6-Appendix B –Nutrition Program Service Specifications.pdf

DELAWARE HEALTH AND SOCIAL

SERVICES

Division of Services for Aging and Adults with Physical Disabilities

Nutrition Program

Revision Table

Revision Date Sections Revised Description

10/02/25 -

New Service Specifications established: a combination of former the “Home-Delivered Nutrition” and “Congregate Nutrition” Service Specifications into one universal set for the entire DSAAPD Nutrition Program and its related services.

Complete revision of all content: reorganization of sections; condensing of information and removal of redundancy; inclusion of clearer definitions, examples, and expectations; explanation of new attachments and reporting requirements; inclusion of updated hyperlinks to national, state, and federal standards including the requirements of the OAA Final Rule;

etc.

Addition of new attachments: “Congregate Nutrition Screening Tool” (A), “Home-Delivered Nutrition Screening Tool” (B), “Nutrition Program Monthly Report” (C), and “Senior Nutrition Provider Policy Manual” (D).

10/21/25 Attachments A, B, C, D Minor alterations made post-contract renewal upon Provider feedback.

1.0 SERVICE GOAL

1.1 To promote the general health and well-being of aging adults by:

1.1.1 reducing hunger, food insecurity, and malnutrition;

1.1.2 promoting socialization;

1.1.3 providing at least one hot or other appropriate meal per day to participants, at least five days per week, to the maximum extent possible;

1.1.3.1 congregate or grab-and-go participants are limited to 1 meal per mealtime per day (i.e. a grab-and-go participant may not pick up 3 bulk lunches to go, but may pick up 1 lunch and return that same day to pick up 1 dinner).

1.1.4 delaying the onset of adverse health conditions resulting from poor nutritional health or sedentary behavior; and

1.1.5 assisting in gaining access to nutrition and other disease prevention and health promotion services via the Division of Aging and Adults with Physical Disabilities (DSAAPD)’s Aging and Disability Resource Center (ADRC).

2.0 SERVICE AREA

2.1 Services are to be made available to all eligible residents of the State of Delaware.

2.1.1 Eligibility requirements can be found in Section 7.0.

3.0 SERVICE LOCATION

3.1 Congregate Nutrition.

3.1.1 Services are to be made available at Provider Nutrition Sites which include but are not limited to senior centers, faith-based locations, schools, community centers, and other private facilities under the supervision of the Provider.

3.1.1.1 Provider Nutrition Sites will be open at least five (5) days a week unless otherwise approved by DSAAPD.

3.2 Home-Delivered Nutrition.

3.2.1 Services are to be made available at the home(s) of eligible homebound persons residing in the State of Delaware.

4.0 SERVICE CONFLICT OF INTEREST

4.1 To eliminate any potential conflicts of interest, Providers are required to abide by the “Nutrition Program Service Specifications” and all of its contents, including the exclusive utilization of its attachments for eligibility screening and data collection/reporting purposes.

4.1.1 DSAAPD reserves the right to request access to any Nutrition Program-related documentation for purposes of compliance auditing and monitoring to ensure successful service delivery in accordance with relative state and federal standards and requirements.

5.0 SERVICE DEFINITIONS

5.1 Congregate Meal.

5.1.1 A meal served in communal, group setting at Provider Sites such as senior centers, faith-based facilities, restaurants, etc. to promote socialization and keep older adults healthy and living independently.

5.1.1.1 Congregate Meals must “meet the Dietary Guidelines for Americans and Dietary Reference

Intakes (DRI) as set forth in section 339 of the Older Americans Act (42 USC 3030g-21) https://www.dietaryguidelines.gov/ https://ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx https://ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx https://www.govinfo.gov/content/pkg/USCODE-2023-title42/pdf/USCODE-2023-title42-chap35-subchapIII-partC-subpartiii-sec3030g-21.pdf provided under Title III, part C-1 by a qualified nutrition service provider to eligible individuals and consumed while congregating virtually or in-person (45 CFR 1321.87 (a)(1))” except as specified under 45 CFR 1321.87 (a)(1)(i-iii).

5.1.1.2 Congregate Meals must also meet the requirements of the “Senior Nutrition Provider Manual” established by DSAAPD found in Attachment D.

