FY 2015 ACL Congressional Justification

250 Pages·2014·1.86 MB·English

DEPARTMENT
of HEALTH
and HUMAN
SERVICES

Fiscal Year
2015

Administration for
Community Living

Justification of
Estimates for
Appropriations Committees
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DEPARTMENT OF HEALTH & HUMAN SERVICES Administration for Community Living

Washington, DC 20201

I am pleased to present the Administration for Community Living’s (ACL) FY 2015 President’s Budget
request. Like ACL’s first budget request in FY 2014, this request includes our two main program
components: the Administration on Aging and the Administration on Intellectual and Developmental
Disabilities.

ACL’s FY 2015 request matches the FY 2014 enacted level in nearly all respects, which reflects our first and
highest priority: maintaining funding for ACL’s core programs. The vast majority of ACL’s funding is for
direct services and supports, and the States, Tribes, and localities that depend upon these funds have limited
options to offset losses of Federal funding. Maintaining funding for these programs is therefore critical to our
efforts to help more people to have the option to live in their homes and to fully participate in their
communities, including the more than 50 percent of home-delivered meal recipients who report that these
meals represent the majority of their food in a given day.

This budget also includes several new initiatives. The first, recognizing the Administration on Aging’s
longstanding emphasis on elder justice, is funding for the Elder Justice Act (EJA) at HHS. The issues of
elder abuse, neglect, and exploitation affect millions of Americans. Reflecting HHS’ leadership of the Elder
Justice Coordinating Council, funding the Elder Justice Act would firmly establish ACL as a federal resource
on nationwide issues of elder justice and respond to the call from the Government Accountability Office
(GAO) for Federal leadership.

Second, ACL proposes a new initiative addressing the transition from adolescence to adulthood for young
people with developmental disabilities. This initiative would respond to GAO and Congressional inquiries
seeking to develop best practices and an evidence base in supporting young people with developmental
disabilities in this particularly important transition.

In addition, ACL is proposing renewed mandatory funding for the Aging and Disability Resource Centers
(ADRC) program, which has demonstrated proven success in helping connect people to the resources they
need to continue living independently in their communities. These successful systemic changes are ready to
be expanded to the remaining States, but continued funding is vital to the program’s nationwide expansion.

Finally, ACL is proposing new funding to hold a White House Conference on Aging, as well as the
establishment of a Holocaust Survivors Fund that would assist elderly Holocaust survivors to remain in their
homes and communities.

ACL’s first year has been a time of growth, learning, and a rededication of our efforts to ensure that all
people, regardless of age or disability, can live and thrive in their communities. This budget will allow us to
continue serving our populations and position us for greater successes on their behalf.

Kathy Greenlee
Administrator and Assistant Secretary for Aging
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Table of Contents
Organization Chart .......................................................................................................................................................iv

Executive Summary
Introduction and Mission ............................................................................................................................................... 1
Overview of Budget Request ......................................................................................................................................... 3
Overview of Performance .............................................................................................................................................. 9
All Purpose Table ........................................................................................................................................................ 23

Appropriations Language ............................................................................................................................................ 25
Appropriations Language Analysis ............................................................................................................................. 27
Amounts Available for Obligation .............................................................................................................................. 28
Summary of Changes ................................................................................................................................................... 29
Budget Authority by Activity ...................................................................................................................................... 30
Authorizing Legislation ............................................................................................................................................... 32
Appropriations History Table ...................................................................................................................................... 34
Appropriations Not Authorized by Law ...................................................................................................................... 35

Health and Independence
Summary of Request ................................................................................................................................................... 37
Home and Community-Based Supportive Services ..................................................................................................... 41
Nutrition Services ........................................................................................................................................................ 49
Preventive Health Services .......................................................................................................................................... 63
Chronic Disease Self-Management Education ............................................................................................................ 69
Falls Prevention ........................................................................................................................................................... 75
Senior Community Service Employment Program ...................................................................................................... 79
Native American Nutrition and Supportive Services ................................................................................................... 85
Aging Network Support Activities .............................................................................................................................. 91

Caregiver Services
Summary of Request ................................................................................................................................................. 100
Family Caregiver Support Services ........................................................................................................................... 104
Native American Caregiver Support Services ........................................................................................................... 112
Alzheimer’s Disease Supportive Services Program .................................................................................................. 115
Alzheimer’s Disease Initiative - Services .................................................................................................................. 121
Lifespan Respite Care ................................................................................................................................................ 125

