HomeMy WebLinkAbout2022-137-E-Health-Duke University - Charlene Wong-Federal awarding agencyCost Reimbursement Subaward
Federal Awarding Agency:
Pass-Through Entity (PTE): Subrecipient:
PTE Federal Award No: Subaward No:
PTE PI: Sub PI:
Project Title:
Subaward Period of Performance (Budget Period):
Start: End: Amount Funded This Action (USD): $
Estimated Project Period (if incrementally funded):
Start: End: Incrementally Estimated Total (USD): $
Terms and Conditions
DateDate
Title:
By an Authorized Official of the PTE:
__________________________________________________
Name:
Title:
By an Authorized Official of the Subrecipient:
__________________________________________________
Name:
.
.
1.PTE hereby awards a cost reimbursable Subaward, (as determined by 2 CFR 200.331), to Subrecipient. The Statement of Work
and budget for this Subaward are as shown in Attachment 5. In its performance of Subaward work, Subrecipient shall be an
independent entity and not an employee or agent of PTE.
2.Subrecipient shall submit invoices not more often than monthly and not less frequently than quarterly for allowable costs
incurred. Upon the receipt of proper invoices, the PTE agrees to process payments in accordance with this Subaward and 2
CFR 200.305. All invoices shall be submitted using Subrecipient’s standard invoice, but at a minimum shall include current and
cumulative costs (including cost sharing), breakdown by major cost category, Subaward number, and certification, as required in
2 CFR 200.415(a). Invoices that do not reference PTE Subaward number shall be returned to Subrecipient. Invoices and
questions concerning invoice receipt or payments shall be directed to the party's Contact, shown in
Attachment 3A.
3. A final statement of cumulative costs incurred, including cost sharing, marked "FINAL" must be submitted to PTE’s
Contact, as shown in Attachment 3A, not later than 60 days after the
The final statement of costs shall constitute Subrecipient's final financial report.
4. All payments shall be considered provisional and are subject to adjustment within the total estimated cost in the event such
adjustment is necessary as a result of an adverse audit finding against the Subrecipient.
5. Matters concerning the technical performance of this Subaward shall be directed to the appropriate party’s Principal Investigator
as shown in Attachments 3A and 3B. Technical reports are required as shown in Attachment 4.
6. Matters concerning the request or negotiation of any changes in the terms, conditions, or amounts cited in this Subaward, and
any changes requiring prior approval, shall be directed to the PTE's Contact and the Subrecipient’s
Contact shown in Attachments 3A and 3B. Any such change made to this Subaward requires the
written approval of each party’s Authorized Official as shown in Attachments 3A and 3B.
7. The PTE may issue non-substantive changes to the Period of Performance and budget . Unilateral
modification shall be considered valid 14 days after receipt unless otherwise indicated by Subrecipient when sent to
Subrecipient's Contact, as shown in Attachment 3B.
8.Each party shall be responsible for its negligent acts or omissions and the negligent acts or omissions of its employees, officers,
or directors, to the extent allowed by law.
9.Either party may terminate this Subaward with 30 days written notice. PTE notice shall be directed to the
Contact, and Subrecipient notice shall be directed to the
Contact as shown in Attachments 3A and 3B. PTE shall pay Subrecipient for termination costs as allowable under Uniform
Guidance, 2 CFR 200, or 45 CFR Part 75 Appendix IX, as applicable.
10.By signing this Subaward, including the attachments hereto which are hereby incorporated by reference, Subrecipient certifies
that it will perform the Statement of Work in accordance with the terms and conditions of this Subaward and the applicable terms
of the Federal Award. The parties further agree that they intend this Subaward to comply with all applicable laws, regulations,
and requirements.
SPS 270868
Other PHS [Type in Agency]Centers for Medicare and Medicaid Services
Duke University Orange County Health Department
Charlene Wong Dana Crews
2B2CMS331758-03-00 309000009
North Carolina Integrated Care for Kids Model
01/01/2022 12/31/2022 55,026.00
Financial
Financial Budget Period end date.
Authorized Official
Authorized Official
Unilaterally
Authorized Official
Administrative Authorized Official
QUINTANA STEWART
HEALTH DIRECTOR
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
3/23/2022
Attachment 1
Certifications and Assurances
Certification Regarding Lobbying (2 CFR 200.450)
By signing this Subaward, the Subrecipient Authorized Official certifies, to the best of his/her knowledge and belief, that
no Federal appropriated funds have been paid or will be paid, by or on behalf of the Subrecipient, to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement in accordance with 2 CFR 200.450.
If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or
intending to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement,
the Subrecipient shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," to the PTE.
This certification is a material representation of fact upon which reliance was placed when this transaction was made
or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31
U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
Debarment, Suspension, and Other Responsibility Matters (2 CFR 200.214 and 2 CFR 180)
By signing this Subaward, the Subrecipient Authorized Official certifies, to the best of his/her knowledge and belief that
neither the Subrecipient nor its principals are presently debarred, suspended, proposed for debarment, declared
ineligible or voluntarily excluded from participation in this transaction by any federal department or agency, in accordance
with 2 CFR 200.213 and 2 CFR 180.
Audit and Access to Records
Subrecipient certifies that it will provide PTE with notice of any adverse findings which impact this Subaward.
Subrecipient certifies compliance with applicable provisions of 2 CFR 200.501-200.521. If Subrecipient is not required to
have a Single Audit as defined by 200.501, Awarding Agency requirements, or the Single Audit Act, then Subrecipient
will provide notice of the completion of any required audits and will provide access to such audits upon request.
Subrecipient will provide access to records as required by parts 2 CFR 200.337 and 200.338 as applicable.
Program for Enhancement of Contractor Employee Protections (41 U.S.C 4712)
Subrecipient is hereby notified that they are required to: inform their employees working on any federal award that they
are subject to the whistleblower rights and remedies of the program; inform their employees in writing of employee
whistleblower protections under 41 U.S.C §4712 in the predominant native language of the workforce; and include such
requirements in any agreement made with a subcontractor or subgrantee.
The Subrecipient shall require that the language of the certifications above in this Attachment 1 be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
Use of Name
Neither party shall use the other party’s name, trademarks, or other logos in any publicity, advertising, or news release
without the prior written approval of an authorized representative of that party. The parties agree that each party may use
factual information regarding the existence and purpose of the relationship that is the subject of this Subaward for
legitimate business purposes, to satisfy any reporting and funding obligations, or as required by applicable law or
regulation without written permission from the other party. In any such statement, the relationship of the parties shall be
accurately and appropriately described.
Subaward Number:
Prohibition on Certain Telecommunication and Video Surveillance Services or Equipment
Pursuant to 2 CFR 200.216, Subrecipient will not obligate or expend funds received under this Subaward to: (1) procure
or obtain; (2) extend or renew a contract to procure or obtain; or (3) enter into a contract (or extend or renew a contract)
to procure or obtain equipment, services, or systems that uses covered telecommunications equipment or services (as
described in Public Law 115-232, section 889) as a substantial or essential component of any system, or as a critical
technology as part of any system.
309000009
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
Attachment 2
Federal Award Terms and Conditions
Required Data Elements
General Terms and Conditions
By signing this Subaward, Subrecipient agrees to the following:
Subaward Number
The data elements required by Uniform
Guidance are incorporated
This Subaward Is:
Research & Development Subject to FFATA
Federal Award Issue Date FAIN CFDA No.
Data Rights: Subrecipient grants to PTE the right to use data created in the performance of this Subaward solely for the purpose of and only to the extent required to meet PTE's obligations to the Federal Government under its PTE Federal Award.
Copyrights:
to PTE an irrevocable, royalty-free, non-transferable, non-exclusive right and license to use, reproduce, make derivative works, display, and perform publicly any copyrights or copyrighted material (including any computer software and its documentation and/or databases) first developed and delivered under this Subaward solely for the purpose of and only to the extent required to meet PTE's obligations to the Federal Government under its PTE Federal Award.
Subrecipient grants to PTE the right to use any written progress reports and deliverables created under this Subaward solely for the purpose of and only to the extent required to meet PTE’s obligations to the Federal Government under its Federal Award.
Key Personnel Per NOA
1.To abide by the conditions on activities and restrictions on expenditure of federal funds in appropriations acts that are applicable
to this Subaward to the extent those restrictions are pertinent. This includes any recent legislation noted on the Federal Awarding
Agency’s website:
2.2 CFR 200
3.The Federal Awarding Agency's grants policy guidance, including addenda in effect as of the beginning date of the period of
performance or as amended found at:
4.Terms and Conditions, including any Federal Awarding Agency's Specific Requirements found at:
a.No-cost extensions require the written approval of the PTE. Any requests for a no-cost extension shall be directed to the
Contact shown in Attachment 3A, not less than 30 days prior to the desired effective date of the requested
change.
b.Any payment mechanisms and financial reporting requirements described in the applicable Federal Awarding Agency Terms and
Conditions and Agency-Specific Requirements are replaced with Terms and Conditions (1) through (4) of this Subaward; and
c.Any prior approvals are to be sought from the PTE and not the Federal Awarding Agency.
d.Title to equipment as defined in 2 CFR 200.33 that is purchased or fabricated with federal funds or Subrecipient cost sharing funds,
as direct costs of the project or program, shall vest in the Subrecipient subject to the conditions specified in 2 CFR 200.313.
e.Prior approval must be sought for a change in Subrecipient PI or change in Key Personnel (defined as listed on the NOA). Treatmentof program income:
except for the following :
Promoting Objectivity in Research (COI): Subrecipient must designate herein which entity’s Financial Conflicts of Interest policy (COI) will apply:
If applying its own COI policy, by execution of this Subaward, Subrecipient certifies that its policy complies with the requirements of the relevant Federal Awarding Agency as identified herein:
Subrecipient shall report any financial conflict of interest to PTE’s Administrative Representative or COI contact, as designated on Attachment 3A. Any financial conflicts of interest identified shall, when applicable, subsequently be reported to Federal Awarding Agency. Such report shall be made before expenditure of funds authorized in this Subaward and within 45 days of any subsequently identified COI.
Special Terms and Conditions:
Subrecipient agrees to comply with the Federal Awarding Agency's data sharing and/or access requirements as reflected in the NOA or the Federal Awarding Agency's standard terms and conditions as referenced in General Terms and Conditions 1-4 above.
Data Sharing and Access:
Awarding Agency Institute (If Applicable)
CFDA Title
309000009
in the attached Federal Award.
n
https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html
and 45 CFR Part 75.
https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html
https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html
Principal Investigator
Additive
No additional requirements
Subrecipient Grants
Subrecipient
42 CFR Part 50 Subpart F
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
No Human or Vertebrate Animals
Additional Terms
Work Involving Human or Vertebrate Animals (Select Applicable Options)
Human Subjects Data (Select One)
n Human Subjects Exempt
Vertebrate Animals
IRB Exempt and determination will be provided upon request
The PTE requires verification of IRB and/or IACUC approval be sent to the Administrative Contact as required above:
Subrecipient agrees that any non-exempt human and/or vertebrate animal research protocol conducted under this Subaward shall be reviewed and
approved by the appropriate Institutional Review Board (IRB) and/or its Institutional Animal Care and Use Committee (IACUC), as applicable and that
it will follow current and duly approved research protocols for all periods of the Subaward involving human and/or vertebrate animal research. If
Subrecipient is using its own IRB and/or IACUC, Subrecipient certifies that its IRB and/or IACUC are in full compliance with applicable state and
federal laws and regulations. The Subrecipient certifies that any submitted IRB/IACUC approval represents a valid, approved protocol that is entirely
consistent with the Project associated with this Subaward. In no event shall Subrecipient invoice or be reimbursed for any human or vertebrate animals
related expenses incurred in a period where any applicable IRB/IACUC approval is not properly in place.
This section left intentionally blank
Not Applicable
This section left intentionally blank
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
Subaward Number: Attachment 3A
Pass-Through Entity (PTE) Contacts
PTE Information
Entity Name:
Legal Address:
Yes No Invoice email (if different):
Website:
PTE Contacts
Central Email:
Principal Investigator Name:
Email:
Administrative Contact Name:
Email:
COI Contact email (if different to above):
Financial Contact Name:
Email invoices?
Authorized Official Name:
Email:
Email:
Telephone Number:
Telephone Number:
Telephone Number:
Telephone Number:
PI Address:
Administrative Address:
Invoice Address:
309000009
Duke University
2200 West Main Street, Erwin Square - Suite 900
Durham, NC 27705
www.duke.edu
contracts.management@mc.duke.edu
Charlene Wong
charlene.wong@duke.edu 919-620-5333
Agreement Manager
contracts.management@mc.duke.edu 919-684-5442
dosicoi@duke.edu
Office of Post Award Administration
ospsubcontractmgmt@duke.edu 919-684-5442
Jennifer McCallister
contracts.management@mc.duke.edu 919-684-5442
2200 West Main Street, Erwin Square - Suite 900
Durham, NC 27705
2200 West Main Street, Erwin Square - Suite 900
Durham, NC 27705
Subcontract Manager - 2200 West Main Street Suite 300
Durham, NC 27705
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
Attachment 3B
Subrecipient Contacts
Yes
Subaward Number:
Zip Code Look-up
Subrecipient Information for FFATA reporting
Entity's DUNS Name:
No
This section for U.S. Entities:
Congressional District: Zip Code+4:
Institution Type:
Currently registered in SAM.gov: Yes
Exempt from reporting executive compensation:
EIN No.:
DUNS:
Parent DUNS:
No (if no, complete 3Bpg2)
Legal Address:
Subrecipient Contacts
Email:
Administrative Address:
Payment Address:
Telephone Number:Email:
Administrative Contact Name:
Telephone Number:
Telephone Number:
Telephone Number:Email:
Invoice/Payment Email:
Authorized Official Name:
Financial Contact Name:
Email:
Principal Investigator Name:
Central Email:
Website:
Place of Performance Address
309000009
ORANGE COUNTY
56-6000327
139209659
County Government
NC 4TH 27278-2438
300 WEST TRYON STREET
HILLSBOROUGH, NC 27278
n/a
https://orangecountync.gov/204/Health-Department
Dana Crews
DCREWS@ORANGECOUNTYNC.GOV 919-245-2458
KIMBERLEE QUATRONE
KQUATRONE@ORANGECOUNTYNC.GOV 919-245-2460
KIMBERLEE QUATRONE
KQUATRONE@ORANGECOUNTYNC.GOV 919-245-2460
HEALTH_PURCHASING@ORANGECOUNTYNC.GOV
QUINTANA STEWART
QSTEWART@ORANGECOUNTYNC.GOV 919-245-2412
ORANGE COUNTY - LEGAL DEPARTMENT
PO BOX 8181
HILLSBOROUGH, NC 27278
ORANGE COUNTY HEALTH DEPARTMENT
PO BOX 8181
HILLSBOROUGH, NC 27278
ORANGE COUNTY HEALTH DEPARTMENT
ATTN: KIMBERLEE QUATRONE
PO BOX 8181
HILLSBOROUGH, NC 27278
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
Attachment 3B-2
Highest Compensated Officers
Subaward Number:
Subrecipient:
Institution Name:
Highest Compensated Officers
The names and total compensation of the five most highly compensated officers of the entity(ies) must be listed if
the entity in the preceding fiscal year received 80 percent or more of its annual gross revenues in
Federal awards; and $25,000,000 or more in annual gross revenues from Federal awards; and the public does
not have access to this information about the compensation of the senior executives of the entity through
periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. §§
78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986. See FFATA § 2(b)(1) Internal Revenue
Code of 1986.
Officer 1 Name:
Officer 1 Compensation:
Officer 2 Name:
PI Name:
Officer 2 Compensation:
Officer 3 Compensation:
Officer 4 Compensation:
Officer 5 Compensation:
Officer 3 Name:
Officer 4 Name:
Officer 5 Name:
309000009
Orange County Health Department
Dana Crews
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
Attachment 4
Reporting and Prior Approval Terms
to the PTE’s . Such report shall also include a detailed budget for the next Budget Period,
Subaward Number:
Quarterly technical/progress reports will be submitted within 30 days after the end of each project quarter to
the PTE’s
days prior to the end of each budget period
Subrecipient agrees to submit the following reports (PTE contacts are identified in Attachment 3A):
Technical Reports:
within days of Monthly technical/progress reports will be submitted to the PTE’s
of the end of the month.
Annual technical / progress reports will be submitted within
updated other support for key personnel, certification of appropriate education in the conduct of human subject
research of any new key personnel, and annual IRB or IACUC approval, if applicable.
days of thewithin
in order for the PTE
A Final technical/progress report will be submitted to the PTE’s
end of the Project Period or after termination of this award, whichever comes first.
Technical/progress reports on the project as may be required by PTE’s
to satisfy its reporting obligations to the Federal Awarding Agency.
Prior Approvals:
Carryover:
Other Reports:
In accordance with 37 CFR 401.14, Subrecipient agrees to notify both the Federal Awarding Agency via iEdison
and PTE's within 60 days after Subrecipient’s inventor discloses invention(s) in writing
to Subrecipient’s personnel responsible for patent matters. The Subrecipient will submit a final invention report
using Federal Awarding Agency specific forms to the PTE’s within 60 days of the end
of the Project Period to be included as part of the PTE's final invention report to the Federal Awarding Agency.
A negative report is required:
Property Inventory Report (only when required by Federal Awarding Agency), specific requirements below.
Additional Technical and Reporting Requirements:
.
309000009
Administrative Contact 15
Administrative Contact
n
30
Principal Investigator
n Principal Investigator 60
n Principal Investigator
Carryover is restricted for this subaward by the:Federal Awarding Agency
Submit carryover requests to the Principal Investigator .
Carryover instructions and requirements are as
stated by the Federal Awarding Agency
guidance or as shown below.
n
Principal Investigator
Principal Investigator
No
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
Attachment 5
Statement of Work, Cost Sharing, Indirects & Budget
Statement of Work
Below Attached, pages
If award is FFATA eligible and SOW exceeds 4000 characters, include a Subrecipient Federal Award Project Description
%
Budget Information
Subaward Number:
Cost Sharing
If Yes, include Amount: $
Below Attached,pages
Direct Costs $
Indirect Costs $
Total Costs $
All amounts are in United States Dollars
Indirect Information Indirect Cost Rate (IDC) Applied
Rate Type:
Budget Details
Budget Totals
309000009
3
0
Modified Total Direct Costs
No
`
55,026.00
55,026.00
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
Attachment 6
Notice of Award (NOA) and any additional documents
The following pages include the NOA and if applicable any additional documentation referenced
throughout this Subaward.
Not incorporating the NOA or any additional documentation to this Subaward.
Subaward Number:
309000009
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
NC Integrated Care for Kids Service Integration Coordinator Statement of Work
Glossary
Service Integration Coordinator (SIC); Integrated Care for Kids (InCK).
Problem Statement
The goal of the North Carolina Integrated Care for Kids Model (NC InCK) is to provide efficient, optimal
physical and behavioral healthcare for children ages birth to 21 who receive services through North
Carolina’s Medicaid or CHIP program. Children must live in one of five NC counties to enroll in NC
InCK – Alamance, Durham, Granville, Orange or Vance.
A Service Integration Coordinator (SIC) is an educated professional with an innovative mindset who
provides strategic coordination of care management services so that child serving systems are aligned and
identified children have a Single Plan of Care. A Service Integration Coordinator (SIC) should have
experience in coordination of care activities, care management or case management. This role will be
responsible for a range of care coordination support on behalf of children in the InCK model- and
systems-level support to better integrate key services for children and families in InCK’s 5-county region.
The SIC will also serve as a knowledgeable resource for the broader InCK team on the sector they
represent (early childhood, child welfare, behavioral health, etc.) and serve as a proponent of InCK’s
work to improve care coordination for children within their hiring institution. Through this role, the SIC
will be an integral part of an interdisciplinary team of authorized clinicians, care managers, case
managers, social service providers, and care givers, working to improve the health status and transitions
of care to achieve optimal clinical and child well-being outcomes.
Goals
1. During years NC InCK planning 2020 and 2021, the SIC staffed the hiring organization or agency
will be onboarded to the NC InCK model and receive training on their roles. SICs will support
model development through their expertise in their own sector as well as any relevant past
experience. The on-boarding of SICs will be supported by the UNC National Implementation
Research Network.
2. During the implementation period of the model (2022-2026), the SIC will perform the following
activities:
a. Identify, record and maintain relevant contact information and work with a Single Point
of Contact for integrated care coordination or case management across healthcare and
social services sectors for children requiring multiple services or who are at risk of out of
home placement.
b. Assist in the development of a Shared Action Plan for children with higher medical and
social needs with common goals determined by families and key stakeholders supporting
the family. Monitor services, make referrals and assess progress of children toward their
Shared Action Plan goals.
c. Use a patient-centric, collaborative partnership approach in all model activities.
d. Monitor quality and effectiveness of interventions to the population by setting long term
and/or short-term specific, measurable goal(s).
e. Electronically document all activity in relevant documentation systems.
f. Communicate and coordinate with the child’s Single Point of Contact as needed to
minimize fragmented care and foster appropriate utilization of services.
g. Provide on-site, community, and telephonic outreach to families, providers, and
community stakeholders to advance NC InCK model goals and supported initiatives (e.g.,
stakeholder or parental training programs).
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
h. Strengthen the capacity within their home services area;
including, championing the InCK vision and goals to care managers and coordinators in
their home service area.
i. Strengthen partnerships between core child service areas by connecting managers and
coordinators across child service areas through referrals and developing collaborative
infrastructure that promotes coordinated care across sectors.
Tasks:
1. Hiring: Work with InCK Executive Leadership to co-design a process for joint selection of the
candidate. InCK requirements are:
i. Any candidate, internal or external, must be jointly approved by the hiring
organizations and NC InCK Executive Leaders.
ii. NC InCK and the hiring organization will jointly draft the job description prior to
posting externally for applicants;
iii. NC InCK and the hiring organization will jointly work in partnership to vet,
interview and select external candidates for the Service Integration Coordinator;
iv. If reviewing internal candidates, NC InCK Executive Leadership must review at
least 2 different candidates for the SIC role;
2. Replacement of SIC: If a candidate needs to be replaced, NC InCK Executive Leadership and the
hiring organization will go through a similar hiring process to jointly select a replacement SIC.
3. Identify internal organizational processes that can be leveraged to fulfill the mission of NC InCK.
4. Assist in the training of the SIC to ensure that the goals of both Title V and NC InCK can be
fulfilled.
5. Work collaboratively with NC InCK to identify existing processes for plans of care for children
in different sectors and to design the implementation of a single plan of care.
Deliverables:
1. Identification of at least 2 potential candidates for each SIC role within your organization to
elevate to NC InCK Executive leadership for joint selection. Candidates can be internal or
external or a combination.
2. Hiring of SIC for NC InCK within your organization by November 2020.
3. Training and onboarding of the SIC to your organization, including computer and internet access,
building access, HR, and management. NC InCK will provide SIC onboarding on the role of the
SIC and responsibilities specific to the role.
4. Documentation of all agency processes that pertain to and can be leveraged to attain the goals of
the NC InCK model.
