FY 2016 ACL Congressional Justification

266 Pages·2015·3.58 MB·English

by  Greg Pugh

DEPARTMENT
of HEALTH
and HUMAN
SERVICES

Fiscal Year
2016

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 2016 President’s Budget
request, totaling $2.1 billion, an increase of +$177 million, which focuses on two main goals. First it
sustains the core ACL services that allow older adults and people of all ages with disabilities to remain
independent. To this end, +$106 million would support investments in home and community based services
(including nutrition programs) for seniors, Independent Living services for those with disabilities, and
programs that support caregivers for older adults. Second, the request would add +$70 million to increase
innovation and efficiency of ACL programs and to help them to modernize and be better positioned to meet
future service needs.

I would like to highlight several of these initiatives. Our Family Support Initiative would direct $15 million
to encourage the use of community assets and opportunities to help families to reduce stress, improve
emotional well-being, develop support skills, and plan for the future. Over 80 percent of the long-term
services and supports provided to older Americans come from family caregivers while over 75 percent of
people with developmental disabilities in this country rely primarily on family members, often for most of
their lives.

Second, ACL proposes to devote $20 million to modernize its older adult nutrition programs. These funds
would support competitive grants to translate research into evidence-based models for delivering services at
the community level. Nutrition services are particularly critical to keeping older Americans healthy and
preventing the need for more costly medical interventions, and this effort would increase the knowledge base
of nutrition providers, drive improved health outcomes for program recipients by promoting higher service
quality, and increase program efficiency through innovative service delivery models.

ACL is also proposing to increase funding by $21 million to continue to develop a national Adult Protective
Services data system, including grants to states to test and develop infrastructure, while also providing
funding for key research. Research in the area of adult protective services is essential to the future
development of evidence-based interventions that will effectively prevent, identify, report, and respond to
abuse of adults of all ages.

The FY 2016 request also incorporates funds for programs transferred from the Department of Education by
the Workforce Innovation and Opportunity Act. These programs—the National Institute on Disability,
Independent Living, and Rehabilitation Research; Independent Living; and Assistive Technology—help
further ACL’s vision that all people, regardless of age and disability, live with dignity, make their own
choices, and participate fully in society.

The three years since ACL’s creation have been a time of growth, learning, and a rededication of our efforts
to ensure that all Americans, 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
Executive Summary
Introduction and Mission ............................................................................................................................................... 1
Overview of Budget Request ......................................................................................................................................... 3
Overview of Performance .............................................................................................................................................. 9
All Purpose Table ........................................................................................................................................................ 19

Appropriations Language ............................................................................................................................................ 21
Appropriations Language Analysis ............................................................................................................................. 23
Amounts Available for Obligation .............................................................................................................................. 24
Summary of Changes ................................................................................................................................................... 25
Budget Authority by Activity ...................................................................................................................................... 26
Authorizing Legislation ............................................................................................................................................... 28
Appropriations History Table ...................................................................................................................................... 30
Appropriations Not Authorized by Law ...................................................................................................................... 31

Health and Independence for Older Adults ............................................................................................................ 32
Home and Community-Based Supportive Services ..................................................................................................... 36
Nutrition Services ........................................................................................................................................................ 45
Preventive Health Services .......................................................................................................................................... 60
Chronic Disease Self-Management Education ............................................................................................................ 67
Falls Prevention ........................................................................................................................................................... 73
Native American Nutrition and Supportive Services ................................................................................................... 79
Aging Network Support Activities .............................................................................................................................. 85

Caregiver and Family Support Services .................................................................................................................. 92
Family Caregiver Support Services ............................................................................................................................. 96
Family Support .......................................................................................................................................................... 105
Native American Caregiver Support Services ........................................................................................................... 113
Alzheimer’s Disease Supportive Services Program .................................................................................................. 117
Alzheimer’s Disease Initiative - Specialized Supportive Services ............................................................................ 123
Lifespan Respite Care ................................................................................................................................................ 127

Protection of Vulnerable Adults ............................................................................................................................. 133
Long-Term Care Ombudsman Program .................................................................................................................... 135
Prevention of Elder Abuse and Neglect ..................................................................................................................... 141
Senior Medicare Patrol Program ............................................................................................................................... 147
Elder Rights Support Activities ................................................................................................................................. 151

