Common use of Ineligibility criteria Clause in Contracts

Ineligibility criteria. Each award made under this Funding Opportunity should not be used for activities funded by other CMS or federal grant/cooperative agreement awards. In the budget request, applicants should distinguish between activities that will be funded under this application and similar activities funded with other CMS or federal sources, if applicable. The following entities are ineligible to apply under this Funding Opportunity: • Health insurance issuers; • Subsidiaries of health insurance issuers; • Issuers of stop loss insurance and their subsidiaries; • Associations that include members of, or lobby on behalf of, the insurance industry; or • Recipients of any direct or indirect consideration from any health insurance issuer or issuer of stop loss insurance in connection with the enrollment of any individuals or employees in a QHP or non-QHP. CMS has clarified in regulation that no health care provider shall be ineligible to operate as a Navigator in an FFE solely because it receives consideration from a health insurance issuer for health care services provided. Consistent with 45 C.F.R. § 155.215(a)(1)(i), all applicants (individuals, entities, and all members making up a consortium) should submit a brief statement (one or two short paragraphs) within the Cover Letter attesting that they, as Navigator cooperative agreement applicants, are not ineligible entities, and include attestations that all other Navigator entities (including subrecipients and contractors performing Navigator duties, the Navigator(s) including the Navigator's staff),19 do not have any of the prohibited relationships with health insurance or stop loss insurance issuers that are outlined above. As is explained in 45 C.F.R. § 155.215 and the preamble language discussing that provision, some conflicts of interest (other than the prohibited relationships outlined above) would not be absolute bars to service as a Navigator, provided that the conflict of interest would not ultimately prevent the entity or individual from providing information and services in a fair, accurate, and impartial manner. In addition, in accordance with 45 C.F.R. § 155.215(a)(1)(ii) and in compliance with the Standard Terms and Conditions that will be included in a Notice of Award, all successful applicants will be required to provide a written plan to remain free of conflicts of interest and to disclose to CMS, as operator of the FFE, certain non- disqualifying conflicts of interest as specified in 45 C.F.R. § 155.215(a)(1)(iv).