5.2 Grab-And-Go Meal.

5.2.1 A meal also referred to as carry-out, drive-through, or pick-up meals, which must provide the opportunity for in-person, phone, or virtual socialization and interaction by requiring said meal to be picked up by the participant from the Provider Site, or a site facilitated elsewhere to later be eaten elsewhere.

5.2.1.1 Grab-and-Go Meals are not delivered.

5.2.1.2 Grab-And-Go Meals must “meet the Dietary Guidelines for Americans and Dietary

Reference Intakes (DRI) as set forth in section 339 of the Act (42 USC 3030g-21) provided under Title III, part C-1 by a qualified nutrition service provider to eligible individuals and consumed while congregating virtually or in-person (45 CFR 1321.87 (a)(1)(i-iii)).”

5.2.1.3 Grab-And-Go Meals must also meet the requirements of the “Senior Nutrition Provider Manual” established by DSAAPD found in Attachment D.

5.3 Home-Delivered Meal.

5.3.1 A meal delivered to a participant at their place of residence directly from the Provider Site to help combat malnutrition and social isolation, while promoting independence to allow participants to age in place.

5.3.1.1 Home-Delivered Meals must “meet the Dietary Guidelines for Americans and Dietary

Reference Intakes (DRI) as set forth in section 339 of the Act (42 USC 3030g-21) provided under Title III, part C-2 by a qualified nutrition service provider to eligible individuals and consumed at their residence or otherwise outside of a congregate setting, as organized by a service provider under the Act (45 CFR 1321.87 (a)(2)).”

5.3.1.2 Home-Delivered Meals must also meet the requirements of the “Senior Nutrition Provider Manual” established by DSAAPD found in Attachment D.

5.4 Nutrition Counseling.

5.4.1 Personalized guidance characterized by a collaborative counselor-patient relationship to establish food/nutrition/physical activity priorities, goals, and individualized action plans that acknowledge and foster responsibility for self-care to treat an existing condition and promote health to individuals who are at nutritional risk.

5.4.1.1 Nutrition Counseling must be provided by a state-licensed, Registered Dietitian.

5.5 Nutrition Screening and Intervention Services.

5.5.1 Nutrition Screening identifies participants that will benefit from nutrition assessment and intervention.

5.5.2 Nutrition Intervention Services include practices such as Nutrition Education, Nutrition Counseling and/or coordination of nutrition care provided as appropriate, based on the needs of meal participants and as outlined by the Academy of Nutrition and Dietetics in the “Snapshot of Nutrition Intervention.”

5.5.2.1 Nutrition Education is information which provides individuals with the knowledge and skills to make healthy food and beverage choices based upon the needs of meal participants.

https://www.ecfr.gov/current/title-45/subtitle-B/chapter-XIII/subchapter-C/part-1321/subpart-D/section-1321.87 https://www.ecfr.gov/current/title-45/subtitle-B/chapter-XIII/subchapter-C/part-1321/subpart-D/section-1321.87 https://www.dietaryguidelines.gov/ https://ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx https://ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx https://www.govinfo.gov/content/pkg/USCODE-2023-title42/pdf/USCODE-2023-title42-chap35-subchapIII-partC-subpartiii-sec3030g-21.pdf https://www.ecfr.gov/current/title-45/subtitle-B/chapter-XIII/subchapter-C/part-1321/subpart-D/section-1321.87 https://www.dietaryguidelines.gov/ https://ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx https://ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx https://www.govinfo.gov/content/pkg/USCODE-2023-title42/pdf/USCODE-2023-title42-chap35-subchapIII-partC-subpartiii-sec3030g-21.pdf https://www.ecfr.gov/current/title-45/subtitle-B/chapter-XIII/subchapter-C/part-1321/subpart-D/section-1321.87 https://www.cdrnet.org/vault/2459/web/CDR%20Screening%20Terminology.pdf https://www.andeal.org/vault/2440/web/files/20140527-NI%20Snapshot.pdf https://www.andeal.org/vault/2440/web/files/20140527-NI%20Snapshot.pdf

5.5.2.2 Other Nutrition Services may be provided to meet nutritional needs or preferences of eligible participants, such as weighted utensils, supplemental foods, oral nutrition supplements, or groceries.

