r-1 Notice of Grant Application: DPHSS 2 attachments '!2:l N Notice to Speaker.pdf 311K 12:l 201& OPHSS 032N.

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1 413/2015 Mail at Jt.di Won Pat Mail - Notice of Grant Application: DPHSS ii Notice of Grant Application: DPHSS Speaker Won Pat <speaker@judlwonpatcom> Speaker Won Pat <speaker@judiwonpat.com> To: Guam Legislature Clerks Office <clerks@guamlegislature.org> Fri, Apr 3, 2015 at 2:15 PM Office of the Governor of Guam Department of Public Health and Social Services federal grant renewal application submitted for concurrent intergovernmental revie\v [Quoted text hidden] Ufisinan Etmas Ge'helo'Gi Liheslaturan Guahan Office of Speaker Judith T. Won Pat, Ed.D. Kumiten ldukasion Tinakhelo', Kottura, Laibirihan Pupbleko siha yan Asunton Famalao'an 155 Hesler Place, Suite 201, Hagatna, Guam Tel: (671) Fax: (671) speaker@judiwonpat.com 2 attachments '!2:l N Notice to Speaker.pdf 311K 12:l 201& OPHSS 032N.pdf 9403K r-1 ()liil-t' ol 1hc "'P'-.\\,, Judith i. \\ Pll P:il dj) 0:: 0(l7...;) htlps:llmail.google.com/maillulof?l;=2&ik=684dd7ee87&view=pt&search=sent&msg= 14c7d7d84396a4bO&siml= 14c7d7dB4396a4bO 1/1

2 GUAM STATE CLEARNGHOUSE P.O. Box 2950 Hagåtna, Guam Tel: (671) Website: EDDE BAZA CALVO Maga låhen Guahan RAYMOND S. TENORO Segundu Na Maga låhen Guahan Kate G. Baltazar Administrator Honorable Judith T. Won Pat, Ed.D. Speaker Mina Trentai Dos Na Liheslaturan Guåhan 155 Hesler Place Hagåtña, Guåhan July 23, 2013 Ref: Department of Public Health and Social Services federal grant renewal application submitted for concurrent intergovernmental review Hafa Adai Speaker Won Pat: This is to notify the Bureau of Budget Management and Research (BBMR) the Guam State Clearinghouse (GSC) has received a federal grant application from the Department of Public Health and Social Services, Division of Senior Citizens. The Guam State Clearinghouse has accepted the application, assigned a State Application dentifier (SA) N and has initiated the process for intergovernmental review. nformation on the application is provided below: CFDA Number: Grantor: US Department of Health and Human Services, Administration for Community Living Grant Title: State Health nsurance Assistance Program (SHP) Details: Start Date: 04/01/2014 End Date: 03/31/2016 Federal Amount: $40, The funds from this grant will be used to support SHP activities. The program provides beneficiaries with information and assistance to help them understand their Medicare benefits so they can make informed health care decisions. This is done through personalized counseling, awareness presentation, and outreach activities throughout the community. Deadline for comments is April 13, 2015 and can be sent via to clearinghouse@guam.gov. This is in an effort to reduce costs associated with the review process while maintaining efficiency. This notice is sent to you as part of the intergovernmental review of this application and may be referred to the appropriate overseeing committee of Liheslaturan Guåhan. The GSC point of contact designated for this application is Roe-Ann M. Cruz and can be contacted via at roeann.cruz@guam.gov. Please convey any instruction to GSC that may be incorporated in the review of this application. Dångkolo Na Si Yu os Ma åse, Kate G. Batazar Administrator CC: File

3 GOVERNMENT OF GUAM DEPARTMENT OF PUBLC HEALTH AND SOCAL SERVCES DPATTAMENTON SALUT PUPBLEKO YAN SETBSON SUS/AT EDDE BAZA CALVO GOVERNOR RAY TENORO LEUTENANT GOVERNOR Memorandum FEB JAMES W. GLLAN DRECTOR LEOG.CASL DEPUTY DRECTOR To: From: Subject: Administrator, Guam State Clearinghouse Director, Department of Public Health and Social Services Request for Review of the FY 2015 Guam SHP Basic Program Grant Renewal Application (CFDA: ) Buenas! Provided for concurrent review is the FY 2015 Guam State Health nsurance Assistance Program (SHP) Grant Renewal Application, which the Department of Public Health and Social Services (DPHSS) will upload on grantsolutions.gov by the submission deadline of February 18, 2015 as a non-competitive and non-matching application for funding to continue supporting SHP activities in Grant Year The granting agency, Administration for Community Living (ACL), has pre-determined in the grant application kit that Guam SHP will receive $40,870 in FY 2015, a decrease of2.66% from the FY 2014 award. The Division of Senior Citizens, within DPHSS, has been administering the island's SHP, locally known to residents as the Guam Medicare Assistance Program, since Program staff and a cadre of volunteers provide our island's Medicare beneficiaries with information and assistance to help them understand their Medicare benefits for them to make informed health care decisions. Guam SHP provides assistance through personalized counseling, awareness presentations, and various outreach activities throughout the community. Should you have any questions, please feel free to contact Mr. Arthur U. San Agustin, MHR, Senior Citizens Administrator at or Attachments 123 CHALAN KARETA, MANGLAO, GUAM Ph.: Fax:

4 GUAM STATE CLEARNGHOUSE P.O. Box 2950 Hagatna, Guam Tel: (671) Website: EDWARD J.B. CALVO Maga 'a hen Guahan RAYMOND S. TENORO Segundu Na Maga 'lrlhen Guahan Grant Project Application Notice of ntent to Apply for Federal Assistance GSC FORM REVSED 03/ 21 / 2012 Guam State C/eal'inglumse Use Only Date Received: ~ll~ \l( " Received By: ~~\ffo ~~ - SAl Number: ~J- l~1(57)-~ Type of Application 1 New Grant* [X Continuing Grant** 1 Supplemental Grant** 1 Other* A.) DUNS Number B.) Date [February 16,2015 C.) Applicant/Department Name Guam Dpeartment of Public Health and Social Services D.) Division [Division of Senior Citizens E.) Applicant Address 123 Chalan Kareta Mangilao, Guam F.) Applicant/Department Point of Contact nformation Contact Person Name!Arthur U. San Agustin, MHR Phone Number Address [arthur.sanagustin@dphss.guam.gov G.) Due Date to Federal Agency [February 18, ) Non-Federal, Matching Funds a.) Local!o H.) Federal Funds a.) Grant b.) Other 1$40,870 b.) n-kind c.) Other jo lo J.) TOTAL FUNDS 1$40,870 K.) CFDA/Federal Program Name State Health nsurance Assistance Program L.) Federal Agency Name!Administration for Community Living M.) Federal Agency Address One Massachusetts Avenue, NW Washington, DC Page 1 of 2 Proceed to Question Section 0. **Proceed to Section N - ONLY *Doc. APPLCABLE No. 33GL TO CONTNUNG AND SUPPLEMENTAL GRANTS.

5 N.) For Continuing or Supplemental Grants, Please provide the following information: a.) nitial Grant Period [April1, 2012 through March 31, 2016 b.) Guam State Clearinghouse SAl Number SY c.) Grant Year This Application mpacts 0.) Has the Federal Funding Agency been notified? !Xi YES NO P.) During which Fiscal Year will this program be implemented? FY 2015 Q.) f the project requires local funding in addition to the federal funding requested, please specifically identify source and rationale: None R.) This program is: Budgeted - Please identify legal budget authority X Non- Budgeted S.) Will this program require the hiring of additional employees? s YES, please provide the number of employees (both existing and new) and justification. E.. X YES - s1xt1ng 1 New 1 1 NO Two (2) Program Coordinator ll positoins are funded through this grant through cost allocation. Of these two (2) posiions, one (1) is currently vacant and is in the process of being recruited. T.) List Departments and Agencies that would be affected directly or indirectly by this application Department of Public Health and Social Services U.) Please provide a Project Summary with supporting documents if needed. Section 4360 of the Omnibus Budget Reconciliation Act of 1990 (OBRA) (Public Law , codified at 42 USC 1395 b-4) authorizes the Department of Health and Human Services (HHS) to make grants to states and territories to fund Stated Health nsurance Assistance V.) Please answer the following: SUBMTED AND APPROVED BY: a.) Does this application require an Environmental mpact Study? b.) Will this application conflict with any existing law? c.) s enabling legislation required? d.) Will the program require a maintenance of effort? e.) Are in-kind services allowed for this program? f.) Does this program allow an indirect cost rate to be applied? YES [X NO YES X NO 1 YEs X No 1 YEs rx No X YES [ NO YES X NO Printed Name, Position!Title of Authorized Representative James W. Gillan, DPHSS Director SGNATURE Date FEB

6 Table Of Contents Applicant: Application Number: Project Title Status: Guam, Division of Senior Citizens DPHSS SA STATE HEALTH NSURANCE ASSSTANCE PROGRAM Submitted Grant Announcement SHP Basic Grant Program Renewal Application SHP Basic Grant Program Announcement nformation for the Applicant 1. FY2014 Year End and FY15 Basic Grant Submission Online Forms 1. SF-424 Application for Federal Assistance Version 2 2. SF-424A Budget nformation - Non-Construction 3. SF-424B Assurances - Non-Construction 4. Key Personnel Additional nformation to be Submitted 1. ACL Lobbying Form (Upload #1): 2015 Guam SHP ACL Lobbying Form 2. Miscellaneous nformation (ACL) (Upload #2): 2015 Guam SHP Mise- Blank Sheet 3. Project Narrative (ACL) (Upload #3): Guam SHP FY14 Year End and FY15 Basic Grant Submission 4. Budget Narrative (Upload #4): 2015 Guam SHP Detailed Budget Justification Note: Upload document(s) printed in order after online forms. Page 1 of 37

