[Federal Register Volume 69, Number 96 (Tuesday, May 18, 2004)]
[Notices]
[Pages 28133-28141]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-11241]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2189-N]
RIN 0938-ZA46


Medicaid Program; Real Choice Systems Change Grants

Part 1. Overview Information

    Funding Opportunity Title: Medicaid Program; Real Choice Systems 
Change Grants.
    Announcement Type: Notice of funding availability (new 
announcement).
    Funding Opportunity Number: Not applicable.
    Catalog of Federal Domestic Assistance (CFDA) No.: 93.779.

DATES: Deadline for Letter of Intent To Apply: States are encouraged to 
submit a notice of intent to apply for a grant no later than June 8, 
2004.
    Date of Applicant's Teleconference: Information regarding the time 
and call-

[[Page 28134]]

in number for an open applicant's teleconference is available on the 
CMS Web site at http://www.cms.hhs.gov/newfreedom.
    Deadline for Grant Submission: Grant applications are due by July 
19, 2004. All grant awards will be made before September 30, 2004. All 
grants awarded under this funding opportunity will have a budget period 
of 36 months and a start date of no later than October 1, 2004.

Part 2. Full Text of the Announcement

I. Funding Opportunity Description

A. Overview of Funding Opportunity

    This notice announces the availability of funding from the Centers 
for Medicare & Medicaid Services (CMS) for Real Choice Systems Change 
Grants. The Conference Report accompanying the Consolidated 
Appropriations Act, 2004 (Pub. L. 108-199) contained language 
expressing an intent to fund the Real Choice Systems Change Grants at 
$40 million. Although the Congress appropriated $40 million in funding 
for Real Choice Systems Change activities, the Congress also passed an 
across-the-board rescission of .59 percent and a second rescission of 
.6864 percent which would reduce the original $40 million to 
$39,491,060. Some of these funds will be used for fiscal year (FY) 2004 
Aging and Disabilities Resource Centers grants that CMS will fund in 
collaboration with the Administration on Aging (AoA). This notice 
announces the availability of approximately $31 million in funding for 
nine grant opportunities pursuant to the President's Executive Order 
13217 ``Community-Based Alternatives for Individuals with 
Disabilities'' and authorized under section 1110 of the Social Security 
Act (the Act).
    The Congress recognized that States face formidable challenges in 
their efforts to fulfill their legal responsibilities under the 
Americans with Disabilities Act (ADA). In fiscal years 2001, 2002, and 
2003, the Congress appropriated funds for ``Real Choice Systems Change 
Grants'' specifically to improve community-integrated services; and CMS 
awarded grants totaling approximately $158 million to 49 States, the 
District of Columbia, and two territories. With this support, States 
are continuing to address issues such as personal assistance services, 
direct service worker shortages, transitions from institutions to the 
community, respite service for caregivers and family members, and 
better transportation options. CMS has an ambitious national technical 
assistance strategy to support States' efforts to improve community-
based service systems and enhance employment supports. CMS is also 
helping States assist each other by posting a repository of ``Promising 
Practices'' on its Web site at http://www.cms.hhs.gov/promisingpractices and by supporting the dissemination of technical 
assistance materials at http://www.hcbs.org.
    Real Choice Systems Change Grants are a part of the President's New 
Freedom Initiative to eliminate barriers to equality and grant a ``New 
Freedom'' to children and adults of all ages who have a disability or 
long-term illness so that they may live and prosper in their 
communities. They are designed to assist States and others in building 
infrastructure that will result in effective and enduring improvements 
in long-term support systems. These systemic changes are designed to 
enable children and adults of any age who have a disability or long-
term illness to:
     Live in the most integrated community setting appropriate 
to their individual support requirements and preferences;
     Exercise meaningful choices about their living 
environment, the providers of services they receive, the types of 
supports they use and the manner by which services are provided; and
     Obtain quality services in a manner as consistent as 
possible with their community living preferences and priorities.
    The complete solicitation package for the Real Choice Systems 
Change Grants, which includes programmatic, administrative, and 
eligibility information needed to apply for these grants is available 
at http://www.cms.hhs.gov/newfreedom/2004solicitation.pdf.

