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State Planning & Establishment Grants for the Affordable Care Act’s Exchanges

Pre-Application Conference Call
August 5, 2010
2:00 pm ET

Operator:

    Welcome and thank you for standing by.  At this time all participants are in a listen only mode.  During the question and answer session press star 1.  Today’s conference is being recorded so if you have any objections you may disconnect at this time.

I would now like to turn today’s meeting over to Miss Nancy De Lew.  Thank you, you may begin.

Nancy De Lew:

    Hi, thank you.  My name is Nancy De Lew, I’m here in the Office of Consumer Information and Insurance Oversight.  I want to welcome all of you to our call today to discuss the state planning and establishment grants for health insurance exchanges.

As you know this funding opportunity announcements was released by HHS on July 29 with applications due from states on September 1.

I will provide an overview of the purpose of the grants and then I will turn to my colleague Donna Laverdiere to walk through the grants announcement and to review the questions that we’ve already received.

Then we’ll open the phones to take your questions.  We ask that you identify yourself, your state and your organization when you ask a question.

So for those of you who attended the federal state dialogue on exchanges in Minnesota on Tuesday you will hear many of the same messages today.

We are repeating those messages today to make sure that all states hear them.  We will also respond to the questions raised in Minneapolis later on this call so that all states have the benefit of the answers we provided.

So I want to start with my most important message and that is we want to work with states as you move forward on exchanges.  Secretary Sebelius is committed to building capacity in states to implement their provisions of the Affordable Care Act.

This grant program is part of that commitment.  We welcome your feedback about what we can do to support your efforts as an example of our responding to the concerns we’ve heard from states.

I would note that at the NGA meeting on health reform in June we heard states tell us that you need funds right now to hire staff to begin planning for the exchange.

We know that state budgets are tight, the grant announcement that we are discussing today was developed in response to your requests.

We are making up to $1 million available to each state to assist you in your planning.  States may use the planning grant funds to determine whether or not you wish to proceed with an exchange or if a state so elects, the federal government will establish an exchange on your behalf.

We appreciate that states are in different places in their planning and I want to emphasize that these are not competitive grants.  Every state can apply for a grant and is eligible to receive up to $1 million.

This is the first round of grants for states regarding the health insurance exchanges.  A second round of grants will be announced next spring; the purpose of the second round of grants will be to provide assistance to establish an exchange.

Funding for the second round will be based on budgets submitted by states.  We do not have a predetermined amount of funding available for each state so we encourage you to use the planning grants to develop a detailed implementation plan along with a detailed budget.

That way you’ll be ready to apply for the second round of grants next spring.  The Affordable Care Act provides funding for state planning and establishment grants through January 1 of 2015 at which time the exchanges will need to be self supporting.

Let me close my remarks by noting that we will work with you to make any appropriate modifications to your grant that may be needed in response to guidance that we may provide or as leadership may change in your state. 

So we ask that we use your best judgment right now as you develop your application and please we ask that you turn it in early.  Do not wait until the day it is due.

If there are any technology issues as we found with the rate review grants we want to solve them early.  I’m now going to turn the microphone if you will over to Donna Laverdiere who will walk us through the grant announcement.

And she’ll review the questions that we’ve been asked by states already and then we will open the phones for questions.

Donna Laverdiere:

    Thanks Nancy.  I’m Donna Laverdiere; I’m the main contact person on program questions on the funding opportunity announcement.  I’m going to briefly walk through the application materials that are required for this funding opportunity.

But first I really encourage you to log into grants.gov right away and download the application to familiarize yourself with the process for submitting this application.

For any required material that does not have a specific form to fill out these documents should be submitted as attachments on the general attachment forms.

We wanted to clarify that for you.  I’d like to turn your attention to Page 9 of the opportunity announcement which shows the documentation you need to provide which I would like to walk through with you.

First your application needs to include a cover sheet and you should refer to Attachment C for instructions on what needs to be included there.

Next there are a number of standard forms that everyone needs to complete and those are in the online application on grants.gov which is another reason it’s very important that you log into grants.gov right away to familiarize yourselves with all of those forms that you need to fill out.

The next element of the application is the required letter of support from the governor or the mayor if you’re from DC.  We’ve gotten a lot of questions or a few questions on what states are committing to if they receive these grants from HHS.

And I want to clarify if you read the language in the opportunity announcement it says that the letter must express a sincere commitment to conduct activities in order to assess whether the state will establish an exchange.

So I want to make that very clear on this call.  The next element of the application is the cover letter which is fairly self explanatory.  The following element is a project abstract and that’s just a short summary of the proposal and I also wanted to let you know that there is a form on grants.gov that you do need to fill out on the project abstract.

