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Operational grants also may include the operation of managed care and practice management networks and plans. Administration and Services

June 2010 Aging Cluster HHS

    DEPARTMENT OF HEALTH AND HUMAN SERVICES

    CFDA 93.044 SPECIAL PROGRAMS FOR THE AGING--TITLE III, PART B

    GRANTS FOR SUPPORTIVE SERVICES AND SENIOR CENTERS

    CFDA 93.045 SPECIAL PROGRAMS FOR THE AGING--TITLE III, PART C

    NUTRITION SERVICES

    CFDA 93.053 NUTRITION SERVICES INCENTIVE PROGRAM

    CFDA 93.705 ARRA AGING HOME-DELIVERED NUTRITION SERVICES FOR

    STATES

    CFDA 93.707 ARRA AGING CONGREGATE NUTRITION SERVICES FOR

    STATES

    I. PROGRAM OBJECTIVES

    Grants for Supportive Services and Senior Centers

    The objective of this program is to assist States and area agencies on aging in facilitating the development and implementation of a comprehensive, coordinated system for providing long-term care in home and community-based settings, in a manner responsive to the needs and preferences of older individuals and their family caregivers, by

    (A) collaborating, coordinating activities, and consulting with other local public and

    private agencies and organizations responsible for administering programs,

    benefits, and services related to providing long-term care;

    (B) conducting analyses and making recommendations with respect to strategies for

    modifying the local system of long-term care to better

    (i) respond to the needs and preferences of older individuals and family

    caregivers;

    (ii) facilitate the provision, by service providers, of long-term care in home and

    community-based settings; and

    (iii) target services to older individuals at risk for institutional placement, to

    permit such individuals to remain in home and community-based settings;

    (C) implementing, through the agency or service providers, evidence-based programs

    to assist older individuals and their family caregivers in learning about and

    making behavioral changes intended to reduce the risk of injury, disease, and

    disability among older individuals; and

    (D) providing for the availability and distribution (through public education

    campaigns, Aging and Disability Resource Centers, the area agency on aging

    itself, and other appropriate means) of information relating to

    (i) the need to plan in advance for long-term care; and

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June 2010 Aging Cluster HHS

    (ii) the full range of available public and private long-term care (including

    integrated long-term care) programs, options, service providers, and

    resources (Older Americans Act [OAA] Section 305(a)(3)).

    The target population for these supportive services is individuals with greatest economic and social need (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas), and older individuals at risk for institutional placement (OAA

    Section 306(a)(1)); however; proof of age (or income) is not required as a condition of receiving services.

    Supportive services may include a full range of economic and social services, including, but not limited to: (1) access services (transportation, health services [including mental health services]

    outreach, information and assistance); (2) legal assistance and other counseling services; (3) health screening services (including mental health screening); (4) ombudsman services; (5) provision of services and assistive devices (including provision of assistive technology services and assistive technology devices); (6) services designed to support States, area agencies on aging, and local service providers in carrying out and coordinating activities for older individuals with respect to mental health services, including outreach for, education concerning, and screening for such services, and referral to such services for treatment; (7) activities to promote and disseminate information about life-long learning programs, including opportunities for distance learning; and (8) services designed to assist older individuals in avoiding institutionalization and to assist individuals in long-term care institutions who are able to return to their communities any other services necessary for the general welfare of older individuals (OAA Section 321). Nutrition services are provided under a separate authorization as described below.

    Organizations funded under this program and the nutrition services program (see below) also receive funds from other Federal sources as well as from non-Federal sources. Grants for Nutrition Services

    The purposes of this grant program are to: (1) reduce hunger and food insecurity; (2) promote socialization of older individuals; and (3) promote the health and well-being of older individuals by helping them gain access to nutrition and other disease prevention and health promotion services to delay the onset of adverse health conditions resulting from poor nutritional health or sedentary behavior (OAA Section 330). Services are provided through this program to individuals aged 60 or older, in a congregate setting or in-home. These services include meals, nutrition education, nutrition counseling, and nutrition screening and assessment, as appropriate (OAA Sections 331, 336, and 339). This program is clustered with the grants for supportive

    services and senior centers for purposes of this program supplement since these services, although separately earmarked, fall under the overall State planning process and process for allocation of funds.

