FY 2017 ACL Congressional Justification

291 Pages·2017·2.48 MB·English

by  Greg Pugh

DEPARTMENT
of HEALTH
and HUMAN
SERVICES
Fiscal Year
2017
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 2017 President’s Budget
request, totaling $2.0 billion, a net increase of +$28 million. The vast majority of ACL’s funding is allocated
for grants that provide direct services and supports. ACL received modest increases in FY 2016 for many of
these core services programs and our FY 2017 request maintains these increases while also requesting
additional funding for three key areas. First, +$23.8 million is requested for nutrition and supportive services
programs to help meet the needs of a growing senior population— and thereby reduce or delay the need for
more expensive medical interventions and institutional services. Second, +$2 million is requested for Elder
Justice/Adult Protective Services (APS). Historically, an absence of federal stewardship in APS has led to
inconsistent data systems and no reporting requirements at the national level, and prevented APS programs
from conducting meaningful program evaluations. The additional funding will further support states by
providing significant, on-going technical assistance and resources for identifying promising and best practices,
participating in national APS data collection efforts; and conducting research and evaluations to increase the
knowledge base about effective APS programming and practices. Finally, +$3.6 million is requested for two
cross-cutting programs—Lifespan Respite Care and Aging and Disability Resource Centers—to further
develop more efficient, cost-effective and consumer responsive State-wide systems that support both seniors
and those of all ages with disabilities, and their families and caregivers.

The FY 2017 request also incorporates a new proposal to use up to 1% of the funds appropriated to ACL’s
nutrition programs to develop innovative, evidence-based practices for senior nutrition. Examples of
promising practices that enhance the quality and effectiveness of our nutrition program include service
products that appeal to caregivers (such as web-based ordering systems and carryout meals), increased
involvement of volunteers (such as retired chefs), new service models (testing variations and hybrid strategies)
and other innovations to better serve older adults. These funds may be used to help develop and test additional
models or to replicate models that have already been tested in other community-based settings.

Finally, ACL continues to work towards the seamless integration of its recently transferred programs—
including Traumatic Brain Injury, Limb Loss, and those programs transferred by the 2014 Workforce
Innovation and Opportunity Act—having brought them all together under one roof in our recent move to the
Mary E. Switzer building. These programs closely align with ACL’s vision that all people, regardless of age
and disability, live with dignity, make their own choices, and participate fully in society. The transfer of these
programs is a significant step in the evolution of ACL. ACL’s past few years have 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
Executive Summary
Introduction and Mission .............................................................................................................................. 1
Overview of Budget Request ........................................................................................................................ 3
Overview of Performance ............................................................................................................................. 9
Appropriations Language ............................................................................................................................ 19
Appropriations Language Analysis ............................................................................................................. 21
Amounts Available for Obligation .............................................................................................................. 22
Summary of Changes .................................................................................................................................. 23
Budget Authority by Activity ..................................................................................................................... 24
Authorizing Legislation .............................................................................................................................. 26
Appropriations History Table ..................................................................................................................... 28
Appropriations Not Authorized by Law ..................................................................................................... 29

Health and Independence for Older Adults
Summary of Request ................................................................................................................................... 31
Home and Community-Based Supportive Services .................................................................................... 35
Nutrition Services........................................................................................................................ 45
Preventive Health Services ......................................................................................................................... 61
Chronic Disease Self-Management Education............................................................................................ 69
Falls Prevention .......................................................................................................................................... 75
Native American Nutrition and Supportive Services .................................................................................. 81
Native American Nutrition & Supportive Services .................................................................................... 84
Aging Network Support Activities ............................................................................................................. 87

Caregiver and Family Support Services
Summary of Request ................................................................................................................................... 95
Family Caregiver Support Services ............................................................................................................ 99
Native American Caregiver Support Services .......................................................................................... 107
Alzheimer’s Disease Supportive Services Program .................................................................................. 111
Alzheimer’s Disease Supportive Services Program .................................................................................. 114
Lifespan Respite Care ............................................................................................................................... 121