7 OMB Number: 4040~0004 Expiration Date: 03/31/ Application for Federal Assistance SF-424 Version 02 " 1. Type of Submission: * 2. Type of Application: *f Revision, select appropriate letter(s): 0Preapplication 0New ~pplication 18]continuation * other (Specify) Ochanged!Corrected Application QRevision * 3. Date Received: 4. Applicant dentifier: jo2/17/2015 Sa. Federal Entity dentifier: * Sb. Federal Award dentifier: 90SA0026 State Use Only: 6. Date Received by State: 102/17/ State Application dentifier: 1 8. APPLCANT NFORMATON: a. Legal Name: Guam, Division of Senior Citizens DPHSS " b. Employerffaxpayer dentification Number (ENfTJN): *c. Organizational DUNS: E d. Address: * Street1: 1123 Chalan Kareta Street2: *City: Mangilao County: *State: Guam Province: *Country:!UNTED STATES *Zip Postal Code: e. Organizational Unit: Department Name: Division Name:!Guam Deparment of Public Heal! Division of Senior Citizens f. Name and contact information of person to be contacted on matters involving this application: Prefix: Mr. First Name: Arthur Middle Name: 1 U. Last Name: San AQustin Suffix: MHR Title:!Guam SHP Project Director Organizational Affiliation: Telephone Number: Fax Number: * larthur.sanagustin@dphss.guam.gov Page 2 of37

8 OMB Number: Expiration Date: 03/31/2012 Application for Federal Assistance SF-424 Version Type of Applicant 1: Select Applicant Type: u.s. Territory or Possession Type of Applicant 2: Select Applicant Type: Type of Applicant 3: Select Applicant Type: *Other (specify): * 10. Name of Federal Agency: ACL-Center for Disability and Aging Policy 11. Catalog of Federal Domestic Assistance Number: CFDATitle: state Health nsurance Assistance Program(SHP) * 12. Funding Opportunity Number: Not Applicable,, *Title:,,.,~- 13. Competition dentification Number: Not Applicable Title:,., """''""' 14. Areas Affected by Project (Cities, Counties, States, etc.): Guam "15. Descriptive Title of Applicant's Project: STATE HEALTH NSURANCE ASSSTANCE PROGRAM Attach supporting documents as specified in agency instructions. Page 3 of37

9 OMB Number: Expiration Date: 03/31/2012 Application for Federal Assistance SF-424 Version Congressional Districts Of: * a. Applicant Guam * b. Program/ProjectfGuam Attach an additional list of Program/Project Congressional Districts if needed. u 17. Proposed Project: a. Start Date: 104/01/2014 b. End Date: 103/31/ Estimated Funding($): *a. Federal <tuo/ Uj * b. Applicant Ol *c. State Ol *d. Local Ol *e. Other Ol *f. Program ncome Ol g. TOTAL * 19. s Application Subject to Review By State Under Executive Order Process? oa. This application was made available to the State under the Executive Order Process for review on Eib. Program is subject to E.O but has not been selected by the State for review. De. Program is not covered by E.O * 20. s the Applicant Delinquent On Any Federal Debt? {f "Yes", provide explanation.) Oves ~No ~!~e~.j -~: '':=' this application, certify (1) to the statements contained in the list of certifications** and (2) that the statements 1 are true, complete and accurate to the best of my knowledge. also provide the required assurances** and agree to com ~~-i-~-i~~-_any resulting terms if accept an award.! am aware that any false, fictitious, or fraudulent statements or claims may me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) ~.. AGREE **The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions. Representative: Prefix: Mr. * First Name: Middle Name: W. *Last Name: Gillan Suffix: Title:!Guam DPHSS Director Telephone """'""' : Fax Number:~u liames.gillan@ldehss.guam.gov Signature of Authorized Representative: [Mr. Artfiijf ~an ~n 1 Date Signed: 102/17/2015 Authonzed for Local Reproduction Standard Form 424 (Rev1sed 10/2005) Prescribed by OMB Circular A-102 Page 4 of37

10 OMB Number: Expiration Date: 03/31/2012 Application for Federal Assistance SF-424 Version 02 *Applicant Federal Debt Delinquency Explanation The following field should contain an explanation if the Applicant organization is delinquent on any Federal Debt. Maximum number of characters that can be entered is 4,000. Try and avoid extra spaces and carriage returns to maximize the availability of space. Page 5 of37

11 7<:, ;'. tid;;,;;~:;;; Grant Program Function or Activity (a) Catalog of Federal Domestic Assistance Number (b) BUDGET NFORMATON- Non-Construction Programs : ::;~' {~< (2' ~$'i;~:tlo.r:j:faj\\~!:jj!>:gjo;i;[~j1j:flm~]~. ~F?. Estimated Unobligated Funds New or Revised Budget OMB Approval No t:.xpiration LJate: UO/::SU:l01 Federal Non-Federal Federal Non-Federal Total (c) (d) (e) (f) (q) 1. SA- State Health nsuran $40, $40, SA- State Health nsuram 3. SA- State Health nsuran1 4. SA- State Health nsuram 5. Totals 6. Object Class Categories '"'' $40, $40, :y;;j ;;,o$10:citi!llnjlb}:ll.s:u.q:!:i!oifrt{ ~'il!og~q8.1es}. :... GRANT PROGRAM, FUNCTON OR ACTVTY (1) SA- State Health nsurance (2) SA- State Health nsurance (3)1th nsurance Assistance (4)1th nsurance Assistance (5) Total a. Personnel b. Fringe Benefits c. Travel d. Equipment e. Supplies f. Contractual g. Construction h. Other i. Total Direct Charges (sum of 6a-6h) j. ndirect Charges k. TOTALS (sum of6i and 6j) }.'' "; ;. :. ;..}. '. '.,; '. ;! )'';\L}:C.''',.,, 7. Program ncome Previous Edition Usable Page 6 of 37 $22, $10, $7, $ $ $40, $40, :;;;{;' ;;;,, ~ 0~2}}!1".!' : Authorized for Local Reproduction $22, $10, $7, $ $ $40, $40, ~ Standard Form 424A (Rev. 7-97) Prescribed by OMB Circular A-102

12 SA -State Health nsurance Assistance Program(SHP) SA- State Health nsurance Assistance Program(SHP) 1 O. SA- State Health nsurance Assistance Program(SHP) 11. SA- State Health nsurance Assistance Program(SHP) 12. TOTAL (sum of lines 8-11) 13. Federal $40, $40, Non-Federal 15. TOTAL (sum of lines 13 and 14) $40, $40, SA- State Health nsurance Assistance Program(SHP) 17. SA- State Health nsurance Assistance Program(SHP) 18. SA- State Health nsurance Assistance Program(SHP) 19. SA- State Health nsurance Assistance Program(SHP) Authorized for Local Reproduction Standard Form 424A (Rev. 7-97) Page 2 Page 7 of37

13 OMB Approval No.: Expiration Date: 06/30/2014 ASSURANCES NON-CONSTRUCTON PROGRAMS Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project ( ), Washington, DC PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFCE OF MANAGEMENT AND BUDGET. SEND T TO THE ADDRESS PROVDED BY THE SPONSORNG AGENCY. NOTE: Certain of these assurances may not be applicable to your project or program. f you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. f such is the case, you will be notified. As the duly authorized representative of the applicant, certify that the applicant: Has the legal authority to apply for Federal assistance and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management and completion of the project described in this application. Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. Will initiate and complete the work within the apphcable time frame after receipt of approval of the awarding agency. Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U. S.C ), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L ), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L ), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health Service Act of 1912 (42 U.S. C. 290 dd-3 and 290 ee- 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title V of the Civil Rights Act of 1968 (42 U.S.C et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, 0) the requirements of any other nondiscrimination statute(s) which may apply to the application Will comply with the ntergovernmental Personnel Act of 1970 (42 U.S.C ) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title V of the Civil Rights Act of 1964 (P.L ) which prohibits discrimination on the basis of race, color or national origin; (b) Title X of the Education Amendments of 1972, as amended (20 U.S.C , and ), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Will comply, or has already complied, with the requirements of Titles and ll of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L ) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federallyassisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. Will comply, as applicable, with provisions of the Hatch Act (5 U.S.C and ) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. Previous Edition Usable Standard Form 4248 (Rev. 7 97) Prescribed by OMB Circular A-102 Authorized for Local Reproduction Page 8 of37

14 9. Will comply, as applicable, with the provisions of the Davis Bacon Act (40 U.S.C. 276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874), and the Contract Work Hours and Safety Standards Act (40 U.S.C ), regarding labor standards for federally-assisted construction subagreements. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L ) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L ) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C et seq.); (f) conformity of Federal actions to State (Clean Air) mplementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L ); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L ). 12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C et seq.) related to protecting components or potential components of the national wild and scenic rivers system. ' SGNATURE OF AUTHORZED CERTFYNG OFFCAL JAMES W. GLLAN ' APPLCATON ORGANZATON Guam, Division of Senior Citizens DPHSS 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.). 14. Will comply with P.L regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L , as amended, 7 U.S.C et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C et seq.) which prohibits the use of lead-based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non-Profit Organizations." 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program. 19. Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000, as amended (22 U.S.C ) which prohibits grant award recipients or a sub-recipient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is in effect (2) Procuring a commercial sex act during the period of time that the award is in effect or (3) Using forced labor in the performance of the award or subawards under the award. *TTLE GUAM DPHSS Director *DATE SUBMTTED 02/17/2015 Standard Form 424B (Rev. 7-97) Back Page 9 of37