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    Nutrition Services Incentive Program

    The objective of this grant program is to provide resource incentives to encourage and reward effective and efficient performance in the delivery of nutritious meals to older individuals. The Administration on Aging (AoA) is responsible for this program (previously included in the Supplement as the Department of Agriculture‘s (USDA) Nutrition Services Incentive Program (CFDA 10.570)) as described in II, ―Program Procedures - Administration and Services.‖ This

    program is included as part of this cluster because of its direct relationship to the nutrition services program.

    II. PROGRAM PROCEDURES

    Administration and Services

    The AoA, a component of the Department of Health and Human Services, administers the supportive services and senior centers program and the nutrition services program in cooperation with States, sub-State agencies, and other service providers. The States receive a formula grant from AoA, which is used by the State Unit on Aging (State Agency) both for its planning, administration, and evaluation of these programs as well as to pass through to other entities. Planning and Service Areas (PSAs) are designated by the State Agency in accordance with AoA guidelines after considering the geographical distribution of the service populations, location of available services, available resources, other service area boundaries, location of units of general-purpose local government, and other factors. An Area Agency on Aging (Area Agency) is then designated by the State for each PSA after considering the views of affected local governments (States that had a single statewide planning and service area in place prior to fiscal year (FY) 1981 had the option to continue that method of operation; there are currently eight States in this category). A single Area Agency may serve more than one PSA. The Area Agencies, which may be public or private non-profit agencies or organizations, develop and administer counterpart area aging plans, as approved by the State Agency, and, in turn, provide subgrants to or contract with public or private service providers for the provision of services. A-133 Compliance Supplement 4-93.044-3

June 2010 Aging Cluster HHS

    With limited exceptions (e.g., ombudsman services, information and assistance, case 1management), the State Agency and the Area Agencies are precluded from the direct provision of services, unless providing the services is necessary to ensure an adequate supply of services, the services are related to the agency‘s administrative functions, or where services of comparable

    quality can be provided more economically by the agency. Federal funds may pay for only a portion of the costs of administration and services with the State and subrecipients required to provide a matching share from other sources.

    AoA administers NSIP in cooperation with States, sub-State agencies, and other service providers. Under Section 311(b) (1) and (d) (1) of the OAA, States receive a cash grant from AoA, based on the formula in the OAA. The amount of a State‘s grant is determined by dividing

    the number of meals served to eligible persons in the State during the preceding Federal fiscal year by the number of such meals served in all States and Tribes, and applying the resulting ratio

    to the amount of funds available. Under OAA Section 311(d)(1), a State may choose to use all

    or any part of its grant to obtain commodities distributed by the USDA through State Distributing Agencies. The amount a State chooses to use in commodities, as well as

    administrative costs from USDA associated with the purchase of commodities are deducted from

    the State‘s grant from AoA. AoA transfers funds to USDA. USDA remains responsible for the

    overall management of the commodities program, including ordering, purchase, and delivery of the requested commodities. (Also see ―IV, Other Information.‖)

    State Plan and Area Plans

    A State plan, approved by AoA, is a prerequisite to funding of the supportive services and nutrition programs; however, the State Plan covers the totality of AoA programs for which the State is the recipient under the OAA. The State Plan is developed on the basis of input from the Area Agencies as well as input from the affected populations as a result of public hearings. The State Plan addresses how the State intends to comply with the various requirements of the OAA and, specifically for Title III, its program objectives, designation of Planning and Service Areas (PSAs), and specification of the intrastate allocation formula for distribution of funds to each PSA. The State Plan also contains assurances required by the Act and implementing regulations.