6.0 SERVICE UNIT

6.1 Meal Unit.

6.1.1 The Meal Unit is one complete meal provided to one eligible participant.

6.1.1.1 A complete meal is defined as that which meets one-third of the daily DRI of nutrients of concern in Older Americans, as established by the Food and Nutrition Board (FNB) of the Institute of Medicine (IOM), and the most recent Dietary Guidelines for Americans, published by the Secretaries of the United States Department of Health and Human Services (DHHS) and the United States Department of Agriculture (USDA), and nutrition program guidelines established by DSAAPD via the “Senior Nutrition Provider Manual” found in Attachment D.

6.1.1.2 A Meal Unit should be planned and prepared under the advice and recommendations of a Registered Dietitian.

6.1.1.3 A Meal Unit, to the maximum extent practicable, is encouraged to be adjusted to meet any special dietary needs of program participants, including meals adjusted for cultural considerations and preferences and medically tailored meals.

6.1.2 The following are approved Meal Unit types:

6.1.2.1 Meal.

6.1.2.1.1 A meal that meets Subsection 6.1.1 as defined above.

6.1.2.2 Emergency Meal.

6.1.2.2.1 A meal that consists of shelf-stable items which are provided to the participant for use when the Nutrition Program is unable to deliver meals due to weather related and/or other unforeseen emergencies.

6.1.2.2.1.1 Shelf-stable foods that do not require refrigeration for safe consumption can be kept at room temperature until their “use-by” date.

6.2 Nutrition Screening and Intervention Services.

6.2.1 Nutrition Screening and Intervention Services will be incorporated into the meal budget but will be tracked according to federal and/or state reporting requirements.

6.2.1.1 There are no separate line items (reimbursement) on invoices for these services.

6.2.2 Outreach and Intake are performed to ensure eligible participants are identified and screened for eligibility (eligibility requirements found in Section 7.0).

6.2.3 Nutrition Screenings are conducted as a part of the initial Nutrition Program eligibility enrollment process and annually thereafter, to ensure the continued, appropriate level(s) of Nutrition programming, for each meal participant using DSAAPD’s “Congregate Nutrition Screening Tool” found in Attachment A, or “Home-Delivered Nutrition Screening Tool” found in Attachment B, and detailed under Section 7.0.

6.2.3.1 Participants identified as “high nutritional risk” must be referred for further malnutrition risk screening and counseling by the Provider’s Registered Dietitian.

6.2.3.1.1 Service units for nutrition counseling will be reported as hours. Partial hours may be reported to two decimal places (i.e. 0.25 hours).

6.2.3.2 Nutrition Education is to be provided at minimum, on a quarterly basis and can be delivered in-person, via video, online, or through the distribution of hard-copy materials, and should be reported by total audience size.

6.2.3.2.1 Nutrition Education must be overseen by a Registered Dietitian or an individual with comparable expertise per the Older Americans Act (OAA) Nutrition Reporting Guidelines.

6.3 Other Units of Service.

6.3.1 Other units of service, or activities, that support Home-Delivered Nutrition Services include but are not limited to, staff training and development, site monitoring, and menu development.

6.3.2 These costs should be absorbed into the allowable meal unit cost as previously mentioned in

Subsections 6.2.1 and 6.2.1.1.

7.0 ELIGIBILITY

7.1 Congregate Nutrition.

7.1.1 Providers are required to utilize DSAAPD’s “Congregate Nutrition Screening Tool,” found in Attachment A, to determine service eligibility for all Nutrition Services.

7.1.1.1 The screening criteria and data collection points of the “Congregate Nutrition Screening

Tool” is a compilation of national, federal, and state requirements and standards which include but are not limited to:

7.1.1.1.1 the Federal Code of Regulations;

7.1.1.1.2 the Delaware State Code of Regulations;

7.1.1.1.3 the Older Americans Act;

7.1.1.1.4 the Older Americans Act Performance System;

7.1.1.1.5 the “DETERMINE Your Health” nutrition checklist; and

7.1.1.1.6 the “Hunger Vital Sign” food insecurity screening tool.

7.1.1.2 The purpose of the “Congregate Nutrition Screening Tool” is to implement comprehensive compliance monitoring measures to ensure effective service delivery, connect Nutrition Program participants to additional DSAAPD services and supports, ensure accurate data collection and reporting, enforce responsible spending of approved budgets, and strengthen Provider relationships via open communication and collaboration.