15 KevP Name Position Title Annual Salary No.Months % Fed Non-Fed Total Amount Budget Time Amount Amount Requested Cathy Bayona Program Coordinator 46, , , , Page 10 of 37

16 Upload #1 Applicant: Application Number: Project Title Status: Document Title: Guam, Division of Senior Citizens DPHSS SA STATE HEALTH NSURANCE ASSSTANCE PROGRAM Submitted 2015 Guam SHP ACL Lobbying Form Page 11 of37

17 Close fom1 Print Page About CERTFCATON REGARDNG LOBBYNG Certification for Contracts, Grants, Loans, and Cooperative Agreements The undersigned ce11ifies, to the best of his or her knowledge and belief. that: () No Federal appropriated funds have been paid or 1\~ll be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan. the entering into of any cooperative agreement, and the extension, continuation, renewal. amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) f any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contrac t, grant, loan, or cooperative agreeme nt, the undersigned shall complete and submit Standard Form-LLL. "Disclosure of Lobbying Activities." in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts. subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certi fi cation is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submjssion of this certification is a prerequisite for making or entering into th.is transaction imposed by section 1352, title 31. U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,00 0 and not more than $1 00,000 for each such failure. Statement for Loan Guarantees and Loan nsurance The undersigned states, to the best of his or her knowledge and belief. that: f any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. Submission of this statement is a prerequisite for making or entering into thjs transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall be subjec t to a civil penalty of not less than $1 0,000 and not more than $100,000 for each such failure. 'APPLCANT'S ORGANZATON!Guam Depa11ment of Public Health and Social Services ' PRJNTED NAME AND TTLE OF AUTHORZED REPRESENT A T!VE Prefix: Mr. First Name: James Middle Name: W. Last Name: Gi llan Suffix: Title: Guam DPHSS Director 'SGNATURE: \completed on submission to Grants.gov * DATE: Completed on submission to Grants.govl Page 12 of 37

18 Upload #2 Applicant: Application Number: Project Title Status: Document Title: Guam, Division of Senior Citizens DPHSS SA STATE HEALTH NSURANCE ASSSTANCE PROGRAM Submitted 2015 Guam SHP Mise- Blank Sheet Page 13 of 37

19 This page is left intentionally blank to remove the red exclamation point under Miscellaneous contained in our 2015 Guam SHP Grant Application (90SA0026) Page 14 of 37

20 Upload #3 Applicant: Application Number: Project Title Status: Document Title: Guam, Division of Senior Citizens DPHSS SA STATE HEALTH NSURANCE ASSSTANCE PROGRAM Submitted Guam SHP FY14 Year End and FY15 Basic Grant Submission Page 15 of37

21 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE VEl. What actions has your State taken in FY 2014 to expand your outreach and counseling efforts to improve your PM 1 rating? (PMl -Number of total client contacts per 1, 000 Medicare beneficiaries in the State.) Please complete the chart below, and provide your plan or strategy to increase your score to meet or exceed the Minimal Attainment Threshold (MAT.) SLCES for Performance Measure (PM) 1 LCM LFM MM SM MC OUT PM for Period Ending Sept % CALCULATON SCORES (purple column) N/A N/A N/A N/A N/A PM for Period ncrease Ending Sept 14 Final Achieved 10 MAT- ndicate Below, At, or Above N/A N/A N/A N/A N/A Above EB- ndicate At or Above N/A N/A N/A N/A N/A Above VEl Guam SHP Response: Guam SHP exceeded both the Minimal Attainment Threshold and Exemplary Benchmark for PM1 yielding a Final Achieved score of 10 out of 10. Our PM calculated score for the period ending September 30, 2014 is 231.5, as compared to for the same period in 2013 increasing our score by 8.3%. During this reporting period, Guam SHP increased its counseling and outreach activities from the previous period, however, Guam SHP's continuous improvement in PM1 is as a result of Guam SHP staff and volunteers improving upon recording their client contacts efforts into shipnpr.shiptalk.org. Undoubtedly, Medicare information and assistance services are being provided to the island's beneficiaries, but in the past not all efforts were being reported timely into shipnpr.shiptalk.org, or were not being entered at all because Counselors were either forgetting their passwords or because they lost access to the system for not changing their password when prompted to. Now, once Counselors report the inability to access shipnpr.shiptalk.org, Program staff provide immediate assistance to identify their issue with the system and work to restore their access as soon as possible so they can enter their client contacts into this data base. f a Program staff is unable to resolve the issue, then Technical Frontiers, the group contracted to manage shipnpr.shiptalk.org is notified, via , to request for their assistance. Eventually, access is restored and data reporting resumes. For those who are not computer comfortable with using a computer, their client contact efforts are recorded on an intake form, which is then submitted to a Program staff to input the contact into shipnpr.shiptalk.org. BGP1. What specific and significant changes will your State enact during the FY 2015 grant year to expand your outreach and co unseling efforts, resulting in an improved performance score for performance measure 1? {PMl - Number of total client contacts per 1,000 Medicare beneficiaries in the State.) BGP1 Guam SHP Response: The Bureau of Community Support (BCS), where Guam SHP is administered within, recruited a Program Coordinator ll position in November 2014, partially funded by Guam SHP through cost allocation with other Federal resources performing similar activities. The newly recruited staff will coordinate and participate in more activities throughout the community to promote and heighten the Medicare information and assistance services provided by Guam SHP. Another Program Coordinator ll position within BCS, also cost allocated with SHP grant funds, is anticipated to be recruited during the 2015 grant period providing additional opportunities to 1 Page 16 of 37

22 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE conduct a greater number of activities, as well as will help to manage the volunteer workforce. Further, Guam SHP expects to provide its Joint SHP and SMP nitial Medicare Volunteer Training from March 23-27, 2015 for new Program volunteers. The increase in Program staff along with an expanded volunteer workforce in FV 2015 will provide Guam SHP with the ability to expand its scheduled counseling days from two (2) days per week to possibly three (3) to four (4) days, or to increase counseling hours on scheduled counseling days. Assessments will be conducted when the new Program staff and new volunteers are in place to determine the most feasible schedule for the Program. n FV 2015, Guam SHP will work on providing a greater number of personalized counseling assistance, engaging in a greater number of community outreach activities, and conducting more interactive awareness presentations to beneficiaries, their caregivers and family, thus, further increasing its score for PM 1. VE2. What actions did your St ate t ake in FY 2014 to expand your outreach and counseling efforts to improve your PM 2 rating? (PM2 -Number of persons reached through presentations/booths/exhibits at health/ senior fairs, enrollment events per 1,000 Medicare beneficiaries in the State.) Please complete the chart below, and provide your plan or strategy to increase your score to meet or exceed the Minimal Attainment Threshold (MAT.) SLCES for Performance Measure (PM) 2 LCM LFM MM SM M C OUT PM for Period Ending Sept % CALCULATON SCORES (purple column) N/A N/A N/A N/A N/ A PM for Period Decrease Ending Sept 14 Final Achieved 10 MAT- ndicate Below, At, or Above N/A N/ A N/A N/ A N/A Above EB- ndicate At or Above N/ A N/A N/ A N/A N/ A Above VE2 Guam SHP Response: Guam SHP exceeded both the Minimal Attainment Threshold and Exemplary Benchmark yielding a Final Achieved score of 10 out of 10. Our PM calculated score for the period ending September 30, 2014 is 260.0, as compared to for the same period in 2013 resulting in our score decreasing by 17.32%. For the period of October 1, 2013 through September 30, 2014, Guam SHP provided 148 interactive presentations, participated in 26 outreach events, and conducted 26 dedicated Part D enrollment events. Despite performing above the national Exemplary Benchmark, and slightly increasing its overall outreach activities in FY 2014, the Program' s score decreased from the previous year as there were less individuals reached through booths/exhibits at outreach events during the reporting period. The Program has gained a lot of Program exposure by being visible in the community at various outreach events; however, individuals who have seen us at other events are not likely to visit our table again if they have already inquired about the Program, or if they have no Medicare questions or issues to address. The purpose for Guam SHP being at these events is to provide awareness of the services provided by Guam SHP so that in the future if Medicare information and assistance is ever needed, then individuals w ill know they can seek assistance locally from o ur Program. BGP2. What specif ic and significant changes will your State enact during t he FY 2015 grant year to expand your out reach and co unseling efforts, resulting in an improved performance score for performance measure 2? 2 Page 17 of 37

