Affordable Care Act: Testing Experience and Functional Assessment Tools

CMS is offering a Demonstration grant to up to ten qualified State Grantees through a competitive process.

CMS will accept one application from each State applicant.

The Single State Medicaid Agency (SMA) must be the lead applicant.

The primary goals of this Demonstration Grant are to:

Field test an experience survey for validity and reliability on multiple Community-Based Long Term Services and Supports (CB-LTSS) programs;

Field test the CARE functional assessment tool for use with beneficiaries of CB-LTSS programs;

Demonstrate personal health records with beneficiaries of CB-LTSS; and

Curate an electronic Long Term Services and Supports (eLTSS) standard coordinated through the Office of National Coordinator s (ONC) Standards and Interoperability Framework.

The Demonstration has the potential to positively impact care coordination efforts, reduce overall health care costs, and integrate health related data sources that go beyond primary and acute medical records.

Agency - Department of Health and Human Services

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

Office - See Regional Agency Offices.

Program Accomplishments

Not Applicable.


Section 2701 of the Affordable Health Care Act.

Uses and Use Restrictions

The State agrees to use the Federal grant funds to field test two instruments , demonstrate personal health records, and participate in the creation of an eLTSS standard for use in electronic health records.

Eligibility Requirements

Applicant Eligibility

Applicants must be any single State Medicaid Agency.

Only one application can be submitted for a given State.

The term ""State Medicaid program means the State program for medical assistance provided under a State plan under title XIX of the Social Security Act and under any waiver approved with respect to such State plan.

A cover letter must accompany the application.

The cover letter must be signed by the State Medicaid Director, and must indicate the title of the project, the Principal Investigator, and the amount of federal funding requested.

Beneficiary Eligibility



No Credentials or documentation are required. This program is excluded from coverage under OMB Circular No. A-87.

Aplication and Award Process

Preapplication Coordination

Preapplication coordination is not applicable.

Environmental impact information is not required for this program.

This program is excluded from coverage under E.O.


Application Procedures

OMB Circular No. A-102 applies to this program. This program is excluded from coverage under OMB Circular No. A-110. Applicants must register on in order to apply for this grant. Applicants are encouraged to register early as the registration process can take as long as four weeks if all steps are not completed in a timely manner. The standard application form SF-424 and related forms must be used for this program. Applicants must submit their applications electronically through Applicants are encouraged to submit a non-binding Letter of Intent to Apply. Letters of Intent to Apply are not required and a state s submission or failure to submit a letter has no bearing on the scoring of proposals received. Applicants should review the application and submission information in the funding opportunity announcement for specific instructions on applying for this grant program.

Award Procedures

An independent review of all applications will be conducted by a panel of experts. The review panel will assess each application to determine the merits of the proposal and the extent to which it furthers the purposes of the demonstration program. The panel will evaluate each application for further review by CMS. CMS reserves the right to request that States revise or otherwise modify certain sections of their proposals based on the recommendations of the panel and the budget. A low score in one or two areas, even if offset by high scores in other areas, may result in a rejection of the proposal. Final approval of demonstration projects will be made by the Administrator of CMS after consideration of the comments and recommendations of the review panelists, program office recommendations, and the availability of funds. CMS reserves the right to approve or deny any or all proposals for funding. CMS seeks to achieve reasonable balance among the grants to be awarded in a particular category in terms of key factors such as geographic distribution and broad target group representation. CMS may redistribute grant funds based upon the number and quality of applications received. (e.g., to adjust the minimum or maximum awards permitted or adjust the aggregate amount of Federal funds allotted to a particular category of grants).


Aug 22, 2012 to Sep 12, 2012 Electronic Grant Application Due Date: September 12, 2012.

Range of Approval/Disapproval Time

Successful applicants will receive a Notice of Award (NoA) on or before September 30, 2012. Any communication between CMS and applicants prior to issuance of the NoA is not an authorization to begin performance of a project. Unsuccessful applicants will be notified by letter, sent through the U.S. Postal Service to the applicant organization as listed on its SF- 424, after September 30, 2012.




Grantee can receive a noncompetitive second year of funding based on first year performance and progress towards meeting the grant project goals outlined in the application as well as in the terms and conditions.

Assistance Considerations

Formula and Matching Requirements

This program has no statutory formula.
This program has no matching requirements.
This program does not have MOE requirements.

Length and Time Phasing of Assistance

Grants agreements are funded on a 12-month basis, with support subsequent years contingent upon acceptable evidence of satisfactory progress, continuing program relevance, and availability of funds. The maximum time period for funding is 12 months. See the following for information on how assistance is awarded/released: Successful applicants will receive a Notice of Award. Unsuccessful applicants will be notified by letter. Applicants should review the award administration information of the funding opportunity announcement issued under this CFDA program for more information.

Post Assistance Requirements


Grantees must provide semi- annual and final (at the end of the grant period) reports.

States must submit a quarterly electronic Federal Financial Report (FFR) via the Payment Management System.

The quarterly report identifies cash transactions against the authorized funds for the grant.

The FFR Cash Transaction Reports must be filed within 30 days of the end of each quarter.

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

Go to - for additional information.

The final FFR, including both cash transactions and expenditures, must be submitted and received within 90 days of the end of the project period.

The Grantees must participate in monthly TA conference calls (or other periods as defined by CMS), creating the opportunity for States to share lessons learned, develop solutions to address challenges, and provide hands on technical assistance and guidance to Grantees.

Grantees must include expenditures on the annual FFR (submitted at the end of the budget period).

The final FFR must be submitted within 90 days after the end of the project period end date and include both cash transactions and expenditures data.

No performance monitoring is required.


In accordance with the provisions of OMB Circular No. A-133 (Revised, June 27, 2003), "Audits of States, Local Governments, and Non-Profit Organizations," nonfederal entities that expend financial assistance of $500,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $500,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in Circular No. A-133. Awardees must comply with the audit requirements of Office of Management and Budget (OMB) Circular A-133. Information on the scope, frequency, and other aspects of the audits can be found on the internet at:


Grantees are required to follow Section 2701 of the Affordable Care Act, 45 CFR 74.53, and all requirements as listed in the Funding Opportunity Announcement to be posted in May 2011. Recipients are required to maintain grant accounting records 3 years after the date the grant is officially closed. If any litigation, claim, negotiation, audit or other action involving the award has been started before the expiration of the 3-year period, the records shall be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular 3-year period, whichever is later.

Financial Information

Account Identification



(Salaries) FY 11 Not Available; FY 12 est $20,000,000; and FY 13 est $8,333,000

Range and Average of Financial Assistance

There is not a predetermined maximum floor or ceiling grant award. CMS reserves the right to reduce the requested grant award, based on the number and size of additional grant awards given under this demonstration, as well as because of concerns contained within a State"s application.

Regulations, Guidelines, and Literature

Section 2701 of the Affordable Care Act.

Information Contacts

Regional or Local Office

See Regional Agency Offices.

Headquarters Office

Anita Yuskauskas 7500 Security Boulevard, Baltimore, Maryland 21244 Email: Phone: 410 786-0268

Criteria for Selecting Proposals

Refer to the Funding Opportunity Announcement for more information.

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