The next element is the project narrative.  There are a number of domains that we ask you to please address in your project narrative.  These include background research, stakeholder involvement, program integration, resources and capabilities, governance, finance, technical infrastructure, business operations and regulatory or policy actions.

We wanted to clarify that we’ve highlighted these areas because we consider these to be critical considerations that you must address in your planning process and your project narrative we want you to address every one of these areas listed.

But if you do not propose to undertake any of these activities under this grant we also want you to just express that in your narrative.

We do expect that each of these domains will be addressed in your planning and implementation process as you move forward with an exchange even if you do not include these activities under this grant.

I also wanted to clarify that we have a page limit of 15 pages for the narrative but this is just a maximum page limit.  We’re looking for quality here and not quantity, so if your application is less than 15 pages, that is fine.

The next element is work plan and timeline.  To clarify the checklist in Attachment B and the application does say that a work plan and timeline are not necessarily required activities.

But we do require you to submit these as part of your proposal and we will ask states to provide us with progress reports in this area.

The next element is a budget narrative and we understand that states may not have very much time to provide an exact budget at this time but please do your best and ensure that you provide some justification for the amount of the grant you are requesting.

You do have flexibility to adjust your budget after you submit your proposal by 25% within any line item.

The final elements of the application are just a few supporting documents.  The application attestation and Attachment B, and organizational chart and job descriptions for each of your key personnel and letters of agreement if you are sub contracting.

I also encourage you to visit grants.gov where there are tons of really helpful application resources for you.  A good website to visit is www.grants.gov/applicant/resources.

Okay now I’m going to turn to going over some of the questions that we’ve already received.  We’ve received a few questions on the phone and we received a lot of questions at the state meeting in Minnesota.

And I just want to highlight a few of the questions that we thought were appropriate for this board audience.

First question we received was who are eligible applicants for these grants?  The governor must designate a state entity as the grant applicant.  There has been a little bit of confusion about what exactly is a state entity.

The only eligible applicants for these grants are states. 

Nancy De Lew:

      A state is either a state agency such as a state Medicaid agency, the department of insurance or an independent state agency.  Non-profits are not eligible to apply for these grants.

You’ll note in the statute that the non-profit estate can have a non-profit run the exchange but a non-profit is not eligible to apply for the grant.  A state needs to apply for the grant.

States can choose to subcontract these activities to a non-profit entity but the state is the party ultimately responsible for compliance with the terms and conditions of the grant.

If a state sets up a subcontract in a relationship they must provide us with a letter or letters of agreement describing these relationships and the work that will be carried out.

And we’ve got more information on Page 12 of the grant announcement for information on this requirement.

Donna Laverdiere:

    Okay, a second question that we received is, is it permissible to use the grant funds for state travel costs to federally sponsored meetings related to the grants?

This is a question that we got in Minnesota and we did want to address this on the call.  The answer is yes, the grant funds can be used for state travel costs.  To the extent possible we would like you to outline these costs in your budget.

We anticipate bringing states together for some meetings but we aren’t quite ready to provide an exact sense of how many meetings will be taking place.

So we would just ask that you do your best to include some budget resources for travel and we’ll work with states to provide some more information about what our expectations are around that.

The next question is we got a question about whether or not states could fund activities that they’re already carrying out.  We do want to clarify that this grant only covers prospective costs that you incur after the project period begins.

We appreciate this concern and we hear that states have started their planning activities and we will consider counting or allowing you to claim funds for activities you have carried out previously under the next round of grants.

The next question is, if a state is using existing staff to work on planning can we use the grant to back fill those folks?

As you’ll see on Page 14 it indicates that a grantee must use funds exclusively for the project identified in the application or agreed upon subsequently with HHS.

We want to know how much it costs to fund these staff; it is acceptable if you obtain the staff through other offices in your state.

We received some questions related to the grants that are authorized under section 1561 of the Affordable Care Act for enrollment and eligibility standards and protocols.

And we do want to provide some clarification on this.  The grant authorizing under section 1561 of the Affordable Care Act are not actually funded.  And we do want to clarify that any systems cost related to the establishment and operation of exchanges including eligibility and enrollment should be funded using the exchange planning and establishment grants.

However it’s very important that you ensure that you do not use these funds for any activities outside of the exchange, for example on Medicaid only systems changes.

On Page 5 of the announcement we do state that applicants may apply along with consumer assistance grants and we did get a question on whether there was a limit on the scope of your ability to use these funds for the consumer activities.

We do ask that you just adhere to the grant application and do not go beyond what the application says you can do and what you can’t do.

States can use part of the exchange grants to complement activities funded under consumer assistance.  And all activities must be clearly outlined in the budget narrative.

We did receive a question in Minnesota about whether a newly elected legislature or governor could amend the plan that you submit as this grant proposal.