23 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE (PM2 -Number of persons reached through presentations/booths/exhibits at health/senior fairs, enrollment events per 1,000 Medicare beneficiaries in the State.) BGP2 Guam SHP Response: For Guam SHP to improve upon its own score, it must engage in a greater number of community outreach as well as participate in events were a larger audience is expected to be in attendance to provide a better opportunity to reach more individuals at a single event. As mentioned in BCPl above, the Program is expected to recruit an additional Program staff and expand its volunteer workforce in FY 2015, which will allow Guam SHP to participate in other types of outreach activities that would reach the general community aside from the "health fair/conference/mall" setting and at the village level. One outreach activity that Guam SHP will work with its partner, the Title ll Case Management Services (CMS) Program, is to seek assistance from the village Mayors' offices to identify individuals within their respective villages who are living in isolated areas or whom are homebound and frail for the Program to provide them, their families and caregivers with Medicare information as well as aging program services through the Title ll CMS Program if they are not already accessing such services. YE3. What actions did your State take in FY 2014 to expand your outreach and counseling efforts to improve your PM 3 rating? (PM3-Number of substantialj personalj direct client contacts (te/ephonej in-person officej inperson home) per 1,000 Medicare beneficiaries in the State.) Please complete the chart below and provide your plan or strategy to increase your score to meet or exceed the Minimal Attainment Threshold {MAT.) SliCES for Performance Measure {PM) 3 LCM LFM MM SM MC OUT PM for Period Ending Sept % CALCULATON SCORES {purple column) N/A N/A N/A N/A N/A PM for Period ncrease Ending Sept 14 Final Achieved 10 MAT -ndicate Below, At, or Above N/A N/A N/A N/A N/A Above EB -ndicate At or Above N/A N/A N/A N/A N/A Above YE3 Guam SHP Response: Guam SHP exceeded both the Minimal Attainment Threshold and Exemplary Benchmark yielding a Final Achieved score of 10 out of 10. Our PM calculated score for the period ending September 30, 2014 is 220.1, as compared to for the same period in 2013 resulting in our score increasing by 7.26%. PM 1 and PM 3 correlates with one another as both measures, for the most part, use the same client contact data, however, PM1 takes into account a SHPs 11 total" client contacts through in-person office, in-person homej telephone {all durations}, and contacts by , postal and fax. n FY 2013, Guam SHP recorded 2,037 total client contacts, whereas in this reporting period, there were 2,549 contacts, an increase of 512 contacts or 25.13% from the previous year. Guam SHP's improvement in PM 3 is as a result of Counselors being more diligent in reporting their client data. There is no doubt that Guam SHP is servicing an increased number of the island's Medicare beneficiaries as there is greater awareness that Medicare information and assistance is available locally, which beneficiaries, families or caregivers prefer to access rather than going through the CMS information channels, such as MEDCARE and as many find these systems challenging to access because of language and technological barriers. 3 Page 18 of 37

24 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE Guam SHP's primary partner, the Title ll Case Management Services (CMS) Program, however, did not improve upon their own client contact numbers as in FY 2013, CMS recorded 903 total client contacts, whereas in FY 2014, they had 761 contacts, a decrease of 142 contacts or 15.72% from the previous year. The decrease can be attributed to the CMS Program experiencing several staff turn overs throughout the year, and the CMS staff not inputting their client contacts into shipnpr.shiptalk.org. The same issues Guam SHP encountered with regards to its Counselors' untimely reporting into shipnpr.shiptalk.org, and also not inputting their client contacts because individuals either forgot their passwords or because they lost access to the system for not changing their password when prompted are what the CMS Program staff are dealing with now. BGP3. What specific and significant changes will your State enact during the FY 2015 grant year to expand your outreach and counseling efforts, resulting in an improved performance score for performance measure 37 {PM3-Number of substantial, personal, direct client contacts (telephone, in-person office, in-person home) per 1,000 Medicare beneficiaries in the State.) BGP3 Guam SHP Response: For Guam SHP to further improve upon this PM, it will have to continue ensuring that Counselors are inputting all their client contact data within the required timeframe, which is 30 days after each reporting month. For Guam SHP to help its primary Program partner, the Title ll Case Management Services Program, improve upon their performance, Guam SHP will provide each Case Worker from this program with their client contact data during Guam SHP's monthly scheduled in-service session with this group showing each of them their client contact numbers inputted into shipnpr.shiptalk.org for the month, their year-to-date total, as well as a comparison of their efforts for the same period a year ago for those who were with the CMS Program back then. Guam SHP believes that presenting this information on a monthly basis will compel the Case Workers to want to improve upon their own personal scores and, hopefully, over time will show progress in their data reporting. YE4. What actions did your State take in FY 2014 to expand outreach and serve Medicare beneficiaries under the age of 65 with a disability to improve your PM 4 rating? (PM4- Number of contacts with Medicare beneficiaries under the age 65 with a disability per 1,000 Medicare beneficiaries under the age 65 in the State.) Please complete the chart below, and provide your plan or strategy to increase your score to meet or exceed the Minimal Attainment Threshold (MAT.) SLCES for Performance Measure (PM) 4 LCM LFM MM SM MC OUT PM for Period Ending Sept % CALCULATON SCORES (purple column) N/A N/A N/A N/A N/A PM for Period ncrease Ending Sept 14 Final Achieved 10 MAT -ndicate Below, At, or Above N/A N/A N/A N/A N/A Above EB - ndicate At or Above N/A N/A N/A N/A N/A Above YE4 Guam SHP Response: Guam SHP exceeded both the Minimal Attainment Threshold and Exemplary Benchmark yielding a Final Achieved score of 10 out of 10. Our PM calculated score for the period ending September 30, 2014 is 137.7, as compared to 95 for the same period in 2013 resulting in our score increasing by 44.94%. Because Guam SHP is 4 Page 19 of 37

25 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE housed within the Guam State Office on Aging, and it's primary Program partner, the Title ll Case Management Services {CMS) Program services those who are 60 years and above, individuals below 65 whom may also have a disability are generally provided Medicare information or asked if they have Medicare coverage when they are accessing aging program services through the CMS Program. Additionally, the outreach Guam SHP conducts at the four {4) dialysis facilities on Guam during Part D's Annual Election Period to reach those with End Stage Renal Disease (ESRD) has increased this population being aware of the locally accessible services provided by Guam SHP, which has resulted in a greater number of ESRD patients, their families or caregivers going to Guam SHP to seek coverage information, assistance with Part D enrollment or assistance with billing issues that they need help to resolve. Additionally, Guam SHP participates annually in several outreach events sponsored by groups servicing individuals with disabilities, such as the Autism Awareness Fair and the Guam System for Assistive Technology Fair to heighten Program awareness to the island's population of persons with disabilities, their families and caregivers. Guam SHP also conducts monthly awareness presentations at the Skilled Nursing Facility (SNF) to provide Medicare information and most especially Part D enrollment assistance to beneficiaries who are in need of a Part D plan as they have become eligible to enroll in a prescription drug plan under the Special Enrollment Period (SEP), as a result of being admitted into the inpatient unit at the SNF. BGP4. What specific and significant changes will your State enact during the FY 2015 grant year to expand outreach and serve Medicare beneficiaries under the age of 65 with a disability, resulting in an improved performance score for performance measure 4? {PM4- Number of contacts with Medicare beneficiaries under the age 65 with a disability per 1,000 Medicare beneficiaries under the age 65 in the State.) BGP4 Guam SHP Response: To reach a greater number of Medicare beneficiaries with a disability below the age of 65, Guam SHP, in FY 2015, will work closer with agencies serving individuals with disabilities, such as the Department of ntegrated Services with Disabilities {DSD), and the Guam Behavioral Health and Well ness Center {GBHWC) to gain access to the clients they serve by participating in their departmental activities when appropriate for Guam SHP to heighten and promote Program awareness to this population, their families and caregivers. Guam SHP will also meet with the Guam State Office (Guam SOA) on Aging's Program Coordinator overseeing the State Office's grant, "No Wrong Door (NWD) Program/ ADRC", which was awarded in September 2014 by the Administration for Community Living, as their main program partners involved in the NWD effort include the Guam Medicaid Program, DSD, and GBHWC. Although Guam SOA is in receipt of NWD grant funds, the first year of this program is solely planning, which at the end of the grant period is hoped to yield a 3-Year Plan that will provide a single NWD System for Guam's population to access available long Term Care Services and Supports on island. As Guam SHP is under the Guam State Office on Aging, Program staff will meet with the NWD coordinator to ensure our inclusion to the NWD system, which will provide greater access of Guam SHP services to the island's Medicare beneficiaries with a disability below the age of 65. YES. What actions did the State take in FY 2014 to reach low income beneficiaries and potential limited income subsidy (LS) eligible beneficiaries designed to improve your PM 5 rating? (PMS -Number of unduplicated lowincome Medicare beneficiary contacts and/or contacts that discussed /ow-income subsidy (LS) per 1,000 lowincome Medicare beneficiaries in the State.) Please complete the chart below, and provide your plan or strategy to increase your score to meet or exceed the Minimal Attainment Threshold (MAT.) 5 Page 20 of 37