7.1.1.3 The “Congregate Nutrition Screening Tool” is to be completed at first engagement with potential participants to determine Nutrition program eligibility and enrollment, and annually assess thereafter to ensure the continued, appropriate level(s) of Nutrition programming, for each meal participant.

7.1.1.4 The “Congregate Nutrition Screening Tool” is to be completed in its entirety with accuracy to the best of the Provider Personnel’s ability to ensure the appropriate recommendation(s) and referral(s) for Nutrition and/or additional services and programming as identified by said tool.

7.1.1.4.1 Participants may fill out the “Congregate Nutrition Screening Tool” themselves, however, the Provider Personnel must be present to provide guidance and answer any questions, as well as to ensure the tool is filled out in its entirety.

7.1.1.4.2 The Provider Personnel must complete the “Provider Personnel Collection” portion of the tool (section VIII) to certify the complete and accurate completion of the tool and to make recommendation(s) and/or referral(s) as appropriate based upon the scoring criteria.

https://acl.gov/sites/default/files/nutrition/NutritionServiceReportingQuickTips2023.pdf https://acl.gov/sites/default/files/nutrition/NutritionServiceReportingQuickTips2023.pdf

7.1.1.5 Additional referrals and/or recommendations such as referrals for additional DSAAPD services, recommendations for Nutrition Counseling, and/or other Nutrition Intervention Services are to be made as appropriate as determined by the “Congregate Nutrition Screening Tool.”

7.1.1.6 Additional instructions on how to properly utilize the “Congregate Nutrition Screening Tool” can be found in Attachment A.

7.2 Providers specifically facilitating Congregate Nutrition Services funded by the OAA under Title III-C are required to adhere to the service eligibility standards and requirements as outlined by the OAA.

7.2.1 Congregate Nutrition Services will be made available to persons aged sixty (60) and over.

7.2.2 Congregate meals will be made available to spouses of eligible persons regardless of the age of spouse; the age-eligible participant must be a registered participant of the program.

7.2.3 Eligible individuals include persons providing designated volunteer services during the meal hours.

7.2.4 Congregate Meals may be made available to individuals with disabilities under age sixty (60) who reside in housing facilities occupied primarily by older adults at which congregate nutrition services are provided.

7.2.4.1 This provision is only applicable to public housing facilities in which nutrition sites are located.

7.2.4.2 The person with the disability must be a resident of this same housing facility.

7.2.4.3 Spouses of individuals with disabilities are not eligible unless they too have disabilities.

7.2.5 Congregate meals may be made available to individuals with disabilities under age sixty (60) who reside in non-institutional households with a person eligible for congregate meals and accompany that person.

7.2.6 Staff and guests under the age of sixty (60) may purchase meals at congregate sites, as long as the provision of such does not take away from providing meals to age-eligible participants.

7.2.7 Services are not intended to reach every individual in the community. Targeted populations include those in the community with the greatest social and economic need.

7.2.8 Priority will be given to the following: older adults, persons with disabilities, older individuals at risk for institutional placement, minorities, those with limited English proficiency, older individuals residing in rural areas and underserved populations. Underserved populations include male caregivers, older adults in the LGBTQ+ (Lesbian, Gay, Bisexual, Transgender) community, individuals with limited English proficiency, and Hispanic/Latinx older Delawareans.

7.2.9 Income shall not be criteria for eligibility.

7.3 Home-Delivered Nutrition.

7.3.1 Providers are required to utilize DSAAPD’s “Home-Delivered Nutrition Screening Tool,” found in Attachment B, to determine service eligibility for all Nutrition Services.

7.3.1.1 The screening criteria and data collection points of the “Home-Delivered Nutrition

Screening Tool” is a compilation of national, federal, and state requirements and standards which include but are not limited to:

7.3.1.1.1 the Federal Code of Regulations;

7.3.1.1.2 the Delaware State Code of Regulations;

7.3.1.1.3 the Older Americans Act;

7.3.1.1.4 the Older Americans Act Performance System;

7.3.1.1.5 the “DETERMINE Your Health” nutrition checklist; and

7.3.1.1.6 the “Hunger Vital Sign” food insecurity screening tool.

https://www.govinfo.gov/content/pkg/FR-2024-02-14/pdf/2024-01913.pdf

7.3.1.2 The purpose of the “Home-Delivered Nutrition Screening Tool” is to implement comprehensive compliance monitoring measures to ensure effective service delivery, connect Nutrition Program participants to additional DSAAPD services and supports, ensure accurate data collection and reporting, enforce responsible spending of approved budgets, and strengthen Provider relationships via open communication and collaboration.

