The Community Living Program:
Post Date
June 4th 2009
Application Due Date
August 3rd 2009
Funding Opportunity Number
HHS-2009-AOA-CD-0919
CFDA Number(s)
93.048
Funding Instrument Type(s)
Cooperative Agreement
Funding Activity Categories
Income Security and Social Services
Number of Awards
16
Eligibility Categories
Funding
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Estimated Total Funding:
$6000000
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Award Range:
$600000 - $1000000
Grant Description
Under this Announcement, AoA will award Cooperative Agreements to assist State Units on Aging (SUA) to strengthen the capacity of the Aging Network to help individuals who are not eligible for Medicaid but at imminent risk of nursing home placement and spend-down to remain at home and in the community and have access to flexible, consumer-directed services. States are expected to use existing federal and state program funds to cover the cost of the home and community-based services provided under the proposed projects. Not more than 20% of the total amount of grant funds made available under this Announcement may be used to cover the cost of the home and community-based services provided under the proposed projects. Projects funded under this Announcement must be able to monitor and follow-up with the individuals they are serving to ensure that the necessary services are being rapidly authorized and initiated, that client and family needs are being met, and that necessary adjustments in services are rapidly being made as the needs of the client and/or family caregiver change, as well as insuring that all payment, payroll and tax functions are completed accurately and in a timely manner. Projects must also be able to track individual clients and be able to document and report on the effectiveness of the program in successfully diverting individuals away from long-term nursing home placement and Medicaid spend-down. Projects will be funded for a 24-month project period. A SUA may propose a project within one or more Planning and Service Areas (PSA). States with a single PSA may propose a project targeted to one or more counties or regions of the state. Other than States where there is a single PSA, the SUA is encouraged to look to the AAA (in coordination with the local ADRC or ADRC-type entity if the AAA is not such an entity) to lead the local implementation of any project within its PSA that is supported under this Announcement. No later than the end of the 12th month after receiving the grant award, projects funded under this Announcement must have at least one local project up and be delivering services to the high-risk individuals targeted under this Announcement in a way that: A. Uses an ADRC or ADRC-type program to identify individuals who are not eligible for Medicaid but are at imminent risk of nursing home placement and spend-down to Medicaid, B. Has formal protocols and other tools in place for use by key stakeholder organizations (e.g., AAAs, ADRCs, aging services providers, hospitals, nursing homes, Centers for Independent Living, VHA, etc.) for making client referrals, prioritizing clients, authorizing services, and following-up with clients to ensure that local projects can rapidly provide home and community-based services and supports to the high–risk individuals who are identified by the ADRC program, and that the services for these individuals can be quickly adjusted as necessary as their needs change, and C. Is able to provide Financial Management Services (FMS) to facilitate delivery of consumer directed services by providing necessary supports including payment for goods and services, payroll functions and reports. Definition of Terms: For purposes of this Announcement, an “Aging and Disability Resource Center” (ADRC) or ADRC-type program must have the operational capacity to: A. effectively and efficiently identify individuals who are at imminent risk of nursing home placement but not eligible for Medicaid and who, without some type of intervention, will in fact go into – or stay in – a nursing home facility and spend-down to Medicaid (consistent with Standards I.B and I.D in Appendix G); B. asses the needs of such individuals; provide them with options counseling; and, as needed, work with them to develop care plans and arrange for services, including linking them to services provided by aging network provider organizations (consistent with Standard II. A in Attachment G); C. provide streamlined processes for determining an individual’s eligibility for publicly supported long-term care services and supports. This means the ADRC programs used for projects under this Announcement need to be integrated, in some manner, with the process that is used by the state to determine a person’s eligibility for Medicaid long-term care (both their programmatic eligibility and their financial eligibility for Medicaid). To the extent feasible it would be beneficial that individuals who are deemed by Medicaid to be ineligible for Medicaid long-term care and who are at imminent risk of nursing home placement have the opportunity to be referred to the diversion program supported under this Announcement (consistent with Standard II.A. in Attachment G). For purposes of this Announcement, an “aging services provider organization” is an organization that is currently operating a program that serves older adults and is funded (at least in part) through the Older Americans Act. A Native American Tribal Organization funded under Title VI of the Older Americans Act may be included as an aging services provider under this grant announcement. For purposes of this Announcement, “Financial Management Services” (FMS) are services that provide fiscal accountability for state and local government agencies and safeguards for individuals enrolled in self-direction programs and their workers by ensuring that payroll, worker’s compensation insurance policy management, and vendor payment tasks are performed accurately and in accordance with federal, state, and local rules and regulations, and in a timely manner. There are various FMS provider models including government and vendor fiscal employer agent models with which a project can contract. (See Standards in Attachment F and FMS Providers in Attachment G and Attachment L) For purposes of this Announcement, “models to deliver flexible services” includes service authorization and service delivery. The service authorization process should include the authority to utilize funds that are not tied to any one provider and can support a wide variety of service options so that services can be tailored to the unique and changing needs of individual clients. Models should enable many provider organizations to provide and coordinate a complete array of services for elderly individuals and foster greater utilization of these types of providers. This approach to flexible services will foster greater efficiency and reduce per capita costs of services. “Consumer-directed models” are methods of delivering services that give the individuals being served the option to determine the specific types of services they receive, the manner in which those services are provided, and the ability to directly manage those services. (See Standards I.A and I.C in Attachment G) Two examples of tools and protocols that a SUA and/or AAA might want to promote in their policies include: Contracting – States or Area Agencies that have fixed contracts (e.g. $25,000 to a specific homemaker agency) may consider implementing fee for service contracting or other variations. Based on an established unit rate, the total amount of funds and service hours can then be controlled by the consumer. When money