Administration
In Year 1, the NC InCK model will provide funding to cover up to 75% of salary and benefits for two
SICs to support the hiring of a Service Integration Coordinator (SIC) who will fulfill the SIC role over a
two month period (November 1 through December 31, 2020). In subsequent years, the NC InCK model
will provide funding to cover up to 75% of salary and benefits for two SICs to support the work of the
family engagement specialist.
Duke’s Role:
• Provide funding to cover the salary and fringe benefits for the Service Integration Coordinator
from the Integrated Care for Kids (InCK) Cooperative Agreement from the Centers for Medicare
and Medicaid Services (CMMS).
• Provide a Travel allotment of $557/year to cover 80 miles/month at the federal rate of $0.575
/mile. Travel will support SIC attendance at InCK Trainings and SIC Collaboratives intended to
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
further model goals. Please note that these individuals will be required to provide monthly reports
of their mileage in order to receive reimbursement for Model-related trips.
•Salary and fringe benefits will be charged directly to the fund code for the Cooperative
Agreement. Please note that this position is funded 75% from a Cooperative Agreement from
Centers for Medicare and Medicaid Services and will terminate upon completion of the award.
•Provide training related to the InCK Model and provide ongoing professional development and
support through InCK’s SIC Learning Collaborative.
•Provide feedback to the supervisors of the Service Integration Coordinator for the purposes of
performance review, including any performance issues, in a timely manner.
•The NC InCK Care Integration Program Manager will be responsible for providing feedback
regarding the Service Integration Coordinator’s performance of duties related to NC InCK.
•Provide mileage and travel expense reimbursement for any travel related to the NC InCK model.
Please note that these funds will be provided from the NC InCK Cooperative Agreement.
•Be responsible for communicating with the employee and Title V regarding funding and giving
notification of termination at the conclusion of the NC InCK Cooperative Agreement.
Hiring Organization’s role:
•Post and fill the Service Integration Coordinator position, which will be done in consultation with
the NC InCK Executive Leadership Team.
•Conduct performance reviews with input from the NC InCK Care Integration Program Manager.
Performance reviews must be at least once in the first 90 days and at least annually thereafter.
•Oversee merit and timing increases in consultation with the NC InCK Executive Leadership
Team and the InCK Care Integration Program Manager. Any compensation increases should be
discussed and approved by NC InCK Executive Leadership and incorporated into the new
calendar year subcontract with the hiring organization.
•Provide training required for employees of your organization, including all human resources and
safety trainings.
•Provide ongoing feedback and coaching to the Service Integration Coordinator. This includes
feedback and coaching related to performance issues, in a timely manner.
•Communication (written or meeting) between supervisors at the hiring organization and NC InCK
on the SIC’s performance and workload should occur monthly.
•Provide workspace for the employee, including paying any costs associated with these
workspaces.
•Manage timekeeping, vacation requests, sick days, and other paid time-off. Your organization
will be responsible for informing the NC InCK Care Integration Program Manager of all requests,
approvals, and denials. If extended time off is required by the employee or the employee requests
time-off under the Family Medical Leave Act, the InCK Care Integration Program Manager will
be responsible for managing the employee’s workload.
•Manage personnel upon the end of their employment or upon the end of the NC InCK
Cooperative Agreement, including but not limited to providing 30 days notice of termination;
return of all provided supplies/equipment; and administration of a departure checklist to ensure
that all materials and information have been transferred back to the InCK Care Integration
Program Manager and Title V.
Timeline
Timeline for hiring will be determined in conjunction with the
organization.
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
Program Director/Principal Investigator (Last, First, Middle): Crews, Dana, Wilson
DETAILED BUDGET FOR INITIAL BUDGET PERIOD
DIRECT COSTS ONLY
List PERSONNEL (Applicant organization only)
Use Cal, Acad, or Summer to Enter Months Devoted to Project
Enter Dollar Amounts Requested (omit cents) for Salary Requested and Fringe Benefits
ROLE ON Cal. Acad. Summer INST.BASE
NAME PROJECT Mnths Mnths Mnths SALARY
Dana Crews PD/Pl 9.0 $56460
SUBTOTALS ... r
CONSUL TANT COSTS
EQUIPMENT (Itemize)
SUPPLIES (Itemize by category)
TRAVEL
Mileage
INPATIENT CARE COSTS
OUTPATIENT CARE COSTS
ALTERATIONS AND RENOVATIONS (Itemize by category)
OTHER EXPENSES (Itemize by category)
FROM 01/01/2022
SALARY
REQUESTED
$37434
$37434
THROUGH 12/31/2022
FRINGE
BENEFITS TOTAL
$17159 $54593
$17159 $545931
$433
CONSORTIUM/CONTRACTUAL COSTS I DIRECT COSTS
SUBTOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD (Item la, Face Page)
CONSORTIUM/CONTRACTUAL COSTS I FACILITIES AND ADMINISTRATIVE COSTS
TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD
PHS 398 (Rev. 03/2020 Approved Through 02/28/2023)
Page_
$ 550261
$ 550261
0MB No. 0925-0001
Form Page 4
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
Summary Federal Award Financial Information
19. Budget Period Start Date - End Date
20.Total Amount of Federal Funds Obligated by this Action20a. Direct Cost Amount20b. Indirect Cost Amount
21.Authorized Carryover
22.Offset
23. Total Amount of Federal Funds Obligated this budget period
24. Total Approved Cost Sharing or Matching, where applicable
25. Total Federal and Non-Federal Approved this Budget Period
26.Project Period Start Date - End Date
27.Total Amount of the Federal Award including Approved Cost Sharing or Matching this Project Period
28. Authorized Treatment of Program Income
29. Grants Management Officer – Signature
Recipient Information
Fe deral Agency Information
10.Program Official Contact Information
Federal Award Information
30.Remarks
1. Recipient Name
9. Awarding Agency Contact Information
Notice of Award
Award#
FAIN#
Federal Award Date:
Page 1
2. Congressional District of Recipient
3.Payment System Identifier (ID)
4.Employer Identification Number (EIN)
5.Data Universal Numbering System (DUNS)
6.Recipient’s Unique Entity Identifier
7.Project Director or Principal Investigator
8.Authorized Official
11. Award Number
12. Unique Federal Award Identification Number (FAIN)
13. Statutory Authority
14. Federal Award Project Title
15. Assistance Listing Number
16. Assistance Listing Program Title
17. Award Action Type
18. Is the Award R&D?
01/01/2022 12/31/2022
01/01/2020
ADDITIONAL COSTS
01
1560532129A1
North Carolina Integrated Care for Kids Model
93.378
Integrated Care for Kids Model
Non-Competing Continuation
No
Not Available
560532129
Meeka Jackson
Ms.
meeka.jackson@cms.hhs.gov
4107865792
Centers for Medicare & Medicaid Services
Department of Health and Human Services
2B2CMS331758-03-00
2B2CMS331758-03-00
2B2CMS331758
2B2CMS331758
12/15/2021
Office of Acquisitions and Grants Management
See Remarks (continuation)
Mr. Gabriel Nah
Grants Management Officer
Ms. Jennifer McCallister
Authorized Representative
gcmail@mc.duke.edu
919 684-5175
Duke University
2200 W Main St Ste 820
Duke Univ. School of Medicine
Durham, NC 27705-4673
[NoPhoneRecord]
Dr. Charlene Wong
Assistant Professor of Pediatrics
charlene.wong@duke.edu
919-668-5972
$2,244,230.00
$287,351.00
12/31/2026
$2,000,000.00
$0.00
$0.00
$0.00
$531,581.00
Section 1115A of the Social Security Act (added by section 3021 of the Patient Protection and Affordable
Care Act (P.L. 111-148))
044387793
Jamie Atwood
Sr. Grants Policy Specialist
Jamie.Atwood@cms.HHS.gov
301-492-4295
$2,000,000.00
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
Page 2
33.Approved Budget(Excludes Direct Assistance)
I.Financial Assistance from the Federal Awarding Agency Only
II.Total project costs including grant funds and all other financial participation
a.Salaries and Wages
b.Fringe Benefits
c. Total Personnel Costs
d.Equipment
e.Supplies
f.Travel
g.Construction
h.Other
i.Contractual
j. TOTAL DIRECT COSTS
INDIRECT COSTS
TOTAL APPROVED BUDGET
m.Federal Share
n.Non-Federal Share
34. Accounting Classification Codes
k.
l.
Not Available
31.Assistance Type
32.Type of Award
Notice of Award
Award#
FAIN#
Federal Award Date:
Recipient Information
Recipient Name
Congressional District of Recipient
Payment Account Number and Type
Employer Identification Number (EIN) Data
Universal Numbering System (DUNS)
Recipient’s Unique Entity Identifier
$583,890.00
$146,650.00
$730,540.00
$0.00
$0.00
$3,273.00
$0.00
$90,336.00
$1,420,081.00
$2,244,230.00$2,244,230.00
$287,351.00$287,351.00
$2,531,581.00$2,531,581.00
$2,531,581.00$2,531,581.00
$0.00$0.00
12/15/2021
2B2CMS331758-03-00
2B2CMS331758
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Duke University
2200 W Main St Ste 820
Duke Univ. School of Medicine
Durham, NC 27705-4673
[NoPhoneRecord]
Cooperative Agreement
01
044387793
560532129
1560532129A1
Other
FY-ACCOUNT NO.DOCUMENT NO.ADMINISTRATIVE CODE OBJECT CLASS AMT ACTION FINANCIAL ASSISTANCE APPROPRIATION
2-5991466 2B2331758A 2B2 4158 $2,000,000.00 75-X-0522
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
Notice of Award
Award#
FAIN#
Federal Award Date:
Remarks (Continuation)
Page
12/15/2021
2B2CMS331758-03-00
2B2CMS331758
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Non-competing continuation funds have been authorized in accordance with the final negotiated budget dated November 10, 2021 conditional upon the restrictions noted in
the Recipient Specific Terms and Conditions.
Carryover of funds from budget period 2 to budget period 3 have also been authorized in accordance with the budget information submitted November 20, 2021 and
December 14, 2021 conditional upon the restrictions noted in the Recipient Specific Terms and Conditions.
Please see the attached Recipient Specific, Program, and Standard Terms and Conditions.
3
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
AWARD ATTACHMENTS
Duke University 2B2CMS331758-03-00
Recipient Specific Terms and Conditions1.
Program Terms and Conditions2.
Standard Terms and Conditions3.
DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307
December 13 , 2021
Integrated Care for Kids (InCK) Model Program
Duke University (or Recipient)
Recipient Specific Terms and Conditions
Budget
1. By January 15, 2021, Recipient must submit a revised year 3 non-competing continuation
budget ($2,000,000) that addresses the following in both the budget workbook and
narrative :
Subrecipients
UNC Chapel Hill – address travel computation error; explain how contractual
costs total was determined (verify accuracy)
Granville/Vance – Verify accuracy of fringe benefit costs
Orange C ounty District Health Dept. – Verify accuracy of personnel and fringe
benefit costs
Orange County Dept. of Social Services – Verify accuracy of fringe benefit,
travel, and indirect costs
Chape l Hill Training Head Start – Verify accuracy of fringe benefit costs and that
they do not exce ed the authorized rate
Dept. of HHS, Division of Public Health – Verify accuracy of fringe benefit costs
Total Budget
The revised year 3 non-competing continuation budget submitted 11/10/2021
totals $1,999,994. This is $6 short of the $2,000,000 awarded. Please allocate this
$6 to allowable costs.
2. Recipient may not incur costs or drawdown funds for the following carryover
placeholder funds ($336,161) until Recipie nt determines how these costs will be
reallocated in the budget, requests these funds to be released via an amendment request in
GrantSolutions including all required infor mation , and receives CMS prior approval via
Notice of Award.
Personnel ($97,642)
Frin ge Benefits ($24,634)
Subrecipients/Contracts/Consultants ($140,822) + $431 (not currently allocated)
Other ($4,357)
Indirect Costs ($68,275)
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Center for Medicare & Medicaid Innovation
Integrated Care for Kids (InCK) Model
Program Terms and Conditions – Model Year 3 (2022)
The following definitions apply for purposes of these Program Terms and Conditions :
• Applicant means the entity that responded to the InCK Model Notice of Funding Opportunity
by submitting an InCK Model Application via Grants.gov.
• Application means the InCK Model application submitted by the Applicant in response to the
Notice of Funding Opportunity, including any attachments, revisions or amendments thereto,
which are hereby approved in writing by CMS.
• “Budget P eriod” means the 12-month period beginning January 1 and ending December 31
of each calendar year.
• “Cooperative Agreement” means an alternative financial assistance instrument distinguished
from a grant in that it provides for substantial involvement between CMS and the recipient in
carrying out the activities of the federal award.
• “Days” means calendar days, or if a due date falls on a weekend or federal holiday, the next
business day.
• “Implementation Plan” means the section of the Project Narrative that details a Recipient’s
ability to engage state and local community partners to support model implementation, its
plan and timeline for achieving the InCK service integration model, and its approach to
designing an alternative payment model(s) and supporting model sustainability.
• “Model Partners” means subrecipients of the award, such as the state Medicaid agency;
Partnership Council members ; service integration coordinators ; and Core Child Service
providers.
• “Model Year” means the InCK Model’s annual implementation period.
• “NCC ” Application stands for “non-competing continuation” application and means a
financial assistance request (in the form of an application or a performance or progress
report) for the third or any subsequent Budget Period, within a previously appr oved project
period, for which the Recipient does not have to c ompete with other applicants .
• “N oA” means Notice of Award.
• “NOFO” stands for Notice of Funding Opportunity and means the NOFO identified by the
funding opportunity number CMS-2B2-20-001.
• “Operational Plan” (and corresponding timeline) means an annually submitted plan that
outlines how the Recipient shall execute what is set forth in its CMS-approved
Implementation Plan during the next Budget Period.
• “Program Terms and Conditions” means the InCK Model-specific requirements set forth in
this document, whic h is updated and reissued annually.
• “Quarter” means one of the four periods of three months each in a Budget Period, as follows:
o Quarter 1: January 1-March 31
o Quarter 2: April 1 -June 30
o Quarter 3: July 1-September 30
o Quarter 4: October 1-December 31
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• “Recipient” means the entity that receives a federal award from CMS and retains the primary
responsibility and dominant role for planning, directing and executing activities under the
proposed project as outlined in the terms and conditions of the Cooperative Agreeme nt and
with substantial CMS involvement.
• “Recipient-Specific Terms and Conditions” means necessary, additional terms and conditions
for a Recipient beyond those included in the Program and Standard Terms and Conditions.
These Recipient Specific Terms and Conditions are applied because of particular
circumstances surrounding the recipient such as (but not limited to):
o outstanding administrative or budgetary concerns,
o a history of failure to comply with the terms or conditions of award, or not mee ting
performance milestones, or that are not otherwise responsible.
• “Reusable Framework” means the system used by Recipients to submit all model-specific
data to CMMI and its contractors.
• “Standard Terms and Conditions” means the requirements set forth in the Standard Terms
and Conditions document that is incorporated by reference in, and included as an attachment
to, the Notice of Award.
• “State” means a specific state Medicaid agency.
• “Substantive Change” means any modification to previously agreed upon la nguage in a
written document that alters the meaning, purpose, scope, participants, components, roles,
responsibilities, or milestones stated in the document.
• “Terms and Conditions of Award” means, collectively, the following: (i) Recipient-Specific
Terms and Conditions (if applicable); (ii) the Program Terms and Conditions; and (iii) the
Standard Terms and Conditions incorporated by reference in, and included as an attachment
to, the Notice of Award.
1. The HHS/CMS Center for Medicare & Medicaid Innovation (Innovation Center)
Project Officer (PO). Unless otherwise specified in writing, the name and contact
information of the PO from the Division of Population Health Incentives & Infrastructure
who is responsible for the technical and programmatic administration aspects of the award is
identified in field 10 of the Notice of Award.
2. The CMS Grants Management Specialist. Unless otherwise specified in writing, the Grants
Management Specialist assigned responsibility for responding to Recipients’ questions
about financial and administrative aspects (non-programmatic areas) of the award is Jamie
Atwood in the Division of Grants Management (email: jamie.atwood@cms.hhs.gov and
telephone: 301-492-4295).
3. Notice of Funding Opportunity (NOFO). All relevant project requirements and definitions
outlined in the NOFO (CMS-2B2-20-001) apply to this award and are incorporated into the
Terms and Conditions of Award by reference.
4. Statutory Authority. This award is issued under statutory authority of Section 1115A of
the Social Security Act (the Act). By receiving funds under this award, the R ecipient is
obligated to comply with the Act, and certifies to CMS that it will carry out the InCK Model
as authorized and will comply with the Terms and Conditions of Award.
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5. Role of CMS in a Cooperative Agreement. As explained in the NOFO (Section B7. Type
of Competition), upon award of a Cooperative Agreement, the Recipient can expect
involvement from CMS (including its contractor(s)) during the InCK Model project period.
A Cooperative Agreement award is an assistance mechanism in which substantial federal
involvement with the Recipient is anticipated during the performance of the a c tivities.
Under each Cooperative Agreement, CMS’s purpose is to support and stimulate the
Recipient’s activities by working jointly with the award Recipient in a partnership role.
CMS will not assume direction or primary responsibility for the Recipient ’s activities. The
Recipient retains ultimate responsibility for coordination and oversight of all model-related
activities. For additional details related to the Recipient’s responsibilities, refer to Section 41
of the Standard Terms and Conditions (Recipient’s Responsibility for Subrecipients). CMS
and its contractors will provide learning supports and activities and technical assistance to
the Recipient. CMS will also conduct the separate functions of programmatic monitoring
and evaluation of the Recipient’s progress toward specific milestones and outcomes
throughout the duration of the project period.
6. Waivers for Models Conducted Under Section 1115A of the Act. Under Section
1115A(d)(1) of the Social Security Act, the Secretary of HHS may waive such requirements
of titles XI and XVIII and of Sections 1902(a)(1), 1902(a)(13), and 1903(m)(2)(A)(iii) as
may be necessary solely for purposes of carrying out Section 1115A with respect to testing
models described in Section 1115A(b). For this model and consistent with this standard, the
Secretary is not issuing waivers of certain fraud and abuse provisions in Sections 1128A,
1128B, and 1877 of the Social Security Act. Thus, notwithstanding any other provision of
the Terms and Conditions of Award, the Recipient, all subrecipients, and all other relevant
individuals or entities must comply with all applicable laws and regulations . None of the
provisions of this Cooperative Agreeme nt limits or restricts any authority of the HHS Office
of Inspector General (OIG), U.S. Government Accountability Office or other federal agency
or body, to audit, evaluate, investigate or inspect the Recipient, subrecipients, or other
relevant entities or individuals.
Additionally, CMS provides no opinion on the legality of any contractual or financia l
arrangement that the Recipient, subrecipients, clinicians, affiliated entities or any other
relevant individuals or entities may propose, implement, or document, including in the
Recipient’s Implementation Plan. The receipt or approval by CMS of any such documents in
the course of the application process or otherwise shall not be construed as a waiver or
modification of any applicable laws, rules or regulations, and will not prec lude CMS, HHS,
OIG, a law enforcement agency, or any other federal or state agency from e nforcing any and
all applicable laws, rules and regulations.
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7. Budget Periods and Project Periods. The project period for the InCK Model award is
from January 1, 2020 to December 31, 2026. The total budget will be distributed over the
84-month project period, during seven separate 12-month Budget Periods. The Budget
Periods are:
A. Pre-Implementation Period
1. Year 1: 12-month Budget Period: January 1, 2020 to December 31, 2020
2. Year 2: 12-month Budget Period: January 1, 2021 to December 31, 2021
B. Performance Period
3. Year 3: 12-month Budget Period: January 1, 2022 to December 31, 2022
4. Year 4: 12-month Budget Period: January 1, 2023 to December 31, 2023
5. Year 5: 12-month Budget Period: January 1, 2024 to December 31, 2024
6. Year 6: 12-month Budget Period: January 1, 2025 to December 31, 2025
7. Year 7: 12-month Budget Period: January 1, 2026 to December 31, 2026
8. Restriction of Funds. Specific restrictions, if applicable, are detailed in the separate terms
and conditions document titled Recipient-Specific Terms and Conditions . In addition, the
Recipient must review and comply with the list of Unallowa ble Use of Funds outlined in
Section 24 (Use of Funds) of this document.
The Recipient must request prior approval for activities or costs to support new subrecipient,
contractual, and consultant agreements not already approved through a NoA . A detailed
itemized budget must be provided for all subrecipient, contractual, and consult ant
agreements. If this information is unknown at the time of Application or a subsequent non-
competing continuation application, Recipient must follow -up and provide this information
via a Revision (NoA Other) or Revision (Budget) amendment in GrantSolutions as soon as
this information can be provided to CMS. Additionally, please see Appendix A of the
Notice of Funding Opportunity, Guidance for Preparing a Budget Request and Narrative, for
required contractual and consultant questions that must be addressed by Recipient. Recipient
may not incur costs or draw down funds to support these agreements until CMS provides
approval.
CMS may restrict funding (make funding unavailable for Recipients’ use) if the Recipient’s
performance on Operational Milestones and Performance Measure Milestones is not
satisfactory. A subset of the Performance Measure Milestones (“measure milestones”) will
be linked to reporting- and performance -based funding in years five through seven of the
model. This funding is not guaranteed and will not be released unless the Recipient achieves
satisfactory reporting and/or performance on the selected measure milestones.
9. Non-Competing Continuation (NCC) of Funding. The Recipient must submit a n NCC
Application before the end of each Budget Period as a prerequisite to continued funding the
following budget year. The Recipient must submit the application via GrantSolutions no
later than 75 Days before the end of Budget Period 3, and each subsequent Budget Period.
Continued funding is contingent on adequate progress (i.e., demonstrated progress towards
the goals and objectives of the InCK Model), compliance with the Terms and Conditions of
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Award of the previous Budget Period, and the availability of funds. If approved, the
Recipient shall be issued a n NCC award for the next 12-month Budget Period prior to the
expiration of the current Budget Period. The Recipient will only have access to the funding
approved for the current Budget Period unless (if applicable) CMS accepts the Recipient’s
request for carryover of funds from the prior Budget Period. See Section 14 of the Standard
Terms and Conditions (Continuation of Funding) for additional requirements.
10. Complete and Accurate Submissions. The Recipient shall ensure that all data, reports and
documentation that it or its subrecipient(s), the state Me dicaid agency (SMA), or the SMA’s
contractor(s) submits to CMS or its contractor(s) under the InCK Model is complete and
accurate to the best of the Recipient’s knowledge ; and that such data are submitted on time
and in a format that complies with CMS requirements.
A. Requesting an extension: Recipients seeking an extension on the submission of any
deliverables must request the extension in writing to their PO at least 10 Days before the
deadline . The request must be signed by its Authorized Organizational Representative
(AOR) and submitted as a Grant Note in GrantSolutions. If the milestone is missed and
no extension was requested or granted, the submission is considered late . Corrective
action may be undertaken at CMS’s discretio n based on extension requests and missed
milestones. The PO , in consultation with the Grants Management Specialist, has the
discretion to approve or reject any requested extension.