We want to clarify that if a grantee would like to amend their project plan after the project year has begun that that change is possible but it would be considered a change in scope. 

A request for approval of the change in scope must be submitted to the program office, HHS and only after the change of scope is approved internally by HHS and the grantee receives a written response can the grantee alter the proposal.

We also received a question on whether states can use these grant funds for regional exchanges and yes you can indicate in your grant application that you can use – that you intend to use the funds for regional planning.

And the last question is if multiple entities want to work on an exchange together can they do that?  And this is multiple entities within the same state.

Just want to clarify that one entity must apply for the grant and is therefore responsible for the grant but more than one entity in a state can use this funding.

You just need to make this clear in your proposal.  And I think now we’re ready to open up for questions from the states.  And we please ask that when a state asks a question if they could just identify themselves and the state where they are from.

Operator:

    Thank you, if you would like to ask a question press star 1 and record your name when prompted.  Once again it was star 1 and it is star 2 to withdraw your request.

And I’ll just take one moment for the first question.  We have a question from [caller name] with Alabama and Department of Insurance.  Your line is open.

Caller:

    Yeah, actually I’ve got two questions.  One you refer to the letters of agreement if you’re sub contracting on Page 12, but we are so early into this planning process we don’t know exactly who that would be, who we’re going to be using as a sub contractor.

Can we just simply say that in the grant narrative?

Michelle Feagins:

    Yes, you can say that in the narrative but preferably we would like for you to try to go ahead and seek out the sub contractor up front.

Caller:

    We can’t do that with our system the way we are, we have to go through our request for proposal process which would take three months.

Michelle Feagins:

    Right, which I understand you’re talking about the bid process right?  We understand that, if you can identify that in your proposal we’re fine with that.

Caller:

    Okay and then the second question is on the grant project narrative you talk about background research, stakeholder involvement.  Are you wanting sub heads in the narrative?

Or if we refer to this because as I said we’re very early in this planning process so we really can’t tell you exactly how an exchange will be build on existing state and federal programs yet because we don’t know.

Nancy De Lew:

    Right, that’s fine.  I mean what we want you to do in response to each of the elements in the project narrative is to tell us what you plan to do in that category.

So for background research for example what we have there are some examples of what you might want to do under background research.

That’s there to give you a sense of what it is we’re looking for from each of those categories but you are free to tell us what your plan is under that category.  Is that clear?

Caller:

    I think so.  We’ll wing it.

Nancy De Lew:

    Well I mean we understand that there’s a short amount of time for states to complete the application and get it back into us.  So we’re asking you to make your best effort to you know read the application and to respond to it.

But we know that many states are early in their planning efforts and we know that you don’t have a lot of time to complete this document.

So we’re asking you to make your – you know your best effort and we are happy to take additional questions as you develop your application.

We have in the grant announcement information on how to contact us with questions.  We would rather get questions now than have an application in September that looks problematic, meaning we’ve got a short window in September to review the applications and to make the funding award.

Our commitment is to get the funding out in fiscal year 2010 for the federal government, that means by the end of September.  So please ask us questions as you’re going in August rather than you know potentially have a problem in review in September.

Operator:

    The next question comes from [caller name], Maine Governor’s Office Consultant, your line is open.

Caller:

    Hi, thank you.  This is very helpful.  You mentioned that if a newly elected administration or a legislature comes in and changes the planning on documents or significant changes to the project plan that that would need to be amended.

What if the principle investigator or the person who is charged with who we name for the state changes when that new administration comes in?

Michelle Feagins:

    That is what we consider a post award action, so you have to come in for approval for that as well.  So you just submit the change to the program office.

Caller:

    Okay.  So we should just make our best effort at making those decisions now, knowing that if there’s a lot of states going through administration changes likely in the next – you know in the fall.

So there would probably be a lot of those changes.

Nancy De Lew: 

    Right, we understand that and that’s partly why we wanted to address that issue on this call because we’ve gotten that question now several times.

Caller:

    Excellent, thank you.

Operator:

    The next question comes from [caller name], Colorado, State HCPS.  Your line is open.

Caller:

    It’s Healthcare Policy and Financing, we have a very long mouthful of a name.  My question is kind of related to the last two questions about the continuity when we have some kind of you know regime change come the fall.

And partly I mean asking the question about the PI changes is helpful but in order to ensure some continuity we did want to run a lot of the grant work through a foundation or a non-profit. And we would still be the applicant but if we can partner with a non-profit that would have more continuity than a state agency might after the change of administration.

Is it okay to contract out the majority of the work on this grant?

Donna Laverdiere:

    Yes.

Caller:

    Okay.  Thank you.  Oh a related question then, there was a project site location form which isn’t something that we’re familiar with for our normal grants.gov submissions.

