget Narrative/Financial Analysis (30 Points) Scoring
- 15. • The following will be considered when scoring applicants’ Model Design Strategy: – Clear process for plan design – State government/key stakeholder engagement – Use of policy/regulatory levers – Alignment with existing CMS/HHS efforts – Improve access of care – Leverage State Marketplace Exchanges – Reach preponderance of state’s population – For continuing Round 1 states- demonstrate how the proposal will enhance the state’s Round 1 efforts Scoring (1 of 5): Model Design Strategy
- 16. • The following will be considered when scoring applicants’ Provider Engagement Strategy: – Provider Commitment – For Round 1 states: demonstrate progress in provider engagement Scoring (2 of 5): Provider Engagement Strategy
- 17. • The following will be considered when scoring applicants’ Payer/Other Stakeholder Engagement Strategy: – Multi-payer payment innovation – Measure alignment – Participation of commercial payers and purchasers – Involvement and commitment from other stakeholder groups – For Round 1 states: demonstrate progress in payer/other stakeholder engagement Scoring (3 of 5): Stakeholder Engagement Strategy
- 18. • The following will be considered when scoring applicants’ Operational Plan: – Demonstration of organizational structure/capacity/leadership/expertise – Detailed project plan and timeline – Staff skills needed to ensure implementation Scoring (4 of 5): Operational Plan
- 19. • A Model Design Budget Narrative & Financial Analysis should: – Include a carefully developed budget consistent with Model Design requirements – Reflect reasonable administrative & overhead costs (limited to 10% of direct costs) – Indicate other resources that will aid in designing the State Health System Innovation Plan – Describe how the overall Financial Analysis will be developed Scoring (1 of 5): Model Design Budget Narrative and Financial Analysis
- 20. Programmatic Contact Information All programmatic questions about the State Innovation Models Initiative must be directed to the program e-mail address: stateinnovations@cms.hhs.gov. The submitter may direct a follow-up question to: Leah B. Nash Centers for Medicare & Medicaid Services Center for Medicare & Medicaid Innovation Phone: 410-786-8950 or e-mail: Leah.Nash@cms.hhs.gov Administrative Questions Administrative grant questions about the State Innovation Model initiative may be directed to: Grants Management Specialist, Gabriel Nah Centers for Medicare & Medicaid Services Office of Acquisitions and Grants Management Phone: 301-492-4482 or email: Gabriel.Nah@cms.hhs.gov Agency Contacts
- 21. • Upcoming Webinar : “How to Apply Using Grants.gov” – June 12th, 4-5pm EDT – URL: https://webinar.cms.hhs.gov/simr2grantsgov/ – Start Time & Date: 06/12/2014 4:00 PM ET – Call-in line: 1-877-267-1577, Meeting ID#: 991 442 564 • Submit questions to StateInnovations@cms.hhs.gov • FAQs will be updated and posted to the Innovation Center website at innovation.cms.gov/initiatives/state-innovations • Additional information is also available on our website Next Steps