follows the consumer, a choice of service providers can be made and a greater focus on quality service provision can result. Prioritization – The specific aim of the Community Living Program Grants is to identify and serve individuals at imminent risk of going into a nursing home and spending down to Medicaid. States and Area Agencies that have served consumers on a “first come, first served” basis may consider implementing assessment and screening tools, as well as care planning and case coordination processes, that have been proven to identify and serve those individuals in priority order. Priority will be given to states with project proposals that demonstrate real potential to: • Identify the amount and source(s) of funding from existing federal and state programs to be used for home and community-based services and supports that will be provided to clients under their proposed project no later than the end of the 12th month, as well as during the rest of the grant’s 24 month project period. • Effectively identify individuals who are at imminent risk of nursing home placement and spend-down to Medicaid. • Rapidly provide home and community-based services and supports to individuals who are identified by an ADRC or ADRC-type program as being at imminent risk of nursing home placement and spend-down to Medicaid. • Provide a full range of service options to the individuals who are targeted under this Announcement as well as giving them the option to use consumer-directed/self-directed models that give people control over the types of services they receive, the manner in which they are provided, and the ability to directly manage those services. • Provide home and community-based services, and access to consumer directed models, to significant numbers of clients in the target population in one or more geographic areas of the state over the 24 months of the grant period. Applications must indicate the anticipated number of targeted individuals that will be diverted from nursing home placement and spend-down to Medicaid during the 24 month grant period. (Attachment K includes a chart that estimates the total number of people within each state that may be at risk of nursing home placement and spend down to Medicaid. Applicants should project the percentage of the estimated population they anticipate to divert from nursing home placement and spend down to Medicaid.) • Implement the types of system changes described in this Announcement (see Page 1), in comparison to the status quo statewide and within the geographic areas covered by the grant project, and the likelihood that such changes will be sustained beyond the project period. Grant funds under this announcement can be used for the following activities: • Not more than 20% of the total grant funds can be used for the provision of home and community-based services and supports to individuals. These services can include, but are not limited to, personal care, homemaker/chore services, transportation, meal preparation, home-delivered meals, home modifications, respite, assistive devices, and other good and services that support the individual’s ability to remain at home or the families ability to continue to provide support. • Supporting Community Living Program operations of an ADRC to help ensure it is capable of effectively performing, directly or through a seamless system, the functions of client screening, assessment, options counseling, care planning, and streamlined access to all publicly supported long-term care services and supports, including Medicaid HCBS and nursing home care, for the population targeted under this Announcement. Among other things, this can include: developing or refining a program’s targeting criteria and tools to ensure that those at-risk of imminent nursing home placement and spend-down to Medicaid are effectively and efficiently targeted. • Case management/support brokerage services that provide supports to individuals to understand and manage their consumer directed services including developing and controlling a budget and spending plan, hiring and supervising workers, and other activities related to self directing services. • Costs related to developing or contracting with a Financial Management Services provider to supply the necessary supports for consumer directed services that include payment of goods and services and tax and payroll functions. • Training and technical assistance activities designed to assist the state and its partners in understanding and achieving project goals and objectives. AoA is funding a Community Living Program Technical Assistance Center that will provide technical assistance to successful grantees • Designing and implementing evaluation and quality assurance systems and protocols. • Costs related to development and implementation of VDHCBS including funds needed to cover service costs for Veterans between when AAA submits and bill and is reimbursed by the local VAMC. • Project administration, but not costs for hiring state or AAA staff without a direct role in the project. As part of its diversion program, states may propose to direct a portion of its diversion activities on transitioning individuals who are not eligible for Medicaid out of acute care and other facility settings, including hospitals and nursing homes, into the community if such individuals otherwise would have remained in, or have been sent to, a nursing facility for a long-term stay and spent down to Medicaid. Applicants should note in their Project Narrative if activities developed under this funding opportunity are supported with other funding and if so, how the multiple funding sources will support, and not duplicate, efforts (e.g. CMS Real Choice Systems Change grants for ADRC and Hospital Discharge Planning activities, previous CLP (NHD) grants, etc.). In addition, applicants for this opportunity should indicate if they are currently applying for: • The 2009 Aging and Disability Resource Center grant and how activities proposed under that opportunity support and do not duplicate efforts proposed in the CLP application. • The Veterans Health Administration Option (Veteran Directed Home and Community Based Service Program) described in Attachment I of this announcement. The Veteran Directed Home and Community Based Service ((VDHCBS) Program is designed to serve Veterans of any age at risk of nursing home placement with consumer directed services. The AoA application shall include a statement regarding how the VDHCBS program will be implemented in conjunction with the Community Living Program Grant, including how much of the proposal’s funds will be needed for VDHCBS start-up costs. States interested in applying for this option must complete a separate application as described in Attachment I and submit it with their AoA grant application. States can find more information on the VDHCBS Option in Attachment M: VDHCBS Program Standards. The States where the Veterans Health Administration has already committed funding for VDHCBS need not reapply through this process. NOTE: Additional information important in the development of proposals for this grant opportunity can be found in Section IV.2.C Project Narrative and in Section V.1. Application Review Criteria.
Contact Information
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Agency
Department of Health and Human Services
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Office:
Administration on Aging
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Agency Contact:
Margaret Tolson
Grants Management Specialist -
Agency Mailing Address:
margaret.tolson@aoa.hhs.gov
- Agency Email Address:
- More Information:
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