B. Correcting a submission: The Recipient shall correct and/or facilitate corrections to any
inaccurate or incomplete data, reports or documentation that it, the SMA, or its
subrecipients previously submitted to CMS. The corrections s hall occur no later than two
(2) weeks after the Recipient becomes aware of the inaccuracy or incompleteness, and be
in a manner and form specified by CMS. Failure to do so may prompt additional
corrective action pursuant to Section 25 (Corrective Action and Termination) of this
document.
11. InCK Model Implementation Plan & Operational Plan Documents . This section
addresses InCK Model Implementation Plan and Operational Plan documents . See Section
16A (Operational Milestones) of this document for details on the process for submitting
specific documents over the duration of the project period.
A. The Recipient’s original, CMS -approved Implementation Plan submitted with the
Application provides the vision, direction, and goals for the Recipient’s InCK model and
is not an annual submission.
1. If the Recipient wants to make Substantive Changes (see definition on page 2) to its
original CMS-approved Implementation Plan, the Recipient shall submit a Change in
Scope amendment in GrantSolutions. The amendment request must include
appropriate justification with supporting budget information and a cover letter signed
by the AOR. The amendment request and revisions to the Implementation Plan
(highlighted in yellow) is subject to CMS review and approval.
2. If the Recipient’s desired changes to the Implementation Plan are approved through
the amendment process, the Recipient shall submit the revised, CMS-approved
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Implementa tion Plan with the non-competing continuation (NCC) application in that
same Budget Period.
3. CMS reserves the right to reduce the award amount in subsequent years if the
Recipient makes (or requests to make) Substantive Changes to the Implementation
Plan that no longer warrant the same level of proposed funding. In addition, failure to
obtain prior CMS approval of Substantive Changes to the Implementation Plan could
result in restriction of funds and corrective action pursuant to Section 25 (Corrective
Action and Termination) of this document.
B. The Operational Plan with corresponding timeline is an annual submission that outlines
how the Recipient shall execute during the next Budget Period what is set forth in its
CMS-approved Implementation Plan. Among other items, the Operational Plan,
timeline , and any documentation supporting the Operational Plan are submitted annually
with the NCC Application 75 Days before the end of the current Budget Period.
1. To revise the Operational Plan for the current Budget Period (the version CMS
approved during the last NCC Application ), the Recipient must submit a Revision
(NoA Other) amendment request in GrantSolutions with supporting budget
information and a cover letter signed by the AOR. The request is subject to CMS
approval.
2. The revised Operational Plan must align with the Recipient’s current CMS-approved
Implementation Plan. If the revisions to the Operational Plan will significantly alter
the current CMS-approved Implementation P lan, the Recipient shall include both a
revised Implementation Plan and Operational Plan through a Change in Scope
amendment (see Section 10A InCK Model Implementation Plan and Operational Plan
Documents ).
C. GrantSolutions : The Operational Plan submitted with the NCC Application shall be in a
narrative format using Microsoft Word and a maximum of 25 pages , and submitted as a
standalone document within the NCC Application Kit in GrantSolutions . The
corresponding timeline and any documentation supporting the Operational Plan shall be
submitted in GrantSolutions as separate attachments within the NCC Application Kit.
The timeline and supporting documentation do not count toward the 25-page limit for the
Operational Plan narrative. Recipients will receive NCC Application instructions and
submission details in advance of the submission deadline.
D. InCK Portal: The Operational P lan, timeline, and any supporting documents will also be
submitted through the Milestone Reporting section of the InCK Portal.
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12. Standard Operating Procedures (SOPs) and Needs Assessment Tool(s). Recipients shall
begin conducting needs assessments with the InCK attributed population at the start of
model year 3 (MY 3).
A. If applicable, Recipients will follow their CMS-accepted Needs Assessment and
Stra tification and Service Integration SOPs, and needs assessment tool(s), as accepted
by CMS in MY2.
B. If the Recipient’s SOPs are in draft form at the start of MY3, the Recipient shall use
Quarter 1 to gather real-time information to refine its processes and tool(s) as the
Recipient conducts needs assessments with the attributed population. The Recipient
shall finalize the SOPs and the selected needs assessment tool(s) and submit the m to
CMS for review and acceptance as a Grant Note via GrantSolutions by March 30, 2022.
Recipients’ final SOPs and needs assessment tool(s) must address all CMS feedback and
be compliant with model policy, as outlined in the SOP Review Criteria provided to
Recipients in MY2 .
Per the Needs Assessment and Stratification SOP Review Criteria, Recipients shall, by
the end of MY3, validate their data-driven method for identifying beneficiaries’ needs in
the corresponding SIL eligibility criteria listed on page 3 of the document. CMS defined
validation f or the purposes of the InCK Model on page 4 of the document.
C. Revisions. CMS understands that Recipients may find it is necessary to make changes to
some aspect(s) of the needs assessment process. If necessary, Recipients can revise the
CMS-accepted SOPs and/or needs assessment tool(s) only after the Recipient and the PO
have discussed the reasons for the desired changes. Recipients shall submit the revised
SOP(s) and/or needs assessment tool(s) to CMS for review as a Grant Note via
GrantSolutions. Recipients shall finalize and receive CMS-acceptance of the revised
SOPs and/or needs assessment tool(s) prior to the NCC Application period in October
2022.
D. Submission with NCC Application for Budget Period 4 :
1. To obtain CMS approval of the SOPs and tool(s), all Recipients shall sub mit CMS-
accepted SOPs and the selected needs assessment tool(s) as attachments to the NCC
Application by October 15, 2022. This submission includes SOPs and tool(s) that
CMS initially accepted on March 30, 2022 and were not subsequently revised and
SOPs and/or tool(s) that were revised later in MY3 and accepted by CMS.
2. Thereafter, Recipients can request to revise the SOPs or needs assessment tool(s) with
appropriate justification submitted as a Revision (NoA Other) amendment in
GrantSolutions, which is subject to CMS approval. A cover letter signed by the AOR
must accompany the amendment.
CMS reserves the right to request the Recipient revise either of the SOPs or needs assessment
approach if the Recipient fails to meet established milestones.
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13. InCK Model Beneficiary Needs Assessment and Service Integration Level (SIL)
Stratification. The InCK Model NOFO (Section F.51.1., Table 1 InCK Model Operational
Milestones ) outlines the requirement that Recipients provide an “aggregate count of : unique
attributed children assessed for SIL eligibility, unique attributed children found to be
eligible for SIL 2 and SIL 3, and unique attributed children who received services under
SIL 2 and SIL 3.”
A. Beneficiary data submission: The Recipient is required to provide to CMS beneficiary-
level information documenting the results of each beneficiary’s screening within a SIL
Data Elements Workbook on a quarterly basis, beginning 30 Days following the last day
of Quarter 1 in MY3 (April 30, 2022). The workbook, completed for each beneficiary
screened, includes an overall tab with the assigned SIL and 12 individual tabs for each
assessment area. Recipients must populate these tabs as separate files with beneficiary-
level data. When completed, the workbook must be submitted by award recipients
through the InCK Reusable Framework.
B. Flexibility for total beneficiaries screened in MY3 : Section F.5.1.1 of the NOFO states
that Recipients are required to report a set of Performance Measure Milestones to CMS
covering at least 80 percent of their attributed population. In MY2, CMS provide d
Recipients with updated guidance for how to submit needs assessment (screening) and
SIL stratification data on attributed beneficiaries and flexibility for working toward the
minimum 80 percent screening threshold in MY3. CMS does not plan to take corrective
action based solely on missing the 80 percent screening threshold in 2022. CMS may still
initiate corrective action, funding restrictions, or termination for not making progress
towards meeting the 80 percent threshold or for not meeting other model requireme nts
outlin ed in the Cooperative Agreement Notice of Award, Terms and Conditions of
Award, or other federal award documentation. Recipients should anticipate that CMS will
monitor their progress in 2022 by measuring the Recipient’s trend toward the 80 percent
screening threshold.
14. Monitoring. CMS will primarily monitor awards through data collection and reporting;
Recipient documentation; and communications with the PO, Grants Management Specialist,
and the model’s I mplementation & Monitoring (I&M) contractor. See Section 20 of this
document (Implementation and Monitoring) for more details on the I&M contractor.
Recipient shall participate in model monitoring activities that include, but are not limited to:
1) routine tele phone calls and correspondence between the Recipient and the PO and Grants
Management Specialist; 2) submission and review of QPRs, annual progress reports
(APRs), quarterly cash transactions reports , and annual expenditure reports ; 3) prior-
approval requests to use funding; 4) attendance and participation in Learning System events;
5) provision of data for audit and validation; 6) document review; 7) virtual or in -person site
visits; and 8) other activities necessary to provide monitoring-related information and data
to CMS and its contractor(s).
A. Communications . The Recipient shall inform the PO and Grants Management Specialist
of the activities and tasks performed under this Cooperative Agreement. In addition, the
Recipient shall establish lines of communication among all of the individuals and entities
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involved in the model (i.e., Model Partners), mechanisms for sharing information about
model or operational changes, and techniques for sharing best practices or challe nges
with Model Partne rs. The Recipient shall provide regular and ad hoc status updates at the
request of the PO, including participating in teleconferences or web confere nces. With
reasonable notice from CMS, the Recipient shall be prepared to substantive ly discuss
model-related issues including the status of activities, milestones, activities with partners,
and changes to objectives or goals; budgetary changes ; as well as technical assistance
received and any additional assistance needed from CMS. CMS or its contractors may
pe rform announced site visits (virtual or in person) and audits. The Recipient shall make
itself available for and cooperate with such site visits, and be prepared to discuss the
status of its Implementation Plan, Operational Plan and timeline, Needs Assessment and
Stratification and Service Integration SOPs, needs assessment tool(s ), and milestone
progress. The discussion may range from personnel and budgetary changes to successes
and significant challenges the Recipient and its partners have encountered under the
model.
B. Required Report ing . The Recipient shall submit quarterly, annual, and final progress
reports to GrantSolutions as a Grant Note and to the InCK Portal via the Milestone
Reporting section using the reporting templates provided by CMS, within the time frames
outlined below. The Recipient shall email the PO and Grants Management Specialist to
notify them the reports were submitted. The Recipient can use the following link to
access Grant Solutions www.grantsolutions.gov , and this link to access the InCK Portal
https://cmmi.my.salesforce.com/.
The QPR is specific to activities completed for the applicable quarter. The APR is
cumulative and must include information covering the entire Budget Period. The Final
Project Report is cumulative and must include information covering the entire project
period. CMS reserves the right to require the Recipient to provide additional details and
clarification on the content of these reports. The Recipient shall also submit quarterly
cash transaction reports, annual financial expenditure reports, and a fina l financial
expenditure report. At a minimum, the Recipient shall satisfy the following reporting
requirements:
1. QPR. The Recipient shall submit a QPR to GrantSolutions as a Grant Note and to the
InCK Portal via the Milestone Reporting page no later than 30 Days following the last
day of each quarter in each Budget Period. The QPR must cover the progress
achieved during the previous quarter. See Section 16A (Operational Milestones) of
this document for documents that must be submitted with the QPR.
2. APR. The Recipient shall submit a n APR covering the entire Budget Period to
GrantSolutions as a Grant Note and to the InCK Portal via the Milestone Reporting
page no later than 90 Days following the last day of each Budget Period. The APR
must cover the progress ac hieved during the entirety of the previous Budget Period.
See Section 16A (Operational Milestones ) of this document for documents that must
be submitted with the APR. With the APR submission, the Recipient shall submit as
an attachment:
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a) One electronic copy of each final published article or publication released during
that Budget Period, resulting from work performed under the InCK Model into
GrantSolutions and the InCK Portal, if applicable .
b) The individualized driver diagram only if changes were made to the previous
CMS-accepted version.
3. Quarterly Federal Cash Transaction Report (FCTR). The R ecipient shall
complete the Quarterly Federal Cash Transaction Report in the Payment Management
System no later than 30 Days following the last day of each quarter in each Budget
Period . The FCTR addresses lines 10a -10c of the Federal Financial Report (SF-425 or
FFR)
4. Annual Expenditure Federal Financial Report. The Recipient shall complete the
Annual Expenditure Federal Financial Report (SF-425 or FFR) in the Payment
Management System no later than 90 Days following the last day of the applicable
annual reporting period listed in the Notice of Award. This annual expenditures report
addresses lines 10d-10o plus line 11 of the FFR. For specific directions on filing the
Annual Expenditure Federal Financial Report, s ee Section 12 of the Standard Terms
and Conditions (Reporting Requirements ).
5. Final Expenditure Federal Financial Report. The Recipient shall submit the final
Expenditure Federal Financial Report (SF-425 or FFR) in the Payment Management
System no later than 120 Days following the end of the project period. This final
expenditures report addresses lines 10d-10o plus line 11 of the FFR.
6. Final Project Report . The Recipient shall submit a Final Project Report, along with
other required materials, to CMS through a Closeout amendment in GrantSolutions
and to the InCK Portal via the Milestone Reporting section, within 120 Days after the
project period end date . The Recipient shall notify the PO and Grants Management
Specialist via email of its submission. In the Final Project Report, the Recipient shall
use the reporting template supplied by CMS to provide a summary of activities that
occurred during the entire Cooperative Agreement term, including but not limited to,
a complete discussion of the use of funds for model activities, analysis of the
effectiveness or success of the model, lessons learned to date, and a description of
model activities that will continue after the Cooperative Agr eement activities have
ceased.
The Recipient shall include in its Final Project Report the following disclaimer
regardless of whether the intent is to publish the report: “The contents are those of the
author(s) and do not necessarily represent the official views of, nor an endorsement,
by CMS, HHS or the U.S. Government.” If the Recipient plans to publicly release the
Final Project Report, the report must be submitted to the PO for review and comment
at least 30 Days prior to the release date.
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Reports are due as follows:
Progress Report Budget Periods 1 -7 Reporting Period
Due Date
Quarterly Progress
Report 1
January 1 to March 31 of each year April 30 of each year
Quarterly Progress
Report 2
April 1 to June 30 of each year July 30 of each year
Quarterly Progress
Report 3
July 1 to September 30 of each year October 30 of each
year
Annual Progress Report January 1 to December 31 of each
year
March 31 of each year
Financial Report Budget Periods 1 -7 Reporting Period
Due Date
Quarterly Federal
Financial Report 1
January 1 to March 31 of each year April 30 of each
year
Quarterly Federal
Financial Report 2
April 1 to June 30 of each year July 30 of each year
Quarterly Federal
Financial Report 3
July 1 to September 30 of each year October 30 each year
Quarterly Federal
Financial Report 4
October 1 to December 30 of each
year
January 30 of each
year
Financial Report Budget Periods 1 -7 Reporting
Period Due Date
Annual Expenditure
Federal Financial
Report
January 1 to December 31 of each
year
March 31 of each
year
Project and Financial
Report s
End of Project Period Reporting Period
Due Date
Final Project Report December 31, 2026 April 30 , 2027
Final Expenditure
Federal Financial
Report
December 31, 2026 April 30 , 2027
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See Section 12 of the Standard Terms and Conditions (Reporting Requirements ), for
supplemental details and instructions. Failure to submit any of the required reports in the
CMS-designated template by the time and manner determined by CMS could result in
corrective action, pursuant to Section 25 of this document (Corrective Action and
Termination ).
15. Transformed Medicaid Statistical Information System (T-MSIS) Requirements.
The universe of Medicaid and CHIP claims and encounter data for each state is submitted
monthly by the state Medicaid agency (or its contractor) to CMS’s T-MSIS in accordance
with CMS guidance . Unless otherwise stipulated, the InCK evaluation contractor will access
data via T -MSIS for the Recipient’s InCK-attributed population and comparison group. The
timely submission of complete and accurate Medicaid and CHIP claims and encounter data
via T -MSIS or directly to CMS, if requested, is a prerequisite for continued funding.
A. The Recipient must meet or exceed targets for all Outcome Based Assessment Criteria.
Non-compliance status occurs when one or more OBA criteria remain unmet. If the
Recipient falls into non-compliance status, it must alert the PO within five (5) business
Days of the date the Recipient became aware of its non-compliant status. CMS will
periodically audit T-MSIS records to ensure the Recipient meets compliance. If the
Recipient does not comply with T-MSIS data quality expectations, the Recipient must
demonstrate they have delivered a compliance plan to CMS within 30 days, as required
for continued enhanced system maintenance and operations funding.
B. When T-MSIS data quality expectations remain unmet after 6 months from creation of
the compliance pla n, the Recipient will be asked to submit claims and encounter data
directly to CMS through the InCK Reusable Framework, within 90 Days of being
notified by CMS.
16. M ilestones. The Recipient shall achieve the Operational and Performance Measure
Milestones described in NOFO Section F 5.1.1., as well as any additional milestones
identified by the Recipient and approved by CMS in the Recipient’s Operational Plan . The
Recipient shall protect the confidentiality of all model-related information that identifies
individuals, in accordance with all applicable federal laws, regulations , and polic ies . CMS
reserves the right to revise Operational and Performance Milestones based upon agency
needs , an individual Recipient’s Implementation P lan , and unforeseen circumsta nces that
arise during the model pre-implementation and implementation periods .
CMS may require the Recipient to provide additional information regarding its milestone
progress at any time during the project period as follow -up to reports described in Section
12 of the Standard Terms and Conditions (Reporting Requirements ). Failure to achieve any
of the applicable milestones in accordance with the stated schedule could result in corrective
action pursuant to Section 25 of this document (Corrective Action and Termination).
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A. Operational Milestones. The Recipient shall achieve the following Operational
Milestones and comply with CMS’s and its contractor(s)’ monitoring of the
Recipient’s progress towards such milestones for the duration of the project
period.
Table 1: InCK Model Operational Milestones
Operational Milestone
Due Date
Description
Learning System Attendance
and P articipation
See detailed description of learning system activities in
Section 19 of this document (Learning System).
Medicaid and CHIP (if
applicable) Claims and
Encounter Data
State Medicaid Agency:
Standard Monthly T-MSIS
Reporting
Due: Monthly
On a monthly basis, e ach state Medicaid agency
(or its contractor) submits the universe of
Medicaid and CHIP claims and encounter data
from its Medicaid Management Information
System (MMIS) to CMS’s Transformed
Medicaid Statistical Information System
(T-MSIS) per CMS guidance . Abt Associates,
the InCK Model evaluation contractor , will have
direct access to the T-MSIS data to identify
claims and encounter data for all InCK-attributed
beneficiaries. CMS will use the retrospective
attribution file submitted by the Recipient to
identify the attributed beneficiaries in T-MSIS
data. Recipients that do not meet T-MSIS data
quality standards or have other T-MSIS data
quality issues (e.g., incomplete information) will
be asked to submit claims and encounter data
directly to CMS through the InCK Reusable
Framework (RF) within 90 D ays of being
notified by CMS. These Recipients shall submit
the data via RF no later than 30 Days following
the last day of each quarter in every Budget
Period for the duration of the project period, or
until CMS determines that the state Medicaid
agency has corrected all quality issues in
T-MSIS.
Claims matching in T -MSIS: CMS does not
require the Recipient to develop a separate
“InCK beneficiary model ID ” for each InCK
attributed beneficiary or each beneficiary in the
comparison group population for the purposes of
claims matching in T -MSIS. Medicaid ID
numbers and/or social security numbers are
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sufficient for that purpose . Moreover, CMS does
not require any c hanges to the T-MSIS data
submission files , such as additional flags to
identify InCK beneficiarie s or an additional field
for “InCK beneficiary model ID .” If the
Recipient chooses to develop an “InCK
beneficiary model ID ” for use across its network
of core child service data partners, the Recipient
will have the option to include it in other file
submissions (e.g., retrospective attribution list ,
Core Child Service, service integration level data
elements, and measures data).
Updated Implementation Plan
Due: Submission with NCC
Application only if CMS
approved revisions to the plan
through the amendment
process earlier in th at Budget
Period
The Implementation Plan is not an annual submission
requirement. The Recipient shall resubmit the
Implementation Plan with the NCC Application only if
CMS approved revisions to the plan through the
Change in Scope amendment process earlier in that
Budget Period. See Section 11 (InCK Model
Implementation Plan & Operational Plan Documents)
of this document for additional guidance on the
amendment process .
Note : The Recipient must ensure it s Operational Plan
for subsequent Budget Periods suppor ts the revised,
CMS-approved Implementation P lan and its current
driver diagram.
Quarter 1: January – March 2022
Retrospective Lists of
Attributed Children and
Comparison Group
Due : January 31, 2022
Resubmission thereafter with
Service Integration Level
(SIL) Data Elements
Workbook only if updates to
the RAF have been made since
the previous submission
Attributed beneficiaries: The Recipient shall provide
CMS with a retrospective file annually, at a minimum,
of all attributed beneficiaries who had Medicaid (or
CHIP, if applicable) coverage for at least one month
during the previous 12 months. The retrospective
attribution file (RAF) must be submitted through the
InCK Reusable Framework (RF) and must:
• Specify the duration of each beneficiary’s
Medicaid or CHIP coverage during the last 12
months, and
• Include required fields requested for data file
submission, including at a minimum each
beneficiary’s Medicaid ID number and/or social
security number needed to match beneficiaries to
T-MSIS data.
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Comparison Group Population: The Recipient shall
also submit through the RF information on the
comparison group population in a manner and format
specified by CMS.
CMS will provide R ecipients with complete data
submission guidance at least 90 Days prior to the due
date. Recipients shall submit the list through the RF
unless CMS designates an alternative mechanism prior
to the first submission.
Final Needs Assessment and
Stratification and Service
Integration SOPs
Due : March 30, 2022
Res ubmission with NCC
Application for Budget Period 4
The Recipient shall submit as a Grant Note via
GrantSolutions both finalized SOPs to CMS for review
and acceptance by March 30, 2022. Recipients’ final
SOPs must address all CMS feedback and be compliant
with model policy, as outlined in the SOP Review
Criteria provided to Recipients in MY2.
To obtain CMS approval of the SOPs, the Recipient
shall resubmit the latest CMS-accepted versions of both
SOPs as attachments to the Year 4 Operational Plan
submitted with the non-competing continuation (NCC)
application for Budget Period 4 (due October 15,
2022).
See Section 12 (Standard Operating Procedures and
Needs Assessment Tool(s)) of this document for
additional details .
Selected InCK Needs
Assessment Tool(s)
Due: March 30, 2022
Resubmission with NCC
Application for Budget Period 4
The Recipient shall confirm its selection of needs
assessment tool(s) and submit the tool(s) as a Grant
Note via GrantSolutions to CMS for review and
acceptance by March 30, 2022. Recipients’ selected
tool(s) must address all CMS feedback and be
compliant with model policy, as outlined in the SOP
Review Criteria provided to Recipients in MY2.
To obtain CMS approval of the tool(s), the Recipient
shall resubmit the latest CMS-accepted tool(s) as an
attachment(s) to the Year 4 Operational Plan submitted
with the non-competing continuation (NCC)
application for Budget Period 4 (due October 15,
2022).
See Section 12 (Standard Operating Procedures and
Needs Assessment Tool(s)) of this document for
additional details .