26 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Applicat ion GUAM STATE SLCES for Performance Measure (PM) 5 LCM LFM MM SM MC OUT PM for Period Ending Sept % CALCULATON SCORES (purple column) N/A N/A N/A N/A N/ A PM for Period ncrease Ending Sept 14 Final Achieved MAT- ndicate Below, At, or Above N/A N/A N/A N/A N/A Below EB- ndicate At or Above N/A N/A N/A N/ A N/ A Below YES Guam SHP Response: Guam SHP did not meet the Minimal Attainment Threshold nor did it reach the Exemplary Benchmark for PMS, as the yielded a Final Achieved score of.45 out of 10. Our PM calculated score for the period ending September 30, 2014 is 65.5, as compared to 57.1 for the same period in 2013 resulting in our score increasing by 14.71%. This measure engages the SHPs to identify beneficiaries with limited income and resources to inform them about the Low ncome Subsidy {LS) Program as these individuals may qualify to receive "extra help" with their Part D premium, deductible and co-payments through this federally subsidized program. Guam SHP has always scored below the MAT for PM3, and will likely continue to do so as the LS program does not apply to the U.S. Territories, thus eligible beneficiaries on Guam do not qualify for this program. Although the LS program is not extended to the U.S. Territories, Guam SHP will occasionally receive inquiries from beneficiaries who received letters from the Social Security Administration (SSA) informing them that they qualify to receive "Extra Help" with their prescription drugs as they were automatically deemed eligible by SSA for this program. Each time this occurs, Guam SHP informs the beneficiary to disregard SSA's letter as LS is not available to eligible beneficiaries living in the U.S. Territories. Guam SHP has communicated this issue with SSA and was told that although these letters should not be issued to eligible beneficiaries living in the Territories, there are a few that are mistakenly mailed out because the letters are computer generated. t has become easier for Guam SHP to explain that the LS program is not extended to the Territories because this information is now indicated in the Medicare and You Handbook, unlike when the program initially began Program staff were without a written source to reference and beneficiaries were adamant on receiving help with their prescription drug costs because of the written notification received from SSA. BGPS: What specif ic and significant changes w ill your State enact during the FY 2015 grant year to expand outreach and serve M edicare beneficiaries wit h limited incomes, resulting in improved performance score for performance measure 5? (PMS -Number of unduplicoted low-income Medicare beneficiary contacts and/or contacts that discussed Low-ncome Subsidy {LS} per 1,000 low-income Medicare beneficiaries in the State.) BGPS Guam SHP Response: t is difficult for Guam SHP to improve upon PMS as this measures places emphasis on efforts to reach individuals eligible for the LS program, a program f irst offered in 2006 but has never been available for Guam's eligible Medicare beneficiaries. As a result, Guam SHP would like to request the Administration for Community living to discount PMS for Guam SHP until such time the LS program is extended to the Territories. Guam SHP finds it difficult to even attain the MAT level for this m easure, which subsequently impacts Guam SHP's Overall Performance Score (OPS) as PMS is w eighted at 15%. Despite this quandary, Guam SHP intends to develop an even closer relationship wit h the Bureau of Health Care Finance Administration within the Department of Public Health and Social Services for this bureau oversees 6 Page 21 of 37

27 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE both, the Medicaid and Medically ndigent Program providing the island's low income population with health care coverage. n FY 2015, Guam SHP will continue to encourage Medicare beneficiaries with limited income to seek eligibility for additional health coverage with the Guam Medicaid Program as dual-eligibles (Medicare/Medicaid) receive assistance from Medicaid to cover their out-of-pocket health care and drug expenses as well as with their monthly Part B premium payments and annual deductible. For those with limited income but not Medicaid eligible, possibly due to non-u.s. Citizenship status or not meeting Medicaid's income eligibility criteria, Guam SHP will encourage these individuals to seek eligibility with the locally funded Medically ndigent Program (MP) as this program covers a percentage of a person's out-of-pocket health care and drug expenses based on their low income level. YE6. What actions did your State take in FY 2014 to increase the number of beneficiaries provided enrollment assistance designed to improve your PM6 rating? (PM6 - Number of unduplicated enrollment contacts discussed per 1,000 Medicare beneficiaries in the State.) Please complete the chart below, and provide your plan or strategy to increase your score to meet or exceed the Minimal Attainment Threshold (MAT.) SliCES for Performance Measure (PM) 6 LCM LFM MM SM MC OUT PM for Period Ending Sept % CALCULATON SCORES (purple column) N/A N/A N/A N/A N/A PM for Period Decrease Ending Sept 14 Final Achieved 10 MAT -ndicate Below, At, or Above N/A N/A N/A N/A N/A Above EB- ndicate At or Above N/A N/A N/A N/A N/A Above YE6 Guam SHP Response: Guam SHP exceeded both the Minimal Attainment Threshold and Exemplary Benchmark yielding a Final Achieved score of 10 out of 10. Our PM calculated score for the period ending September 30, 2014 is , as compared to for the same period in 2013 resulting in our score decreasing by 5.26%. Although Guam SHP experienced a decrease in this PM, awareness of Guam SHP's services has increased over the years, that Guam SHP is now known in the community as the Program locally available to obtain Medicare information and to seek assistance. Prior to 2004, islanders primarily obtained their Medicare information and assistance from the Social Security Administration (SSA), Guam District office, however SSA's Medicare services were limited to fulfilling their mandate of determining Medicare eligibility and processing enrollments for Original Medicare. For those needing assistance beyond what SSA provides, SSA now refers beneficiaries to Guam SHP to obtain locally accessible comprehensive Medicare counseling to get their questions answered or Medicare billing issues resolved. As such, Guam SHP receives a continuous flow of referrals from this Federal agency. n an effort to raise awareness of Original Medicare's General Enrollment Period (GEP), SSA supported Guam Department of Public Health and Social Services' issuance of a press release in January 2015 to the local media outlets informing the community about the brief period to enroll in Medicare for those eligible. This effort is beneficial to the Program not only because there was no cost to heighten GEP awareness through the media, but a local newspaper, the Pacific Daily News, offered to occasionally publish the GEP information through March 31' 1 in a section within their paper called "On the Fridge" to continue promoting the awareness of the GEP. n addition to Original Medicare, Guam SHP also provides awareness and answers inquires about Medicare Supplemental nsurance, also known as Medigap. There are currently two (2) providers, one (1) locally based 7 Page 22 of 37

28 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE and one (1) from off-island, both licensed to sell such policies on Guam. Beneficiaries looking to obtain additional coverage to help pay for their out-of-pocket expenses are informed about how the various Medigap policies work together with Medicare. f they are interested in learning more about Medigap or express the desire to purchase a plan, then beneficiaries are encouraged to visit TakeCare nsurance's office to obtain additional coverage as well as cost information from them. n addition, beneficiaries are also assisted in requesting United HealthCare to send them their Medigap materials so they can compare plans and costs. Only after obtaining information from both providers will beneficiaries be able to make an informed health care decision on whether they should obtain Medicare supplemental insurance, and if so, identify a policy that would be affordable and best meet their health care needs. BGP6: What specific and significant changes will your State enact during the FY 2015 grant year to expand the number of beneficiaries provided enrollment assistance, resulting in an improved performance score for performance measure 6? (PM6- Number of unduplicated enrollment contacts discussed per 1,000 Medicare beneficiaries in the State.) BGP6 Guam SHP Response: This is the first time Guam SHP has collaborated with the Social Security Administration (SSA), Guam District Office, on the issuance of a press release to the local media to promote island-wide awareness of the General Enrollment Period (GEP) for Original Medicare. Feedback on the impact of the press release from SSA's Guam District Manager has been positive that Guam SHP would likely replicate this effort next grant year as long as SSA continues to provide support. The effect of releasing such information to the community produces higher call volumes and office visits to SSA as more people become aware of the opportunity to enroll in Medicare if they have missed their nitial Enrollment Period (EP) to obtain Federal health care coverage. Despite having limited staff and shortened hours for the public, SSA Guam District Manager welcomes the influx of Medicare eligibility and enrollment inquiries. Additionally, there are individuals who are of Medicare age and do not receive a Social Security pension, but worked for the private sector or the Federal government/civil Service and were having Medicare taxes taken from their payroll check. When Guam SHP meets up with these individuals they are highly encouraged to go to SSA's office to find out if they qualify for Part A (hospital insurance coverage) as a result of them, or their spouse, meeting the 40 work credit requirement. Guam SHP is seeing an increase in Medicare supplemental insurance inquiries as beneficiaries hear about these plans from companies marketing their plans on television, or from their friends who share how this type of supplemental coverage along with Medicare has helped them pay their medical expenses. n FY 2015, Guam SHP will continue providing awareness on the availability of such plans, most especially to those with only Medicare insurance and are faced with high out-of-pocket health care expenses. YE7. What actions did your State take in FY 2014 to reach and enroll Medicare Part D beneficiaries designed to improve your PM7 rating? (PM7- Number of unduplicated Part D enrollment contacts discussed per 1,000 Medicare beneficiaries in the State.) Please complete the chart below, and provide your plan or strategy to increase your score to meet or exceed the Minimal Attainment Threshold (MAT.) 8 Page 23 of 37

