[Federal Register Volume 86, Number 224 (Wednesday, November 24, 2021)]
[Notices]
[Pages 67120-67122]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-25600]


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DEPARTMENT OF THE TREASURY


Agreement for a Social Impact Partnership Project

AGENCY: Department of the Treasury.

ACTION: Notice.

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SUMMARY: In accordance with the Social Impact Partnerships to Pay for 
Results Act (``SIPPRA''), the U.S. Department of the Treasury 
(``Treasury'') and City and County of Denver (``Denver'') have entered 
into an agreement for a social impact partnership project (the 
``Project Grant Agreement''). The SIPPRA program makes funding 
available to state and local governments for pay-for-results social 
impact partnership projects. SIPPRA projects may seek to improve a 
variety of social problems,

[[Page 67121]]

including increasing employment, wages, and financial stability for 
low-income families; improving family health and housing; and reducing 
recidivism.

SUPPLEMENTARY INFORMATION: The Project Grant Agreement contains the 
following features:
    (1) The outcome goals of the social impact partnership project:
    The Denver Housing to Health (``H2H'') Pay for Success Project 
Denver proposes the following intermediate outcomes: Increased housing 
stability; decreased police contacts; and increased access to health 
services. Denver also proposes the following long-term outcomes: 
Improved health; increased access to health services (resulting in 
decreased visits to detoxification centers and decreased avoidable 
emergency room and hospital visits); and decreased criminal justice 
involvement. Overall, the project objective is to reduce the Medicaid 
and Medicare expenditures of the target population.
    (2) A description of each intervention in the project:
    Two service providers, the Colorado Coalition for the Homeless 
(``CCH'') and the Mental Health Center of Denver (``MHCD'') will 
deliver permanent supportive housing, modified assertive community 
treatment (``ACT'') and case management to 125 participants.
     Permanent Supportive Housing is an evidence-based 
intervention that provides housing plus intensive case management and 
connects clients with community services, including primary health 
care.
     Modified Assertive Community Treatment consists of a 
multidisciplinary team that strives to meet behavioral health and other 
needs of clients in order to maximize opportunities for recovery. Among 
the primary benefits of ACT is its ability to have multiple 
perspectives for treatment planning and assessment, ongoing 
collaboration, and planning and evaluation, with the client being an 
active member of the team.
     Case Management includes evidence-based motivational 
interviewing and trauma-informed care to assist participants in 
engaging and connecting with integrated health services, as deemed 
clinically appropriate and fitting the clients' needs. This approach is 
designed to help improve health outcomes, address barriers to housing 
stability, manage mental illness and reduce interaction with the 
criminal justice system.
    (3) The target population that will be served by the project:
    H2H will target individuals who are chronically homeless, have a 
record of at least eight arrests over the past three years in Denver 
County, and are at high risk for avoidable and high-cost health 
services paid through Medicaid.
    (4) The expected social benefits to participants who receive the 
intervention and others who may be impacted:
    H2H is expected to help individuals improve their health outcomes, 
break the cycle of jail and homelessness, and save taxpayer dollars on 
the cost of health care in jail and in the community.
    (5) The detailed roles, responsibilities, and purposes of each 
Federal, State, or local government entity, intermediary, service 
provider, independent evaluator, investor, or other stakeholder:

------------------------------------------------------------------------
          H2H role                   Partner          Responsibilities
------------------------------------------------------------------------
Lead applicant/Local          City of Denver......  Repay investors with
 government.                                         SIPPRA funds if
                                                     performance
                                                     benchmarks are met.
Intermediary................  A special purpose     Manage service
                               vehicle will be       provider
                               created by The        performance, day-to-
                               Corporation for       day operations and
                               Supportive Housing    facilitate investor
                               (``CSH'').            agreements and
                                                     payments from the
                                                     DOF to investors.
                                                    Serve as project
                                                     manager--providing
                                                     project oversight,
                                                     communicating with
                                                     all parties, and
                                                     providing advisory
                                                     services.
Service providers...........  Colorado Coalition    Provide housing.
                               for the Homeless.
                              Mental Health Center  Provide supportive
                               of Denver.            housing services.
                                                    Deliver ACT.
Independent evaluation......  Urban Institute.....  Establish research
                                                     design.
                                                    Verify that
                                                     performance
                                                     benchmarks are met.
                                                    Measure other
                                                     outcomes of
                                                     interest.
Pay for Success investors...  Including Northern    Provide capital to
                               Trust, The Denver     fund services.
                               Foundation.
                              There has been        Receive principal
                               significant           and interest when
                               investor interest,    performance
                               and project           benchmarks are met.
                               partners intend to
                               add investors if
                               the project
                               receives SIPPRA
                               funding. In
                               addition to letters
                               of commitment from
                               the investors named
                               above, letters of
                               interest and
                               support from other
                               investors are
                               included as
                               attachments.
------------------------------------------------------------------------

    (6) The payment terms, the methodology used to calculate outcome 
payments, the payment schedule, and performance thresholds:
    The Recipient's outcome payment will be equal to the sum of the 
annual difference between the treatment group's Medicaid and Medicare 
expenditures and the control group's Medicaid and Medicare expenditures 
over the project period.
    (7) The project budget:

                             Project Budget
------------------------------------------------------------------------
 
------------------------------------------------------------------------
Service Delivery..................................        $13,524,300.00
Evaluation........................................          1,282,800.00
                                                   ---------------------
  Total Project Costs.............................         14,807,100.00
------------------------------------------------------------------------

    (8) The project timeline:
    The intervention will take place over seven years, beginning on 
April 29, 2022 and serving clients through April 28, 2029.
    (9) The project eligibility criteria:
    The eligibility criteria for H2H are that individuals must be at 
least 18 years old, have had at least eight arrests over the past three 
years, were experiencing homelessness at the time of their last arrest 
and are at high risk for avoidable and high-cost health services paid 
through Medicaid and Medicare. Potentially eligible clients will be 
referred to H2H through Denver Health and Denver Police Department 
(``DPD'').
    (10) The evaluation design:
    H2H'S randomized controlled trial (``RCT'') design will compare the 
trajectories of homeless, frequent users

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of medical services who receive supportive housing and those who 
receive usual care. Because available supportive housing is not 
available to all of the people who need it, the limited 125 housing 
slots will be allocated by lottery, which is a fair way to allocate the 
scarce housing resources and also enables random assignment. The 
evaluation will track outcomes for both groups and attribute any 
differences to the H2H program intervention.
    (11) The metrics that will be used in the evaluation to determine 
whether the outcomes have been achieved as a result of each 
intervention and how these metrics will be measured:
    The evaluation metrics will include information on housing 
stability and reductions in jail days and net reductions in federal 
expenditures for Medicaid and Medicare claims, to be paid by SIPPRA 
funding if successful. The net reduction in federal expenditures will 
be measured as the average difference in the change over time (pre and 
post randomization) in the amount billed for claims between the 
treatment and control groups.
    (12) The estimate of the savings to the Federal, State, and local 
government, on a program-by-program basis and in the aggregate, if the 
agreement is entered into and implemented and the outcomes are achieved 
as a result of each intervention:

Federal Savings: $5,512,000
City Savings: $9,235,055

    Authority: Public Law 115-123, Division E, Title VIII, 42 U.S.C. 
1397n-1397n-13.

Catherine Wolfram,
Deputy Assistant Secretary for Climate and Energy Economics, Office of 
Economic Policy.
[FR Doc. 2021-25600 Filed 11-23-21; 8:45 am]
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