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Annual Progress Report
(APR)
Due : March 31, 2022
The Recipient shall submit to both GrantSolutions (as a
Grant Note) and the InCK Portal (via the Milestone
Reporting page) an APR covering the progress
achieved during the previous Budget Period (2021).
Driver Diagram
Due: March 31, 2022, with the
APR, if applicable
The Recipient shall submit to the InCK Portal the
revised driver diagram as a separate attachment with
the APR covering Budget Period 2 (2021) only if
changes were made to the previously approved version.
Quarter 2: April – June 2022
Service Integration Level
(SIL) Data Elements
Workbook
Due : April 30, 2022
Resubmission quarterly
thereafter, for the remainder
of the Budget Period
The Recipient shall provide identifiable, beneficiary-
level information documenting the results of each
beneficiary’s screening within a SIL Data Elements
Workbook on a quarterly basis, beginning 30 Days
following the last day of Quarter 1 (April 30, 2022).
The workbook, completed for each beneficiary
screened, includes an overall tab with the assigned SIL
and 12 individual tabs for each assessment area.
Recipients must populate these tabs with beneficiary-
level data, treating each tab as a separate file. When
completed, the workbook must be submitted by award
recipients through the InCK Reusable Framework.
Quarter 3: July – September 2022
Reporting for Measures in the
Food and Housing Domains
Due : July 30, 2022
The Recipient shall submit food and housing measure
sets 1 annually through the InCK Reusable Framework,
beginning July 30, 2022. Thereafter, annual submission
shall occur 30 Days following the last day of Quarter 2
in every Budget Period.
• This first submission will capture data
from January 1, 2022 - March 31, 2022
(reported by July 30, 2022).
• The second submission (in Budget Period
4) will capture data from April 1, 2022 to
December 31, 2022 (reported by July 30,
2023).
1 For MY3 (2022) only, CMS is relaxing enforcement related to the requi rement to report data on food and housing
measures for at least 80 percent of the attributed population. CMS does not plan to take corrective action based
solely on the Recipient missing this threshold in MY3. Recipients should anticipate that CMS will monitor their
progress in MY3 by measuring a Recipient’s trend toward the 80 percent screening threshold (InCK
Model_2022_Flexibilities Memo, released September 30, 2021).
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• Starting in Budget Period 5, and annually
thereafter, the recipient will submit food
and housing data for the entirety of the
previous calendar year.
Reporting for Measures in the
Clinical D omain
Due : July 30, 2022
The Recipient shall submit annually clinical care
measure sets 2 covering the attributed population
eligible for reporting (per individual clinical care
measure specifications) through the InCK Reusable
Framework, beginning July 30, 2022. Note : For 2022,
the Recipient is only required to submit the Screening
for Clinical Depression and Follow -up Plan (CDF-CH)
measure with additional measures to follow in
subseque nt years. Thereafter, annual submission shall
occur 30 Days following the last day of Quarter 2 in
every Budget Period.
Core Child Services Data
Due : July 30, 2022 and
January 30, 2023
For the July 30, 2022 submission, the Recipient shall
collect and retain existing administrative data for the
attributed population and comparison group
documenting their participation in locally -, state-, and
federally-funded programs aligned with Core Child
Services. Examples of these data include , but are not
limited to, child and/or family participation in free or
reduced-price school lunch programs; Temporary Aid
for Needy Families (TANF); the Special Supplemental
Nutrition Program for Women, Infants, and Children
(WIC); the Supplemental Nutrition Assistance Program
(SNAP); special education services; subsidized housing
programs; Head Start, and state and local child welfare
programs. Additional guidance on this milestone is
forthcoming early in MY3.
The Recipient shall provide CMS with Core
Child Services data on all attributed beneficiaries
and comparison group twice annually, 30 Days
following the last day of Quarter 2 and Quarter 4
for the duration of the project period. Should
more frequent submissions be required (e.g.,
quarterly), CMS will notify the Recipient at least
90 Days in advance of the effective date. Most
2 For MY3 (2022) only, CMS is relaxing enforcement related to the requirement to report data on depression
screening and follow up for at least 80 percent of the attributed population. CMS does not plan to take corrective
action based solely on the Recipient missing this threshold in MY3. Recipients should anticipate that CMS will
monitor their progress in MY3 by measuring a Recipient’s trend toward the 80 percent screening threshold (InCK
Model_2022_Flexibilities Memo, released September 30, 2021).
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Core Child Services data will be submitted to
CMS directly through the InCK Reusable
Framework. The state Medicaid agency or
Department of Health & Human Services may
transmit the data, depending on the individual
state’s functional responsibilities.
Note : The July 30, 2022 submission of Core
Child Services data will include calendar years
2018-2021 data and data collected through
March 31, 2022.
Quarter 4: October – December 2022
Operational Plan and timeline
Due : October 15, 2022, with
NCC Application
The Operational Plan with corresponding timeline is an
annual submission requirement. The Operational Plan
outlines how the Implementation Plan will be executed
by laying out the intended key activities for the
upcoming 12-month Budget Period, and a
corresponding timeline for meeting milestones (i.e.,
convening the Partnership Council, sharing data among
Model Partners, conducting data collection and
reporting activities, monitoring outcomes, developing
timelines).
The Recipient shall submit the Year 4 Operational
Plan , corresponding timeline , and documentation
supporting the plan for the next Budget Period with the
non-competing continuation (NCC) application on
October 15, 2022.
See Section 11 (InCK Model Implementation Plan &
Operational Plan Documents) of this document for
additional details on this milestone.
Partnership Council Charter
Due : October 15, 2022, with
NCC Application , if
applicable
The Recipient shall resubmit its Partnership
Council Charter only if there are changes to the
charter or membership. If applicable, submit it as
an attachment with the non-competing
continuation (NCC) application due October 15,
2022.
Changes to the charter must be highlighted for
CMS review (e.g., changes in membership, focus
or direction), and the revised charter must be
signed by each currently participating member.
The Recipient shall submit a clean version and a
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highlighted version showing revisions with the
NCC Application . The Recipient shall notify the
PO of upcoming changes to the council or charter
during regular telephone calls.
Contract Between State
Medicaid Agency and Lead
Organization
Submission: October 15,
2022, with NCC Application ,
if applicable
The Recipient shall submit an updated contract
with the non-competing continuation (NCC)
application only if there are changes to the terms,
associated costs, responsibilities, key individuals
or parties identified in the most recent version of
the contractual agreement submitted to CMS.
If applicable, submit a clean version of the
agreement and a separate version with changes
highlighted as attachments with the NCC
Application due October 15, 2022. The Recipient
must notify the PO of upcoming changes to the
agreement during regular telephone calls.
Documentation of Managed
Care Plan Participation (if
applicable )
Due : October 15, 2022, with
NCC Application , if
applicable
The Recipient shall submit documentation with
the non-competing continuation (NCC)
application an MOU or contract language
reflecting managed care plan organizations’
agreement to participate in InCK Model APMs
only if there are changes to the terms,
responsibilities, key individuals or parties
identified in the most recent CMS-accepted
version of the MOU or contract language. The
updated documentation shall be submitted as an
attachment with the NCC Application due
October 15, 2022.
The Recipient must notify the PO of upcoming
changes to managed care plans’ participation in
the model during regular telephone calls.
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B. Performance Measure Milestones . The Recipient shall report a set of
Performance Measure Milestones (“measure milestones”) described in NOFO
Section F 5.1.1 to CMS directly through the InCK Reusable Framework (RF).
Recipients will only report measure data for the attributed population eligible for
measure reporting (per individual measure specifications), not the comparis on
group.
A. Non-clinical measures – Food and Housing domains 3. Recipients shall
report non-clinical data on InCK participants on an annual basis , beginning July
30, 2022.
1. July 30, 2022: This first reporting period will capture data from January 1,
2022 - March 31, 2022.
2. July 30, 2023: The second reporting period for food and housing data in
Budget Period 4 (2023), will capture data from April 1, 2022 to December
31, 2022.
In alignment with all clinical performance measures, reporting for the Food and
Housing domains will occur annually thereafter, capturing data from the prior
calendar year and reporting it no later than July 30, 2022, for the duration of the
project period. R ecipients shall submit all measure reporting data through the
RF.
Recipients must report on all measures included in the InCK measure set. In
MYs 5, 6, and 7, CMS will link up to $100,000 annually to the Screening for
Clinical Depression and Follow -Up Plan and the CMS-approved Food
Insecurity and Housing Instabilty measures . CMS reserves the right to change
the measure set, revise the method of data submission to CMS or its
contractors , or modify the payment methodology for performance measure
milestones .
B. Clinical measure : Screening for Clinical Depression and Follow up Plan.
Recipients shall report clinical measure results for the 2021 calendar year
(MY2) by July 30, 2022, using the 2021 CMS Child Core Set specifications (as
amended for InCK -specific reporting). The InCK Calculation Guide for Clinical
Care Performance Measure Milestones provides instructions for developing
InCK-specific measure results. Note that only the Screening for Clinical
Depression and Follow up Plan: Ages 12-17 (CDF-CH) measure will be
reported in MY3. CMS may require retroactive reporting on the calculated
measure results and source data for the other five clinical measures covering
3 Per the July 28, 2021 update to the InCK Model Frequently Asked Questions (FAQ) document, CMS decided to
narrow the non-clinical measures requirements to Food and Housing in order to help award recipients strategically
allocate resources toward more imminent tasks, and still maintain the model’s focus on addressing children’s
health -related social needs. Since Education was removed as a required component of the model’s performance
measures portfolio, related measures (Kindergarten Readiness an d Chronic Absenteeism) are no longer subject to
monitoring requirements for the model.
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MY2 at a later date, and no earlier than 2023. Recipients shall submit source
data for CDF-CH in MY3 and may be required to do so for a subset of the
remaining clinical care measures each year going forward. All measures data
are submitted through the RF.
C. Out -of-home placement (OOHP). Reducing the rate of out-of-home placement is a
primary focus area for the InCK Model and each Recipient is expected to participate
in the data reporting and measure development process for a measure to track OOHP
as part of model participation. Once defined, CMS will incorporate the OOHP
measure into the list of Performance Measure Milestones in a future Budget Period,
as early as Budget Period 4. The timing of the OOHP measure’s development is
dependent on CMS’s contractor gaining access to the necessary Core Child Services
data elements from Recipients.
17. Qualitative Data. The Recipient shall ensure that all the Partnership Council members
participate in qualitative data collection activities pertaining to this model. When re quested
by CMS, and for the duration of the project period, the Recipient and its partners shall assist
the model evaluation contractor with the acquisition of qualitative data. Dat a collection
activities that may require the Recipient and its partners to cooperate or participate in
include, but are not limited to, arranging and granting interviews; assisting in recruiting for
focus groups and individual interviews with model-associated staff, beneficiaries, and
beneficiary caregivers; allowing observations of any model-funded activities; providing
agendas, notes and/or minutes from Partnership Council meetings; providing program
documents such as patient education and staff training materials; surveys of staff and/or
beneficiary families; and any other necessary activities.
18. Evaluation. CMS conducts the InCK Model evaluation with the assistance of an
independent contractor , Abt Associates (“Abt”). Abt is CMS’s business associate under the
HIPAA Privacy Rule. The Recipient is an “entity participating” in the testing of a model
under Section 1115A of the Act, and, as such, is required by 42 CFR § 403.1110(b) to
collect and report such data as may be required by CMS, or its contractor (s), to carry out
model evaluation. This includ es personally identifiable information (PII), even if such data
qualifies as protected health information (PHI) as that term is defined at 45 CFR § 160.103.
Recipients shall submit both PII and PHI into CMS patient-protected systems . In addition,
as a condition of receiving award funds, the Recipient is responsible for requiring and
ensuring participation in the model evaluation by all Model Partners (including contractors ,
consultants and subrecipients) and InCK -attributed beneficiaries. See NOFO Section F5.2,
Evaluation.
The Recipient shall enter sub-award agreements with its subrecipients. Such sub-award
agreements must expressly note that the acceptance of award funds will also make the
subrecipient an “entity participating” in a section 1115A model, and, as such, will render
subrecipients also subject to 42 CFR sec. 403.1110(b).
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Recipient and its subrecipients are encouraged to review internally “required by law”
disclosures under the HIPAA Privacy Rule prior to applying for or drawing down funds
under this Cooperative Agreement. For more details on identifying parties as subrecipients
or contractors for the purposes of receiving award funds, see 45 CFR §75.351 Subrec ipient
and Contractor Determinations , and Section 39 of the Standard Terms and Conditions (Pass
Through Entities, Subrecipients, and Contractors ).
Subrecipients are bound by all Terms and Conditions of Award under the guidance of the
Recipient. The Recipient shall plan for, and carry out, the collection and reporting of any PII
and PHI that may be required for the evaluation of the InCK Model, and shall ensure that its
subrecipients have planned for and do the same. The Recipient must also ensure that any
other individuals or entities (i.e., not subrecipients) involved in capturing or providing
model data do so at the time and in the form and manner specified by the Recipient. In
preparing to participate in the model, the Recipient and subrecipients shall ensure that any
institutional requirements (e.g., review by an Institutional Review Boa rd (IRB)) are
completed in time to ensure that the data collection and reporting obligations under 42 CFR
§ 403.1110(b) are met at the time and in the form and manner specified by CMS. All IRB
materials (if applicable), including any consent forms, must contain an explicit statement
that allows PII and PHI collected under this award to be shared with and submitted to CMS
and its contractors for the purpose of carrying out the evaluation of the InCK Model. Should
an institutional requirement present a barrier that delays or prevents the Recipient or a
subrecipient from meeting these data collection and reporting obligations, the Recipient
could be subject to corrective action pursuant to Section 23 of this document (Corrective
Action and Termination).
In ensur ing conformance with this section, CMS encourages the Recipient and its
subrecipients to discuss their obligations under 42 CFR § 403.1110(b) with any approving
bodies (such as an IRB). Failure to obtain IRB approval, if applicable, for the requisite
reporting to CMS and its contractors under 42 CFR § 403.1110(b) will not relieve the
Recipient and its subrecipients’ obligations under 42 CFR § 403.1110(b).
The Recipient shall accurately collect and submit all required data elements in the form and
manner requested by CMS or its contractor s. Such data will include, but are not limited to,
quality measures , person-level screening, referral information , Medicaid and CHIP (if
applicable) claims and encounter data, community service data , medical records or charts,
information on contacts or communications with beneficiaries, and other data generated by
the Recipient’s subr ecipients that CMS determines is necessary to evaluate this model. CMS
will determine whether information regarding an attributed beneficiary is duplicated by
comparing that beneficiary’s Medicaid or CHIP ID number or Social Security number . CMS
will count only information regarding beneficiaries with a valid Medicaid or CHIP ID
toward milestones.
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19. InCK Learning System. The Recipient shall participate in targeted learning on the InCK
Model driver diagram. With ongoing support from the Learning System, the Recipient shall
maintain and update its driver diagram as needed to guide and align intervention design and
implementation activities . Along with implementation and monitoring supports, the InCK
Model Learning System provides outreach and informational resources to all Recipients.
A. The Recipient shall notify the PO of its plans to update the driver diagram.
B. The PO will initiate correspondence between the Recipient and Learning System staff,
who will assist the Recipient in revising the diagram.
C. If the Recipient revises the driver diagram with Learning System staff after initial
submission with the first APR, the final revised driver diagram shall be submitted with
the APR for the Budget Period in which it was updated.
Recipients shall comply with the following conditions related to the Learning System for the
duration of the project period:
A. Respond to CMS and its contractors and staff when using various mechanisms such a s
surveys or interviews to identify Recipient lea rning needs;
B. Participate in the identification and dissemination of promising practices that may involve
sharing lessons learned with other Recipients (e.g., presenting on webinars);
C. Participate in up to two virtual InCK Model learning activities hosted by the InCK
Learning System every month for the duration of the project period . Activities may
include webinars, teleconferences, peer-to-peer learning, virtual or in -person sit e visits,
and training;
D. Share information on state and federal programs that complement InCK Model
interventions in the communities Recipients serve;
E. Share with CMS and its contractors and staff program improvement efforts and activities
at regular intervals; and
F. Participate, virtually or in person, in one CMS-designated meeting per year in
Washington, D.C./Baltimore to learn, collaborate, and disseminate InCK Model
promising practices.
20. Implementation and Monitoring . CMS will closely track model progress through POs and
an Implementation and Monitoring (I&M) c ontractor. Recipients shall cooperate with and
participate in the I&M contractor’s efforts and activities. This includes responding to
inquiries or information requests and participating in virtual or in -person site visits for the
duration of the project period. The InCK Model I&M c ontractor shall be tasked with:
A. Developing systems to monitor and report on both individual Recipient and overall
model progress toward meeting specific milestones and model objectives;
B. Identifying individual Recipient’s implementation and operational challenges in meeting
specific milestones and model objectives;
C. Developing and providing individualized and scalable forms of expert technical
assistance to Recipients as appropriate; and,
D. Collecting, analyzing, and reporting of model data, including process, outcome, and
milestone measures.
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21. Cooperation with CMS and/or CMS Contractor(s). The Recipient shall fully cooperate
with , and shall require and ensure that its subrecipients and partners fully cooperate with,
CMS and/or CMS contractor(s) that will be providing implementation and monitoring
support, technical assistance, Learning System support, and carrying out the evaluation of
the InCK Model. Cooperation include s, but is not limited to, participation in interviews,
surveys, virtual or in -person site visits , and other data collection efforts ; providing necessary
data to CMS; proactively working with CMS contractors to resolve identifie d issues; and
identifying and describing best practices.
22. Prior CMS Approval Requests . Prior to making any Substantive Changes to the model
components listed below, the Recipient shall notify the PO and Grants Manage ment
Specialist of the desired changes by submitting the appropriate amendment request in
GrantSolutions for CMS review. Prior approval requests include, but are not limited to:
A. Revisions to the budget that require prior approval consistent with the requirements in the
Standard Terms and Conditions and HHS grant regulation 45 CFR Part 75. See also
Standard Terms and Conditions 6. Prior Approval Requests and 7. Revision of Budget
and Program Plans.
B. Changes to the Implementation Plan, including its scope and any of its components.
C. Changes to the designated model service area or attributed population.
D. Changes to the activities or milestones in the Operational Plan or corres ponding timeline.
E. Changes in the design or operation of the APM, including the need for a SPA or waiver.
F. Changes in the components or scope of the Needs Assessment and Stratification or
Service Integration SOPs, including changes pertaining to the use of data -driven
methods .
G. Changes in the design of the needs assessment tool(s).
H. Any other deviations from the activities outlined in the InCK Model Application (as
approved), NCC Application (as approved), Notice of Award, and Terms and Conditions
of Award.
23. M eetings . The Recipient shall participate in all virtual and in-person meetings required by
CMS or its contractor(s).
24. Use of Funds. No funds under this award may be used for any of the purposes listed in
Section 11 of the Standard Terms and Conditions (Prohibited Uses of Grant or Cooperative
Agreement Funds ), in NOFO Section D 6, and as outlined below (Unallowable Use of
Funds). In addition, Recipient shall not use award funds to pay for services currently
reimbursable by Medicaid or to supplant existing funding for other sources.
Unallowable Use of Funds
A. No costs may be incurred or funds drawn down to support positions until hired. This
prohibition is applicable to direct personnel, fringe benefit, and supply (e.g. laptops) costs
as well as personnel, fringe benefit, and supply (e.g. laptops) costs for subrecipient,
contractual, and consultant agreements.
B. Incentive costs to organizations are prohibited.
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C. Incentive costs to individuals without CMS prior approval. These costs must be fully
itemized and justified. The link to this specific program must be clear and demonstrate
reasonableness and necessity. Recipient must describe how costs will be determined
including means to avoid fraud, waste, and abuse.
D. Recipient may not incur costs and/or drawdown funds to support subrecipient, contractor,
and/or consultant agreements until all costs are fully itemized and described and CMS
prior approval is received. To fully comply with this restriction, Recipie nt must address
the applicable list of questions for subrecipients , contractors, and/or consultants as
explained and listed in the Notice of Funding Opportunity in Appendix A: Guidance for
Preparing a Budget Request and Narrative (see pages 74-76).
E. InCK funding cannot be used to support direct, contractual, or subrecipient salary and
fringe benefit costs in excess of the current Executive Level II salary cap of $197,300.
This cap is applicable even if the position is not a 100% FTE. Compensation must be
based upon the applicable salary at a 100% FTE. See also section 45 of the Standard
Terms and Conditions (FY 2020 Appropriations Provision).
F. InCK funding cannot be used to fund internal evaluation costs.
G. InCK funding cannot be used to purchase business cards.
H. As defined in 45 CFR §75.421, unallowable advertising and public relations costs include
the following:
1. 75.421(e)(1) All advertising and public relations costs other than as specified in
paragraphs 75.421(b) and 75.421(d);
2. 75.421(e)(2) Costs of meetings, conventions, convocations, or other events related to
other activities of the entity (see also §75.432), including:
a) Costs of displays, demonstrations, and exhibits;
b) Costs of meeting rooms, hospitality suites, and other special facilities used in
conjunction with shows and other special events; and
c) Salaries and wages of employees engaged in setting up and displaying exhibits,
making demonstrations, and providing briefings;
3. 75.421(e)(3) Costs of promotional items and memorabilia, including models, gifts ,
and souvenirs;
4. 75.421(e)(4) Costs of advertising and public relations designed solely to promote the
non-federal entity.
Allowable Use of Funds
Award money will fund such approved InCK Model planning and implementation activities
outlined below and in Appendix A of the NOFO (assuming other federal, state, or local
programs do not already fund these expenses). Activities include but are not limited to:
A. Enrollment and assessment systems development, adaption, or expansion
B. Staff training on model activities
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C. Travel to Baltimore/D.C. metro area annually, potentially beginning in 2022
D. Personnel salaries and wages, fringe benefits
E. Advertising and public relations materials for beneficiary outreach
F. Coalition building activities between Partnership Council members
G. Population health management activities related to the model (e.g., data analysis,
strategic planning, and process improvement)
H. Mobile crisis system development, adaptation, or expansion
I. Participation in CMS evaluation activities, including data collection and reporting
J. Equipment
K. Supplies
L. Annual independent audit of staff time and effort accounting
M. Consultant/subrecipient /contractual costs
CMS may request that the Recipient provide evidence of well-documented internal controls
to ensure that resources are used in the most efficient manner and that activities are not
duplicative of activities that are already funded through other sources . The Recipient shall
notify the PO and Grants Management Specialist in writing within one week of discovering
any service duplication funded through Medicaid, CHIP or other federal initiatives.
25. Corrective Action and Termination. CMS may impose a corrective action plan , funding
restrictions, future recipient-specific terms and conditions for an individual Recipient as
warranted (i.e., not currently included with the N otice of Award); or CMS may terminate
the award if the Recipient does not meet the model requirements outlined in the Cooperative
Agreement Notice of Award, Terms and Conditions of Award, or other federal award
documentation. Failure to comply with the Notice of Award includes without limitation :
A. Failure to submit to CMS or to amend, as requested by CMS, the Implementation Plan
prior to making the plan operational for model activities.