7.3.1.3 The “Home-Delivered Nutrition Screening Tool” is to be completed at first engagement with potential participants to determine Nutrition program eligibility and enrollment, and annually assess thereafter to ensure the continued, appropriate level(s) of Nutrition programming, for each meal participant.

7.3.1.4 The “Home-Delivered Nutrition Screening Tool” is to be completed in its entirety with accuracy to the best of the Provider Personnel’s ability to ensure the appropriate recommendation(s) and referral(s) for Nutrition and/or additional services and programming as identified by said tool.

7.3.1.5 Additional referrals and/or recommendations such as referrals for additional DSAAPD services, recommendations for Nutrition Counseling, and/or other Nutrition Intervention Services are to be made as appropriate as determined by the “Home-Delivered Nutrition Screening Tool.”

7.3.1.6 Additional instructions on how to properly utilize the “Home-Delivered Nutrition Screening Tool” can be found in Attachment B.

7.4 Providers specifically facilitating Home-Delivered Nutrition Services funded by the OAA under Title III- C are required to adhere to the service eligibility standards and requirements as outlined by the OAA.

7.4.1 Home-Delivered Nutrition Services will be made available to persons aged sixty (60) or over who are homebound by reason of illness, incapacitating disability, or are otherwise isolated, in addition to the requirements of Attachment B.

7.4.2 The spouse of an older adult may also receive a Home-Delivered meal if it is in the best interest of the homebound older adult and the provision of the meal will not prevent service delivery to more higher priority individuals.

7.4.3 Meals may be made available to individuals with disabilities under age sixty (60) who reside in housing facilities occupied primarily by older adults at which Home-Delivered nutrition services are provided. This provision is only applicable to public housing facilities in which nutrition sites are located.

7.4.3.1 The person with the disability must be a resident of this same housing facility.

7.4.3.2 Spouses of individuals with disabilities are not eligible unless they too have disabilities.

7.4.4 Meals may also be made available to persons under the age of sixty (60) with a disability who are a member of the household of an older adult who is eligible for Home-Delivered Nutrition Services.

7.4.5 Program applicants who are determined ineligible to receive Home-Delivered meals should be directed to their nearest congregate nutrition site or other appropriate community service.

7.4.6 Services are not intended to reach every individual in the community. Targeted populations include those in the community with the greatest social and economic need.

7.4.7 Priority will be given to the following: older adults, persons with disabilities, older individuals at risk for institutional placement, minorities, those with limited English proficiency, older individuals residing in rural areas and underserved populations. Underserved populations include male caregivers, older adults in the LGBTQ+ (Lesbian, Gay, Bisexual, Transgender) community, individuals with limited English proficiency, and Hispanic/Latinx older Delawareans.

7.4.8 Income shall not be criteria for eligibility.

7.5 Providers specifically facilitating Home-Delivered Nutrition Services funded by the Social Service Block

Grant (SSBG) are required to adhere to the service eligibility standards and requirements as outlined by the SSBG.

7.5.1 Home-Delivered Nutrition Services will be made available to persons between the ages of eighteen (18) and fifty-nine (59) who are homebound by reason of physical disability.

7.5.2 For the purposes of Home-Delivered Nutrition, physical disability would be defined as a disability that is anticipated to last twelve (12) months or longer and that includes at least one Activity of Daily Living (ADL) deficit that impacts the individual’s ability to live independently.

ADLs include bathing, dressing, toileting, bowel/bladder control, transferring, and eating.

7.5.3 The potential participant must be a U.S. citizen or legal alien.

7.5.3.1 Immigration status will be verified from original documents or certified copies from the issuing agency. Once documentation of citizenship and identity has been provided, it is not necessary to obtain documentation again. There are four levels of verification listed in order of preference. If a higher-level document is not available, a lower level may be used.

7.5.3.2 First level documentation of both citizenship AND identity:

7.5.3.2.1 A U.S. passport. A U.S. passport does not have to be currently valid to be accepted as evidence of U.S. citizenship, as long as it was originally issued without limitation. Do not accept any passport as evidence of U.S.

citizenship when it was issued with a limitation. However, such a passport may be used as proof of identity. Note: Spouses and children were sometimes included on one passport through 1980. The citizenship and identity of the included person can be established when one of these passports is presented. U.S. passports issued after 1980 show only one person.

