FY 2018 ACL Congressional Justification

247 Pages·2017·2.97 MB·English

DEPARTMENT
of HEALTH
and HUMAN
SERVICES

Fiscal Year
2018

Administration for
Community Living

Justification of
Estimates for
Appropriations Committees
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 2018 President’s Budget
request, totaling $1.9 billion. While maintaining funding levels for the majority of its core direct services
programs, ACL has reprioritized spending, consolidating programs to enable greater flexibility and more
efficient operations and proposing to eliminate or reduce funding for programs that might be addressed at
State and local levels or through other Federal programs.

ACL has three small programs that serve people affected by Alzheimer’s Disease and Related Dementias:
Alzheimer’s Disease Supportive Services, Alzheimer’s Disease Initiative--Specialized Supportive Services,
and Alzheimer’s Disease Initiative--Communications. Consolidating these programs into a single program,
Alzheimer’s Disease, funded at the same total level, will increase flexibility and efficiency and enable
grantees to better meet the needs of people affected by these illnesses. ACL also proposes to combine three
closely related programs: State Councils on Developmental Disabilities; the State Grants component of the
Independent Living programs, which supports State Independent Living Councils; and the State
Implementation Partnership Grants component of the Traumatic Brain Injury program, which supports State
Advisory Boards on Traumatic Brain Injury. ACL proposes to create a single cross-disability program,
Partnerships for Innovation, Inclusion and Independence (PIII), that can target resources in each State to
support the development of systems and services that increase opportunities for independence, integration,
productivity, inclusion, and self-determination for people with all types of significant disabilities. The
proposed integration of these three programs will eliminate overlap and streamline operations, while saving
$57 million.

ACL is proposing to eliminate discretionary funding for the State Health Insurance Assistance program,
which augments online tools and 1-800-MEDICARE by providing one-on-one help to Medicare
beneficiaries; resource centers on limb loss and paralysis, which expand services provided by other ACL
programs; and the Assistive Technology’s Alternative Financing Program, which duplicates provisions in
current law. Finally, funding would be reduced for the Chronic Disease Self-Management, Developmental
Disability Projects of National Significance, the National Institute for Disability, Independent Living and
Rehabilitation Research and ACL Program Administration.

ACL’s programs provide home- and community-based services and supports and invest in research and
innovation to help older adults and people of all ages with disabilities to live independently and fully
participate in their communities. In most cases, providing these services and supports is significantly less
expensive than the cost of institutional care. ACL remains committed to this central mission. This budget
will allow us to continue serving our populations and refocus to more efficiently provide services on their
behalf.

Dan Berger
Acting Administrator and Acting 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 ............................................................................................................... 6
All Purpose Table ......................................................................................................................... 13
Appropriations Language .............................................................................................................. 15
Appropriations Language Analysis ............................................................................................... 17
Amounts Available for Obligation................................................................................................ 18
Summary of Changes .................................................................................................................... 19
Budget Authority by Activity ....................................................................................................... 20
Authorizing Legislation ................................................................................................................ 22
Appropriations History Table ....................................................................................................... 24
Appropriations Not Authorized by Law ....................................................................................... 25

Health and Independence for Older Adults
Summary of Request ..................................................................................................................... 26
Home and Community-Based Supportive Services ...................................................................... 29
Nutrition Services ......................................................................................................................... 37
Preventive Health Services ........................................................................................................... 51
Chronic Disease Self-Management Education ............................................................................. 58
Falls Prevention ............................................................................................................................ 63
Native American Nutrition and Supportive Services.................................................................... 68
Aging Network Support Activities ............................................................................................... 73

Caregiver and Family Support Services
Summary of Request ..................................................................................................................... 80
Family Caregiver Support Services .............................................................................................. 83
Native American Caregiver Support Services .............................................................................. 91
Alzheimer’s Disease Program ....................................................................................................... 95
Alzheimer’s Disease Supportive Services Program ..................................................................... 99
Alzheimer’s Disease Initiative - Specialized Supportive Services ............................................. 103
Lifespan Respite Care ................................................................................................................. 106