    1 The term ―case management service‖ means a service provided to an older individual, at the direction of the

    older individual or a family member of the individual (i) by an individual who is trained or experienced in the case management skills that are required to deliver the services and coordination described below; and (ii) to assess the needs, and to arrange, coordinate, and monitor an optimum package of services to meet the needs, of the older individual. Case management includes services and coordination such as (i) comprehensive assessment of the older individual (including the physical, psychological, and social needs of the individual); (ii) development and implementation of a service plan with the older individual to mobilize the formal and informal resources and services identified in the assessment to meet the needs of the older individual, including coordination of the resources and services with any other plans that exist for various formal services, such as hospital discharge plans; and with the information and assistance services provided under the OAA; (iii) coordination and monitoring of formal and informal service delivery, including coordination and monitoring to ensure that services specified in the plan are being provided; (iv) periodic reassessment and revision of the status of the older individual with the older individual or, if necessary, a primary caregiver or family member of the older individual; and (v) in accordance with the wishes of the older individual, advocacy on behalf of the older individual for needed services or resources (OAA Section 102(11)).

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    Unless a State is not in compliance with Title III requirements, the State Plan may be submitted on a two-, three-, or four-year cycle, at the option of the State, with annual amendments, as appropriate; however, AoA funding is provided annually. States found to be in noncompliance may be required to submit their State Plans annually until they are determined to be in compliance. Area plans are prepared and submitted to the State for approval for either two, three, or four years, with annual adjustments, as necessary.

    Source of Governing Requirements

    These programs are authorized under Parts B and C, respectively, of Title III of the OAA, as amended, which is codified at 42 USC 3021-3030. These programs may also be referred to as Part B (supportive services and senior centers) and Part C1(congregate nutrition services) and C2 (home-delivered nutrition services). Grants to Indian tribes for similar purposes are authorized under another title of the OAA and are not included in this Supplement. Implementing regulations are published at 45 CFR part 1321.

    The Nutrition Services Incentive Program (NSIP) is authorized in Title III of the OAA, as amended, which is codified at 42 USC 3030a. There are no implementing regulations. Availability of Other Program Information

    Additional information about nutrition and supportive services as amended in 2006 is available at the AoA web site at http://aoa.gov/OAA2006/Main_Site/.

    III. COMPLIANCE REQUIREMENTS

    In developing the audit procedures to test compliance with the requirements for a Federal program, the auditor should first look to Part 2, Matrix of Compliance Requirements, to identify which of the 14 types of compliance requirements described in Part 3 are applicable and then look to Parts 3 and 4 for the details of the requirements.

    A. Activities Allowed or Unallowed

    1. State Agency

    a. State Agencies may use any amount of Title III-B (supportive services)

    funding necessary to conduct an effective ombudsman program (42 USC

    3024 (d)(1)(B)).

    b. Grant funds may be used for State plan administration, including State

    Plan preparation, evaluation of activities carried out under the Plan, the

    collection of data and the conduct of analyses related to the need for

    services, dissemination of information, short-term training, and

    demonstration projects (42 USC 3028 (a)).

    c. No supportive services, nutrition services, or in-home services may be

    provided directly by the State Agency unless the State Agency determines

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    June 2010 Aging Cluster HHS

    of services, where such services are related to the agency‘s administrative

    functions, or where such services of comparable quality can be provided

    more economically by the State Agency (42 USC 3027(a)(8)(A)).

    2. Area Agency

    Supportive Services and Senior Centers and Nutrition Services a. Funds may be used for plan administration, operation of an advisory

    council, activities related to advocacy, planning, information sharing, and

    other activities leading to development or enhancement within the

    designated service area(s) of comprehensive and coordinated community-

    based systems of service delivery to older persons (45 CFR section

    1321.53).

    b. If approved by the State Agency, an Area Agency may use service funds

    for program development and coordination activities (45 CFR section

    1321.17(f)(14)(i)).

    c. No supportive services, nutrition services, or in-home services may be

    provided directly by an Area Agency except if, in the judgment of the

    State Agency, direct provision of services is necessary to ensure an

    adequate supply of services, where such services are related to the

    agency‘s administrative functions, or where such services of comparable

    quality can be provided more economically by the agency (42 USC 3027

    (a) (8)).

    NSIP

    Recipient agencies may use the cash received in lieu of commodities only to purchase domestically produced foods for their nutrition projects (42 USC 3030a(d)(4)).