B. Description of Grant Opportunities

    Following are brief descriptions of the nine grant opportunities 
available under this notice. A full description of the programmatic 
requirements for each of the funding opportunities under the Real 
Choice Systems Change Grants is available in the solicitation package 
for these grants at http://www.cms.hhs.gov/newfreedom/2004solicitation.pdf.
1. Quality Assurance & Quality Improvement System in Home and 
Community-Based Services (HCBS)
    The purpose of the Quality Assurance & Quality Improvement Systems 
in HCBS grant opportunity is to assist States to: (a) Fulfill their 
commitment to assure the health and welfare of individuals who 
participate in the State's home and community-based waivers under 
section 1915(c) of the Social Security Act (the Act); (b) develop 
effective methods to meet statutory requirements and CMS expectations 
by the use of ongoing quality management strategies; and (c) develop 
methods to involve program participants and community members in active 
roles in the State quality management activities.
2. Integrating Long Term Supports With Affordable Housing
    The purpose of the Long Term Supports coordinated with Affordable 
and Accessible Housing grant opportunity is to remove barriers that 
prevent Medicaid-eligible individuals with disabilities of all ages 
from residing in the community or in the housing arrangement of their 
choice. A major barrier to community living for these individuals is 
limited access to affordable, accessible, and quality housing that 
incorporates long term supports. This grant will assist States to 
create the infrastructure to increase the access to and the capacity of 
affordable and accessible housing, and to coordinate with supports 
funded through State Plan services, waiver services or other service 
agencies. It is not the intent of this grant opportunity to fund a 
nursing home transition initiative, nor is it intended as a vehicle for 
Medicaid to pay for housing costs, except for expenses associated with 
the transition of individuals from institutions.
3. Portals from Early Periodic Screening, Diagnosis, and Treatment 
(EPSDT) to Adult Supports
    The purpose of the Portals from EPSDT to Adult Supports grant 
opportunity is to assist States in addressing the needs of children who 
have disabilities who receive community health services through EPDST 
and who are re-determined to be eligible for Supplemental Security 
Income (SSI)/Medicaid at age 21 (or younger at the discretion of the 
State). CMS will assist States in: (a) Developing and implementing a 
State Plan amendment, (b) developing a waiver or demonstration 
application to provide new supports to this population and implement 
enrollment into the waiver or demonstration; or (c) developing a waiver 
amendment application to expand either services or slots in the State's 
existing targeted disability waiver(s). These projects must evidence 
coordination with pertinent transition resources that are provided 
through the Social Security Administration (SSA), Department of Labor 
(DOL), or the Office of Special Education and Rehabilitation Services 
(OSERS).

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4. Comprehensive Systems Reform Effort
    The purpose of the Comprehensive Systems Reform Effort grant 
opportunity is to assist States to decrease their reliance on 
institutional services and increase the level of supports that are 
controlled by the individuals that receive them by supporting a 
comprehensive planning, designing, and implementation effort to reform 
their long term care systems.
5. Mental Health: Systems Transformation
    The purpose of the Mental Health: Systems Transformation grant 
opportunity is to provide funding to improve the ability of States to 
offer evidence-based and recovery-oriented services to consumers with 
mental illnesses with support of the Medicaid system. In July 2003, the 
President's New Freedom Commission on Mental Health finished its work 
and published its final report: Achieving the Promise: Transforming 
Mental Health Care in America. This grant opportunity will assist 
States in addressing recommendations made in this report to further 
align their mental health system with the recovery orientation of 
mental health practice.
6. Rebalancing Initiative
    The purpose of the Rebalancing Initiative grant opportunity is to 
enable States to develop and implement strategies to reform the 
financing and service designs of State long-term support systems to 
decrease reliance on institutional forms of care and increase the 
utilization of community-based long-term supports. These rebalancing 
strategies are likely to include systems for increasing access to home 
and community based services and transitioning individuals out of 
institutions.
7. Living With Independence, Freedom, and Equality (LIFE) Account 
Feasibility and Demonstration
    The purpose of the LIFE Account Feasibility and Demonstration grant 
opportunity is to enable States to conduct studies assessing the 
feasibility of developing LIFE Account savings programs. States may 
examine the feasibility of establishing and maintaining a program of 
individual savings accounts which eligible Medicaid participants can 
save money without affecting their eligibility or benefit levels for 
the State's Medicaid program, Supplemental Security Income, Social 
Security Disability Income, or any Federal assistance program. The LIFE 
Account savings program is intended to enable people with a disability 
or chronic condition to become more independent, assume increased 
responsibilities, and contribute to the communities in which they live.
8. Family-to-Family Health Care Information and Education Centers
    The purpose of this grant opportunity is to support the development 
of Family-to-Family Health Care Information and Education Centers. 
Organizations will use grant funds to establish Statewide family-run 
centers that will: (a) Provide education and training opportunities for 
families with children with special health care needs; (b) develop and 
disseminate needed health care and home and community-based services 
(HCBS) information to families and providers; (c) collaborate with 
existing Family-to-Family Health Care Information and Education Centers 
to benefit children with special health care needs; and (d) promote the 
philosophy of individual and family-directed supports.
9. National State-to-State Technical Assistance Program for Community 
Living
    This national technical assistance grant will support all of the FY 
2004 ``Real Choice Systems Change Grants'' efforts for the entire 36-
month project period. CMS expects that the technical assistance Grantee 
will engage in activities that include: (a) Providing technical 
assistance to the FY 2004 Real Choice Systems Change Grantees, FY 2004 
Aging and Disability Resource Center Grantees, and others; (b) 
providing on-site State-to-State technical assistance; (c) developing 
technical assistance materials; (d) developing or providing expertise 
for States and children and adults of any age with a disability or 
long-term illness; (e) working with individual States, national 
associations of State agencies, consumer organizations, the National 
Governors Association, the National Conference of State Legislatures, 
and others to collect, refine, and disseminate information that aids in 
the effective administration of programs for community living; and (f) 
developing, gathering, analyzing, and disseminating relevant practical 
information.