29 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE SLCES for Performance Measure (PM} 7 LCM LFM MM SM MC OUT PM for Period Ending Sept % CALCULATON SCORES (purple column) N/A N/A N/A N/A N/A PM for Period Decrease Ending Sept 14 Final Achieved 10 MAT -ndicate Below, At, or Above N/A N/A N/A N/A N/A Above EB- ndicate At or Above N/ A N/A N/A N/A N/A Above YE7 Guam SHP Response: Guam SHP exceeded both the Minimal Attainment Threshold and Exemplary Benchmark yielding a Final Achieved score of 10 out of 10. Our PM calculated score for the period ending September 30, 2014 is 90.7, as compared to for the same period in 2013 resulting in our score decreasing by One cause for the decreased score is attributed to a large number of beneficiaries already in a Part D plan, and because they are automatically enrolled by their plan sponsor to continue receiving coverage for the next plan year, these beneficiaries no longer seek enrollment assistance or Part D information from Guam SHP as the plan sponsor also sends materials notifying them of any changes to their plan for the upcoming coverage period. Also, there is also a large number of beneficiaries enrolled in health insurance plans that offer them "creditable prescription drug coverage". These insurances are provided from their or their spouse's current employer, their retiree coverage, or from Medicaid, thus beneficiaries elect not to enroll in a Part D plan as their existing health insurance provides them with equal to or a better drug coverage plan than Part D. Each year during Medicare Part D's Annual Election Period (AEP) Guam SHP significantly increases its outreach activities, interactive presentations and one-on-one counseling sessions in an effort to raise Part D awareness during this short period. Since 2006, Guam SHP has been providing the island's beneficiaries with Part D information, as well as enrollment and disenrollment assistance as the Part D plan sponsor is not locally available for beneficiaries to direct their inquiries or to submit their enrollment applications. Guam SHP has established core Part D AEP activities which have been replicated for a number of years that beneficiaries now come to anticipate to occur each year. Senior Citizens attending the 12 Senior Citizens Centers and three (3} Adult Day Care facilities are provided an awareness presentation at their respective locations and enrollment assistance thereafter if they wish to subscribe to Medicare's prescription drug plan. Those undergoing End Stage Renal Disease treatment at U.S. Renal Care's four (4) facilities are also provided the same activities as the Senior Citizens and Adult Day Care Centers. For the general community, awareness presentations and enrollment assistance are offered twice daily on Tuesdays and Thursdays throughout the AEP. Awareness of these activities are provided to the local media by making in-studio radio appearances, and through press releases issued by the Department of Public Health and Social Services, which are regularly publicized throughout the various media outlets. Since 2006, United HealthCare has been the sole Part D provider for Guam's beneficiaries up until this AEP when another company, EnvisionRx, joined the market now providing the island's beneficiaries with Part D plan options. n addition to the AEP, Part 0 enrollment assistance is provided throughout the year for beneficiaries eligible to enroll during their nitial Enrollment Period (EP) or under a Special Enrollment Period (SEP). BGP7. What specific an d significant changes will your State enact during the FY 2015 grant year to expand the number of beneficiaries provided enrollment assistance for Part D benefits, resulting in an improved performance score for performance measure 7? (PM7- Number of undup/icated Part D enrollment contacts discussed per 1,000 Medicare beneficiaries in the State.) 9 Page 24 of 37

30 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE BGP7 Guam SHP Response: Guam SHP recognizes that awareness as well as an understanding of Medicare's benefits and services is necessary in order for beneficiaries to make informed health care decisions so as to avoid making costly, and sometimes avoidable mistakes, such as paying penalties because of delayed enrollment, or for not reporting their prior creditable prescription drug coverage. n FY 2015, Guam SHP will once again replicate its core Part D activities during the AEP, and will also provide Part D information and enrollment assistance throughout the year for those who meet a condition that would allow them to enroll under a SEP or under their EP as result of being new to Medicare. Additionally, efforts will be taken by Guam SHP to reach ethnic, faith-based groups, and other types of community-based organizations to provide Part D awareness and enrollment assistance within their respective group settings. Program volunteers whom are already associated with some of these groups will help open the doors for Guam SHP to have access to their membership. With the anticipated expanded volunteer workforce, Guam SHP hopes to see an improvement in its performance of this measure this upcoming year. YES. What actions did your State take in FY 2014 to increase your total counselor hours (from Client Contact Form) per 1,000 Medicare beneficiaries in the State designed to improve your PM 8 rating? (PMB -Total number of counselor hours per 1,000 Medicare beneficiaries in the State.) Please complete the chart below, and provide your plan or strategy to increase your score to meet or exceed the Minimal Attainment Threshold (MAT.) SLCES for Performance Measure (PM) 8 LCM LFM MM SM M C OUT PM for Period Ending Sept % CALCULATON SCORES (purple column) N/A N/A N/A N/A N/A PM for Period Decrease Ending Sept 14 Final Achieved 10 MAT -ndicate Below, At, or Above N/A N/A N/A N/A N/A Above EB -ndicate At or Above N/A N/A N/A N/A N/A Above YES Guam SHP Response: Guam SHP exceeded both the Minimal Attainment Threshold and Exemplary Benchmark yielding a Final Achieved score of 10 out of 10. Our PM calculated score for the period ending September 30, 2014 is 117.5, as compared to for the same period in 2013 resulting in our score decreasing by 6.89%. This decrease can be attributed to Guam SHP's main Program partner, the Title ll Aging Case Management Program (CMS), as they faced staff turnovers this past year. Catholic Social Service (CSS), a non-profit, faith-based organization, is contracted by the Guam State Office on Aging to administer the Title ll Aging Case Management Program for the elderly. The function of the CMS is to assess and reassess the needs of the island's elderly who seek assistance from their program, provide pertinent information that would support their independence, and link them to supportive services that would support their care and allow them to age in place for as long as possible. Most of their newly recruited CMS staff are recent graduates of the University of Guam, but within a couple of months of employment the new recruits leave the organization when presented a better job opportunity causing CSS to have to once again recruit for the vacated position. Because the Medicare program is new material for the new Case Workers their Medicare knowledge base is almost always nil. Until they are able to undergo Guam SHPs Medicare training, Case Workers are highly encouraged to attend a Guam SHP Medicare awareness presentation as it covers Medicare and related programs available on Guam, providing the Case 10 Page 25 of 37

31 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE Workers with basic knowledge, which they are able to share with their clients, their families and caregivers. Additionally, Guam SHP meets monthly with the CMS Case Workers to provide them with updated information, discuss complex cases, share current trends, and to answer their Medicare inquiries thereby further expanding their Medicare knowledge base. BGP8. What specific and significant expansion of your available volunteer and/or paid staff counselor resources will you pursue during the FY 2015 grant year that will result in an improved performance score for performance measure 8? (PMB -Total counselor hours (from Client Contact Form) per 1, 000 Medicare beneficiaries in the State.) BGP8 Guam SHP Response: n an effort to provide timely, accurate and comprehensive Medicare information to the island's beneficiaries, their caregivers and family members, Guam SHP together with the Guam Senior Medicare Patrol Project conducts an annual Joint Medicare Training for new Program volunteers to educate them on the Medicare program, for existing volunteers who request to audit the training as a way to reinforce and expand their knowledge base, and also for new staff of Program partners who want to know more about Medicare to assist their clients navigate through this Federal health insurance program. Guam SHP and Guam SMP's training this year is scheduled to be provided from March 23-27, 2015, which will offer 20 hours of training covering topics, such as Original Medicare (Parts A and B); Prescription Drug Coverage (Part D); Medicare Supplemental nsurance (Medigap); Public health insurance coverage (Medicaid and Medically ndigent Program), Private and Military (Tri-Care and VA) health insurance coverage; Rights and Protection; Coordination of Benefits; Preventive Services; Durable Medical Equipment; Hospice Service; Fraud, Waste and Abuse; GovGuam Medicare Reimbursement Program; and Sensitivity Training. n 2013, Guam SHP maintained 5 (five) volunteers, but expanded to 10 in FY n FY 2015, Guam SHP hopes to increase its current pool of volunteers as it recently recruited an additional eight (8) volunteers all of whom will be undergoing training soon and mentoring thereafter. Of the eight (8) new recruits, one (1) volunteer is originally from Chuuk, and having him on board will greatly benefit the Program as Guam SHP has never had a volunteer who speaks Chuukese. n addition to English, a majority of the remaining recruits are fluent in speaking either Chamorro or Tagalog, which is also advantageous for the Program as the top two (2) ethnicities served by Guam SHP are the Chamorro and Filipino populations. Additionally, a Program Coordinator ll position partially funded by both Guam SHP and SMP was recently filled in November The new staff, Cathy Bayona, will also be a participant in the upcoming Medicare training to build upon her Medicare knowledge base as not only is she responsible to ensure Program activities are planned, coordinated and implemented, but she will also be working alongside with the volunteers by participating in outreach activities, conducting interactive presentations and providing counseling to beneficiaries. Guam SHP also provides partial funding for another Program Coordinator ll position, which is currently vacant, but efforts to recruit were recently initiated as funding from other Federal sources also sharing the cost for this position just became available. The eventual full complement of Program staff, along with an expanded workforce of volunteers will yield more counseling hours and Program activities, thereby improving Guam SHPs performance for PM8 in FY BGP9. Are there any performance measures that the State anticipates that the SHP will decline in performance during the FY 2015 grant year? (Yes or No) Guam SHP can anticipate yielding a low score for PMS as historically the Program has never come close to reaching the Minimum Attainment Threshold (MAT) as this measure counts a SHPs effort to target Medicare beneficiaries with low-income and resources to provide them with awareness about possible drug coverage 11 Page 26 of 37