    3. Service Providers

    Supportive Services and Senior Centers and Nutrition Services

    a. Funds may be used to assist in the operation of multi-purpose senior

    centers and to meet all or part of the costs of compensating professional

    and technical personnel required for center operation (42 USC 3030d

    (b)(2)).

    b. Funds may be used for nutrition services and supportive services

    consistent with the terms of the agreement between the Area Agency and

    the service provider (42 USC 3026(a)(1), 3030d(a), and 3030e).

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    c. Funds may be used for services associated with access to supportive

    services for in-home services, and for legal assistance (42 USC 3026

    (a)(2)).

    d. Nutrition services may be provided to older individuals‘ spouses, who

    may not be eligible for these services in their own right, on the same basis

    as they are provided to older individuals, and may be made available to

    handicapped or disabled individuals who are less than 60 years old but

    who reside in housing facilities occupied primarily by older individuals at

    which congregate nutrition services are provided (42 USC 3030g-21(2)(I)).

    e. In accordance with procedures established by the Area Agencies, nutrition

    project administrators may offer meals to individuals providing volunteer

    services during the meal hours and to individuals with disabilities who

    reside at home with eligible individuals (42 USC 3030g-21(2)(H)).

    f. Funds may be used for provision of home-delivered meals to older

    individuals (42 USC 3030f).

    g. Funds may be used to acquire (in fee simple or by lease for 10 years or

    more), alter, or renovate existing facilities or to construct new facilities to

    serve as multi-purpose senior centers for not less than 10 years after

    acquisition, or 20 years after completion of construction, unless waived by

    the Assistant Secretary for Aging (42 USC 3030b).

    NSIP

    Cash received in lieu of commodities may be used only to purchase domestically

    produced foods for their nutrition projects (42 USC 3030a(d)(4)).

    E. Eligibility

    1. Eligibility for Individuals - Not Applicable

    2. Eligibility for Group of Individuals or Area of Service Delivery - Not

    Applicable

    3. Eligibility for Subrecipients

    Service providers may include profit-making organizations except that providers

    of case management services must be public or non-profit agencies (42 USC

    3026(a)(8)(C)).

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    G. Matching, Level of Effort, Earmarking

    1. Matching

    a. State

    (1) States must contribute from State or local sources at least 25

    percent of the cost of State Plan administration as their matching

    share. This may include cash or in-kind contributions by the State

    or third parties (42 USC 3028 (a)(1) and 42 USC 3029 (b); 45 CFR

    section 1321.47).

    (2) All services, whether provided by the State Agency, an Area

    Agency or other service provider (including any ombudsman

    services provided under the authority of 42 USC 3024 (d)(1)(D))

    must be funded with a non-Federal match of at least 15 percent.

    This percentage must be met on a statewide basis. Funds for

    ombudsman services provided under the authority of 42 USC 3024

    (d)(1)(B) are not required to be matched (42 USC 3024 (d)(1)(D);

    45 CFR section 1321.47).

    b. State and Area Agencies

    Area Agencies, in the aggregate, must contribute at least 25 percent of the

    costs of administration of area plans (42 USC 3024 (d)(1)(A);

    45 CFR section 1321.47).

    (1) State - Since this match is computed based on the aggregate of all

    Area Agencies in the State, the auditor‘s testing of the amount of

    this match is performed at the State Agency.

    (2) Area Agencies - The auditor‘s testing of the allowability of the

    matching (e.g., from an allowable source and in compliance with

    the administrative requirements and allowable costs/cost principles

    requirements) should be performed at the Area Agencies.

    2.1 Level of Effort - Maintenance of Effort

    State - The State Agency must spend for both services and administration at least the average amount of State funds it spent under the State plan for these activities for the three previous fiscal years. If the State Agency spends less than this amount, the Assistant Secretary for Aging reduces the State‘s allotments for supportive and nutrition services under this part by a percentage equal to the percentage by which the State reduced its expenditures (42 USC 3029 (c); 45 CFR section 1321.49). See III. L.1, ―Reporting - Financial Reporting‖ for the

    reporting requirement regarding maintenance of effort.