II. Award Information

Funding Available

    This notice announces the availability of Real Choice Systems 
Change funding of approximately $31 million for FY 2004. CMS 
anticipates making approximately 46 to 76 grants to States and others 
in nine categories. The anticipated number of awards, individual award 
amounts, and period of performance are detailed in section VIII of this 
notice in the table, ``Table of Real Choice Systems Change Grants--FY 
2004.'' In this table, the amounts listed in the ``maximum award'' and 
``anticipated average award'' columns refer to the amount available for 
the entire project period (that is, up to 36 months) and not an annual 
award amount renewable every 12 months.
    Grant applications are due on July 19, 2004. All grant awards will 
be made before September 30, 2004. All grants awarded under this 
funding opportunity will have a budget period of 36 months and a start 
date of no later than October 1, 2004. No more than one grant award per 
type of grant will be made to any State. A full description of the 
eligibility requirements for each of the funding opportunities under 
the Real Choice Systems Change Grants is available in the solicitation 
package for these grants at http://www.cms.hhs.gov/newfreedom/2004solicitation.pdf.

III. Eligibility Information

1. Eligible Applicants

    A. States. By ``State'' we refer to the definition provided under 
45 CFR 74.2 as ``any of the several States of the United States, the 
District of Columbia, the Commonwealth of Puerto Rico, any territory or 
possession of the United States, or any agency or instrumentality of a 
State exclusive of local governments.'' By ``territory or possession'' 
we mean Guam, the U.S. Virgin Islands, American Samoa, and the 
Commonwealth of the Northern Mariana Islands.
    States may and are encouraged to apply for more than one grant 
opportunity. For example, a State may apply for a Mental Health: 
Systems Transformation and a Rebalancing Initiative grant. 
Additionally, different State agencies may apply for different grant 
opportunities. For example, the single State Medicaid agency might 
apply for the Quality Assurance & Quality Improvement Systems in HCBS 
grant and the agency administering a relevant section 1915(c) (of the 
Act) waiver might apply for the Portals From EPSDT to Adult Supports 
grant. However, no State may be awarded more than one grant per type of 
grant opportunity. For example, a State may not receive two Mental 
Health Systems Transformation grants, two Rebalancing Initiative 
grants, or two Integrating Long Term Supports with Affordable Housing 
grants. States may apply for any grant