Is that in anticipation that the grant work might not be done by the agency applying for it?  That would be information for like our contractor?

Michelle Feagins: 

    No, this is a new requirement that came about within like a year or so mandated by the OPM.  Basically this form is just designated just to know where your site is going to be at as far as your project.

Caller:

    So if we’re contracting with a local foundation or non-profit, would it be their address or would it be the applicant’s address?

Michelle Feagins:

    It would be the applicant.

Caller: 

    Okay, thank you.

Operator:

    The next question comes from [caller name], Montana State Auditor’s Office, your line is open.

Caller:  

    Yes, we would like to know with regard to Attachment A on Page 17 it’s unclear what kind of a document you’re asking for.

Donna Laverdiere: 

    We’re not actually asking for a document here.  This is just to communicate to you what the prohibited uses of grant funds are.

Caller:  

    So we don’t need to put anything in there that we verify that we’re not going to use the grant for any of those things?

Donna Laverdiere:

    No.

Caller: 

    Okay, just information?  It’s not really an attachment then.

Donna Laverdiere:

    Yeah, just to clarify, it’s an attachment to the funding opportunity announcement; it’s not an attachment to the application.

Caller:

    Okay, thank you.

Operator:

    And the next question comes from [caller name], Utah Health Exchange, your line is open.

Caller:

    Hi, I actually had three questions.  My first question is it was mentioned that this would be for hiring personnel to go through this planning process.  Is it anticipated that these funds would be used primarily just for personnel?

Nancy De Lew:

    No, I mean you can use funds for other purposes as well, like if you want to hire a consultant for example or a sub contractor.

That’s an example of an approved use of funds.

Caller:

    Okay great.  My second question is – talks about a timeline that we would need to submit.  Is this timeline just for the timeline of different planning activities or is this timeline for actually implementing the exchange?

Donna Laverdiere:

    The timeline that you’re asked to submit with your application I believe is just for the period of the grant.  But we will be asking you as part of this – these grant activities to develop a timeline and a work plan for establishing an exchange.

Caller: 

    Okay.  But this time I would just – the grant period’s 12 months, correct?

Donna Laverdiere:  

    Correct.

Nancy De Lew:

    Right, just to be clear on Page 11, I think that’s what you’re referring to, item 7 so that other people on the call can follow this.  So Page 11 item number 7 work plan and timeline, what we’re asking you for here on this page is how do you propose to use these funds, whatever your request is over the course of that one year period.

As Donna just noted we will also be asking you to submit you know down the road a little bit what’s your work plan and timeline to build an exchange which is obviously a longer time table.

Caller:

    Right, right.  My last question then is Utah is in a little bit different situation.  We actually have an exchange that’s up and running to some extent right now.

These funds are only to be used for planning an exchange that adheres to the federal requirements, is that correct?

Nancy De Lew:

    What we would expect a state like Utah or a state like Massachusetts for example which already has you know obviously very related activity, you know you might well want to you in your planning determine how you would move from your current exchange to the Affordable Care Act’s requirements for an exchange.

Caller

    Okay.  All right, thank you.

Operator:

    And the next question comes from [caller name], New York State Insurance Department, your line is open.

Caller

    Hi there, thank you.  I also have three questions.  The first is a clarifying question for one of the substantive areas in the project narrative.

And that’s the sixth bullet down on Page 10, the finance requirement, I was hoping you could just expand on that a bit.

Nancy De Lew:

    Well I think that the – I think what we’re looking for there is you know we will be having monitoring and reporting over the course of the grant cycle.  We’ll want you to have a plan for how you're going to account for the funding that you apply for and how you use those funds.

And I would ask Michelle and Donna if you want to add anything to that.

Donna Laverdiere: 

    Yeah, I would just refer you to some of the requirements in the legislation about fraud and abuse for exchanges and the fact that exchanges will be subject to annual audit.

So I think what we’re getting at here is how you will be planning to meet some of those requirements.

Caller:

    Okay, that’s helpful.  And then also on the bottom of page 14, there’s what looks to be a federal requirement, this is bullet point four under section B that all grant budgets must include some funding to facilitate participation on the part of individuals who have a disability or long term illness in their families.

To the extent that that requires specific mention in our budget worksheet or budget narrative we were wondering if you could provide a little bit more guidance on that or what sorts of accommodation have folks traditionally made to provide an accessible environment for those communities and facilitate their participation?

Michelle Feagins: 

    Right, I think the intent here is to basically if you do have someone in your organization that has a disability we will want you to identify that and let us know how you’re funding that particular position.

Caller: 

    Well to the extent our organization would already be ADA compliant or you know accessible in terms of physical space and this appears to require consumer or stakeholder participation for specific disability representing communities.

