The Centers for Medicare & Medicaid Services (CMS) issued the Health Care Innovation Awards funding opportunity announcement (FON# CMS-1C1-12-001) (FOA) on Nov. 14, 2011, seeking to award up to $900 million toward innovative projects that test new payment and service delivery models to deliver high-quality health care services and lower costs. Awards were to be made for up to three years through annually renewable cooperative agreements.
CMS received approximately 3,000 applications for the Health Care Innovation Awards, representing many individuals and organizations from across all states, U.S. territories, and the District of Columbia. CMS contracted with an external organization with extensive experience in managing independent grant review processes to administer the award review process to ensure an objective review of each application.
Initial Application Screen
The CMS contractor, Grant Solutions, reviewed all applications to ensure they met the criteria specified in the FOA. Approximately 700 applications did not meet the criteria for review based on the FOA and the Awarding Agency Grants Administration Manual (AAGAM). The organizations that submitted these applications were notified that their application did not meet the criteria for review and that their application would not be moving forward in the review process. Ultimately, Grant Solutions determined that 2,260 applications met the eligibility criteria.
Role of the Review Panels
Next, eligible applications were reviewed and scored by objective review panels in accordance with the procedures described in the AAGAM, Chapter 2.04.104C. Due to the large number of applications, 190 independent panels were required. Each review panel consisted of two to three reviewers and a panel lead. All panel reviewers were trained by the independent contractor on how to apply the criteria in the FOA to evaluate each application and how to record scores and comments in their online system. The Innovation Center staff explained the goals of the awards to the reviewers during the contractor's training on the FOA criteria.
Final Decisions by the Designated Official
The designated official, Richard J. Gilfillan, MD, convened a group of the senior, experienced leaders within the Center for Medicare and Medicaid Innovation (Innovation Center) to serve on a Health Care Innovation Awards advisory selection committee. The Health Care Innovation Awards advisory selection committee closely reviewed each of the highest scoring applications and recommended to the designated official either:
a) The application not be considered for funding because of its inconsistency with criteria specified in the FOA; or
b) The application be assigned to the appropriate group for prioritization among related applications (a portfolio category).
In this process, 166 applications were grouped into portfolio categories. The Health Care Innovation Award advisory selection committee then reviewed each portfolio category and prioritized of the applications within each group.
Since these 166 applications constituted requests for funding that far exceeded the $900 million available, the designated official consulted with the Health Care Innovation Awards selection committee to prioritize recommendations for funding up to the funds available. The recommendations were selected in a manner that sought to create a balanced portfolio representing a range of interventions and geographic diversity across the United States and its territories.
At all times, staff and Health Care Innovation Awards advisory selection committee members recused themselves from discussion of an application if their participation could have created the appearance of a conflict of interest. Final decisions were made by the designated official, Dr. Gilfillan, except in one case where there was a possible appearance of a conflict of interest. In that case, the Acting Deputy Director for Policy and Programs of the Innovation Center, Sean Cavanaugh, was the deciding official.