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except the Family-to-Family Health Care Information and Education 
Center grants.
    B. State agencies or instrumentalities may apply for funding under 
any grant except the Family-to-Family Health Care Information and 
Education Centers grants. If an application is from an applicant that 
is not the Single State Medicaid Agency, a letter of endorsement from 
the Governor, State Medicaid Director, or Agency administering a 
relevant section 1915(c) (of the Act) home and community-based waiver 
must accompany the application; this requirement does not apply to 
applicants for the National State-to-State Technical Assistance Program 
for Community Living grant. To apply for a Mental Health: Systems 
Transformation grant, the Single State Medicaid Agency must have the 
support of the Mental Health Authority as demonstrated by a letter of 
endorsement from the State Mental Health Director.
    C. Any entity may apply for the National State-to-State Technical 
Assistance Program for Community Living grant.
    D. Any nonprofit organization, as defined as a corporation or 
association whose profits may not lawfully accrue to the benefit of any 
private shareholder or individual, may apply for the Family-to-Family 
Health Care Information and Education Center grant. Nonprofits whose 
mission includes services to families with children with special health 
care needs and whose Board of Directors have a majority of parents of 
children with special health care needs are especially encouraged to 
apply.

2. Cost Sharing or Matching

    Grantees are required to make a non-financial contribution of 5 
percent of the total grant award (including all direct and indirect 
costs). Non-financial contributions may include the value of goods and/
or services contributed by the Grantee (for example, salary and fringe 
benefits of staff devoting a percentage of their time to the grant not 
otherwise included in the budget or derived from Federal funds). The 
non-financial contribution requirement may also be satisfied if a third 
party participating in the grant makes an ``in-kind contribution,'' 
provided that the Grantee's contribution and/or the third-party in-kind 
contribution equals five percent of the total grant award (including 
all direct and indirect costs). Third-party in-kind contributions may 
include the value of the time spent by consumer task force members 
(using appropriate cost allocation methods to the extent that non-
Federal funds are involved) who specifically contribute to the design, 
development, and implementation of the grant. Non-financial 
contributions must be included in the applicant's budget in Item 15 
(Estimated Funding) on Standard Form 424A and described in the budget 
narrative/justification section of the solicitation package. The 
solicitation package for these grants is available at http://www.cms.hhs.gov/newfreedom/2004solicitation.pdf.

3. Eligibility Threshold Criteria

    Applications that are not received by the application deadline will 
not be reviewed.
    Even though an application may be reviewed and scored, it will not 
be funded if the application fails to meet any requirements as outlined 
in the ``Format and Content of Applications'' or ``Eligibility 
Information'' sections of the solicitation package at http://www.cms.hhs.gov/newfreedom/2004solicitation.pdf.
    Applications from an eligible applicant will not be considered for 
funding if they submit the same or substantially similar scope of work 
(a) under more than one of this year's grant opportunities or (b) from 
the applicant's Real Choice Systems Change Grant that was funded in FY 
2001, 2002, or 2003.
    For all grant opportunities except the Family-to-Family Health Care 
Information and Education Centers, only one application per grant 
category will be considered per State. Should a State submit multiple 
applications for a single grant category, only the highest-ranked 
application received from that State would be considered for funding.
    Although more than one non-profit organization within a State may 
submit an application for a Family-to-Family Health Care Information 
and Education Centers grant, a letter of endorsement from the Governor, 
State Medicaid Director, or Agency administering a relevant section 
1915(c) (of the Act) home and community-based waiver (if applicable) is 
required for each applicant under this grant opportunity and no more 
than one application per State will be awarded in this grant 
opportunity.
    To apply for the Mental Health: Systems Transformation grant, the 
Single State Medicaid Agency and the State Mental Health Authority must 
both endorse the grant application. Either the Medicaid Agency or the 
Mental Health Authority may serve as the project lead.
    States that received a Assurance and Quality Improvement in Home 
and Community-Based Services grant in FY 2003 (that is, California, 
Colorado, Connecticut, Delaware, Georgia, Indiana, Maine, Minnesota, 
Missouri, New York, North Carolina, Ohio, Oregon, Pennsylvania, South 
Carolina, Tennessee, Texas, West Virginia, Wisconsin) are not eligible 
for a Quality Assurance & Quality Improvement in HCBS grant award from 
CMS in FY 2004.
    No CMS Family-to-Family Health Care Information and Education grant 
awards in FY 2004 will be made to any organization within a State that 
already has an entity that:
     Was awarded a Family-to-Family Health Care Information and 
Education grant in FY 2003 (that is, Alaska, Colorado, Indiana, 
Maryland, Montana, Nevada, New Jersey, South Dakota, Wisconsin) or
     Currently operates a Family-to-Family Health Care 
Information and Education Center funded through the Health Resources 
and Services Administration (HRSA) (that is, California, Florida, 
Maine, Minnesota, Tennessee, and Vermont).
    States that received a Money Follows the Person Rebalancing 
Initiative grant in FY 2003 (that is, California, Idaho, Maine, 
Michigan, Nevada, Pennsylvania, Texas, Washington, and Wisconsin) that 
plan to apply for a Rebalancing Initiative grant are strongly cautioned 
that CMS will not fund applications that propose activities that are 
currently funded under a State's existing CMS grants.