Nancy De Lew:  

    Right, so as an example let’s say you have a public meeting.  We would want any public meeting you have to be able to accommodate you know someone who’s hearing impaired for example.

So you would have a translator available or it would need to be held in a facility you know where handicapped individual could access the facility.

So we’re asking that in the – you know you need – there’s an obligation in the law to consult with stakeholders.  And we’re asking you to meet that obligation in a way that allows everyone who wants to participate to do so.

Is that clear?

Caller:

    Yes, and do you have some sense of kind of the target you know allocation that if other folks have already had budget lines to have some amounts or you know you’re looking for a number I take it in the budget aiming for that.

Michelle Feagins:

    No.  We’re not looking for a particular number, no.  We just want you to identify it, that you meet those needs.

Nancy De Lew: 

    Right, we want you to provide assurances that your consultations with consumers and stakeholders are in compliance with these various laws.

Caller:

    Okay, the FOA says that all grant budgets must include some funding; we can just take a number and need to change it if that’s up or down.

Donna Laverdiere:

    I think what you need to do as Nancy mentioned, you know if you are planning on doing a public meeting, you know you indicate how much you’re budgeting for that activity and then you also indicate that that budgeted amount includes enough funding for those requirements.

Nancy De Lew: 

    We’re not meaning to impose that you tell us right now that it requires X amount of dollars to allow the participation of someone with a disability in your public meeting.  That’s a level of detail that we don’t need right now.

Caller

    Okay, very good.  And then the last question is something that you just mentioned today.  To the extent that our budget allocations would change going forward after we submit the application you mentioned that there would be a 25% maximum limit per line item to shift the allocation of that funding.

Donna Laverdiere:

    That’s without prior approval, that’s 25%.  You can contact the program official and request a change of scope to shift a greater amount of funding.

Caller:

    Okay.  Is that a particularly significant process or that’s – is that subject to significant review and delay or that’s something that is done frequently.

Donna Laverdiere: 

    It’s done frequently.

Caller

    Okay, very good.  Thank you.

Operator:

    And the next question comes from [caller name] from the Maryland Healthcare Commission, your line is open.

Caller:

    Yes, thank you very much and I hope I’m not redundant to questions in Minnesota.  Just simply money is available to do a number of models on exchanges during this process.

So one is better prepared in direction for the future as to where we want to go?

Nancy De Lew:

    You can use funding here to evaluate alternative ways of setting up an exchange that are in compliance with the law obviously.

You know I mean there are terms laid out for the exchange in the Affordable Care Act.

Caller

    Exactly.

Nancy De Lew: 

    Right.  So you are – the purpose of this funding is to allow states to plan how they’d like to move forward.

And in your planning you can consider alternative structures, etcetera.

Caller: 

    Okay, thank you.

Operator:

    The next question comes from [caller name], West Virginia Insurance Commission your line is open.

Caller:

    Thank you.  I had a question concerning language on Page 14, it indicates that consumers and other stakeholders must have meaningful input into the planning of the project.

Certainly we’ve engaged stakeholders as part of our overall exchange plan.  The timeline on this specific grant may make it difficult to have open meetings or actual input into the specifics of this grant.

I was just wondering how we should address that in our narrative.  Also would it be possible for OCIIO to inventory questions and answers that you’re getting today and at other times for grant recipients to look at since we’re on such a tight time frame, that might be helpful in streamlining the process.  Thanks.

Nancy De Lew: 

    Right.  I’ll take the second question first because we do intend to put on our website, the OCIIO website the questions and answers we’ve already received as well as those that we’re talking about right now to make them available.

And then you know one of the – on Page 10 of the grant announcement we talk about stakeholder involvement.  We would like you to address that meaning we’d like you to talk about how you plan to involve stakeholders.

You have you know flexibility in terms of how you do that but we’d like you to address stakeholder involvement.

Operator

    The next question comes from [caller name] of Washington State Health Care Authority your line is open.

Caller:

    Good morning, thank you.  In Washington State we’ll likely explore whether to implement a basic health option and one way we might look at that would be to administer it under the same structure as the exchange.

Can we study that exploration with these grant funds?

Nancy De Lew:

    Definitely.  We’ve been wondering if you were going to do a basic health option.  So you may use these funds to explore how you would like to proceed.

Caller

    Thank you.

Operator

The next question comes from [caller name], Ohio Health Fund, your line is open.

Caller

    We’ve also got three questions, the first is if you could explain a little bit more about the 1561 grant reference, that was a little oblique for us.

Another one has to do with there was a reference to exchange funding for IT infrastructure and where that would need to be developed and the expectation for financing would be.

And then the last one being on Page 5 when you talk about cost sharing and matching, we’d like to know a little bit more about what you’re thinking about there, particularly with regard to matching approach must be appropriately tracked to account for federal dollars.