Protection of Vulnerable Adults
Summary of Request ................................................................................................................... 112
Long-Term Care Ombudsman Program ..................................................................................... 114
Prevention of Elder Abuse and Neglect ...................................................................................... 121
Health Care Fraud and Abuse Control/Senior Medicare Patrol Program ................................... 126
Elder Rights Support Activities .................................................................................................. 131
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Disability Programs, Research, and Services_Toc483399451
Summary of Request ................................................................................................................... 138
Partnerships for Innovation, Inclusion and Independence .......................................................... 141
State Councils on Developmental Disabilities ............................................................................ 144
Developmental Disabilities – Protection and Advocacy ............................................................ 149
University Centers for Excellence in Developmental Disabilities ............................................. 155
Developmental Disabilities – Projects of National Significance ................................................ 160
Independent Living ..................................................................................................................... 163
Limb Loss Resource Center ........................................................................................................ 170
Paralysis Resource Center ........................................................................................................... 173
Traumatic Brain Injury ............................................................................................................... 176
National Institute on Disability, Independent Living, and Rehabilitation Research .................. 183

Consumer Information, Access, and Outreach
Summary of Request ................................................................................................................... 188
Aging and Disability Resource Centers ...................................................................................... 190
State Health Insurance Assistance Programs .............................................................................. 195
Voting Access for Individuals with Disabilities ......................................................................... 200
Assistive Technology .................................................................................................................. 205
Alzheimer’s Disease Initiative - Outreach Campaign ................................................................ 216
Medicare Improvements for Patients and Providers Act Programs (MIPPA) ............................ 218

Program Administration .......................................................................................................... 229

Supplementary Tables
Object Classification Table - Direct ........................................................................................... 231
Salaries and Expenses ................................................................................................................. 232
Detail of Full-Time Equivalent Employment (FTE) .................................................................. 233
Detail of Positions ....................................................................................................................... 234
Programs Proposed for Elimination ............................................................................................ 235
FTE Funded by the Affordable Care Act .................................................................................... 236
Physicians’ Comparability Allowance Worksheet ..................................................................... 237

Significant Items in Appropriations Committee Reports ..................................................... 238

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EXECUTIVE SUMMARY
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 16 percent between 2015 and
2020, from 66.8 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 3.9 and 5.3 million individuals.3

 The number of seniors age 65 and older with severe disabilities – defined as 3 or more
limitations in activities of daily living – that are at greatest risk of nursing home
admission, is projected to increase by 18 percent by the year 2020.4

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. Accessed 08
January 2015. U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age Groups by Sex
for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1,
2015. Released June 2016. Accessed 29 March 2017.
2 U.S. Census Bureau, “Americans With Disabilities: 2010,” Issued July 2012. Accessed 21 August 2014.
3 Extrapolated from Developmental Disabilities Assistance and Bill of Rights Act of 2000, Section 101(a)(1) and
U.S. Census Bureau, Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2016.

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EXECUTIVE SUMMARY

Meeting the long-term support needs of these populations can place tremendous strain on
families, and if families become overwhelmed by the challenges of caregiving, the costs of
providing this care will fall on other, more costly, government resources. For example, a 2014
Rand Corporation study found that the care provided by informal (family and friend) caregivers
of elderly adults has an estimated economic value of $522 billion.5 Maintaining funding for
community-based services and supports, including supports for family caregivers, is therefore
critical to delaying, reducing, or eliminating reliance upon institutional residential services, a
more expensive and less preferable option.

4 Ibid and Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare
population. Data from the 2013 Medicare Current Beneficiary Survey. [data tables 2.5a and 2.6a]. Accessed 10
January 2016.
5 The Opportunity Costs of Informal Elder-Care in the United States. Rand Corporation.
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EXECUTIVE SUMMARY
Overview of Budget Request
The Administration for Community Living (ACL) is committed to the fundamental principle that
all people, regardless of age or disability, should be able to live where they choose, with the
people they choose, and fully participate in their communities. By advocating across the federal
government for older adults, people with disabilities, and families and caregivers; funding
services and supports provided primarily by networks of community-based organizations; and
investing in training, education, research and innovation, ACL helps makes this principle a
reality for millions of Americans.