IV. Application and Submission Information

1. Address To Request Application Package

    A complete electronic application package, including all required 
forms, for the Real Choice Systems Change Grants is available at http://www.grants.gov. Applicants are strongly encouraged to submit their 
applications electronically through http://www.grants.gov.
    Standard application forms and related instructions are available 
online at http://www.whitehouse.gov/omb/grants/sf424.pdf.
    Standard application forms, related instructions, and the 
solicitation package are also available from Nicole Nicholson, Centers 
for Medicare & Medicaid Services, Office of Operations Management, 
Acquisition and Grants Group, C2-21-15 Central Building, 7500 Security 
Boulevard, Baltimore, MD 21244-1850, (410) 786-5158, e-mail: 
[email protected].

2. Content and Form of Application Submission

    Applicants are encouraged to submit a Notice of Intent to Apply. 
Submission

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of a Notice of Intent to Apply is not required, does not bind the 
applicant to apply, nor does its submission cause an application to be 
reviewed more favorably. The receipt of Notices enables CMS to better 
plan the application review process. A Notice of Intent to Apply may be 
submitted in any format; however, a sample Notice is available in the 
solicitation package for these grants at http://www.cms.hhs.gov/newfreedom/2004solicitation.pdf.
    A full description of the content and form of applications for each 
of the funding opportunities under the Real Choice Systems Change 
Grants is available in the solicitation package for these grants at 
http://www.cms.hhs.gov/newfreedom/2004solicitation.pdf. A complete 
application consists of the following materials organized in the 
following sequence: (a) Title Page and Cover Letter; (b) Standard 
Forms, (c) Letter of Endorsement (if applicable); (d) Project Abstract; 
(e) Project Narrative; (f) Budget Narrative/Justification; (g) Required 
Attachments; and (h) Other Appendices. Applicants may meet CMS' pre-
award requirements for documentation to verify cost sharing 
requirements of this notice through (a) letters of support and 
commitment from partners who will supply a non-financial match and/or 
(b) the project budget which specifies the non-financial match provided 
by the applicant organization.

3. Submission Dates and Times

    Information regarding the time and call-in number for an open 
applicant's teleconference is available on the CMS Web site at http://www.cms.hhs.gov/newfreedom.
    Notices of Intent to Apply for a grant are due by June 8, 2004. All 
grant applications are due by July 19, 2004. Applications submitted 
through http://www.grants.gov until 11:59 p.m. eastern time on July 19, 
2004, will receive an automatic time stamp upon submission and be 
considered ``on time.'' Applicants will receive an automatic reply 
email acknowledging the application's receipt.
    Applications mailed through the U.S. Postal Services or a 
commercial delivery service will be considered ``on time'' if received 
by close of business on July 19, 2004, or postmarked (first class mail) 
by July 19, 2004, and received within five (5) business days. If 
express, certified, or registered mail is used, proof of timely mailing 
is a legible dated mailing receipt from the U.S. Postal Service. 
Private metered postmarks are not acceptable as proof of timely 
mailings. Applicants who submit applications through the U.S. Postal 
Services or a commercial delivery service will not receive official 
notification that their application has been received on time from CMS. 
Applications that do not meet the above criteria will be considered 
late. Late applications will not be reviewed.

4. Intergovernmental Review

    Applications for these grants are not subject to review by States 
under Executive Order 12372, ``Intergovernmental Review of Federal 
Programs'' (45 CFR part 100).