What federal dollars would one be imagining there other than the grant dollars?  Were you envisioning if in fact part of the work gets done under Medicaid and there would be Medicaid administrative dollars that would need to be accounted for separately?

Donna Laverdiere: 

    Okay, the reference to 1561 was basically predicated on the fact that we got a few questions from states about the grants that were established under Section 1561 of the Affordable Care Act.

That section of the act requires the secretary of HHS to issue recommendations for standards and protocols for involvement in eligibility systems.

And there were grants authorized to allow states to implement some of those standards and protocols.  Those grants are actually not funded by the Affordable Care Act and there was some confusion among some states about whether or not they were supposed to use those grant funds to do the IT work for eligibility enrollment that they needed to do for the exchanges.

And we wanted to clarify that that work and the cost for those system changes or bills had to come from the exchange planning and establishment grants and not from those grant funds for standards and protocols.

Caller

    Now let me go – what are those that you’re referencing, the exchange funding grants, what is that?  Is that what we’re talking about today or is there something in addition to that?

Donna Laverdiere:

    Yes, I’m talking about these grants and future rounds of these grants.  So this first round of grants is for planning for these exchanges, the second round of funding and future rounds will be for the actual establishment of the exchanges.

Nancy De Lew:

    And let’s pause there for a second, as Donna noted there’s been a 1561 – there’s an activity, the office of the National Coordinator for Health Information Technology in HHS has been running a very public process through a federal advisory committee act, (DOTI) to talk about the – meeting the requirements of that provision.

So that’s why we wanted to address it, because some states were maybe going to wait and try to fund things there which they otherwise could have funded here under the exchange grants.

We don’t want people to miss the opportunity to use these funds.  That’s why we want to be clear about it.

If a state wants to use the standards that are developed through 1561 as part of what they’re doing on the exchange that’s perfectly permissible.  So we just want to be clear about how the exchange planning grants relate to section 1561.

Now you had two other questions as well.  IT budgeting, you know the funding that we have now to give grants $1 million we would anticipate that states may want to use some of those funds to assess their Medicaid eligibility systems, determine what kinds of systems they will need to run an exchange.

So we would expect you to be able to develop a plan for how much funding and support you might need to do systems work so that in a second round you could make that kind of a request and we could consider it in the second round.

Donna Laverdiere:

    Okay, and then your final question about cost sharing and matching on Page 5, I believe you’re referring to the last sentence which says applicants that choose to utilize a cross sharing matching approach must take care in appropriately tracking and accounting for federal dollars spent under this FOA.

I believe what we’re saying there is just that if you choose to use any other funding sources whether that be foundation or other state dollars that we just ask you to ensure that you’re appropriately tracking the federal dollars provided under this grant.Does that clarify?

Caller:

    It does, thank you.

Operator:

    The next question comes from [caller name], California HHS, your line is open.

Caller:

    Thank you.  My question builds a bit on the Ohio question on the use of funds for assessing IT system change needs.  And it could be an imponderable question.

Much of – we know this will be expensive and is the most important thing to get started on right away for us.  But we’re also really looking for a signal from you as to what kind of work the federal government might be engaging in to harmonize Medicaid, CHIP and exchange eligibility and enrollment in your own work to establish the federal fall back exchange.

So we don’t want to make imprudent use of funds if we might be able to build on the work that you will of necessity also need to do.  Can you comment on that and then I have one more question after.

Nancy De Lew: 

    Sure, we’ve had that question several times now, it’s a good one.  We have as I think we talked about in Minnesota, for those who weren’t with us we have a series of work teams underway with the IRS.

We are working with them closely to determine what the data flows at the federal level will look like.  We are also talking about how we interact with states and we are looking to be able to provide more guidance on this topic to assist you in your planning.

We understand it’s a question where you need some answers.

Caller:

    Okay.  My second question might go in the category of cheeky so forgive me.  If all states don’t submit proposals for these planning grants might states who could see a need for more than $1 million submit budget in case there is money that might be reallocated from states who don’t choose to apply?

Nancy De Lew

    No.  We do not have a fixed pool of funds that are available for this grant, we are able to provide up to $1 million for each state so each state that wants to apply may receive up to $1 million.

In the second round of grants where we will have a solicitation out next spring we will have – we will be able to work with states to meet the needs that you address in this round.

We don’t have a predetermined amount of an award for states in eh second round so if you need more than $1 million to do the work that you have you know outlined, in the second round of grants you may apply for the funding that you need.

Caller:

    And you mentioned in Minnesota this was 12 months of funding.  We’ve been assuming that’s October 1 through September 30, is that a reasonable 12 month period to assume?

Nancy De Lew

    Right, it’s September 30 of 2010 through September 30 of 2011.