    2.2 Level of Effort - Supplement Not Supplant - Not Applicable

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    3. Earmarking

    a. State

    (1) Overall expenditures for administration are limited to the greater of

    five percent (or $300,000 or $500,000 depending on the aggregate

    amount appropriated or a lesser amount for the U.S. territories) of

    the overall allotment to a State under Title III unless a waiver is

    granted by the Assistant Secretary on Aging (42 USC 3028 (b)(1),

    (2), and (3)).

    (2) After a State determines the amount to be applied to State plan

    administration under 42 USC 3028 (b), the State may:

    (a) Make up to (and including) 10 percent of that amount

    available for the administration of Area Plans. The State

    may either calculate the 10 percent based on the total

    allotment from AoA or on the amount remaining after

    deducting the amount to be applied to State Plan

    administration (42 USC 3024(d)(1)(A)); and

    (b) Use any amounts available to the State for State plan

    administration which the State determines are not needed

    for that purpose to supplement the amount available for

    administration of Area Plans (42 USC 3028(a)(2)). (3) Any State which has been designated as a single planning and

    service area may elect to be subject to the State Plan administration

    limit (five percent) or the Area Plan administration (10 percent)

    limit (42 USC 3028(a)(3)).

    (4) A State may transfer:

    (a) Up to 40 percent of a State‘s separate allotments for

    congregate and home-delivered nutrition services between

    those two allotments without AoA approval (42 USC 3028

    (b)).

    (b) Not more than 30 percent between programs under Part B

    and Part C (Parts C1 and/or C2) for use as the State

    considers appropriate (42 USC 3028(b)).

    (c) An additional 10 percent may be transferred between C1

    and C2 with an AoA waiver (42 USC 3028(b)).

    (d) A waiver may be requested to transfer an amount which is

    above the allowable 30 percent between Parts B and C

    (42 USC 3030c-3(b)(4)).

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    A State Agency may not delegate to an Area Agency or any other

    entity the authority to make such transfers (42 USC 3028(b)(6)).

    (5) The State agency will not fund program development and

    coordinated activities as a cost of supportive services for the

    administration of area plans until it has first spent 10 percent of the

    total of its combined allotments under this program on the

    administration of area plans (45 CFR section 1321.17(f)(14)).

    b. Area Agency

    As provided in agreements with the State Agency, Area Agencies earmark

    portions of their allotment. The typical earmarks are:

    (1) A maximum amount or percentage for program development and

    coordination activities by that agency (42 USC 3024(d)(1)(D);

    45 CFR section 1321.17(f)(14)(i)).

    (2) A minimum amount or percentage for services related to access,

    in-home services, and legal assistance (42 USC 3026(a)(2)).

    H. Period of Availability of Federal Funds

    Funds are made available to the State annually and must be obligated by the State by the end of the Federal fiscal year in which they were awarded. The State has two years to liquidate all obligations for its administration of the State Plan and for awards to the Area Agencies consistent with its intrastate allocation formula. Therefore, in any given year, multiple years of funding are being used to provide services statewide. Whenever the Assistant Secretary on Aging determines that any amount allotted to a State under Parts B or C for a fiscal year will not be used to carry out the purpose for which the allotment was made, the funds may be reallotted to one or more other States. Any amount made available to a State as the result of a reallotment shall be regarded as part of the State‘s allotment for the same fiscal year in which the funds were appropriated, but shall remain available for obligation by the State until the end of the succeeding fiscal year (42 USC 3024 (b)).

    J. Program Income

    1. Service providers are required to provide an opportunity to individuals being

    served under all Part B and C services program to make voluntary contributions

    for services received. These voluntary contributions are to be added to the

    amounts made available by the State or Area Agency and must be used to expand

    the service from which they are collected (42 USC 3030c-2(b)).

    2. Cost-sharing fees may be collected from Title III-B services except information

    and assistance, outreach, benefits counseling, or case management services. Cost

    sharing is not allowed for Title III-C services or Title VII Elder Rights Services

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