The FY 2018 discretionary request for the ACL is $1,851,450,000, a decrease of -$109,666,242
below the annualized FY 2017 Continuing Resolution level. The FY 2018 Budget request
maintains the majority of ACL’s programs at the annualized FY 2017 Continuing Resolution
level. The Budget prioritizes funding for critical programs that help support older Americans,
individuals with disabilities, and their caregivers and connect them with direct services across the
United States. Consistent with the President’s priorities, the Budget request also maximizes
Federal investments by promoting efficiencies and supporting evidence-based programs.
Streamlining Existing Program Operations, Decreasing Overlap and Increasing Flexibility
ACL has identified existing activities where consolidation could enable greater flexibility and
more efficient program operations. First, ACL has three small programs that serve people
affected by Alzheimer’s Disease and Related Dementias: Alzheimer’s Disease Supportive
Services, Alzheimer’s Disease Initiative--Specialized Supportive Services, and Alzheimer’s
Disease Initiative--Communications. Consolidating these programs into a single program,
Alzheimer’s Disease Program, funded at the same total level, will increase flexibility and
efficiency and enable grantees to better meet the needs of people affected by these illnesses.

ACL also proposes to combine three closely related programs: State Councils on Developmental
Disabilities; the State Grants component of the Independent Living programs, which supports
State Independent Living Councils; and the State Implementation Partnership Grants component
of the Traumatic Brain Injury program, which supports State Advisory Boards on Traumatic
Brain Injury. ACL proposes to create a single cross-disability program, Partnerships for
Innovation, Inclusion and Independence (PIII), that can target resources in each State to support
the development of systems and services that increase opportunities for independence,
integration, productivity, inclusion, and self-determination for people with all types of significant
disabilities. The proposed integration of these three programs will eliminate overlap and
streamline operations, while saving $57 million.

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EXECUTIVE SUMMARY
Devolving Program Responsibilities to States/local Communities
ACL also reviewed its programs to determine which activities could be addressed at the State
and local levels, or where other Federal programs provide similar services. Four programs were
identified:

 State Health Insurance Assistance Program (SHIP): While ACL will reduce the scale of
its one-on-one person assistance through the State Health Insurance Assistance Program,
Medicare beneficiaries will continue to have access to online tools such as Plan Finder
and phone assistance such as CMS’s 1-800-MEDICARE helpline. Some states also
support SHIP programs. The FY 2018 Budget reduces funding for SHIPs by $52 million.
Funding specifically targeted to low-income seniors and seniors living in rural areas is
maintained at $12 million.

 Limb Loss Resource Center and Paralysis Resource Center: The mission and activities
carried out by these programs are duplicative of other Federal efforts. Resources for
individuals affected by limb loss or paralysis is also available through other ACL
programs such as Aging and Disability Resource Centers, Centers for Independent Living
(CILs) and Assistive Technology, which provide resources to people with all types of
significant disabilities. Savings from eliminating these redundant programs total
$3 million and $8 million, respectively.

 Assistive Technology – Alternative Financing Program (AFP): In FY 2005, Congress
amended the AT Act to eliminate the separate AFP authorization and instead authorized
an AT State grant program that is inclusive of financing activities, including alternative
financing loan programs. However, funding has continued to be appropriated for this
program. Since there is no separate AFP discretionary grant program authorization in the
AT Act, ACL is not requesting such funding within the AT Act appropriations request for
FY 2018, resulting in savings of $2 million.

The budget also proposes targeted reductions in funding totaling approximately $15.9 million
across four programs – Chronic Disease Self-Management, Developmental Disability Projects of
National Significance, the National Institute for Disability, Independent Living and
Rehabilitation Research and ACL Program Administration. Savings would be achieved by
restructuring existing activities to achieve greater efficiencies and reducing staff.
Conclusion
Most people who are aging or who have significant disabilities can live in their own homes or in
other independent settings if they have access to the help they need. For many, this help comes
through the community-based services and supports provided by ACL’s programs. In most cases,
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EXECUTIVE SUMMARY
providing these services and supports is significantly less expensive than the cost of institutional
care, which is often borne by Medicaid. ACL remains committed to its central mission to support
people with disabilities and older adults so that they can live independently, fully integrated in
their communities.
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