Caller:

    Okay.  So we need to get through till October 2011 on the million.

Nancy De Lew: 

    We’d like you to – you have 12 months to draw down the funding that you request on this first round.  We will have additional funds available for you next year.

We don’t have an exact date yet in terms of when that solicitation will be out and when those awards will be made.

But we anticipate making additional awards in the second round next year.

Caller:

    Great, thanks so much.

Operator

    And once again to ask a question press star 1 and record your name when prompted and to press star 2 to withdraw your request.  The next question comes from [caller name] of State of Indiana, your line is open.

Caller

    Yes, my question is if we have existing state staff and some of their time is going to be diverted towards helping on this grant can we charge a portion of their time towards the grant or on to the grant?

Nancy De Lew:

    Yes.

Caller:

    Thank you.

Operator

    The next question comes from [caller name], Nebraska Department of Insurance your line is open.

Caller:

    Thank you.  Kind of a follow up question to the funding mechanisms that will cease on 2011.  is there any chance of carry over of that money or does it have to be all expended by that time?

Michelle Feagins:

    Yeah, it’s going to have to be all expended within that 12 month period.

Caller:

    Okay.  Thank you.

Operator:

    The next question comes from [caller name], Massachusetts Health Connector, your line is open.

Caller:

    Hi, thanks very much.  My question is really after the states have been awarded this money and they do their planning does the federal government have any plans on sharing best practices that have come out of the plan that goes on in the various states?

Nancy De Lew: 

    I want to thank you for that question, we have been having lively conversations internally about technical assistance and we would welcome suggestions from states about what kind of TIE you might find valuable.

We’d also like to talk with states about how to bring you all together.  So that’s probably why we had the note earlier about travel costs, we would like you to budget for travel costs.

We would like to convene states.  What we don’t have right now is a calendar for you in terms of when those meetings might occur.  But we would welcome suggestions that states might have in terms of how to share best practices.

We don’t want each state to have to learn everything all by themselves.

Caller

    Yeah right, thanks very much.

Operator:

    The next question comes from [caller name], Connecticut AARP, your line is open.

Caller:

    Hi, thanks.  We have a few states out that are reluctant to establish their own exchanges.  Could these grants funds be used for an analysis of the pros and cons for a state and its residents of a state run exchange as opposed to a federally administered exchange?

Nancy De Lew:

    These grants are only available for states, so states can apply for these funds to plan how to establish an exchange.  The grants are not available to any other applicant.

Caller:

    No, this is – if the state wanted to do some analysis, if a state’s reluctant…

Nancy De Lew: 

    I’m sorry, okay, I get it.  I was misunderstanding your question.  If a state wants to apply for a grant to determine whether or not a state wants to establish an exchange and concludes at the end of that that they decide they don’t want to establish an exchange, they prefer for the federal government to run an exchange in their state, the state has the option to come to such a conclusion.

Caller

    Thank you.

Operator

    The next question comes from [caller name], Montana State Auditor’s Office, your line is open.

Caller

    Yes, this question has to – deals with indirect costs and since we’re new to federal grant applications we don’t have an approve and direct cost rate agreement.

However we are submitting an indirect cost plan to the federal government.  Can we utilize that rate or is this something we should use as a change in scope once we get the approved rate?

Michelle Feagins:

    Right, what you’re going to have to do is not use a rate until you actually get one established and then that’s going to be a poster board action and then we’ll actually insert that rate once its approved.

Caller:

    Okay, thank you.

Operator

    The next question comes from [caller name], Delaware Healthcare Commission your line is open.

Caller

    Yes, I just wanted to go back to the calendar of spending if you will because I thought I understood that you had until September 30 2011 to draw down the funds but that we could continue spending them after September 30 2011 if in fact we had to.

Michelle Feagins:

    No ma’am, this is a 12 month project so you have only during that period to actually expend your funds.  If you want to come in and do a poster board action for a no cost extension to finish out activities then you can do that.

But you only have a 12 month period.

Caller

    Okay, there are no cost extension as an option.

Michelle Feagins:   

    It’s a prior approval, you have to come in for approval for it.

Caller:

    I understand that, okay.  Thank you.

Operator:

    The next question comes from [caller name] Nevada Medicaid, your line is open.

Caller

    Thank you very much, the question was just asked and answered.

Operator:

    The next question comes from [caller name], Ohio Health Plan, your line is open.

Caller

    Hi, I wanted to follow up on a earlier question when I had asked about the IT infrastructure the answer I think was going out into year two or three some of the additional years under this particular grant opportunity that the work could be envisioned there.

And I guess my question is so when we say the work would move out there, would it be the planning for the work or would it be planning inclusive of getting an RFP out on the street and then – what I’m trying to reconcile is how you actually would have enough time out there to not only plan for it, put it out there, finish the procurement and get an installation in place by the time you go live in 2015.