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Disability Programs, Research, and Services ........................................................................................................ 159
State Councils on Developmental Disabilities ........................................................................................................... 161
Developmental Disabilities – Protection and Advocacy ............................................................................................ 169
University Centers for Excellence in Developmental Disabilities ............................................................................. 177
Developmental Disabilities – Projects of National Significance ............................................................................... 183
National Institute on Disability, Independent Living, and Rehabilitation Research .................................................. 188
Independent Living .................................................................................................................................................... 188

Consumer Information, Access, and Outreach ..................................................................................................... 202
Aging and Disability Resource Centers ..................................................................................................................... 206
State Health Insurance Assistance Programs ............................................................................................................. 213
Voting Access for Individuals with Disabilities ........................................................................................................ 217
Assistive Technology ................................................................................................................................................ 223
Alzheimer’s Disease Initiative - Outreach Campaign................................................................................................ 229
National Clearinghouse for Long-Term Care Information ........................................................................................ 229
Limb Loss Resource Center....................................................................................................................................... 237
Paralysis Resource Center ......................................................................................................................................... 241

Program Administration ............................................................................................................................................ 245

Supplementary Tables
Budget Authority by Object Class ............................................................................................................................. 249
Salaries and Expenses ................................................................................................................................................ 250
Detail of Full-Time Equivalent Employment (FTE).................................................................................................. 251
Detail of Positions ..................................................................................................................................................... 252
Programs Proposed for Elimination ........................................................................................................................... 253
FTE Funded by the Affordable Care Act ................................................................................................................... 254

Significant Items in Appropriations Committee Reports ........................................................................................... 255

Prevention and Public Health Fund ........................................................................................................................... 257

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Introduction and Mission

The Administration for Community Living (ACL) is the single agency charged to work with
States, localities, Tribal organizations, nonprofit organizations, businesses, and families to help
older adults and people with disabilities live independently and fully participate in their
communities. ACL’s mission is to maximize the independence, well-being, and health of older
adults, people with disabilities across the lifespan, and their families and caregivers. Those with
disabilities or functional limitations of any type, regardless of age, have a common interest:
access to home and community-based supports and services that can help individuals to fully
participate in all aspects of society, including having the option to live at home, which can be
vital to an individual’s well-being, instead of moving into an institutional setting. ACL works to
improve this access through program lines that address the unique needs of each population.

Through its Administration on Aging (AoA), ACL works with and through its national aging
services network to promote the development of comprehensive and coordinated systems of
home and community-based services and supports that are responsive to the needs and
preferences of older adults and their caregivers. The network is comprised of 56 State and
Territorial Units on Aging (SUA), 618 Area Agencies on Aging (AAA), 264 Indian Tribal and
Native Hawaiian organizations, nearly 20,000 direct service providers, and hundreds of
thousands of volunteers. 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
Americans.

Through its Administration on Intellectual and Developmental Disabilities (AIDD), ACL works
through a network of States 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) to address the needs of those with
intellectual and developmental disabilities. 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 that promote self-determination, independence, productivity,
integration, and inclusion in all facets of community life. The transfer of the Independent Living
programs and the National Institute on Disability, Independent Living and Rehabilitation
Research from the Department of Education is a significant step in the evolution of ACL. These
programs will allow ACL to further address the needs of individuals with disabilities, as well as
enhance the agency’s effort to support and implement disability research.
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EXECUTIVE SUMMARY

Finally, ACL promotes consistency and coordination in community living policy and seeks to
better align the health, social, employment, family and community supports that are critical to
both older adults and people with disabilities, through its Center for Policy and Evaluation (CPE)
and Center for Consumer Access and Self-Determination (CCASD). These Centers support
programs and activities that help provide both older Americans and people with disabilities
information and access to long-term services and support, including the Assistive Technology
program that was transferred by WIOA. Other programs transferred to ACL in recent years, such
as the Limb Loss program, (transferred from the Centers for Disease Control in FY 2015), the
Paralysis Resource Center (transferred from the Centers for Disease Control in FY 2014), and
the State Health Insurance Assistance Program (transferred from the Centers for Medicare and
Medicaid Services in FY 2014) also have expanded ACL’s ability to fulfill this important
objective.

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