5. Funding Restrictions

    Reimbursement of indirect costs under this notice is governed by 
the provisions of OMB Circular A-87. A copy of OMB Circular A-87 is 
available online at: http://www.whitehouse.gov/omb/circulars/a087/a087.html. Additional information regarding the Department's internal 
policies for indirect rates is available online at: http://www.hhs.gov/grantsnet/adminis/gpd/gpd301.htm.
    Grant funds under this notice may be used for direct services to 
beneficiaries for the Quality Assurance & Quality Improvement in HCBS 
and Integrating Long Term Supports with Affordable Housing grant 
opportunities only. Direct Services do not include expenses: (a) 
Budgeted for consumer task force member participation in Real Choice 
Systems Change Conferences, (b) the provision of technical assistance; 
or (c) attendance at technical assistance conferences sponsored by CMS 
or its national technical assistance providers for the benefit of Real 
Choice Systems Change Grantees. No grant awards made under this notice 
may be used to reimburse pre-award costs.

6. Other Submission Requirements

    Applicants may submit either an electronic application or a paper 
copy application. Applicants may not submit the same application in 
more than one format, and the choice of one application format over 
another will not cause an application to be reviewed more favorably. 
All standard application forms may be obtained as detailed in section 
IV of this notice. Additional submission requirements for the Real 
Choice Systems Change Grants is available in the solicitation package 
for these grants at http://www.cms.hhs.gov/newfreedom/2004solicitation.pdf.
    Applicants are strongly encouraged to submit their applications 
electronically. Electronic applications may be submitted through http://www.grants.gov. For complete explanation of the electronic application 
process, applicants should review the ``getting started'' information 
provided at http://www.grants.gov/GetStarted.
    Applicants that choose to submit a paper application are required 
to submit one original application and two copies to: Real Choice 
Systems Change Grants, Attn: Marian Webb, Centers for Medicare & 
Medicaid Services, Acquisition and Grants Group, AGG/DRCG, Mail Stop 
C2-21-15, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Beginning October 1, 2003, applicants are required to have a Dun 
and Bradstreet (DUNS) number to apply for a grant or cooperative 
agreement from the Federal Government. The DUNS number is a nine-digit 
identification number, which uniquely identifies business entities. 
Obtaining a DUNS number is easy and there is no charge. To obtain a 
DUNS number, access the following Web site: http://www.dunandbradstreet.com or call 1-866-705-5711. This number should be 
entered in the block with the applicant's name and address on the cover 
page of the application (Item 5 on the Form SF-424, Application for 
Federal Assistance), with the annotation ``DUNS'' followed by the DUNS 
number that identified the applicant. The name and address in the 
application should be exactly as given for the DUNS number.

V. Application Review Information

1. Criteria

    Each of the nine funding opportunities available under the Real 
Choice Systems Change Grants have extremely detailed evaluation 
criteria, which are available in the solicitation package at http://www.cms.hhs.gov/newfreedom/2004solicitation.pdf. Although the specific 
criteria and point values differ by funding opportunity, all proposals 
will be evaluated on strength of their (a) identification of problems 
or system issues, (b) project description and methodology, (c) 
significance and sustainability, (d) partnerships, and (e) budget 
justification and resources.

2. Review and Selection Process

A. How the Merit of Applications Will Be Determined
    CMS will employ a multiphase review process to determine the 
applications that will be reviewed and the merit of the applications 
that are reviewed. The multiphase application review process includes 
the following:
     Applications will be screened by Federal staff to 
determine eligibility for further review using the criteria detailed in 
section III ``Eligibility Information'' of this notice. Applications 
that that are

[[Page 28138]]

received late or fail to meet the eligibility requirements as detailed 
in the ``Eligibility Information'' section of this notice will not be 
reviewed.
     Applications will be objectively reviewed by a panel of 
experts, the exact number and composition of which will be determined 
by CMS at its discretion, but may include private sector subject matter 
experts, beneficiaries of Medicaid supports, and Federal and State 
policy staff. The review panels will utilize objective criteria to 
establish an overall numeric score for each application.
     Results of the objectively review of applications will be 
used to advise the approving CMS official. Additionally, CMS staff will 
make final recommendations to the approving official after ranking 
applications using the scores and comments from the review panel and 
weighing other factors as described in the ``Factors Other than Merit 
that May be Used in Selecting Applications for Award'' section of this 
notice.
B. Factors Other Than Merit That May Be Used in Selecting Applications 
for Award
    CMS may assure reasonable balance among the grants to be awarded in 
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 for each grant opportunity (for example, to 
adjust the minimum or maximum awards permitted or adjust the aggregate 
amount of Federal funds allotted to a particular category of grants).
    CMS will not fund activities that are duplicative of efforts funded 
through its grant programs or other Federal resources.
    For applicants that have been awarded previous Real Choice Systems 
Change Grants, past programmatic performance will be considered in 
selecting applications for award. To assess the applicant's past 
programmatic performance, CMS will use the semi-annual, annual, and 
financial reports submitted by the applicant under the Terms and 
Conditions of their previously awarded Real Choice Systems Change 
Grant.
    For applicants that have never received a Real Choice Systems 
Change Grant, past programmatic performance will not be a consideration 
in selecting applications for award.