B. Failure to submit to CMS or to amend, as requested by CMS, the Needs Assessment and
Stratification or Service Integration SOPs or needs assessment tool(s).
C. Failure to submit to CMS or to amend, as requested by CMS, the Operational Plan and
corresponding timeline.
D. Failure to obtain prior CMS approval of Substantive Changes to items listed in Section
22 of this document (Prior CMS Approval Requests). See also Standard Terms and
Conditions 6. Prior Approval Requests and 7. Revision of Budget and Program Plans.
E. Failure to create and sustain a CMS-approved APM that meets the criteria outlined in
NOFO section A 4.2.1.3.
F. Failure to meet any Operational or Performance Measure Milestone listed in Section 16
of this document (Milestones ) or a future milestone(s) CMS establishes.
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G. Failure to comply with CMS’s and any of its contractors ’ efforts to monitor the InCK
Model including failure to submit to CMS and/or its contractors complete and accurate
data required for monitoring , as outlined in Section 14 of this document (Monitoring).
H. Failure to comply with CMS’s and any of its contractors’ efforts to evaluate the InCK
Model including failure to submit to CMS and/or its contractors complete a nd accurate
data required for evaluation purposes , as outlined in Section 18 of this document
(Evaluation).
I. Inability or unwillingness to collect or share monitoring or evaluation data.
J. Failure to participate in Learning System activities as required throughout the duration
of the project period.
K. Failure to undertake and implement technical assistance provided by CMS or its
contractors.
L. Failure to submit timely, complete and accurate reports as required including, QPRs,
APRs, Quarterly Federal Cash Transaction Reports, Annual Fina ncial Expenditure
Reports, Final Expenditure and Progress Reports; and other documentation upon
request, such as a sample service integration eligibility checklist and needs assessment
tool. See NOFO section A 4.2.1.2.2 for requirements related to the needs assessment
tool.
M. A documented pattern of non-cooperation with CMS, its contractors, HHS or other
federal agencies, including without limitation, not being available to CMS, or its
contractors, HHS or other federal agencies.
N. Using Cooperative Agreement funds in a manner that does not comply with Section 24
of this document (Use of Funds ).
O. Failure to report and mitigate program duplication as described in NOFO Section
A4.2.3.
26. Notification of risk or problems: The Recipient shall notify the PO and Grants
Management Specialist in writing of any significant problems or risks re lating to the
administrative, financial, and programmatic aspects of the award during the Cooperative
Agreement period of performance immediately following t he time of discover y. Significant
problems include but are not limited to adverse findings pursuant to section 38 of the
Standard Terms and Conditions (Affirmative Duty to Track All Parties to the Award), or
issues or barriers that may cause the Recipient to miss model miles tones described in either
the Implementation Plan, Operational Plan, or the Terms and Conditions of Award, or
failure to implement the InCK Model as described in the Notice of Award.
CMS may elect, at its sole discretion, to allow the Recipient an opportunity to take
appropriate corrective action that may includ e accepting special award conditions, technical
assistance, adhering to a program assistance letter or corrective action plan within a
timeframe and manner determined by CMS, or for CMS to take other enforcement actions,
unless there are actions that endanger the public health and welfare. If the Recipient fails to
meet the terms of any corrective action, CMS may terminate the Cooperative Agreement.
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The regulatory procedures that pertain to suspension and termination are state d in section 35
of the Standard Terms and Conditions (Termination ).
27. Use of Data and Work Products . As described in section 18 of the Standard Terms and
Conditions (Use of Data and Work Products), a t any phase of the project or at its
conclusion, the Recipient shall submit copies of analytic data file(s) with appropriate
documentation, representing the data developed/used in end-product analyses generated
under the award, if so requested by the PO . The analytic file(s) may include primary data
collected, acquired or generated under the award and/or data furnished by CMS. All data
files and any other information and products related to this Cooperative Agree ment shall
become the property of CMS after they are submitted to CMS. All proprietary information
and technology of the Recipient are and shall remain the sole property of the Rec ipient.
28. Management Review/Audit. The funding authorized by this award is subject to any periodic
future financial management review or audit.
29. Management Tool. CMS reserves the right to require Recipients to use a management tool
for tracking model milestone information, and/or for submitting the QPRs, APRs, and the
Final Report, including but not limited to GrantSolutions . CMS will provide the Recipient
with access to this management tool and related instructions.
30. Privacy and Security of Health Information. The Recipient acknowledges that it is a
covered entity, as that term is defined in 45 CFR § 160.103, and will execute business
associate agreements with any persons or entities that will perform operations under the
model that involve the use or disclosure of protected health information (PHI) on behalf of
the Recipient. The Recipient shall have all appropriate administrative, technical, and
physical safeguards in place before the project period start date to protect the privacy and
security of PHI in accordance with 45 CFR § 164.530(c). The Recipient shall maintain the
privacy and security of all model-related information that identifies individuals in
accordance with the HIPAA Privacy and Security Rules and all relevant guidance applicable
to the use and disclosure of PHI by covered entities, as well as applicable state laws and
regulations. In addition, the Recipient shall ensure that its subrecipients’ policies and
procedures are at least as stringent (i.e., protective of privacy) as those governing the use
and disclosure of PHI by the Recipient under 45 CFR P arts 160 and 164. The Recipient and
its subrecipients shall consult with their own counsel and refer to the HIPAA guidance
materials at http://www.hhs.gov/ocr for further information about the HIPAA requirements
in 45 CFR P arts 160 and 164.
31. Section 508 Compliance. The Recipient shall ensure that its systems and materials, and
those of its subrecipients, comply with section 508 of the Rehabilitation Act of 1973 (29
U.S.C. 794(d)) as amended by the Workforce Investment Act of 1998 (P.L. 105-220) if such
systems and materials are to be used by federal agencies . For example, when the Federal
Government procures Electronic and Information Technology (EIT), 508(a)(1) requires the
EIT to allow federal employees and individuals of the public with disabilities comparable
access to and use of information and data that is provided to federal employees and
individuals of the public without disabilities.
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32. Retention Requirements for Records . Financial records, supporting documents, statistical
records, and all other non-federal entity records pertinent to a f ederal award must be retained
for a period of three years from the date of submission of the final expenditure report or, for
federal awards that are renewed quarterly or annually, from the date of the submiss ion of the
quarterly or annual financial report, respectively, as reported to the HHS awarding agency or
pass -through entity in the case of a subrecipient. HHS awarding agencies and pass -through
entities must not impose any other record retention requirements upon non-federal entities.
See 45 CFR §75.361 for a list of exceptions .
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Centers for Medicare & Medicaid Services
Standard 1 Grant/Cooperative Agreement 2 Terms and Conditions
1. Recipient. The Recipient is the Grantee designated in the Notice of Award (NoA).
2. Acceptance of Application & Terms of Agreement. Initial drawdown of funds by the
Recipient constitutes acceptance of this award.
3. Notice of Funding Opportunity (NOFO ). All relevant project requirements outlined in the
NOFO apply to this award and are incorporated into these terms and conditions by reference.
4. Uniform Administrative Requirements, Cost Principles, and Audit Requirements. This
award is subject to 45 CFR Part 75 [available at http://www.ecfr.gov/cgi-bin/text-
idx?node=pt45.1.75&rgn=div5], which implements 2 CFR Part 200, Uniform Administrative
Requirements, Cost Principles, and Audit Requirements for Federal Awards (“Uniform
Guidance”) for the U.S. Department of Health & Human Services (HHS) operating divisions,
effective December 26, 2014. All recipients must comply with Subparts A -F unless as
described immediately below under Cost Principles and Audit Re quirements.
• Uniform Administrative Requirements . All Recipients must comply with Subparts A -D
of 45 CFR Part 75.
• Cost Principles . Centers for Medicare and Medicaid Services (CMS) grant awards
provide for reimbursement of actual, allowable costs incurred and are subje ct to the
Federal cost principles. The cost principles establish standards for the allowability of
costs, provide detailed guidance on the cost accounting treatment of costs as direct or
indirect, and set forth allowability and allocability principles for s elected items of cost.
Applicability of a particular set of cost principles depends on the type of organization.
CMS recipients must comply with the cost principles set forth in HHS regulations at 45
CFR Part 75, Subpart E with the following exceptions: (1) hospitals must f ollow
Appendix IX to part 75 and commercial (for-profit) organizations are subject to the
cost principles located at 48 CFR subpart 31.2 3.
1 Standard Terms and Conditions include all possible grants administrative requirements for CMS awards. All
standard terms and conditions apply unless the requirement is not applicable based on the project
awarded. Recipients should contact their assigned Grants Management Specialist if they have questions about
whether an administrative term and condition applies.
2 A Cooperative Agreement is an alternative assistance instrument to be used in lieu of a grant whenever substantial
Federal involvement with the recipient during performance is anticipated. The difference between grants and
cooperative agreements is the degree of Federal programmatic involvement rather than the type of administrative
requirements imposed. Therefore, statutes, regulations, policies, and the information contained in these Standard
Terms and Conditions that are applicable to grants also apply to cooperative agreements, unless otherwise stated.
3 There are no cost principles specifically applicable to grants to for-profit organiza tions. Therefore, the cost
principles for commercial organizations set forth in the FAR (48 CFR subpart 31.2) generally are used to determine
allowable costs under CMS grants to for-profit organizations. As provided in those costs principles, allowable travel
costs may not exceed those established by the FTR (available on-line at http://gsa.gov/portal/content/104790). The
cost principles in 45 CFR 75, Appendix IX, determine allowable costs under CMS grants to proprietary hospitals.
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Dire ct and Indirect Costs: There is no universal rule for classifying certa in
costs as either direct or indirect (also known as Facilities &Administration
(F&A) costs) under every accounting system. A cost may be direct with
respect to some specific service or function, but indirect with respect to the
Federal award or other final cost objective. Therefore, it is essential that each
item of cost incurred for the same purpose be treated consistently in like
circumstances either as a direct or F&A cost in order to avoid double -charging
of Federal awards. Guidelines for determining direct and F&A costs char ged to
Federal awards are provided in 45 CFR §§75.412 to 75.419. Requirements for
development and submission of indirect (F &A) cost rate proposals and cost
allocation plans are contained in Appendices III-VII and Appendix IX to Part
75.
Commercial (For -Profit) Organizations: Indirect Costs are allowable
under awards to for -profit organizations . For -profit organizations must
still obtain a negotiated indirect cost rate agreement which covers the
grant supported activities and the applicable period of performance .
For-profit entities which receive the preponderance of their federal
awards from HHS may contact the Division of Financial Advisory
Services (DFAS), Indirect Cost Branch, available at
http://oamp.od.nih.gov/dfas/indirect-cost-branch to negotiate an indirect
cost rate. Otherwise, for-profit organizations are limited to the 10% de
minimis rate in accordance with 45 CFR §75.414(f).
Cost Allocation: In accordance with 45 CFR §75.416 and
Appendix V to Part 75 – State/Local Governmentwide Central Service
Cost Allocation Plans, each state/local government will submit a plan to
the U.S. Department of Health & Human Services Cost Allocation
Services for each year in which it claims central service costs under
Federal awards. Guidelines and illustrations of central service cost
allocation plans are provided in a brochure published by the U.S.
Department of Health & Human Services entitled “A Guide for State,
Local and Indian Tribal Governments: Cost Principles and Procedures
for Developing Cost Allocation Plans and Indirect Cost Rates for
Agreements with the Federal Government.” A copy of this brochure
may be obtained from the HHS' Cost Allocation Services at
https://rates.psc.gov . A current, approved cost allocation plan must be
provided to CMS if central service costs are claimed.
Appendix VI to Part 75 – Public Assistance Cost Allocation Plans, state
public assistance agencies will develop, document and implement, and
the Federal Government will review, ne gotiate, and approve, public
assistance cost allocation plans in accordance with Subpart E of 45 CFR
part 95. The plan will include all programs administered by the state
public assistance agency. Where a letter of approval or disapproval is
transmitted to a state public assistance agency in accordance with
Subpart E, the letter will apply to all Federal agencies and programs.
This Appendix (except for the requirement for certification) summarizes
the provisions of Subpart E of 45 CFR part 95.
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• Audit Requir ements. The audit requirements in 45 CFR Part 75, Subpart F apply to
each recipient fiscal year that begins on or after December 26, 2014. A non-Federal
entity that expends $750,000 or more during the non-Federal entity's fiscal year in
Federal awards must have a single or program-specific audit conducted for that year in
accordance with 45 CFR 75 and must submit an audit reporting package to the Feder al
Audit Clearinghouse (FAC), the OMB designated repository of record. In acc ordance
with 45 CFR 75.513(c )(1), HHS grant awarding agencies are required to ensure that
single or program-specific audits are completed and reported by recipients within nine
months after the end of the audit period (recipient fiscal year end date). Recipients
must comply with the following:
i. Within 30 days of the award issue date on the Notice of Award, Recipient
must submit a Grant Note labeled “Recipient Fiscal Year” as the Subject to
GrantSolutions which documents the fiscal year start and end date for the non-
Federal entity;
ii. Within 3 business days of submission of the audit reporting package to
FAC, provide certification (to include evidence of submission) to the CMS
Grants Management Specialist (GMS) as a Grant Note in GrantSolutions
labeled: “FAC Certification ” (Subject)/ “FAC_CERT_mm.dd.yyyy” (File
Name ).;
OR
iii. Within 90 days following the non-Federal entity’s fiscal year end date ,
recipients must certify in writing to the CMS GMS that their entity did not
expend more than $750,000 during their fiscal year as a Grant Note in
GrantSolutions labeled: “FAC Certification” (Subject)/
“FAC_CERT_mm.dd.yyyy” (File Name). Records must still be available for
review or audit by appropriate officials of CMS, pass -through entity, and
Government Accountability Office (GAO).
For questions and information concerning the FAC submission process, please contact
the Federal Audit Clearinghouse (entity which assists Federal cognizant and oversight
agencies in obtaining audit data and reporting packages) at 888-222-9907 or
https://harvester.census.gov/facweb/Default.aspx.
Commercial Organizations (for-profits including for-profit hospitals) should
consult §75.216 for limitations on profit and program income. As explained in 45 CFR
§75.501(i) and §75.216, commercial organizations have two options regarding audits:
(1) A financial related audit (as defined in the Government Auditing Standards, GPO
Stock #020-000-00-265-4) of a particular award in accordance with Government
Auditing Standards. In those cases where the recipient receives awards under
only one HHS program, or, if awards are received under multiple HHS programs,
a financial related audit of all HHS awards in accordance with Government
Auditing Standards; or
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(2) An audit that meets the requirement contained in 45 CFR part 75, subpart F (as
explained above).
Commercial organizations should submit audits directly to the following
electronic address:
AuditResolution@hhs.gov with a copy to KC_OIG_Audit@cms.hhs.gov
(Do not send audits for commercial organizations to the Federal Audit
Clearinghouse (FAC).
As explained under 45 CFR §75.501(h), For-profit su brecipient, since this part does not
apply to for -profit subrecipients, the pass -through entity is responsible for establishing
requirements, as necessary, to ensure compliance by for-profit subrecipients. The
agreement with the for-profit subrecipient mus t describe applicable compliance
requirements and the for-profit subrecipient's compliance responsibility. Methods to
ensure compliance for Federal awards made to for-profit subrecipients may include pre -
award audits, monitoring during the agreement, and post-award audits. See also §75.352
Requirements for pass -through entities.
For information related to potential consequences for failure to apply with the
aforementioned audit requirements, please see Standard Term and Condition 33.
Remedies for Non-Compliance and 45 CFR §75.371, Remedies for noncompliance.
5. The HHS Grants Policy Statement (HHS GPS). This award is subject to the requirements
of the HHS GPS that are applicable to the Recipient based on the Recipient t ype and the
purpose of this award [available at
http://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/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. Although the HHS GPS
is meant to be consistent with applicable statutory or regulatory requireme nts, the current 2007
version has not been updated to parallel the new HHS regulations. The HHS regulation, 45
CFR Part 75, effective December 26, 2014, therefore supersedes information on administrative
requirements, cost principles, and audit requirements for grants and coopera tive agreement
included in the current HHS Grants Policy Statement where differences are identified.
6. Prior Approval Requirements. Recipients must consult and comply with prior approval
requirements outlined under 45 CFR §75.407, Prior written approval (prior approval).
7. Revision of Budget and Program Plans. Recipients must consult and comply with
requirements outlined under 45 CFR §75.308, Revision of budget and program plans. Please
note that CMS is not waiving any prior approval requirements outlined in this sec tion.
Additionally, in accordance with §75.308(e), CMS requires prior approval where the transfer
of funds among direct cost categories or programs, functions and activities in which the
Federal share of the project exceeds the Simplified Acquisition Threshold ($250,000) and the
cumulative amount of such transfers exceeds or is expected to exceed 10 percent of the total
budget as last approved. CMS cannot permit a transfer that would cause any Federal
appropriation to be used for purposes other than those consistent with the appropriation.
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8. Rearrangement, Alteration, Reconversion, and Capital Expenditures. Recipient may not
incur direct costs for rearrangement, alteration, reconversion, or capit al expenditures without
prior written approval by CMS (refer to 45 CFR §§75.439 and 75.462).
Capital expenditures means expenditures to acquire capital assets or
expenditures to make additions, improvements, modifications, replacements,
rearrangements, reinstallations, renovations, or alterations to capital assets that
materially increase their value or useful life (refer to 45 CFR §75.2,
Definitions).
Capital assets means tangible or intangible assets used in operations having a
useful life of more than one year which are capitalized in accordance with
Generally Accepted Accounting Principles (GAAP). Capital assets include:
(1) Land, buildings (facilities), equipme nt, and intellectual property
(including software) whether acquired by purchase, construction,
manufacture, lease-purchase, exchange, or through capital leases; and
(2) Additions, improvements, modifications, replacements, rearrangements,
reinstallations, reno vations or alterations to capital assets that materially
increase their value or useful life (not ordinary repairs and
maintenance). (refer to 45 CFR §75.2, Definitions)
Maintenance and Repair Costs: Costs incurred for utilities, insurance, security,
necessary maintenance, janitorial services, repair, or upkeep of buildings a nd
equipment (including Federal property unless otherwise provided for) which
neither add to the permanent value of the property nor appreciably prolong its
intended life, but keep it in an efficient operating condition, are allowable.
Costs incurred for improvements which add to the permanent value of the
buildings and equipment or appreciably prolong their intended life must be
treated as capital expenditures. These costs are only allowable to the extent not
paid through rental or other agreements (refer to 45 CFR §75.452).
9. Conference and Travel Costs. For attendance at any conference 4, including those sponsored
by CMS, recipients must submit a detailed breakdown of costs associated with attending the
conference for prior written approval. All costs must be individually itemized. This
breakdown should include all costs associated with travel to the conference a nd a brief
narrative explaining the program related purpose/how attending the conference will further the
objectives of the program. As noted in 45 CFR §75.432, Conferences, allowable conference
costs paid by the non-Federal entity as a sponsor or host of the conference may include rental
of facilities, speakers’ fees, costs of meals and refreshments 5, local transportation, and other
4 OMB Memorandum M-12-12 employs, and HHS has adopted the following definition for a conference from the
Federal Travel Regulation (FTR): A “conference” is defined as “[a] meeting, retreat, seminar, symposium or event
that involves attendee travel. The term ‘conference’ also applies to training activities that are considered to be
conferences under 5 CFR 410.404.”
5 Per page II-36 of the HHS Grants Policy Statement, meals are generally unallowable except for the following:
• Subjects and patients under study;
• Where specifically approved as part of the project or program activity (not grantee specific), e.g., in
programs providing children’s services; and
• As part of a per diem or subsistence allowance provided in conjunction with allowable travel.
Guest meals are not allowable (see also II-36 of HHS GPS).
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items incidental to such conferences. Conference hosts/sponsors must exer cise discretion and
judgment in ensuring that conference costs are appropriate, necessary and mana ged in a
manner that minimizes costs to the Federal award. All federally funded travel must be tracked
through a travel log which includes: traveler/position, destination, length of stay, mileage, per
diem, reason for the trip, airfare, and any other reimbursable expenses. Recipie nts must also
consult and comply with requirements outlined under 45 CFR §75.474, Travel Costs.
10. Technology Costs. As defined in 45 CFR §75.2, Definitions, equipment means tangible
personal property (including information technology systems), having a useful life of more
than one year and a per-unit acquisition cost which equals or exceeds the lesser of the
capitalization level established by the non-Federal entity for financial statement purposes, or
$5,000. Supplies means all tangible personal property other than those described in
Equipment. A computing device is a supply if the acquisition cost is less than the les ser of the
capitalization level established by the non-Federal entity for financial statement purposes or
$5,000, regardless of the length of its useful life. See also the definitions in 45 CFR §75.2 of
Capital assets, Computing devices, General purpose equipment, Information technology
systems, and Special purpose equipment. All technology items, regardless of classification as
equipment or supply must still be individually tagged and recorded in an
equipment/technology database. This database should include any information ne cessary to
properly identify and locate the item. For example: serial # and physical location of equipment
(e.g. laptops, tablets, etc.). In addition, purchase of Technology items (both those
classified as equipment and those classified as supplies ), over and above that which is
already approved in the budget must be approved by the Grants Management Specialist
(regardless of acquisition cost).
11. Prohibited Uses of Grant or Cooperative Agreement Funds. The following list contains
costs that are prohibited for all CMS programs. Recipient should consult the Program Terms
and Conditions for other prohibited costs specific to the grant or cooperative agre ement
program.
To match any other Federal funds.
To provide services, equipment, or supports that are the legal responsibility of
another party under Fe deral, 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 provide goods or services not allocable to the approved project.
To supplant existing State, local, tribal, or private funding of infrastructure or
services, such as staff salaries, etc.
To be used by local entities to satisfy State matching requirements.
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.
In accordance with 45 CFR §75.476, the cost of independent research and
development, including their proportionate share of indirect costs, are
unallowable.
In accordance with 45 CFR §75.216(b), except for grants awarded under the
Small Business Innovative Research (SBIR) and Small Business Technology
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Transfer Research (STTR) programs (15 U.S.C. 638), no HHS funds may be
paid as profit to any recipient even if the recipient is a commercial (for-profit)
organization. Profit is 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 Exe cutive
order proposed or pending before the Congress or any state government, state
legislature or local legislature or legislative body.
12. Reporting Requirements. Recipients must comply with the frequency and content
requirements outlined in the Program Terms and Conditions of award. Failure to submit
programmatic and financial reports on time may be basis for withholding financ ial assistance
payments, suspension, termination or denial of continued funding. Recipient’s failure to
timely submit such reports may result in a designation of “high risk” for the r ecipient
organization and may jeopardize potential future funding from the U.S. Department of Health
& Huma n Services. The general information and guidance for financial and programmatic
reporting provided below supplements the specifics included in the P rogram Terms and
Conditions .
Prior to closeout of the grant, Recipients must submit a tangible personal property report.
Specific information is provided below and will be reiterated in the pre -closeout letter sent to
all Recipients.
