Get Grants to Help Seniors Avoid Nursing Homes

This Program Announcement provides an opportunity for the Aging Services Network to modernize its approach to helping individuals who are at imminent risk of nursing home placement but not eligible for Medicaid to avoid nursing home placement and spend-down to Medicaid, consistent with the long-term care provisions that were included in the 2006 Amendments to the Older Americans Act. The Announcement also includes a special funding opportunity?€”being made available by the Veterans Health Administration?€”for the Aging Services network to provide home and community-based services to veterans and their family caregivers. Under this Announcement, applications will be accepted from State Units on Aging (SUA). A successful applicant will propose to implement projects in partnership with Area Agencies on Aging (AAA), aging services provider organizations, Single-Entry-Point programs, and other long-term care stakeholders including the Single State Medicaid Agency.

The total amount of AoA funds available for this new funding opportunity is expected to be up to $10,000,000. AoA plans to fund up to 10 to 15 states for a period of 18 months. Grants under this Announcement are to be used to advance long-term care program changes at the state and community level that will: Enable the Aging Services Network to make better use of single-entry-point programs to efficiently and effectively identify individuals who are not Medicaid eligible but are at imminent risk of nursing home placement and spend-down; Strengthen the Aging Services Network's capacity to rapidly authorize and provide services and supports to help high-risk individuals avoid nursing home placement and spend-down to Medicaid; Enhance the Aging Services Network's capacity to use service delivery models that provide a full range of options and allow the Network to tailor services to the unique and changing needs of high-risk individuals; Expand the Aging Services Network's capacity to use consumer-directed models so the Network can give more people the option to control the types of services they receive and the manner in which those services are provided; and, Strengthen the Aging Services Network's capacity to track client outcomes and document how the Network can help the high-risk individuals targeted under this Announcement to avoid nursing home placement and spend-down and also reduce the rate of growth in Medicaid long-term care expenditures. Projects to be funded under this Announcement must: 1.) No later than the end of the 9th month of the project period, have at least one local project up and running and delivering services to the high-risk individuals targeted under this Announcement in a way that: A.

Uses a Single-entry-point (SEP) 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. Uses formal protocols and other tools across, and by, key stakeholder organizations (e.g., SEP, aging services providers, AAAs, hospitals, nursing homes, Centers for Independent Living, Veterans Health Administration, etc.) for making client referrals, prioritizing clients, authorizing services, and following-up with clients to ensure that the local project can rapidly provide home and community-based services and supports to the high ?€“risk individuals who are identified by the Single-entry-point program, and that the services for these individuals can be quickly adjusted as necessary as their needs change. C. Has in place formal SUA and AAA policies which are in effect-at least in the PSA(s) where the local project(s) are operating?€”that support the investment of some OAA dollars to serve the high-risk individuals who are targeted under this Announcement.

2.) No later than the end of the 15th month of the project period, in addition to the items in #1, be providing 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 models. 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 become more consumer driven.

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 Nursing Home Diversion Modernization 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 management processes, that have been proven to identify and serve those individuals in priority order. Projects funded under this Announcement must be able to monitor and follow-up with the individuals they are serving under this grant to ensure that the necessary services are being provided, that client needs are being met, and that adjustments in the services are being made as necessary.

Projects must also be able to report on client-level data and be able to document the effectiveness of the program in successfully diverting individuals away from long-term nursing home placement and Medicaid spend-down, and any associated cost avoidance for the Medicaid program. AoA, along with the Nursing Home Diversion Technical Assistance Center, will work with successful applicants to identify the specific data that will need to be collected. States may use one or more of the following sources to support the delivery of home and community-based services to the individuals targeted under this Announcement: grant funds made available under this Announcement; the Older Americans Act; Alzheimer's Disease Demonstration Grants to States (ADDGS); and any other public program or source that can be used to serve individuals who are not eligible for Medicaid. The specific requirements and fundable activities for this opportunity are outlined in Section I.5.

Applications will be scored in part based on the degree of progress a state proposes to make toward achieving the types of long-term care program changes called for in this Announcement (see Page 1), in comparison to the status quo statewide and within the geographic areas covered by the grant project. Special Funding Opportunity to Serve Veterans As part of this Program Announcement, The Veterans Health Administration plans to invest approximately $3,000,000 in up to 12 Veterans Integrated Service Networks (VISNs) to successful AoA NHDM grantees that submit a complete application for the Veterans Directed Home and Community Based Service Program (VDHCBS) along with their AoA NHDM grant application.