Protection of Vulnerable Adults
Summary of Request ................................................................................................................................. 129
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Long-Term Care Ombudsman Program ................................................................................................... 131
Prevention of Elder Abuse and Neglect .................................................................................................... 139
Program Description and Accomplishments: ........................................................................................... 139
Funding History: ....................................................................................................................................... 140
Budget Request: ........................................................................................................................................ 140
Output Table: ............................................................................................................................................ 141
Prevention of Elder Abuse and Neglect .................................................................................................... 141
Senior Medicare Patrol Program ............................................................................................................... 145
Elder Rights Support Activities ................................................................................................................ 151

Disability Programs, Research and Services
Summary of Request ................................................................................................................................. 159
State Councils on Developmental Disabilities .......................................................................................... 161
Developmental Disabilities – Protection and Advocacy ........................................................................... 170
University Centers for Excellence in Developmental Disabilities ............................................................ 178
Developmental Disabilities – Projects of National Significance .............................................................. 186
National Institute on Disability, Independent Living, and Rehabilitation Research ................................. 192
Independent Living ................................................................................................................................... 200
Limb Loss Resource Center ...................................................................................................................... 208
Program Description and Accomplishments: ........................................................................................... 208
Funding History: ....................................................................................................................................... 209
Budget Request: ........................................................................................................................................ 209
Limb Loss Resource Center ...................................................................................................................... 210
Paralysis Resource Center ......................................................................................................................... 212
Traumatic Brain Injury ............................................................................................................................. 216

Consumer Information, Access & Outreach
Summary of Request ................................................................................................................................. 224
Aging and Disability Resource Centers .................................................................................................... 226
State Health Insurance Assistance Programs ............................................................................................ 232
Voting Access for Individuals with Disabilities ....................................................................................... 238
Program Description and Accomplishments: ........................................................................................... 238
Funding History: ....................................................................................................................................... 239
Budget Request: ........................................................................................................................................ 239
Grant Awards Table: ................................................................................................................................. 240
Voting Access for Individuals with Disabilities Grant Awards ................................................................ 240
Assistive Technology ................................................................................................................................ 244
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Alzheimer’s Disease Initiative - Outreach Campaign ............................................................................... 256

Program Administration ........................................................................................................................ 260

Supplementary Tables
Object Classification Table - D irect.... ......................................................... ................................266
Salaries and Expenses ............................................................................................................................... 267
Detail of Full-Time Equivalent Employment (FTE) ................................................................................. 268
Detail of Positions ..................................................................................................................................... 269
Programs Proposed for Elimination .......................................................................................................... 270
FTE Funded by the Affordable Care Act .................................................................................................. 271
Physicians’ Comparability Allowance Worksheet.................................................................................... 272

Significant Items in Appropriations Committee Reports.................................................................... 274
Prevention and Public Health Fund ...................................................................................................... 280
Text Description Administration for Community Living Organizational Chart ............... 282

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Introduction and Mission

The Administration for Community Living (ACL) works 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.

ACL’s programs provide community-based services and supports that help people to remain
independent while reducing costs to other public programs such as Medicaid. This is critical given
the growth in the segments of the population that these programs serve:

• The U.S. population over age 60 is projected to increase by 20 percent between 2014 and
2020, from 64.8 million to 77.6 million.1

• According to the U.S. Census Bureau, in 2010, there were 56.7 million Americans living
with disabilities, of which over 12 million required assistance with activities of daily living
or instrumental activities of daily living.2

• Studies indicate that individuals with developmental disabilities comprise between 1.2 and
1.65 percent of the U.S. population, or between 3.8 and 5.3 million individuals.3

1 U.S. Census Bureau, “2014 National Population Projections,” Table 1. Projected Population by Single Year of Age,
Sex, Race, and Hispanic Origin for the United States: 2014 to 2060. Released December 2014,
http://www.census.gov/population/projections/data/national/2014/downloadablefiles.html. Accessed 08 January
2015.
2 U.S. Census Bureau, “Americans With Disabilities: 2010,” http://www.census.gov/prod/2012pubs/p70-131.pdf,
Issued July 2012, Accessed 21 August 2014.
3 Extrapolated from Developmental Disabilities Assistance and Bill of Rights Act of 2000, Section 101(a)(1) (see
http://www.acl.gov/Programs/AIDD/DDA BOR ACT 2000/p2 tI subtitleA.aspx) and census estimates of U.S.
Population, July 1, 2014

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