FINANCIAL REPORTING
Effective October 1, 2020, all grant recipients that receive funding from H HS must submit
both the quarterly Federal Cash Transactions Report (FCTR) and the quarterly, semi-annual,
or annual (as applicable) expenditure Federal Financial Report (SF-425) in the Payment
Management System (PMS). PMS can be accessed via the following link: https://pms.psc.gov.
In support of the federal government's effort to reduce administrative burden for both the
federal government and the federal financial assistance recipient community as outlined in the
Data Act Pilot, President’s agenda Cap Goal 8 and OMB memorandum 18-24, HHS has
implemented the submission of expenditure reporting (SF-425 or Federal Financial Report
(FFR)) in the Payment Management System (PMS) to eliminate the need to report duplic ative
information across multiple reporting sources and instead allow grant recipients to
report/certify expenditure data once through a single entry point.
Quarterly Federal Cash Transactions Report (FCTR) (no change)
Recipient must report, on a quarterly basis, cash transaction data via the Payment Management
System (PMS) using the Federal Financial Report (SF-425 or FFR) form. The FFR combines
the information that grant recipients previously provided using two forms: the Federal Cash
Transactions Report (PSC-272) and the Financial Status Report (SF-269). Cash transactions
data is reflected through completion of lines 10a -10c on the FFR. The quarterly FFR is due
within (30) days after the end of each quarter. Reporting deadlines are outlined below.
For disbursement activity during the months of : The FFR is due on:
October 1 through December 31 (1st Quarter) January 30
January 1 through March 31 (2nd Quarter) April 30
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April 1 through June 30 (3rd Quarter) July 30
July 1 through September 30 (4th Quarter) October 30
Instructions on how to complete the FFR can be found (after logging on) at:
https://pms.psc.gov/pms -user -guide/fede ral-financial-report.html.
Quarterly, Semi-Annual, Annual, and Final Expenditure Reporting (FFR) (effective
10.1.2020)
Recipient must also report on Federal expenditures, Recipient Share (if a pplicable), and
Program Income (if applicable and/or allowable) at least annually via the Payment
Management System (as is used for quarterly FFRs). Frequency of expenditure reporting,
whether quarterly, semi-annually or annually, is stipulated in the Program Terms and
Conditions of award. This information is reflected through completion of lines 10.d through
10.o of the FFR. The expenditures FFR must also include information on indirec t costs if
approved as part of grant award (line 11). Recipients should follow program specific reporting
frequency as stipulated in the Program Terms and Conditions. As appropriate, all lines of the
form must be completed/verified . CMS will review and either approve or reject the
expenditure report submitted. If rejected, Recipient must take appropriate action to correct the
issue and resubmit the report.
The final FFR must show cumulative expenditures under the award and any unobligated
balance of federal funds and as appropriate, all other parts of the form must be completed.
Final, federal cash information (lines 10.a through 10.c) will be reporte d to the Payment
Management System based upon the quarterly schedule established for submission of these
reports (see Quarterly Federal Cash Transactions Reporting section within this term and
condition). The final expenditure report cannot show any unliquidated obligations.
Quarterly and semi-annual expenditure reports are due no la ter than 30 days following the
applicable six -month period. Annual expenditure FFRs are due no later than 90 days
following the applicable budget period end date or 12-month period for multi-year budget
periods and final FFRs are due no later than 120 days following the project period end date.
Per 45 CFR §75.309(b), a non-Federal entity must liquidate all obligations incurred under the
award not later than 120 days after the end of the funding period (or as specified in a program
regulation) to coincide with the submission of the final FFR. This deadline may be extended
with prior written approval from the CMS Grants Management Specialist.
PROGRAMMATIC REPORTING
In accordance with 45 CFR §75.301, Performance Measurement, Recipients must relate
financial data to performance accomplishments of the Federal award and provide cost
information to demonstrate cost effective practices (e.g., through unit cost data). P erformance
will be measured in a way that will help CMS and other non-Federal entities to improve
program outcomes, share lessons learned, and spread the adoption of promising pra ctices.
TANGIBLE PERSONAL PROPERTY REPORTING
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The Tangible Personal Property Report (SF-428) is a standard form to be used by awarding
agencies to collect information related to tangible personal property when re quired by a
Federal financial assistance award. This form allows recipients to r equest specific disposition
of f ederally-owned property and acquired equipment. This form also provides a means for
calculating and transmitting appropriate compensation to CMS for residual unus ed supplies .
The form consists of the cover sheet (SF-428) and three attachments to be used as required:
Annual Report, SF-428-A; Final (Award Closeout) Report, SF-428-B; and a Disposition
Request/Report, SF-428-C. A Supplemental Sheet, SF-428-S, may be used to provide detailed
individual item information.
Recipients are required to complete the SF-428-B and the SF-428-S (as applicable) at the time
of award closeout. The report covers federally owned property, acquired equipment with an
acquisition cost of $5,000 or more, and residual unused supplies with a total aggrega te fair
market value exceeding $5,000 not needed for any other federally sponsored programs or
projects.
PATENTS AND INVENTIONS
In accordance with 45 CFR §75.322(c), all Recipients are subject to applicable regulations
governing patents and inventions, including government-wide regulations issued by the
Department of Commerce at 37 CFR part 401. If applicable, Recipients must report any
inventions on an annual basis using the non-competing continuation application or annual
progress report for multi-year budget periods . A Final Invention Statement and Certification
(Form HHS 568) must be completed and submitted within 120 days following the expiration
or termination of a grant or cooperative agreement. The Statement must include all inventions
which were conceived or first actually reduced to practice during the course of work under the
grant or award, from the original effective date of support through the date of c ompletion or
termination. The Statement shall include any inventions reported previously for grants and
cooperative agreements as part of a non-competing continuation application or annual
progress report. Recipients must also provide details about all inventions tha t have been
licensed but not patented, and include details on income resulting from HHS-funded
inventions and patents. Unpatented research products or resources —research tools—may be
made available through licensing to vendors or other investigators. Income ear ned from any
resulting fees must be treated as program income. This reporting requirement is applicable to
grants and cooperative agreements issued by the U.S. Department of Health & Human
Services in support of research and research-related activities. For further guidance, please
see the HHS Grants Policy Statement: Patents and Inventions and Inventions Reporting.
13. Payment. The Division of Payment Management (DPM) does not award grants. The
issuance of grant awards and other financial assistance is the responsibility of the awarding
agencies. Once an award is made, the funds are posted in recipient accounts established in the
Payment Management System (PMS). Recipients may then access their funds by using the
PMS funds request process.
The PMS funds request process enables Recipients to request funds using a Personal
Computer with an Internet connection. The funds are then delivered to the recipie nt via
Electronic Funds Transfer (EFT). If you are a new grant recipient, please go to
https://pms.psc.gov/grant-recipients/access-newuser.html to find information to register in
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PMS. If you need further help with that process, please contact the One -DHHS Help Desk via
email at pmssupport@psc.gov or call (877) 614-5533 for assistance.
14. Continuation of Funding . The recipient must submit a non-competing continuation
application each year as a prerequisite to continued funding if a project pe riod is comprised of
multiple budget periods. The initial NoA identifies the project period, which may include
multiple 12 -month budget periods. Continued funding is contingent on adequate progress,
compliance with the terms and conditions of the previous budget period, and the availability of
funds. Non-competing application instructions will be provided by the Grants Management
Specialist to recipients prior to applicable budget period end dates.
15. Funding for Recipients . All funding provided under this award shall be used by the
Recipient exclusively for the program referenced in the Notice of Award and described in the
Notice of Funding Opportunity and delineated in the Recipient’s approved proposal. This
includes any approved revisions, as applicable, made subsequent to the Recipient’s approved
proposal. Per 45 CFR §75.309(a), a non-Federal entity may charge to the Federal award only
allowable costs incurred during the period of performance (except as describe d in 45 CFR
§75.461) and any costs incurred before the HHS awarding agency or pass -through entity made
the Federal award that were authorized by the Federal awarding agency or pass-through entity.
Funds available to pay allowable costs during the period of performance include both Federal
funds awarded and carryover balances. Any funds used for any purpose other than for the
approved program, including disallowed costs, should be returned to the United States
Treasury. Instructions for returning funds including interest earned in excess of $500 are
available at https://pms.psc.gov/grant-recipients/returning-funds -interest.html.
16. Public Reporting. Recipients, consistent with the language of the Stevens Amendment, w hen
issuing statements, press releases, publications, requests for proposals, bid solicitations, and
other documents – such as toolkits, resource guides, websites, and presentations (hereafter
“statements”) – describing the projects or programs funded in w hole or in part with U.S.
Department of Health and Human Services (HHS) federal funds , must clearly state: (1) the
percentage and dollar amount of the total costs of the program or project which will be funded
with Federal money; and (2) the percentage and dollar amount of the total costs of the project
or program that is funded by non-governmental sources.
When issuing statements resulting from activities supported by HHS financial assistance, the
recipient entity must include an acknowledgement of federal assistance using one of the
following or a similar statement (see immediately below). For additional supplemental
information, please see Standard Terms and Conditions 17. Acknowledgement of Sponsors
and 18. Use of Data and Work Products.
If the HHS Grant or Cooperative Agreement is NOT funded with other non-governmental
sources:
This [project/publication/program/website, etc.] [is/was] supported by the Centers for
Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human
Services (HHS) as part of a financial assistance award totaling $XX with 100 percent
funded by CMS/HHS. The contents are those of the author(s) and do not necessarily
represent the official views of, nor an endorsement, by CMS/HHS, or the U.S.
Government.
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The HHS Grant or Cooperative Agreement IS partially funded with other nongovernmental
sources:
This [project/publication/program/website, etc.] [is/was] supported by the Centers for
Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human
Services (HHS) as part of a financial assistance award totaling $XX with XX percentage
funded by CMS/HHS and $XX amount and XX percentage funded by non-government
source(s). The contents are those of the author(s) and do not necessarily represent the
official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.
The federal award total must reflect total costs (direct and indirect) for all authorized
funds (including supplements and carryover) for the total competitive segment up to the
time of the public statement.
Any amendments by the recipient to the acknowledgement statement must be coordina ted
with the HHS Awarding Agency.
If the recipient plans to issue a press release concerning the outcome of activities
supported by HHS financial a ssistance, it should notify CMS in advance to allow for
coordination.
17. Acknowledgement of Sponsors . All publications, press announcements, posters, oral
presentations at meetings, seminars, and any other information-dissemination format,
including but not limited to electronic/digital media that is related to this project must include
a formal acknowledgement of support as well as a disclaimer as stated above in Standard
Term and Condition 16. Public Reporting. It is the policy of the Department of Health and
Human Services (HHS) that the results and accomplishments of the activities it funds should
be made available to the public. The Recipient is expected to make the results and
accomplishments of its activities available to the research community and to the public at
large.
(a) The Recipient shall submit the following to the CMS Project Officer for review and
comment unless specified otherwise in the Program Terms and Conditions:
(i) At least 30 days prior to its release :
publications that report results from or describe information obtained through
this award. Note : One copy of each publication, regardless of format, resulting
from work performed under an HHS project must accompany the annual or
final progress report submitted to CMS.
any external formal presentation of any report or statistical or analytical
material based on information obtained through this award. Formal
presentation includes papers, articles, professional publication, spe eches, and
testimony.
external presentation-related material, such as abstracts, power point
presentations or other slide decks, posters, and videos.
all public materials specific to the program including but not limited to,
brochures, recruitment materials, informational materials, advertisements,
website copy, website pages, videos, and op-ed articles.
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(ii) At least 7 days prior to release:
any press release or media advisory concerning the outcome of activities
supported through this award.
all media interviews, media requests, releases of information, filming, and
broadcasts.
(b) For 1 year after completion of the project, the Recipient shall continue to submit for
review and comment all publications, presentations, and communications re sulting from
this award or based on information obtaine d through this award, including papers, articles,
professional publications, power point presentations, posters, speeches, a nnouncements,
and testimony in any format, including digital technology.
(c) It is the policy of the Department of Health and Human Services that the Recipient must
communicate to CMS how the dollar amounts and funding percentages are calculated,
including whether or not indirect costs have been incorporated. Recipient must submit this
information to CMS for review and comment for each applicable type of
result/accomplishment according to the same timeline schedule outlined in 17(a).
(d) Specifically excluded from the review and comment process are internal presentations,
information discussions, in general, class lectures, and informal meetings and
conversations with community leaders. However, if such a presentation or slide deck is
later re-purposed for a public event, it will need to be submitted in advance for CMS
review.
(e) One copy of each publication resulting from work performed under an HHS grant-
supported project must accompany the final progress report.
18. Use of Data and Work Products. At any phase of the project, including the project’s
conclusion, the Recipient, if so requested by the CMS Project Officer, s hall submit copies of
analytic data file(s) with appropriate documentation, representing the data developed/used in
end-product analyses generated under the award. The analytic file(s) may include primary
data collected, acquired or generated under the award and/or data furnished by CMS. The
content, format, documentation, and schedule for production of the data file(s) will be agreed
upon by the Principal Investigator/Project Director and the CMS Project Off icer. The
negotiated format(s) could include both file(s) that would be limited to CMS’s internal use and
file(s) that CMS could make available to the general public.
All data provided by CMS will be used for the research described in this grant award only and
in connection with the Recipient’s performance of its obligations and rights under this
program. Recipient has an obligation to collect and secure data for future monitoring by
CMS. The Recipient will return any data provided by CMS or copies of data at the conclusion
of the project. All proprietary information and technology of the Recipient are a nd shall
remain the sole property of the Recipient.
In the course of this research, whenever the Principal Investigator/Project Director determines
that a significant new finding has been developed, he/she will communicate it to the CMS
Project Officer before formal dissemination to the general public. The R ecipient shall notify
CMS of research conducted for publication.
19. System of Award Management and Universal Identifier Requirements . This award is
subject to the requirements of 2 CFR part 25, Appendix A which is specifically incorpora ted
herein by reference. For the full text of 2 CFR part 25, refer to Attachment A to these
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Standard Terms and Conditions. To satisfy these requirements, Recipient must maintain an
active registration in the System for Award Management (SAM) database. Please consult the
SAM website (https://www.sam.gov/SAM/) for more information.
20. Trafficking in Persons. This award is subject to the requirements of Section 106 (g) of the
Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104). For the full text of
the award term, refer to Attachment B to these Standard Terms and Conditions.
21. Subaward Reporting and Executive Compensation. This award is subject to the reporting
requirements of the Federal Funding Accountability and Transparency Act of 2006 (P ublic
Law 109-282), as amended by Section 6202 of Public Law 110-252 and implemented by 2
CFR Part 170. Recipients must report information for each first-tier subaward of $25,000 or
more in Federal funds and executive total compensation for the Recipient’s and Subrecipients’
five most highly compensated executives as outlined in Appendix A to 2 CFR Part 170.
Information about the Federal Funding Accountability and Transparency Act Subawar d
Reporting System (FSRS) is available at www.fsrs.gov. For the full text of the award term,
refer to Attachment C to these Standard Terms and Conditions.
22. Employee Whistleblower Protections. All Recipients must inform their employees in
writing of employee whistleblower rights and protections under 41 U.S.C. 4712 in the
predominant native language of the workforce. For the full text of the award term, re Pilot
Program for Enhancement of Contractor Employee Whistleblower Protections, refer to
Attachment D to these Standard Terms and Conditions.
23. Conflict of Interest Policies. In accordance with 45 CFR §75.112, these terms and conditions
establish the conflict of interest policy requirements for recipients receiving federal
discretionary grant funding from CMS. Recipient must comply with the conflict of interest
policy requirements outlined in Attachment E to these Standard Terms and Conditions.
24. Recipient Integrity and Performance. In accordance with Appendix XII to 45 CFR part 75,
Recipient must comply with reporting requirements for matters relate d to recipient integrity
and performance. For the full text of the award term, refer to Attachment F to these terms
and conditions.
25. Accessibility Provisions. You must administer your project in compliance with federal civil
rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age
and, in some circumstances , religion, conscience, and sex (including gender identity, sexual
orientation, and pregnancy). This includes taking reasonable steps to provide meaningful access
to persons with limited English proficiency and providing programs that are acces sible to and
usable by persons with disabilities. The HHS Office for Civil Rights provides guidance on
complying with civil rights laws enforced by HHS. See https://www.hhs.gov/civil-rights/for-
providers/provider-obligations/index.html and https://www.hhs.gov/civil-rights/for-
individuals/nondiscrimination/index.html.
• You must take reasonable steps to ensure that your project provides meaningful
access to persons with limited English proficiency. For guidance on meeting your
legal obligation to take reasonable steps to ensure meaningful access to your
programs or activities by limit ed English proficient individuals , see
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https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited -english-
proficiency/fact-sheet-guidance/index.html and https://www.lep.gov.
• For information on your specific legal obligations for serving qualif ied individuals
with disabilities , including providing program access, reasonable modifications,
and taking appropriate steps to provide effective communication, see
http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html.
• HHS funded health and education programs must be administered in an
environment free of sexual harassment, see https://www.hhs.gov/civil-rights/for-
individuals/sex-discrimination/index.html.
• For guidance on administering your project in compliance with applicable federal
religious nondiscrimination laws and applicable federal conscience protect ion and
associated anti-discrimination laws , see https://www.hhs.gov/conscience/conscience-
protections/index.html and https://www.hhs.gov/conscience/religious-
freedom/index.html.
Recipients should review and comply with the reporting and review activities regarding
accessibility requests outlined in Attachment G, to these Standard Terms and Conditions.
26. Fraud, Waste, and Abuse. The HHS Office of the Inspector General (OIG) maintains a toll-
free number (1-800-HHS-TIPS [1-800-447-8477]) for receiving information conc erning fraud,
waste, or abuse under grants and cooperative agreements as well as the HHS OIG website at
https://oig.hhs.gov/fraud/report-fraud/index.asp. Information also may be submitted by email
to hhstips@oig.hhs.gov or by mail to Office of the Inspector General, U.S. Department of
Health & Human Services, Attn: HOTLINE, 330 Independence Ave., SW, Washington, DC
20201. Such reports are treated as sensitive material and submitters may decline to give their
names if they choose to remain anonymous.
27. Human Subjects Protection. If applicable to Recipient’s program, the Recipient bears
ultimate responsibility for protecting human subjects under the awa rd, including human
subjects at all sites, and for ensuring that a Federal-wide A ssurance (FWA) approved by the
Office for Human Research Protections (OHRP ) and certification of Institutional Review
Board (IRB) review and approval have been obtained before human subjects research can be
conducted at each collaborating site . For more information about OHRP, FWA, and IRBs,
please see the following link: http://www.hhs.gov/ohrp/index.html. Recipients may not draw
funds from the payment system, request funds from the paying office, or make obligations
against Federal funds for research involving human subjects at any site engaged in nonexempt
research for any period not covered by both an OHRP -approved assuranc e and IRB approval
consistent with 45 CFR Part 46. Costs associated with IRB review of huma n research
protocols are not allowable as direct charges under grants and cooperative agr eements unless
such costs are not covered by the organization’s indirect cos t rate.
HHS requires Recipients and others involved in grant/cooperative agreement-supported
research to take appropriate actions to protect the confidentiality of inf ormation about and the
privacy of individuals participating in the research. Investigators, IRBs, and other appropriate
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entities must ensure that policies and procedures are in place to protect ide ntifying information
and must oversee compliance with those policies and procedures.
28. Project and Data Integrity. Recipient shall protect the conf identiality of all project -related
information that includes personally identifying information.
The Recipient shall assume responsibility for the accuracy and completeness of the
information contained in all technical documents and reports submitted. The CMS Project
Officer shall not direct the interpretation of the data used in preparing the se documents or
reports.
At any phase in the project, including the project’s conclusion, the Recipient, if so requested
by the CMS Project Officer, must deliver to CMS materials, systems, or other items used,
developed, refined or enhanced in the course of or under the award. The Recipient a grees that
CMS shall have a royalty-free, nonexclusive and irrevocable license to reproduce, publish, or
otherwise use and authorize others to use the items for Federal government pur poses.
29. Public Policy Requirements. By signing the application, the Authorized Organizational
Official (AOR) certifies that the organization will comply with applicable public policies.
Once a grant is awarded, the recipient is responsible for establishing and maintaining the
necessary processes to monitor its compliance and that of its employees and, as appropriate,
subrecipients and contractors under the grant with these requirements. Recipient should
consult these terms and conditions, the applicable Appropriations Law, and Exhibit 3 of the
HHS Grants Policy Statement, titled Public Policy Requirements, located in Section II , pages
3-6, for information on potentially applicable public policy requirements. Additiona l
potentially applicable public policy requirements not included within these sources include:
Military Recruiting and Reserve Officer Training Corps Access 10 U.S.C. §983 [all
types of applications and awards to Institutions of Higher Education]
Text Messaging While Driving (EO 13513) [all awards]
Ban on Cloning of Human Beings (Presidential memorandum of March 4, 1997) [all
awards]
See also Standard Term and Condition 44. FY 2019 Appropriations Provision.
30. Green Procurement. To mitigate the environmental impacts of acquisition of IT and other
products/equipment, Recipients are encouraged to: (1) participate in “Gree n procurement”
based on the HHS Affirmative Procurement Pla n
(http://www.responsiblepurchasing.org/UserFiles/File/HHS_Affirma tive%20Procurement%20
Plan_2006.pdf) and similar guidance from the Environmental Protection Agency (EPA) and
the President’s Council on Environmental Quality (CEQ); (2) use electronic pr oducts that are
Energy Star® compliant and Electronic Product Environmental Assessment Tool (EPEAT)
Silver registered or higher when available; (3) activate Energy Star® features on all equipment
when available; (4) use environmentally sound end-of-life management practices, including
reuse, donation, sale and recycling of all electronic products.
31. Withdrawal. If the Recipient decides to withdraw from this award prior to the end of the
project period, it must provide written notification (both hard copy and via email) to the CMS
Grants Management Specialist at least fifteen (15) days in advance of the date of official
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withdrawal and termina tion of these terms. The letter must be signed by the AOR and other
appropriate individuals with authority. CMS will not be liable for any withdrawal close -out
costs that are borne by the Recipient. Recipients have three (3) days to return all unused gra nt
funds.
32. Mandatory Disclosures. Consistent with 45 CFR §75.113, applicants and r ecipients must
disclose in a timely manner, in writing to CMS, with a copy to the HHS Office of the
Inspector General (OIG), all information related to violations of federal criminal law involving
fraud, bribery, or gratuity violations potentially affecting the federal award. Additionally,
subrecipients must disclose, in a timely manner, in writing to the prime recipient (pass through
entity) and the HHS OIG, all information related to violations of federal criminal law
involving fraud, bribery, or gratuity violations potentially affecting the federal award.
Disclosures must be sent in writing to CMS and to the HHS OIG at the following address es:
U.S. Department of Health & Human Services
Centers for Medicare & Medicaid Services
Office of Acquisition and Grants Management
Attn: Director, Division of Grants Management, Mandatory Grant Disclos ures
7500 Security Blvd, Mail Stop B3-30-03
Baltimore, MD 21244-1850
Materials should also be scanned and emailed to your Grants Management Specialist.