Nancy De Lew:

    Right.  I think that we will want to talk with states about all of these systems issues that have been raised on this call in terms of the timing of these procurements, etcetera.

What we need to do at the federal level is to have some more conversations with our federal partners in terms of what systems we intend to build at the federal level.

So we can then provide you with more guidance about our plans and then how states can interact with those federal systems.  So I would ask you basically right now as you think about how to respond to this solicitation, think about what funding you need to assess the systems you have and to plan for the systems you will need to build.

We don’t expect you to know right now the answer to all those questions because we haven’t given you the guidance that we need to give you.  So we’re asking you to do the best job you can right now in terms of developing a plan.

We will provide more guidance on the IT systems front and then we can have more conversations about the sequence of those builds.

Caller:

    Thank you.

Operator:

    And once again to ask a question press star 1.  And start 2 to withdraw your request and the next question comes from [caller name], Illinois Department of Insurance.  Your line is open.

Caller:

    Hi, I have a question about the letters of agreement, Page 12.  Is it right that those apply only if we propose to sub contract with either a non-profit or external group or another state agency?

Not if we propose simply to work with other state agencies and engage stakeholders, etcetera?

Michelle Feagins: 

    Yeah, it’s basically for you to do sub contracting.  It’s not for you to – for sub recipient.  So for if you want to procure a contract yes, that’s what this letter of intent is for.

Caller:  

    Okay.   Thank you.

Operator

    I’m showing no further questions at this time.

Nancy De Lew:

    Okay.  Then let me make some wrapping up remarks.  I want to…

Judy Ceresa: 

    This is Judy Ceresa from grants.gov, can I just chime in and say that a lot of folks on the line sound like they’re new grantees and I just want to stress that it’s really important to register early in grants.gov because it can take quite a long time to become registered in order to submit your application successfully through the grants.gov system.

And if you have any questions please look on our website, we have some very helpful user guides for applicants and there’s plenty of places to get answers to all of your questions.

Nancy De Lew:  

    Would you recommend people get on grants.gov in the next day or two?

Judy Ceresa:  

    Oh absolutely.  And they need to start registering now.  Because it can take – it’s supposed to take a week but it can take up to four weeks to become completely registered because there’s three parts to the application process, the registration process.

First you need a DUNS number, then you need to register with CCR and then you actually have to register in grants.gov.  So it’s pretty detailed process so I strongly encourage everyone to start that process now.

Nancy De Lew: 

    Okay.  Let’s underscore what Judy just said.  Right, we want people to apply early meaning so get on grants.gov, follow the instructions there in terms of registering.

We also want to underscore that the grants need to be submitted electronically, that’s why it’s important to go ahead and take care of all this housekeeping now while you’re developing what the application looks like.

We have technical support but our concern is that the system can be overloaded if all the states go on line at the same time on September 1 to upload their applications.

We had some issues with the rate review grants in terms of a number of applicants getting on at the last minute.  And it crashed the system.

So we’re trying to say to everyone, please apply early, the last week of August in Washington and like many other parts of the country a lot of people are on vacation.

We will have staff here in OCIIO that will be able to respond to any concerns people have in filing their applications.  We are not all going to be on vacation the last week of August, I can assure you that we will have staff here that will help you.

But you’ll help yourselves if you get on grants.gov and get started early and if you get your application uploaded early.

Wanted to make a couple other comments.  A recording of this call will be available, we expect it will be available in about 24 hours on our website which is www.hhs.gov/ociio.  We will also have a transcript of the call available.

That will be on our website in about 48 hours.  We are going to have a second call on August 25 at 2:00 eastern time with the same call in information for this call today.

We are more than happy to answer any questions you might have in the meantime between now and that call on August 25.  Our goal is that every state who applies gets their application in and we are then able to evaluate it in September.

We want everyone who wants to apply for this grant announcement to be able to do so, we want to be able to answer all your questions.

We’re going to as I noted earlier have questions and answers posted on the same website I noted earlier, our OCIIO website so all applicants will have access to that information.

And Donna I’m going to ask if you want to add anything to the list of items I just ran through.

Donna Laverdiere: 

    No, I would just encourage you to contact me directly if you have any programmatic questions after this call or at any point during the next 30 days.

Nancy De Lew:  

    Right, so Donna is our contact on the program questions, Michelle Feagins who is also on this call today is our contact on all of the grant administration type questions.

Please feel free to call us, we will route the call to the right person.  We look forward to working with states as you establish exchanges.  So with that I’m going to bring us to a close.  Thank you everyone.

Operator:

    This concludes today’s conference, thank you for participating, you may disconnect at this time.   END