32 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE assistance through the Low Subsidy ncome Program (LS), a program that has never been available to Guam's eligible Medicare beneficiaries. Guam SHP does not anticipate a decline in any of the other performance measures as eight (8} potential volunteers will be undergoing Guam SHP and SMP's Joint Medicare Training in March The expanded volunteer workforce will assist Guam SHP to also expand its Program activities such as outreach, interactive presentations and one-on-one counseling sessions providing greater Medicare awareness and further promoting Program services throughout the community. For any element of SHP performance that the State anticipates that performance may decline during the FY 2015 grant year, please provide an explanation of the decline and the plan that the State will initiate to mitigate the expected decline in services (e.g., contractors or partners not providing accurate and/or timely data reporting will be placed on an improvement plan). BGP9 Guam SHP Response: To mitigate the issue is to extend the drug subsidy program to the U.S. Territories, otherwise, Guam SHP can always expect each year to yield a low score for PM 5. BGP10. Based upon diverse populations identified in your 2014 Basic Grant application, what specific year-end actions has your SHP made to reach and serve those populations (e.g. limited English proficiency, low literacy, beneficiaries in intensely urban or rural areas, ethnic and racial groups, etc.)? Further, state your strategies and goals for BGP10 SHP Response: t is not a challenge for Guam SHP to reach the island's diverse populations as the entire population on island is diverse. Guam has a population of approximately 168,000 people and it is considered a melting pot of ethnicities as not only are the native Chamorro people calling Guam their home, but also individuals of other ethnicities, such as Filipino, Caucasian, Japanese, Korean, Chinese, Taiwanese, Palauan, Chuukese, Yapese, Pohnpeians, just to name a few. Only 31 miles long and 7 miles at its widest point, other than traffic congestion, commuting on island is relatively easy taking minutes by car to get from one destination to another, which makes Guam SHP services conveniently accessible for the island's beneficiaries, their families and caregivers. f transportation to Guam SHP presents a barrier, then services can be accessed via telephone, or for those beneficiaries who are elderly and homebound, the Case Workers from the Title ll Aging Case Management Services Program can be activated to provide Medicare information and assistance to these individuals at their residence or facility. n FY 2014 (October 1, 2013 through September 30, 2014), of the 2,549 client contacts recorded in shipnpr.shiptalk.org, 98.4% of these individuals primary language is other than English, with Chamorro and Filipino being the largest two (2} ethnicities served by Guam SHP in this period. Despite their native tongue being their primary language spoken, soliciting information or communicating their issue with a Guam SHP Counselor was not a significant barrier as many of these beneficiaries either speak and understand English, or were accompanied by someone who translated the information between the Counselor and the beneficiary. n FV 2015, Guam SHP will provide Medicare information and assistance services to Guam's diverse populations and will continue to educate beneficiaries of Medicare's benefits and services through its interactive presentations and counseling services. Guam SHP will also heighten and promote Program services by participating in various outreach activities hosted by various organizations and groups through health fairs at malls and at conferences, as well as at the village level through coordination with village mayors and with various ethnic and faith-based groups. 12 Page 27 of 37

33 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Applicat ion GUAM STATE 11. Do you conduct screening (such as criminal background ch ecks and/ or finger printing) for all paid staff, volunteers, and volunteer counselors? What are your 2015 proposed plans to conduct such pre-screening activities? s there any other information you can provide on this issue, including any requirements you have for your part ners? Guam SHP Response: To protect the integrity of the Program, Guam SHP requires Program volunteers to obtain police and court clearances and undergo skin and drug test prior to accepting their services. The fees for the clearances and skin test are at no cost to the volunteer or the Program as Guam Public Law allows individuals serving as volunteers for the Government of Guam to have these fees exempt as they are working without compensation for the benefit of the Government of Guam and its community, and such costs is the responsibility of the Government of Guam. Guam SHP includes in its Program budget funds to cover the cost of drug testing as all Program volunteers must undergo and pass this test prior to accepting their volunteer services. Further, all Government of Guam employees prior to employment are mandated to obtain these same clearances and tests as a condition of their employment. As a primary Program partner, the staff of the Title ll Case Management Services Program are also required within their contract with the Guam State Office on Aging to ensure all employees under this program meet the same requirements mentioned above. 12. Describe your State's efforts to provide service during the M edicare Open Enrollment Period (OEP), which in 2014 was from October 15 through December 7. Please provide your "lessons learned" based on your experience during Open Enrollment and your plans to prepare for the 2015 AEP. Guam SHP Response: n 2014, Guam SHP replicated activities conducted in previous Part D Annual Election Periods (AEP) as beneficiaries have found these efforts beneficial for them and we have determined the activities to be effective. During the 2014 AEP, Senior Citizens participating in the 12 Senior Citizens and 2 (two) Adult Day Care Centers, and End Stage Renal Disease (ESRD) patients receiving treatment from the four (4) dialysis centers were provide Part D awareness and enrollment assistance at their respective Centers. Because these efforts are replicated each year, center participants and patients have come to expect Guam SHP presence at their centers/facility during the AEP to provide Part D awareness and enrollment assistance. This Guam SHP service provides these beneficiaries with the convenience to receive information and assistance at the village level or in a treatment facility which they frequent several times each week. Additionally, the general community has become aware of the Program's Medicare Part D awareness presentations provided every Tuesday and Thursday at 9:00am and at 2:00pm at the Division of Senior Citizens' office during the AEP for anyone needing information or wanting to enroll in a Part D plan. Aside f rom these established activities, Guam SHP also accommodates any requests to provide Part D awareness presentations during the AEP, such to faith-based groups and participate in as m any outreach activities during the AEP to promote Part D awareness. A lesson learned during the recent AEP, which will allow Guam SHP to better manage its 2015 AEP activities is to provide awareness presentatio ns to the Senior Citizens and Adult Day Care Centers in October, and the presentations to the dialysis centers during the first two w eeks in November in order to further promote and heighten awareness throughout the community during the remaining weeks of the AEP. Additionally, requests to provide Part D awareness on live radio and t elevision st ations will be done at least a week before t he start of the AEP to inform those eligible for Part D prior to the start of the AEP. 13. Describe your Stat e's 2014 year-end activit ies and efforts to provide counseling on Medicare well ness and preventive benefit s available under the Affordable Care Act. Fu rt her, state your strategies and goals for Page 28 of 37

34 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE Guam SHP Response: All awareness presentations include information on Medicare's well ness and preventive benefits and encourages beneficiaries to access such benefits with some services having no out-of-pocket fees, such as the annual well ness visit and annual flu shot. Guam SHP informs beneficiaries of the importance of disease prevention, early detection, and lifestyle modifications that support a healthier life. t also shares with beneficiaries Medicare's preventive services and screenings that they can access to prevent disease, detect disease early when it is most treatable and curable, and manage disease so that complications can be avoided, which for some may be life-saving making them live longer and healthier lives. n addition to presenting this information, beneficiaries are also given the CMS publication on preventive services so they can learn more about the screenings and services they are able to attain or access through their providers. Guam SHP, in 201S, will continue promoting Medicare wellness and preventive benefits in its interactive presentations, one-on-one counseling sessions, and at outreach activities. 14. Please provide an update on your relationship with your State Medicaid Office, as they implement their Medicaid Expansion activities, and indicate most recent trainings received on your State's Medicaid model. Also, please provide an update on progress made in establishing an effective Medicaid referral system and network relationships. Guam SHP Response: Guam SHP's relationship with the Guam Medicaid Office reported in Guam SHP's 2014 Mid-Term Report remains the same. Guam Medicaid's expansion activities have not changed as the most recent expansion effort was implemented on January 1, 2012 when the program began providing coverage to non-traditional Medicaid clients, specifically, those without a disability, non-elderly or without a family. According to a Guam Medicaid Program Supervisor, in the near future the Guam Medicaid Program expects to increase the Federal Poverty Level {FPL) for individuals to qualify for Medicaid from 100% to 133%, which may possibly increase the number of inquiries to the Program. 15. For SH Ps in the DMEPOS Competitive Bidding areas, describe your State's activities and issues surrounding DMEPOS in FY 2014 and your State's plan for FY Guam SHP Response: As reported Guam SHP's 2014 Mid-Term Report, Round 2 of the Competitive Bidding areas included Guam in the national mail-order competition for diabetic testing supplies, which now allows the island's Medicare beneficiaries with more options to obtain their diabetic supplies. Despite providing the mail order information, many beneficiaries would rather obtain their supplies locally because they are easily accessible, and there is no actual savings to obtain these supplies through mail order. Nonetheless, Guam SHP will continue to provide mail order information for diabetic testing supplies to beneficiaries so they are aware of this option. 16a. What volunteer engagement activities has your SHP recently participated in and/or implemented? What volunteer engagement activities are proposed for 2015? Guam SHP Response: As mentioned previously, Guam SHP currently has 10 volunteers, which makes overseeing this group manageable not only because of the small number of volunteers, but also because the Program operates out of 14 Page 29 of 37