AND
U.S. Department of Health & Human Services
Office of Inspector General
ATTN: Mandatory Grant Disclosures, Intake Coordinator
330 Independence Avenue, SW, Cohen Building
Room 5527
Washington, DC 20201
Fax: (202) 205-0604 (Include “Mandatory Grant Disclosures” in subject line) or
Email: MandatoryGranteeDisclosures@oig.hhs.gov
Failure to make required disclosures can result in any of the remedies described in 45 CFR
§75.371, Remedies for noncompliance, including suspension or debarment (See 2 CFR parts
180 & 376 and 31 U.S.C. 3321).
33. Remedies for noncompliance. If a non-Federal entity fails to comply with Federal statutes,
regulations, or the terms and conditions of a Federal award, the HHS awarding a gency or pass-
through entity may impose additional conditions, as described in 45 CFR §75.207, Specific
award conditions. If the HHS awarding agency or pass -through entity determines that
noncompliance cannot be remedied by imposing additional conditions, the Federal awar ding
agency or pass -through entity may take one or more actions as set forth in 45 CFR §75.371,
Remedies for noncompliance.
34. Suspension and Debarment Regulations. Recipient must comply with 45 CFR §75.213,
which states that non-federal entities and contractors are subject to the non-procurement
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debarment and suspension regulations implementing Executive Orders 12549 and 12689 at 2
CFR parts 180 and 376. These regulations restrict awards, subawards and contrac ts with
certain parties that are debarred, suspended or otherwise excluded from or ine ligible for
participation in Federal assistance programs or activities.
35. Termination. CMS may terminate this grant agreement, or any part hereof, if the Recipient
materially fails to comply with the terms and conditions of this award, or provisions of law
pertaining to agreement performance. Materially fails includes, but is not limited to, violation
of the terms and conditions of the award; failure to perform award activities in a satisfactory
manner; improper management or use of award funds; or fraud, waste, abuse,
mismanagement, or criminal activity. In addition, CMS may terminate this award if the
Recipient fails to provide the Government, upon request, with adequate written and signed
assurances of future performance. CMS will promptly notify the Recipient in writing of such
termination and the reasons for it, together with the effective date. Recipient may terminate
this award as set forth in 45 CFR §75.372, Termination .
36. Bankruptcy. In the event the Recipient or one of its subrecipients enters into proceedings
relating to bankruptcy, whether voluntary or involuntary, the Recipient agrees to provide
written notice of the bankruptcy to the CMS Grants Management Specialist and CMS P roject
Officer (PO). This written notice shall be furnished within five (5) days of the initiation of the
proceedings r elating to bankruptcy filing and sent to the CMS Grants Management Specialist
and PO. This notice shall include the date on which the bankruptcy petition was filed, the
identity of the court in which the bankruptcy petition was filed, a copy of any and all of the
legal pleadings, and a listing of Government grant and cooperative agreement number s and
grant offices for all Government grants and cooperative agreements against which final
payment has not been made.
37. Disposition of Federally Owned Property, Equipment, and Residual Unused Supplies .
Upon completion (or early termination) of a project, Recipient must take a ppropriate
disposition actions. Recipients of funding from CMS should proceed in accordanc e with the
guidance provided within this term and condition.
Recipient must complete and submit the SF-428-B Tangible Personal Property Report,
Final Report (also see Standard Term and Condition #12, Reporting Requirements). The
Tangible Personal Property Report (SF-428) is a standard form to be used by awarding
agencies to collect information related to tangible personal property when re quired by a
Federal financial assistance award. This form allows recipients to request specific disposition
of federally-owned property and acquired equipment. This form also provides a means for
calculating and transmitting appropriate compensation to CMS for residual unus ed supplies .
As noted in 1.b of this report, if your agency is in possession of Federally-owned property or
acquired equipment (defined as nonexpe ndable personal property with an acquisition cost of
$5,000 or more under the award), you must also submit a SF-428-S, Supplemental Sheet , that
lists and reports on all Federally-owned or acquired equipment under the specific grant or
cooperative agreement award. If there is no tangible personal property to report, select “d.” in
section 1 of the SF-428-B and indicate “none of the above.” Recipient must request specific
disposition instructions from CMS if the Recipient has federally-owned property or if the
following guidance is insufficient for the Recipient to properly complete dispos ition.
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Items of equipment with a current per unit fair market value of $5,000 or less
may be retained, sold or otherwise disposed of with no further obligation to
CMS.
Except as provided in 45 CFR §75.319(b), items of equipment with a current
per-unit fair market value in excess of $5,000 may be retained by the non-
Federal entity or sold. If there is no longer a use for the equipment under the
original project or program or for other activities currently or previously
supported by CMS or other HHS awarding agencies, except as otherwise
provided in Federal statutes and regulations , CMS is entitled to an amount
calculated by multiplying the current market value or proceeds from sale by
CMS’s percentage of participation in the cost of the original purchase. If the
equipment is sold, CMS may permit the non-Federal entity to deduct and retain
from the Federal share $500 or ten percent of the proceeds, whichever is less ,
for its selling and handling expenses.
Reportable Residual Unused Supplies , which in the aggregate exceed $5,000 in
fair market value which cannot be us ed by the original project or program nor
are needed for other activities currently or previously suppor ted by CMS, other
HHS awarding agencies, or another Federal agency, must be retained by the
Recipient for use on other activities or sold, but Recipient must, in either case,
compensate the Federal government for its share. CMS is entitled to an amount
calculated by multiplying the current fair market value or proceeds from sale by
CMS’s percentage of participation in the cost of the original purchase.
In certain instances, the non-Federal entity may transfer title to the property to
the Federal government or to an eligible third party subject to prior approval by
CMS. In such cases, the non-Federal entity must be entitled to compensation
for its attributable percentage of the current fair market value of the property.
38. Affirmative Duty to Track All Parties to the Award. Recipient must at a minimum
regularly track all parties to the award in both the GSA database that is known as the System
for Award Management (SAM) and The Office of the Inspector General (OIG) List of
Excluded Individuals and Entities (LEIE). The purpose of this affirmative duty is to track all
parties that include health care, commercial, non-profit, and other people and entities in order
to report immediately to the CMS Project Officer (PO) and Grants Management Specialist
those that cannot participate in federal programs or receive federal funds. The Recipient
cannot have any persons or entities on the award that cannot participate in fede ral programs or
receive federal funds. If any of these systems are not publicly available, then the Recipient
must comply with the purpose and intent of this requirement using a process tha t meets at least
the level of scrutiny provided by these databases.
The Recipient shall provide the CMS PO and Grants Management Specialis t with the National
Provider Identif ier (NPI), Tax ID, and EIN, as applicable, of all Key Personnel and/or Entities
to the award that may include Subrecipients. This list shall be provided to CMS as a Grant
Note in GrantSolutions within thirty (30) days from the start of the award and must be
maintained up-to-date in real time throughout the award.
39. Pass Through Entities, Subrecipients, and Contractors . As outlined in 45 CFR §75.351,
Subrecipient and contractor determinations, a pass-through entity must make case -by-case
determinations whether each agreement it makes for the disbursement of Federal program
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funds casts the party receiving the funds in the role of a subrecipient or contra ctor. A pass-
through entity means a non-Federal entity that provides a subaward to a subrecipient to carry
out part of a Federal program (45 CFR §75.2, Definitions). As described in 45 CFR §75.351,
a subaward is for the purpose of carrying out a portion of a Federal award and creates a
Federal assistance relationship with the subrecipient while a contract is for the purpose of
obtaining goods and services for the non-Federal entity’s own use and creates a procurement
relationship with the contractor. Characteristics for both types of relat ionships are included in
45 CFR §75.351. All pass -through entities must ensure that every subaward is clearly
identified to the subrecipient as a subaward and includes the information outlined in 45 CFR
§75.352, Requirements for pass-through entities, at the time of subaward and if any of these
data elements change, include the changes in subsequent subaward modifications.
40. Subrecipient Equal Treatment. The Recipient must comply with 45 CFR Part 87, including
the provision that no State or local government Recipient nor any intermediate organization
receiving funds under any program shall, in the selection of service providers, discriminate for
or against an organization’s religious character or affiliation.
41. Recipient’s Responsibility for Subrecipient s. The Recipient is responsible for the
performance, reporting, and spending for each Subrecipient. The Recipient will ensure the
timeliness and accuracy of required reporting for each site of service and Subrecipient under
the award. The Recipient is responsible for the performance and progress of each site of
service or Subrecipient toward the goals and milestones of the program. The Recipient will
take necessary corrective action for any site of service or Subrecipient that is not meeting the
goals and milestones of the program, as set f orth in the NOFO.
42. Nondiscrimination. The Recipient and Subrecipients will comply with all Federal statutes
relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil
Rights Act of 1964 (P.L. 88-352) which prohibits disc rimination on the basis of race, color or
national origin; (b) Title IX of the Education Amendments of 1972, as amended (20
U.S.C.§§1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c)
Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits
discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended
(42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug
Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to
nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended,
relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527
of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee - 3), as amended,
relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil
Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in
the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the
specific statute(s) under which application for Federal assistance is being made; and, (j) the
requirements of any other nondiscrimination statute(s) which may apply to the application.
43. Reservation of Rights. Nothing contained in this Agreement is intended or shall be construed
as a waiver by the United States Department of Justice, the Internal Revenue Service, the
Federal Trade Commission, HHS Office of the Inspector General, or C MS of any right to
institute any proceeding or action against Recipient for violations of any sta tutes, rules or
regulations administered by the Government, or to prevent or limit the rights of the
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Government to obtain relief under any other federal statutes or regulations, or on account of
any violation of this Agreement or any other provision of law. The Agreement sha ll not be
construed to bind any Government agency except CMS, and this Agreement binds CMS only
to the extent provided herein, unless prohibited by law. The failure by CMS to require
performance of any provision shall not affect CMS’s right to require performance at any time
thereafter, nor shall a waiver of any breach or default result in a waiver of the provision itself.
44. Records Retention. Financial records, supporting documents, statistical records, and all othe r
non-Federal entity records pertinent to a Federal award must be retained for a period of three
years from the date of submission of the final expenditure report or, for Feder al aw ards that
are renewed quarterly or annually, from the date of the submission of the quarter ly or annual
financial report, respectively, as reported to the HHS awarding agency or pass -through entity
in the case of a subrecipient. HHS awarding agencies and pass-through entities must not
impose any other record retention requirements upon non-Federal entities. The only
exceptions are stated in 45 CFR §75.361.
45. FY 20 21 Appropriations Provision. U.S. Department of Health & Human Services (HHS)
recipients must comply with all terms and conditions outlined in their grant award(s),
including grant policy terms and conditions contained in applicable HHS Grants Policy
Statements, and requirements imposed by program statutes and regulations, Exe cutive Orders,
and HHS grant administration regulations, as applicable; as well as any requir ements or
limitations in any applicable appropriations acts.
This award is subject to the “Consolidated Appropriations Act, 2021” (Division H –
Departments of Labor, Health and Human Services, and Education, and Related Agencies
Appropriation Act, 2021), see https://www.congress.gov/116/bills/hr133/BILLS-
116hr133enr.pdf . As is noted under Division H, Title II, General Provisions, Section 202,
none of the funds appropriated in this title shall be used to pay the salary of an individual,
through a grant or other extramural mechanism, at a rate in excess of Executive Level II. This
salary cap applies to direct salaries and to those salaries covered under indirect costs, also
known as facilities and administrative (F & A) costs 6]. Please consult the following link to
determine the applicable current salary cap: https://www.opm.gov/policy-data -oversight/pay-
leave/salaries-wages/salary-tables/pdf/2021/EX.pdf.
Recipients must review and comply with applicable General Provisions (see 201-239)
included within the Appropriations Law for the Departme nt of Health and Human Services
(HHS). Additionally, these provisions may apply to all recipients of HHS federal funding OR
may apply directly to recipients of federal funding from one or more HHS agencies. These
provisions are available via https://www.congress.gov/116/bills/hr133/BILLS-
116hr133enr.pdf . Refer to Division H, Title II, Department of Health and Human Services
(Department of Health and Human Services Appropriations Act, 2021).
6 Per the HHS Grants Policy Statement, page II-39 (Salaries and Wages), “If there is a salary limitation, it does not
apply to consultant payments or to contracts for routine goods and services, but it does apply to subrecipients
(including consortium participants).” Though the salary limitation does not apply to consultant costs, recipient must
still provide justification to include examples of typical market rates for this service in your area.
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Centers for Medicare & Medicaid Services
Standard Grant/Cooperative Agreement Terms and Conditions
Attachment A
APPENDIX A TO PART 25—AWARD TERM
I. SYSTEM FOR AWARD MANAGEMENT AND UNIVERSAL IDENTIFIER REQUIREMENTS
A. Requirement for System f or Award Management
Unless you are exempted from this requirement under 2 CFR 25.110, you as the recipient
must maintain the currency of your information in the SAM until you submit the final financial
report required under this award or receive the final payment, whichever is later. This requires that
you review and update the information at least annually after the initial r egistration, and more
frequently if required by changes in your information or another award term.
B. Requirement for unique entity identifier
If you are authorized to make subawards under this award, you:
1. Must notify potential subrecipients that no entity (see definition in paragraph C of this
award term) may receive a subaward from you unless the entity has provided its unique entity
identifier to you.
2. May not make a subaward to an entity unless the entity has provided its unique entity
identifier to you.
C. Definitions
For purposes of this award term:
1. System for Award Management (SAM) means the Federal repository into which an entity
must provide information required for the conduct of business as a recipient. A dditional
information about registration procedures may be found at the SAM Internet site (currently at
h ttp://www.sam.gov ).
2. Unique entity identifier means the identifier required for SAM registration to uniquely
identify business entities.
3. Entity, as it is used in this award term, means all of the following, as defined at 2 CFR part
25, subpart C:
a. A Governmental organization, which is a State, local government, or Indian Tribe;
b. A foreign public entity;
c. A domestic or foreign nonprofit organization;
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d. A domestic or foreign for-profit organization; and
e. A Federal agency, but only as a subrecipient under an award or subaward to a non-Federal
entity.
4. Subaward:
a. This term means a legal instrument to provide support for the performanc e of any portion
of the substantive project or program for which you received this award and that you as the
rec ipient award to an eligible subrecipient.
b. The term does not include your procurement of property and services needed to carry out
the project or program (for further explanation, see 2 CFR 200.330).
c. A subaward may be provided through any legal agreement, including an agreement that
you consider a contract.
5. Subrecipient means an entity that:
a. Receives a subaward from you under this award; and
b. Is accountable to you for the use of the Federal funds provided by the subaward.
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Centers for Medicare & Medicaid Services
Standard Grant/Cooperative Agreement Terms and Conditions
Attachment B
Award Term – Trafficking in Persons
a. Provisions applicable to a recipient that is a private entity.
1. You as the recipient, your e mployees, subrecipients under this award, and
subrecipients’ e mployees may not—
i. Engage in severe for ms of trafficking in persons during the period of
time that the award is in e ffect;
ii. Procure a commercial sex act during the period of time that the award
is in e ffect; or
iii. Use forced labor in the perfor mance of the award or subawards under
the award.
2. We as the Federal awarding agency may unilaterally terminate this award, without
penalty, if you or a subrecipient that is a private entity –
i. Is determined to have violated a prohibition in paragraph a.1 of this
award term; or
ii. Has an employee who is determined by the agency official authorized
to terminate the award to have violated a prohibition in paragraph a.1 of
this award term through conduct that is either—
A. Associated with perfor mance under this award; or
B. Imputed to you or the subrecipient using the standards and due
process for imputing the conduct of an individual to an
organization that are provided in 2 CFR part 180, “OMB
Guidelines to Agencies on Governmentwide Debarment and
Suspension (Nonprocure ment),” as imple mented by our agency at
2 CFR part 376.
b. Provision applicable to a recipie nt other than a private e ntity. We as the Federal
awarding a gency may unilaterally te rminate this award, without penalty, if a subrecipient
that is a private entity—
1. Is determined to have violated an applicable prohibition in paragraph a.1 of this
award term; or
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2. Has an e mployee who is deter mined by the agency official authorized to terminate the
award to have violated an applicable prohibition in paragraph a.1 of this award term
through conduct that is either —
i. Associated with perfor mance under this award; or
ii. Imputed to the subrecipient using the standards and due process for
imputing the conduct of an individua l to an organization that are
provided in 2 CFR part 180, “OMB Guidelines to Agencies on
Governmentwide Debarment and Suspension (Nonprocure ment),” as
implemented by our agency at 2 CFR part 376.
c. Provisions applicable to any recipient.
1. You must inform us immediately of any information you receive from any source
alleging a violation of a prohibition in paragraph a.1 of this award term.
2. Our right to ter minate unilaterally th at is described in paragraph a.2 or b of this
section:
i. Implements section 106(g) of the Trafficking Victims Protection Act
of 2000 (TVPA), as a mended (22 U.S.C. 7104(g)), and
ii. Is in addition to all other re medies for noncompliance that are
available to us under this award.
3. You must include the require ments of paragraph a.1 of this award term in any
subaward you make to a private entity.
d. Definitions. For purposes of this a ward term:
1. “E mployee” means either:
i. An individual e mployed by you or a subrecipient who is engaged in
the perfor mance of the project or program under this award; or
ii. Another person engaged in the perfor mance of the project or program
under this award and not compensated by you including, but not limited
to, a volunteer or individual whose services are contributed by a third
party as an in-kind contribution toward cost sharing or matching
require ments.
2. “Forced labor” means labor obtained by any of the following methods: the
recruitment, harboring, transportation, provision, or obtaining of a person for labor
or services, through the use of force, fraud, or coercion for the purpose of subjection
to involuntary servitude, peonage, debt bondage, or slavery.
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3. “Private entity”:
i. Means any entity other than a State, local government, Indian tribe, or
foreign public entity, as those ter ms are defined in 2 CFR 175.25.
ii. Includes:
A. A nonprofit organization, including any nonprofit institution of
higher education, hospital, or tribal organization other than one
included in the definition of Indian tribe at 2 CFR 175.25(b).
B. A for -profit organization.
4. “Severe for ms of trafficking in persons,” “commercial sex act,” and “coercion”
have the meanings given at section 103 of the TVPA, as amended (22 U.S.C.
7102).
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Centers for Medicare & Medicaid Services
Standard Grant/Cooperative Agreement Terms and Conditions
Attachment C
Award Term - Federal Financial Accountability and Transparency Act (FFATA)
Subaward and Executive Compensation Reporting Requirement
I. Reporting Subawards and Executive Compensation.
a. Reporting of first-tier subawards.
1. Applicability. Unless you are exempt as provided in paragraph d. of this award
term, you must report each action that obligates $25,000 or more in Federal funds
that does not include Recovery funds (as defined in section 1512(a)(2) of the
American Recovery and Reinvestment Act of 2009, Pub. L. 111-5) for a subaward to an
entity (see definitions in paragraph e. of this award term).
2. Where and when to report.
i. You must report each obligating action described in paragraph a.1. of this
award term to http://www.fsrs.gov.
ii. For subaward information, report no later than the end of the month
following the month in which the obligation was made. (For example, if the
obligation was made on November 7, 2010, the obligation must be reported by
no later than December 31, 2010.)
3. What to report. You must report the information about each obligating action that
the submission instructions posted at http://www.fsrs.gov specify.
b. Reporting Total Compensation of Recipient Executives.
1. Applicability and what to report. You must report total compensation for each of
your five most highly compensated executives for the preceding completed fiscal year,
if –
i. the total Federal funding authorized to date under this award is $25,000
or more;
ii. in the preceding fiscal year, you received –
(A) 80 percent or more of your annual gross revenues from Federal
procurement contracts (and subcontracts) and Federal financial assistance
subject to the Transparency Act, as defined at 2 CFR 170.320 (and
subawards); and
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(B) $25,000,000 or more in annual gross revenues from Federal
procurement contracts (and subcontracts) and Federal financial
assistance subject to the Transparency Act, as defined at 2 CFR 170.320
(and subawards); and
iii. The public does not have access to information about the compensation of
the executives through periodic reports filed under section 13(a) or 15(d) of the
Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104
of the Internal Revenue Code of 1986. (To determine if the public has access to
the compensation information, see the U.S. Security and Exchange Commission
total compensation filings at http://www.sec.gov/answers/execomp.htm).
2. Where and when to report. You must report executive total compensation described
in paragraph b.l. of this award term:
i. As part of your registration profile at / https://www.sam.gov/SAM/
ii. By the end of the month following the month in which this award is made,
and annually thereafter.
c. Reporting of Total Compensation of Subrecipient Executives.
1. Applicability and what to report. Unless you are exempt as provided in paragraph
d. of this award term, for each first-tier subrecipient under this award, you shall
report the names and total compensation of each of the subrecipient's five most
highly compensated executives for the subrecipient's preceding completed fiscal
year, if –
i. in the subrecipient's preceding fiscal year, the subrecipient received –
(A) 80 percent or more of its annual gross revenues from Federal
procurement contracts (and subcontracts) and Federal financial assistance
subject to the Transparency Act, as defined at 2 CFR 170.320 (and
subawards); and
(B) $25,000,000 or more in annual gross revenues from Federal
procurement contracts (and subcontracts), and Federal financial assistance
subject to the Transparency Act (and subawards); and
ii. The public does not have access to information about the compensation of
the executives through periodic reports filed under section 13(a) or 15(d) of the
Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104
of the Internal Revenue Code of 1986. (To determine if the public has access to
the compensation information, see the U.S. Security and Exchange Commission
total compensation filings at http://www.sec.gov/answers/execomp.htm).
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2. Where and when to report. You must report subrecipient executive total
compensation described in paragraph c.1. of this award term:
i. To the recipient.
ii. By the end of the month following the month during which you make the
subaward. For example, if a subaward is obligated on any date during the
month of October of a given year (i.e., between October 1 and 31), you must
report any required compensation information of the subrecipient by
November 30 of that year.
d. Exemptions
If, in the previous tax year, you had gross income, from all sources, under $300,000, you
are exempt from the requirements to report:
i. Subawards, and
ii. The total compensation of the five most highly compensated executives of
any subrecipient.
e. Definitions. For purposes of this award term:
1. Entity means all of the following, as defined in 2 CFR part 25:
i. A Governmental organization, which is a State, local government, or
Indian tribe;
ii. A foreign public entity;
iii. A domestic or foreign nonprofit organization;
iv. A domestic or foreign for -profit organization;
v. A Federal agency, but only as a subrecipient under an award or subaward
to a non-Federal entity.
2. Executive means officers, managing partners, or any other employees in
management positions.
3. Subaward:
i. This term means a legal instrument to provide support for the performance
of any portion of the substantive project or program for which you received
this award and that you as the recipient award to an eligible subrecipient.
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ii. The term does not include your procurement of property and services needed
to carry out the project or program (for further explanation, see Sec._.210 of the
attachment to OMB Circular A-133, "Audits of States, Local Governments, and
Non-Profit Organizations").
iii. A subaward may be provided through any legal agreement, including
an agreement that you or a subrecipient considers a contract.
4. Subrecipient means an entity that:
i. Receives a subaward from you (the recipient) under this award; and
ii. Is accountable to you for the use of the Federal funds provided by
the subaward.