VI. Award Administration Information

1. Award Notices

    Successful applicants will receive a Notice of Grant Award (NGA) 
signed and dated by the CMS Grants Management Officer. The NGA is the 
document authorizing the grant award, and it will be sent through the 
U.S. Postal Service to the applicant organization. Any communication 
between CMS and applicants before the issuance of the NGA 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, after October 1, 2004.

2. Administrative and National Policy Requirements

    All relevant provisions of 45 CFR part 74 and 45 CFR part 92 will 
apply to these awards. A full description of the administrative and 
national policy requirements for the Real Choice Systems Change Grants 
is available in the solicitation package for these grants at http://www.cms.hhs.gov/newfreedom/2004solicitation.pdf.
    This funding opportunity will lead to awards with CMS' standard 
terms and conditions and may lead to awards with additional ``special'' 
terms and conditions. Potential applicants should be aware that special 
requirements could apply to particular awards based on the particular 
circumstances of the effort to be supported and/or deficiencies (for 
example, failure to supply or an acceptable Work Plan or detailed 36-
month budget) identified in the application by CMS.

3. Reporting

    Grantees must agree to cooperate with any Federal evaluation of the 
program and provide semi-annual (every 6 months) and final reports (at 
the end of the grant period) in a form prescribed by CMS (including the 
SF-269a ``Financial Status Report'' forms). Reports may be submitted 
electronically. These reports will outline how grant funds were used, 
describe program progress, and describe any barriers and measurable 
outcomes. CMS will provide a format for reporting and technical 
assistance necessary to complete required report forms. Grantees must 
also agree to respond to requests that are necessary for the evaluation 
of the national Real Choice Systems Change Grants efforts and provide 
data on key elements of their Real Choice Systems Change Grant 
activities.

VII. Agency Contacts

    Programmatic questions about the Real Choice Systems Change Grants 
may be directed to:
     An e-mail address that multiple people access so that 
someone will respond even if others are unexpectedly absent during 
critical periods: [email protected] or
     Mary Guy, Centers for Medicare & Medicaid Services, Center 
for Medicaid and State Operations, DEHPG/DCSI, Mail Stop S2-14-26, 7500 
Security Boulevard, Baltimore, MD 21244-1850, 410-786-2772 (voice), or 
410-786-9004 (fax).
    Administrative questions about the Real Choice Systems Change 
Grants may be directed to: Nicole Nicholson, Centers for Medicare & 
Medicaid Services, Acquisition and Grants Group, AGG/DRCG, Mail Stop 
C2-21-15, 7500 Security Boulevard, Baltimore, MD 21244-1850, 410-786-
5158 (voice), 410-786-9088 (fax), or by e-mail at 
[email protected].
BILLING CODE 4120-01-P

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[GRAPHIC] [TIFF OMITTED] TN18MY04.429


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[GRAPHIC] [TIFF OMITTED] TN18MY04.430

BILLING CODE 4120-01-C

IX. Approval of Collection of Information

    This notice informs interested parties of an opportunity to apply 
for Real Choice Systems Change Grants. If interested, applicants must 
submit a completed grant application that can be found at http://www.grants.gov.

[[Page 28141]]

    This information collection requirement is subject to the PRA; 
however, the burden for this collection requirement is currently 
approved under OMB control number 0938-0836 entitled ``Real Choice 
Systems Grants; Nursing Facility Transition/Access Housing Grants; 
Community Personal Assistance Service and Supports Grants, National 
Technical Assistance and Learning Collaborative Grants to Support 
Systems Change for Community Living'' with a current expiration date of 
1/31/2007.

    Dated: March 12, 2004.
Dennis G. Smith,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 04-11241 Filed 5-17-04; 8:45 am]
BILLING CODE 4120-01-P