35 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE one (1) office giving Program staff the ability to provide continuous oversight and guidance to volunteers as requested or needed. Thus, volunteer engagement activities are an ongoing activity for Guam SHP. 16b. Has the number of your volunteer counselors increased or decreased, and why? Guam SHP Response: Guam SHP increased it volunteer workforce from five (5) to 10 in The Program recruited seven (7) individuals who attended the Program's Joint Guam SHP/Guam SMP nitial Medicare Training in March 2014, but after the training three (3) of the new recruits were not able to proceed on as volunteers as one (1) individual relocated back to the U.S. mainland, and the other two (2) had personal matters to attend to, which prevented them from providing any time to the Program. Fortunately for Guam SHP, in June 2014, a Health nsurance Counseling & Advocacy Program (HCAP) Counselor from Riverside California relocated to Guam and learned that the island had a SHP. Wanting to continue providing Medicare information and assistance to Medicare beneficiaries, this individual approached Guam SHP and expressed his desire of becoming a Program volunteer to help provide one-on-one Medicare counseling assistance. Having been a H CAP Counselor for 10 years, Guam SHP worked to get this seasoned Counselor on board as he had the knowledge and skill sets needed to provide SHP counseling. The biggest shift initially experienced by this volunteer was having to change his mind set and only speak about the programs that are available on Guam as Guam does not have other Medicare or related programs unlike the states, such as the Low ncome Subsidy (LS) Program, Medicare Advantage Plans, Qualified Medicare Beneficiary (QMB) Program, and Specified Low-ncome Medicare Beneficiary (SLMB) Program. 16c. What specific additional volunteer engagement technical assistance does your State need? Please be specific. Guam SHP Response: Guam SHP anticipates expanding its pool of volunteers as it will conduct its annual Joint Guam SHP/Guam SMP nitial Medicare Training in March Guam SHP did not find a certification program/tool necessary as its volunteer workforce is small, manageable, and all Program volunteers work in the same office, which allows Program staff to provide continuous and direct oversight over the volunteers. With a larger number of volunteers anticipated in FY 2015, Guam SHP would like to now implement a certification program/tool. Thus, a request will be submitted to the SHP Technical Resource Center in Grant Year 2015 to assist Guam SHP with this effort. More on this is provided in Section 4, No What SH P quality assurance and improvement initiatives in support of locally-based counselors have been conducted in grant year FY 2014? For example, have you considered implementing the Online Counselor Certification Tool (OCCT)? What quality assurance and improvement initiatives were used in grant year 2014 and why? Do you plan on continuing to use those initiatives? How did you measure their effectiveness? Guam SHP Response: Guam SHP Program staff continues to conduct on-site monitoring of its Counselor workforce to ensure accurate and complete information is provided to beneficiaries during counseling sessions, interactive presentations and at outreach events. Because Guam SHP operates out of one location resulting in Program staff and volunteers sharing the same office space, Program staff are able to ascertain whether beneficiaries are receiving timely and accurate information from their Guam SHP Counselor, and/or the proper guidance to resolve their Medicare issue. Counselors having difficulty with resolving a beneficiary's issue seek assistance from other Program staff, with the Counselor staying engaged in the session allowing the Counselor to be aware of the outcome as he/she may have to address the same issue in the future. 15 Page 30 of 37

36 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE Additionally, n-service Training is provided to the Title ll Case Management Services {CMS) Aging Program staff each month to provide updated Medicare information, discuss the latest issues and trends, and to provide guidance on Medicare related issues expressed by home bound elderly beneficiaries, their families or caregivers. 18. s your State using performance-based funding for sub-grantees? f yes, please describe the method(s) used? Guam SHP Response: Not applicable, Guam SHP does not have any sub-grantees. 19. How many counselors were certified in 2014? How many were recertified? Guam SHP Response: Guam SHP does not certify its Program volunteers; however, it will be seeking the assistance from the SHP Technical Resource Center to provide a certification program/tool for adoption and implementation in Grant Year Please provide a description of any innovative or successful efforts that the SHP has undertaken in any aspect of the program during the FY 2014 grant year or plans to initiate in FY 2015 grant year that the program wishes to highlight as part of this grant application. Guam SHP Response: Guam SHP's partnership with the Social Security Administration (SSA), Guam District Office has been positive throughout the years as beneficiaries are continuously being referred to Guam SHP by SSA and vice versa for individuals who would like to enroll into Original Medicare. As mentioned earlier, the great partnership between Guam SHP and SSA has allowed the Guam Department of Public Health and Social Services to issue for the very first time a press release endorsed by SSA informing the island community about Original Medicare's General Enrollment Period {GEP) and directing them to go to the SSA office or go to this Federal agency's website to enroll if eligible to apply for Medicare. Through the press release, GEP information is being announced as a public service announcement by various media outlets at no cost to Guam SHP. Guam SHP intends to build upon this awareness in Grant Year 2015 by disseminating GEP information throughout the year to raise the level of awareness in an effort to prepare those who missed signing up for Medicare during their nitial Enrollment Period {EP). 21. s your State on target with your FY 2014 budget spending? f not, why not? Guam SHP Response: Guam SHP is on target with its budget spending in all areas with the exception of personnel as it has yet to recruit one {1) of the Program Coordinator ll positions partially funded with SHP grant funds. This position still remains vacant because the other Federal funds contributing to this cost allocated position only became available in February 2015 leaving not much time to recruit as the SHP grant will be expiring on March 31, 2015 and the Government of Guam has an arduous recruitment process taking anywhere from 6 to 9 months to fill a vacant position. 16 Page 31 of 37

37 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE 22. s your State able to release all planned contractual funds in FY 2014? Guam SHP Response: Not applicable, as Guam SHP does not use any of its Program funding for contractual services. 23. Will your State have carryover funds at the end of the FY 2014 grant year? And, if so, why? Guam SHP Response: Guam SHP will submit a request to carry over 2014 grant funds to Grant Year 2015 as Guam SHP funds earmarked to partially fund one {1) of the Program Coordinator ll positions funded has yet to expended. Should our carry over request be approved, Guam SHP will have the ability to start the recruitment process for this vacant position as all funding sources for this position will be available. Additionally, should Guam SHP have lapses in other areas because there is not enough funds to meet the $50 minimum requirement to procure goods and services through requisition then Guam SHP will also submit a request to carry over such funds to Grant Year Were there State/County issues {political, financial, staff) that occurred during the FY 2014, or are anticipated in 2015, that impacted any SHP services in any part of the State? f so, what was the impact? Guam SHP Response: On February 14, 2014, Government of Guam employees under the newly adopted Hay Study's General Pay Plan were given 50% of their salary adjustment. On September 12,2014, the remaining 50% of their salary adjustment were paid to employees. With full salary implementation, Guam SHP will have to make the necessary personnel cost adjustments to the Program budget for the two (2) Program Coordinator ll positions partially funded with SHP grant funds. 25. Are there any new trends, hot topics or emerging issues, specific to your State/County and/or region that you expect might impact your SHP in 2015? f so, please describe. Guam SHP Response: On October 3, 2014, Guam SHP ed CMS Region X SHP Liaison, Mr. Peter Bauer of reports from beneficiaries of not being able to access to complete their nitial Enrollment Questionnaire (EQ}, which Mr. Bauer forwarded the concern to ship@acl.hhs.gov. A follow up was sent to Mr. Bauer on January 14, 2015, as the issue still remained and beneficiaries were still inquiring of how to access this website. Guam SHP received an from Stacey (no last name provided) from ship@acl.hhs.gov requesting for more information, which was provided by Guam SHP. After more communications, an dated January 21, 2015 from Stacey forwarding a response to the issue from the CMS web team stating, '7his comes up a lot from the CSRs. MyMedicare is considered a secure site and therefore can't be accessed outside the 50 states. Puerto Rico has the same problem, too....it's the reason she can't see it." An was sent to Stacy on February 1, 2015 suggesting that if MyMedicare will no longer be accessible to Guam's beneficiaries, then the website should not be mentioned in the letters being sent to the island's beneficiaries as an option for them to complete their EQ; the removal of the website on the letters will alleviate beneficiaries inquiring about the website. 17 Page 32 of 37

38 FY 2014 SHP Year End Progress Report and FY 2015 Basic Grant Program Renewal Application GUAM STATE 26. Do you receive any non-federal funding to support your program? f yes, what is the source of this funding? How much have you received each year beginning with the grant year starting April!, 2010 through the FY 2015 grant year beginning April1, 2015? 1 Guam SHP Response: The Guam State Office on Aging has been a SHP grantee since Funding to operate Guam SHP has been provided by the Centers for Medicare and Medicaid Services annually up until the Program was transferred to the Administration for Community Living in 2014/201S. Guam SHPs base grant has always been the smallest of the 54 SHPs primarily due to the Guam having the least amount of Medicare beneficiaries as compared to the other States and Territories. To help support Program operations, Guam SHP relies on the Guam State Office on Aging for needed supplies, equipment as well as personnel when additional staff assistance is required, especially during Part D's Annual Election Period as Program activities is heightened to provide information and assistance to beneficiaries wanting to learn about and/or enroll in a prescription drug plan during this short period. 27. Do you use NPR as your primary reporting system or do you use a third-party proprietary data collection and reporting system? Guam SHP Response: Guam SHP uses the National Performance Reporting system as its primary reporting system for its Client Contacts, and Public and Media activities, and to submit data for the annual SHP Resource Report. 28. Based upon the Partner Chart submitted in your 2014 SH P Basic Grant Renewal Application has your State made any updates (addition, deletion) to your current and planned partnerships listed? f yes, using the template below, please attach your partner list chart with any updates by indicating any additions or deletions and description of performance outcomes to date (e.g., counseled 400 beneficiaries). Please also include any projected outcomes for partners in FY Please attach as Appendix A to this report. Guam SHP has made no updates to its Partner Chart 29. Based on the Counseling Site Services chart you submitted in your 2014 Basic Grant Program application has your State made any updates (additions, deletions) to your current and planned local counseling services list? f yes, using the template below, please attach your counseling site services list chart w ith any updates and check any additions or deletions. Please also include any projected outcomes and new sites for FY Please attach as an Appendix B to this report. Not applicable. Guam SHP operates from one (1) Program office and does not have any field office serving as counseling sites. Guam State Health nsurance Assistance Program Guam Grantee Name and Stat e Reviewer's Name 1 The answers to these questions will have no effect on SHP funding in this year or any future years. ACL is just trying to get a better sense of how the SHP grantees are currently operating. 18 Page 33 of 37