Protection of Vulnerable Adults
Summary of Request ................................................................................................................................................. 131
Elder Justice Initiative ............................................................................................................................................... 135
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Long-Term Care Ombudsman Program .................................................................................................................... 141
Prevention of Elder Abuse and Neglect ..................................................................................................................... 147
Senior Medicare Patrol Program ............................................................................................................................... 153
Elder Rights Support Activities ................................................................................................................................. 157

Developmental Disabilities Programs
Summary of Request ................................................................................................................................................. 163
State Councils on Developmental Disabilities ........................................................................................................... 165
Developmental Disabilities – Protection and Advocacy ............................................................................................ 171
University Centers for Excellence in Developmental Disabilities ............................................................................. 177
Developmental Disabilities – Projects of National Significance ............................................................................... 183
Youth Transitions Initiative ....................................................................................................................................... 187

Consumer Information, Access & Outreach
Summary of Request ................................................................................................................................................. 191
Aging and Disability Resource Centers ..................................................................................................................... 193
Voting Access for Individuals with Disabilities ........................................................................................................ 199
Alzheimer’s Disease Initiative - Outreach Campaign ................................................................................................ 205
State Health Insurance Assistance Programs ............................................................................................................. 209
National Clearinghouse for Long-Term Care Information ........................................................................................ 213
Paralysis Resource Center ......................................................................................................................................... 217

White House Conference on Aging ........................................................................................................................... 221
Holocaust Survivor Assistance Fund ......................................................................................................................... 223

Program Administration ............................................................................................................................................ 225

Supplementary Tables
Budget Authority by Object Class ............................................................................................................................. 227
Salaries and Expenses ................................................................................................................................................ 228
Detail of Full-Time Equivalent Employment (FTE).................................................................................................. 229
Detail of Positions ..................................................................................................................................................... 231
FTE Funded by the Affordable Care Act ................................................................................................................... 233

Significant Items in Appropriations Committee Reports ........................................................................................... 235

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Introduction and Mission

The Administration for Community Living (ACL) is the newest Operating Division within the
U.S. Department of Health and Human Services (DHHS), formed by Secretary Sebelius in
April 2012. ACL serves as a single agency charged to work with States, localities, Tribal
organizations, nonprofit organizations, businesses, and families to help older adults and people
with disabilities to live in their homes and fully participate in their communities. ACL’s mission
is to maximize the independence, well-being, and health of older adults, people with disabilities,
and their families and caregivers.

Those with disabilities or functional limitations of any type, regardless of age, have a common
interest. For these populations, access to home and community-based supports and services can
make the difference in ensuring that people can fully participate in all aspects of society,
including having the option to live at home instead of having little choice but to move into some
form of institutional care. ACL works to improve this access through two distinct program lines
that address the unique needs of each community: programs serving older adults and caregivers
under ACL’s Administration on Aging (AoA) and programs for people with intellectual and
developmental disabilities and their families under ACL’s Administration on Intellectual and
Developmental Disabilities (AIDD).

AoA advances the concerns and interests of older people, and works with and through the
national aging services network to promote the development of comprehensive and coordinated
systems of home and community-based care that are responsive to the needs and preferences of
older people and their caregivers. The network is comprised of 56 State and Territorial Units on
Aging (SUA), 618 Area Agencies on Aging (AAA), 246 Indian Tribal and Native Hawaiian
organizations, nearly 20,000 direct service providers, and hundreds of thousands of volunteers.
AoA’s core programs, authorized under the Older Americans Act (OAA), help older adults
remain at home for as long as possible. These services complement existing medical and health
care systems, help prevent hospital readmissions, and support some of life’s most basic
functions, such as bathing or preparing meals. These programs also support family caregivers,
address issues of exploitation, neglect and abuse of older adults, and adapt services to the needs
of Native American elders.

AIDD advances the concerns and interests of people with developmental disabilities and their
families, working through a network that includes, in each State and Territory, State Councils on
Developmental Disabilities, State Protection and Advocacy systems, and University Centers for
Excellence in Developmental Disabilities (UCEDDs). AIDD programs fund capacity building
and systems change efforts to ensure that people with developmental disabilities and their
families participate in the design of and have access to needed community services,
individualized supports, and other forms of assistance such as rehabilitative services that
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EXECUTIVE SUMMARY
promote self-determination, independence, productivity, integration, and inclusion in all facets of
community life.

ACL will continue to promote consistency and coordination in community living policy and seek
to better align the medical, clinical, and community-based supports that are critical to both older
adults and people with disabilities. ACL’s Center for Aging and Disability Policy provides a
focal point for these efforts to develop new policies and initiatives that support both older
Americans and persons with disabilities in accessing services and supports while fully
participating in their communities.

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