5. Total compensation means the cash and noncash dollar value earned by the
executive during the recipient's or subrecipient's preceding fiscal year and includes the
following (for more information see 17 CFR 229.402(c)(2)):
i. Salary and bonus.
ii. Awards of stock, stock options, and stock appreciation rights. Use the dollar
amount recognized for financial statement reporting purposes with respect to the
fiscal year in accordance with the Statement of Financial Accounting Standards
No. 123 (Revised 2004) (FAS 123R), Shared Based Payments.
iii. Earnings for services under non-equity incentive plans. This does not
include group life, health, hospitalization or medical reimbursement plans that
do not discriminate in favor of executives, and are available generally to all
salaried employees.
iv. Change in pension value. This is the change in present value of defined
benefit and actuarial pension plans.
v. Above -market earnings on deferred compensation which is not tax-qualified.
vi. Other compensation, if the aggregate value of all such other compensation
(e.g. severance, termination payments, value of life insurance paid on behalf
of the employee, perquisites, or property) for the executive exceeds $10,000.
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Centers for Medicare & Medicaid Services
Standard Grant/Cooperative Agreement Terms and Conditions
Attachment D
Pilot Program for Enhancement of Contractor Employee Whistleblower Protections
Recipients are hereby give n notice that the 48 CFR section 3.908, implementing section 828,
entitled “Pilot Program for Enhancement of Contractor Employee Whistleblow er Protections,” of
the National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2013 (Pub. L. 112-239,
enacted January 2, 2013), applies to this award.
Federal Acquisition Regulations
As promulgated in the Federal Register, the relevant portions of 48 CFR se ction 3.908 read as
follows (note that use of the term “contract,” “contractor,” “subcontra ct,” or “subcontractor” for
the purpose of this term and condition, should be read as “grant,” “grantee,” “s ubgrant,” or
“subgrantee”):
3.908 Pilot program for enhancement of contractor employee whistleblower protections
3.908-1 Scope of section.
(a) This section implements 41 U.S.C. 4712.
(b) This section does not apply to—
(1) DOD, NASA, and the Coast Guard; or
(2) Any element of the intelligence community, as defined in section 3(4) of the National
Security Act of 1947 (50 U.S.C. 3003(4)). This section does not apply to any disclosure
made by an employee of a contractor or subcontractor of an element of the intelligence
community if such disclosure -
(i) Relates to an activity of an element of the intelligence community; or
(ii) Was discov ered during contract or subcontract services provided to an element of the
intelligence community.
3.908-2 Definitions
As used in this section –
Abuse of authority means an arbitrary and capricious exercise of authority that is inconsistent
with the mission of the executive agency concerned or the successful performance of a
contract of such agency. Inspector General means an Inspector General appointed under the
Inspector General Act of 1978 and any Inspector General that receives funding f rom, or has
oversight over contracts awarded for, or on behalf of, the executive agency concerned.
3.908-3 Policy
1. Contractors and subcontractors are prohibited from discharging, demoting, or othe rwise
discriminating against an employee as a reprisal for disclosing, to a ny of the entities listed at
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paragraph (b) of this subsection, information that the employee reas onably believes is evidence
of gross mismanagement of a Federal contract, a gross waste of Federa l funds, an abuse of
authority relating to a Federal contract, a substantial and specific danger to public health or
safety, or a violation of a law, rule, or regulation related to a Federal contract (including the
competition for or negotiation of a contract). A reprisal is prohibited e ven if it is undertaken at
the request of an executive branch official, unless the request takes the form of a non-
discretionary directive and is within the authority of the executive branch official making the
request.
2. Entities to whom disclosure may be made.
(a) A Member of Congress or a representative of a committee of Congress.
(b) An Inspector General.
(c) The Government Accounta bility Office.
(d) A Federal employee responsible for contract oversight or management at the relevant
agency.
(e) An authorized official of the Department of Justice or other law enforceme nt agency.
(f) A court or grand jury.
(g) A management official or other employee of the contractor or subcontractor who has
the responsibility to investigate, discover, or address misconduct.
3. An employee who initiates or provides evidence of a contractor or subcontractor
misconduct in any judicial or administrative proceeding relating to waste, fraud, or abuse
on a Federal contract shall be deemed to have made a disclosure.
3.908-9 Contract clause.
The contracting officer shall insert the clause at 52.203-17, Contractor Employee
Whistleblower Rights and Requirement to Inform Employees of Whistleblower Rights, in all
solicitations and contracts that exceed the simplified acquisition thre shold.
Contract clause:
Contractor Employee Whistleblower Rights and Requirement to Inform Employees of
Whistleblower Rights
(Apr 2014)
(a) This contract and employees working on this contract will be subject to the
whistleblower rights and remedies in the pilot program on Contractor employee
whistleblower protections established at 41 U.S.C. 4712 by section 828 of the Na tional
Defense Authorization Act for Fiscal Year 2013 (Pub. L.112-239) and FAR 3.908.
(b) The Contractor shall inform its employees in writing, in the predominant language of
the workforce, of employee whistleblower rights and protections under 41 U.S.C.
4712, as described in section 3.908 of the Federal Acquisition Regulation.
(c) The Contractor shall insert the substance of this clause, including this paragraph (c), in
all subcontracts over the simplified acquisition threshold.
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Centers for Medicare & Medicaid Services
Standard Grant/Cooperative Agreement Terms and Conditions
Attachment E
Conflict of Interest Policy
CMS requires recipients to establish safeguards to prevent employees, officers, or agents of the
non-Federal entity such as consultants, contractors, members of governing bodies, and others
who may be involved in grant-supported activities from using their positions for purposes that
are, or give the appearance of being, motivated by a desire for private financia l or other gain for
themselves or others, such as those with whom they have family, business, or othe r ties. These
safeguards must be reflected in written standards of conduct. Except as provided below, CMS
does not require a recipient to establish separate standards of conduct if it maintains such
standards for its non-grant-supported activities, as long as those standards are consistent with
State, local, and tribal laws and regulations, and cover, at a minimum, expected conduct in regard
to financial interests, gifts, gratuities and favors, nepotism, and suc h other areas for
governmental organizations as political partic ipation and bribery.
Definitions:
"Principal Investigator/Project Director (PI/PD)" means the individual(s) designated by the
recipient to direct the project or program being supported by the grant. The PI/P D is responsible
and accountable to officials of the recipient organization for the proper conduct of the project,
program, or activity. This designation also includes co-principal investigators/co-project
directors, and any other person at the organization who is responsible for the design, conduct, or
reporting of grant activities funded or proposed for funding by CMS.
"Significant financial interest" means anything of monetary value, includin g, but not limited to,
salary or other payments for services (e.g., consulting fees or honoraria); e quity interest (e.g.,
stocks, stock options or other ownership interests); and intellectual property rights (e.g., patents,
copyrights and royalties from such rights).
This term does not include:
a. salary, royalties or other remuneration from the applicant organization;
b. income from seminars, lectures, or teaching engagements sponsored by public or
non-profit entities;
c. income from service on advisory committees or review panels for public or nonprofit
entities;
d. an equity interest that, when aggregated for the PI/PD and the PI/PD’s spous e and
dependent children, meets both of the following tests: does not exceed $10,000 in value
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as determined through reference to public prices or other reasonable measur es of fair
market value, and does not represent more than a 5% ownership interest in any single
entity; or
e. salary, royalties or other payments that, when aggregated for the PI/P D and the
investigator’s spouse and dependent children, are not expected to exceed $10,000
during the prior twelve -month period.
The term “or other interest” means a non-financial benefit which results in a potential or real
conflict of interest. The potential or real conflict of interest poses the same possible harms
received from a financial conflict of interest such as bias due to personal gain. Such benefits
may be received from a tangible or intangible personal benefit.
“Organizational conflicts of interest” means that because of relations hips with a parent
company, affiliate, or subsidiary organization, the non-Federal entity is unable or appears to be
unable to be impartial in conducting a procurement action involving a related or ganization.
“Responsible representative” means the individual(s), named by the applicant/recipient
organization, who is authorized to act on behalf of the applicant/recipient and to assume
responsibility for the obligations imposed by federal laws, regulations, re quirements, and
conditions that apply to CMS grant awards.
Requirements:
The majority of CMS’ grant programs are not supported by Public Health Service (PHS)
funding; therefore, CMS is not subject to the requirements of 42 CFR P art 50, Subpart F,
“Promoting Objectivity in Research.” Notwithstanding, CMS expects grant activities (including
research activities) to be free from bias by any conflicting interest of the PI/PD and any other
person regardless of title or position, who is responsible for the design, conduct, or reporting of
grant activities which may include collaborators or consultants.
Recipient’s conflict of interest policies must reflect the following:
• Have a written and enforced administrative process to eliminate conflicting financial
or other interests with respect to CMS grant/cooperative agreement funds a warded.
This process should ensure:
The merits for determining a conflict of interest are clearly articulated in writing –
i.e., the assigned reviewer(s) can reasonably determine that a significant or other
interest could directly and significantly affect the design, conduct, or re porting of
CMS-funded grant activities. This process should be inclusive of the appearance
of such conflicts.
Each PI/PD discloses to a responsible representative of the Recipient all
significant financial and/or other interests including personal relationships of the
PI/PD (for example, PI/PD’s spouse, dependent children, etc.): (i) that would
reasonably appear to be affected by the grant activities funded or proposed for
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funding by CMS; or (ii) in entities whose financial or other interests would
reasonably appear to be affected by such activities.
One or more objective persons (1) reviews the potential conflict of intere st; (2)
determines whether a pote ntial (appearance of) or real conflict of interest exists;
and (3) Establishes what conditions, or restrictions, should be imposed to
eliminate the conflict of interest.
This information is conveyed to the Responsible Representative for the
organization w ho is designated to act on behalf of the applicable CMS award.
• Prior to expending funds under a new CMS award, the Responsible Representative
must inform the applicable CMS Grants Management Specialist and Project Officer
of any real or potential conflict of interest. The report must detail Rec ipient’s plan to
eliminate the conflict prior to spending CMS funding on the activities in question.
• Require that similar reports for subsequently identified conflicts be ma de within 30
days of identifying them. Funding for those specific activities should cease until the
aforementioned steps are completed.
• Require that continual updates be made for any real or potential conflicts of interest
not fully resolved. Recipient must make additional information available to the CMS
Grants Management Specialist and Project Officer, upon request, as to how it is
handling (or had handled) the real or potential conflict of interest.
• Recipients must maintain records of all disclosures and of all actions taken to resolve
conflicts of interest for at least three years beyond the termination or completion of
the grant to which they relate, or until the resolution of any CMS action involving
those records, whichever is longer.
• The Recipient’s policy must include adequate enforcement mechanisms, and pr ovide
for sanctions where appropriate.
Recipient may resolve such conflicts of interest through one or more of the following options
outlined below. This is not an exhaustive list and Recipient may pursue other re medies.
• Modification of approved project to remove potential or real conflict of intere st.
• Termination of agreement or other services that create potential or real conflict of
interest.
• Removal of individuals with potential or real conflict of interest.
• Severance of relationships that create potential or real conflicts of interest.
• Divestiture of significant financial interests.
Recipient must ensure that CMS award funds are administered in accor dance with conflict of
interest policies that meet, at a minimum, the standards outline d above, inclusive of pass -through
entities, subrecipients, contractors, or collaborators. Each entity must have its own policies in
place that meet these requirements or mandate that the PIs/PDs working for such entities follow
those of the Recipient.
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Procurement:
The Recipient must also maintain written standards of conduct covering conflicts of interest and
governing the actions of its employees engaged in the selection, award and adminis tration of
contracts in accordance with 45 CFR §75.327 General procurement standards . No employee,
officer, or agent may participate in the selection, award, or administration of a contract supported
by a Federal award if he or she has a real or apparent conflict of interest. Such a conflict of
interest would arise when the employee, officer, or agent, any member of his or her immediate
family, his or her partner, or an organization which employs or is about to employ any of the
parties indicated herein, has a financial or other interest in or a tangible personal bene fit from a
firm considered for a contract. The officers, employees, and agents of the non-Federal entity may
neither solicit nor accept gratuities, favors, or anything of monetary value from contractors or
parties to subcontracts. However, non-Federal entities may set standards for situations in which
the financial interest is not substantial or the gift is an unsolicite d item of nominal value. The
standards of conduct must provide for disciplinary actions to be applied for violations of such
standards by officers, employees, or agents of the non-Federal entity.
If the non-Federal entity has a parent, affiliate, or subsidiary organization tha t is not a state, local
government, or Indian tribe, the non-Federal entity must also maintain written standards of
conduct covering organizational conflicts of interest.
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Centers for Medicare & Medicaid Services
Standard Grant/Cooperative Agreement Terms and Conditions
Attachment F
Award Term and Conditions for Recipient Integrity and Performance Matters
REPORTING OF MATTERS RELATED TO RECIPIENT INTEGRITY AND P ERFORMANCE
1. General Reporting Requirement
If the total value of your currently active grants, cooperative agreements, a nd procurement
contracts from all Federal awarding agencies exceeds $10,000,000 for any period of time during
the period of performance of this Federal award, then you as the recipient during that period of
time must maintain the currency of information reported to the System for Aw ard Management
(SAM) that is made available in the designated integrity and performance s ystem (currently the
Federal Awardee Performance and Integrity Information System (FAPIIS)) about civil, criminal,
or administrative proceedings described in paragraph 2 of this award term and condition. This is
a statutory requirement under section 872 of Public Law 110-417, as amended (41 U.S.C. 2313).
As required by section 3010 of Public Law 111-212, all information posted in the designated
integrity and performance system on or after April 15, 2011, except past performance revie ws
required for Federal procurement contracts, will be publicly available.
2. Proceedings About Which You Must Report
Submit the information required about each proceeding that:
a. Is in connection with the award or performance of a grant, cooperative agre ement, or
procurement contract from the Federal Government;
b. Reached its final disposition during the most recent five year period; a nd
c. If one of the following:
(1) A criminal proceeding that resulted in a conviction, as defined in paragraph 5 of this awa rd
term and condition;
(2) A civil proceeding that resulted in a finding of fault and liability and pa yment of a monetary
fine, penalty, reimbursement, restitution, or damages of $5,000 or more;
(3) An administrative proceeding, as defined in paragraph 5 of this award ter m and condition,
that resulted in a finding of fault and liability and your payment of either a monetary fine or
penalty of $5,000 or more or reimbursement, restitution, or damages in excess of $100,000; or
(4) Any other criminal, civil, or administrative proceeding if:
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(i) It could have led to an outcome described in paragraph 2.c.(1), (2), or (3) of this award term
and condition;
(ii) It had a different disposition arrived at by consent or compromise with a n acknowledgement
of fault on your part; and
(iii) The requirement in this award term and condition to disclose information about the
proceeding does not conflict with applicable laws and regulations.
3. Reporting Procedures
Enter in the SAM Entity Management area the information that SAM requires about each
proceeding described in paragraph 2 of this award term and condition. You do not need to s ubmit
the information a second time under assistance awards that you received if you already provided
the information through SAM because you were required to do so under Federal procurement
contracts that you were awarded.
4. Reporting Frequency
During any period of time when you are subject to this requirement in paragraph 1 of this award
term and condition, you must report proceedings information through SAM for the most recent
five year period, either to report new information about any proceeding(s) that you ha ve not
reported previously or affirm that there is no new information to report. Recipients that have
Federal contract, grant, and cooperative agreement awards with a cumulative total value greater
than $10,000,000 must disclose semiannually any information about the criminal, civil, and
administrative proceedings.
5. Definitions
For purposes of this award term and condition:
a. Administrative proceeding means a non-judicial process that is adjudicatory in nature in order
to make a determination of fault or liability (e.g., Securities and Exchange Commission
Administrative proceedings, Civilian Board of Contract Appeals proceedings, and Armed
Services Board of Contract Appeals proceedings). This includes proceedings at the Federal and
State level but only in connection with performance of a Federal contract or grant. It does not
include audits, site visits, corrective plans, or inspection of deliver ables.
b. Conviction, for purposes of this award term and condition, means a judgment or convic tion of
a criminal offense by any court of competent jurisdiction, whether entered upon a verdict or a
plea, and includes a conviction entered upon a plea of nolo contendere.
c. Total value of currently active grants, cooperative agreements, and procurement contracts
includes —
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(1) Only the Federal share of the funding under any Federal award with a recipient cost share or
match; and
(2) The value of all expected funding increments under a Federal award and options, even if not
yet exercised
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Centers for Medicare & Medicaid Services
Standard Grant/Cooperative Agreement Terms and Conditions
Attachment G
Accessibility Provisions
CMS and its recipients are responsible for complying with federal laws regarding accessibility.
The grantee may receive a request from a beneficiary or member of the public for information in
accessible formats. All successful applicants under this announcement must comply with the
following reporting and review activities regarding accessibility requests:
Accessibility Requirements:
1. Public Notification: If you have a public facing website, you shall post a message no
later than 30 business days after award that notifies your customers of their right to
receive an accessible format. Sample language may be found at:
https://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.
Your notice shall be crafted applicable to your program.
2. Processing Requests Made by Individuals with Disabilities:
a. Documents:
i. When receiving a request for information in an alternate format (e.g.,
Braille, Large print, etc.) from a beneficiary or member of the public, you
must:
1. Consider/evaluate the request according to civil rights laws.
2. Acknowledge receipt of the request and explain your process
within 2 business days.
3. Establish a mechanism to provide the request.
ii. If you are unable to fulfill a n accessible format request, CMS may work
with you in an effort to provide the accessible format as funding and
resources allow. You shall refer the request to CMS within 3 business
days if unable to provide the request. You shall submit the request, using
encrypted e -mail (to safeguard any personally identifiable information), to
the AltFormatRequest@cms.hhs.gov mailbox with the following
information:
1. The e -mail title shall read “Grantee (Organization) Alternate
Format Document Request.”
2. The body of the e –mail shall include:
a. Requester’s name, phone number, e -mail, and mailing
address.
b. The type of accessible format requested, e.g., audio
recording on compact disc (CD), written document in
Braille, written document in large print, document in a
format that is read by qualified readers, etc.
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c. Contact information for the person submitting the e -mail –
Organization (Grantee), name, phone number and e -mail.
d. The document that needs to be put into an accessible for mat
shall be attached to the e-mail.
e. CMS may respond to the request and provide the
information directly to the requester.
iii. The Grantee shall maintain record of all alternate format requests received
including the requestor’s name, contact information, date of request,
document requested, format requested, date of acknowledgment, date
request provided, and date referred to CMS if applicable. Forward
quarterly records to the AltFormatRequest@cms.hhs.gov mailbox.
b. Services
i. When receiving a request for auxiliary aids and services (e.g., sign
language interpreter) from a beneficiary or member of the public, you
must:
1. Consider/evaluate the request according to civil rights laws.
2. Acknowledge receipt of the request and explain your process
within 2 business days.
3. Establish a mechanism to provide the request.
ii. If you are unable to fulfill an accessible service request, CMS may wor k
with you in an effort to provide the accessible service as funding and
resources allow. You shall refer the request to CMS within 3 business
days if unable to provide the service. You shall submit the request, using
encrypted e -mail (to safeguard any personally identifiable information), to
the AltFormatRequest@cms.hhs.gov mailbox with the following
information:
1. The e -mail title shall read “Grantee (Organization) Accessible
Service Request.”
2. The body of the e –mail shall include:
a. Requester’s name, phone number, e -mail, and mailing
address.
b. The type of service requested (e.g., sign language
interpreter and the type of sign language needed).
c. The date, time, address and duration of the needed service.
d. A description of the venue for which the service is needed
(e.g., public education seminar, one -on-one interview, etc.)
e. Contact information for the person submitting the e -mail –
Organization (Grantee), name, phone number and e -mail.
f. Any applicable documents shall be attached to the e -mail.
g. CMS will respond to the request and respond directly to the
requester.
iii. The Grantee shall maintain record of all accessible service requests
received including the requestor’s name, contact information, date of
request, service requested, date of acknowledgment, date service provided,
and date referred to CMS if applicable. Forward quarterly records to the
AltFormatRequest@cms.hhs.gov mailbox.
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3. Processing Requests Made by Individuals with Limited English Proficiency (L EP):
a. Documents:
i. When receiving a request for information in a language other than English
from a beneficiary or member of the public, you must:
1. Consider/evaluate the request according to civil rights laws.
2. Acknowledge receipt of the request and explain your process
within 2 business days.
3. Establish a mechanism to provide the request as applicable.
ii. If you are unable to fulfill an alternate language format request, CMS ma y
work with you in an effort to provide the alternate language format as
funding and resources allow. You shall refer the request to CMS within 3
business days if unable to provide the request. You shall submit the
request, using encrypted e -mail (to safeguard any personally identifiable
information), to the AltFormatRequest@cms.hhs.gov mailbox with the
following information:
1. The e -mail title shall read “Grantee (Organization) Alternate
Language Document Request.”
2. The body of the e –mail shall include:
a. Requester’s name, phone number, e -mail, and mailing
address.
b. The language requested.
c. Contact information for the person submitting the e -mail –
Organization (Grantee), name, phone number and e -mail.
d. The document that needs to be translated shall be attached
to the e -mail.
e. CMS may respond to the request and provide the
information directly to the requester.
iii. The Grantee shall maintain record of all alternate language requests
received including the requestor’s name, contact information, date of
request, document requested, language requested, date of
acknowledgment, date request provided, and date referred to CMS if
applicable. Forward quarterly records to the
AltFormatRequest@cms.hhs.gov mailbox.
b. Services
i. When receiving request for an alternate language service (e.g., oral
language interpreter) from a beneficiary or member of the public, you
must:
1. Consider/evaluate the request according to civil rights laws.
2. Acknowledge receipt of the request and explain your process
within 2 business days.
3. Establish a mechanism to provide the request as applicable.
ii. If you are unable to fulfill an alternate language service request, CMS may
work with you in an effort to provide the alternate language service as
funding and resources allow. You shall refer the request to CMS within 3
business days if unable to provide the service. You shall submit the
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request, using encrypted e -mail (to safeguard any personally identifiable
information), to the AltFormatRequest@cms.hhs.gov mailbox with the
following information:
1. The e -mail title shall read “Grantee (Organization) Accessible
Service Request.”
2. The body of the e –mail shall include:
a. Requester’s name, phone number, e -mail, and mailing
address.
b. The language requested.
c. The date, time, address and duration of the nee ded service.
d. A description of the venue for which the service is needed
(e.g., public education seminar, one -on-one interview, etc.)
e. Contact information for the person submitting the e -mail –
Organization (Grantee), name, phone number and e -mail.
f. Any applicable documents shall be attached to the e -mail.
g. CMS will respond to the request and respond directly to the
requester.
iii. The Grantee shall maintain record of all alternate language service
requests received including the requestor’s name, contact information,
date of request, language requested, service requested, date of
acknowledgment, date service provided, and date referred to CMS if
applicable. Forward quarterly records to the
AltFormatRequest@cms.hhs.gov mailbox.
Please contact the CMS Office of Equal Opportunity and Civil Rights for
more information about accessibility reporting obligations at
AltFormatRequest@cms.hhs.gov.
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