7.5.3.2.2 A Certificate of Naturalization (DHS Forms N–550 or N–570).

7.5.3.2.3 A Certificate of U.S. Citizenship (DHS Forms N–560 or N–561).

7.5.3.3 Second level documentation of citizenship:

7.5.3.3.1 A U.S. public birth certificate showing birth in one of the 50 States, the

District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam (on or after April 10, 1899), the Virgin Islands of the U.S. (on or after January 17, 1917), American Samoa, Swain's Island, or the Northern Mariana Islands (after November 4, 1986 (NMI local time)).

7.5.3.3.2 A Certification of Report of Birth (DS–1350) .

7.5.3.3.3 A Report of Birth Abroad of a U.S. Citizen (Form FS–240).

7.5.3.3.4 A Certification of birth issued by the Department of State (Form FS–545) .

7.5.3.3.5 A U.S. Citizen I.D. card (I-197 or I-179)

7.5.3.3.6 A Northern Mariana Identification Card (I–873).

7.5.3.3.7 An American Indian Card (I–872) .

7.5.3.3.8 A final adoption decree showing the child's name and U.S. place of birth. In situations where an adoption is not finalized and the State in which the child was born will not release a birth certificate prior to final adoption, a statement from a State approved adoption agency that shows the child's name and U.S. place of birth is acceptable. The adoption agency must state https://acf.gov/ocs/programs/ssbg in the certification that the source of the place of birth information is an original birth certificate.

7.5.3.3.9 Evidence of U.S. Civil Service employment before June 1, 1976.

7.5.3.3.10 U.S. Military Record showing a U.S. place of birth. (DD–214 or similar official document showing a U.S. place of birth).

7.5.3.3.11 A data verification with the Systematic Alien Verification for Entitlements

(SAVE) Program for naturalized citizens.

7.5.3.4 Third level documentation of citizenship:

7.5.3.4.1 Extract of a hospital record on hospital letterhead established at the time of the person's birth that was created five (5) years before the initial application date and that indicates a U.S. place of birth. Do not accept a souvenir “birth certificate” issued by the hospital.

7.5.3.4.2 Life, health, or other insurance record showing a U.S. place of birth that was created at least five (5) years before the initial application date and that indicates a U.S. place of birth. Life or health insurance records may show biographical information for the person including place of birth and can be used to establish U.S. citizenship when it shows a U.S. place of birth.

7.5.3.4.3 Religious record recorded in the U.S. within three (3) months of birth showing the birth occurred in the U.S. and showing either the date of the birth or the individual's age at the time the record was made. The record must be an official record recorded with the religious organization.

7.5.3.4.4 Early school record showing a U.S. place of birth. The school record must show the name of the child, the date of admission to the school, the date of birth, a U.S. place of birth, and the name(s) and place(s) of birth of the applicant's parents.

7.5.3.5 Fourth level documentation of citizenship:

7.5.3.5.1 Federal or State census record showing U.S. citizenship or a U.S. place of birth. Census records from 1900 through 1950 contain certain citizenship information. The census record must also show the applicant's age.

7.5.3.5.2 One of the documents listed that shows a U.S. place of birth and was created at least 5 years before the application for Medicaid. This document must be one of the following and show a U.S. place of birth:

7.5.3.5.2.1 Seneca Indian tribal census record.

7.5.3.5.2.2 Bureau of Indian Affairs tribal census records of the Navajo

Indians.

7.5.3.5.2.3 U.S. State Vital Statistics official notification of birth registration.

7.5.3.5.2.4 A delayed U.S. public birth record that is recorded more than 5 years after the person's birth.

7.5.3.5.2.5 Statement signed by the physician or midwife who was in attendance at the time of birth.

7.5.3.5.2.6 The Roll of Alaska Natives maintained by the Bureau of Indian

Affairs.

7.5.3.5.3 Institutional admission papers from a nursing facility, skilled care facility, or other institution created at least five (5) years before the initial application date that indicates a U.S. place of birth. Admission papers generally show biographical information for the person including place of birth. The record can be used to establish U.S. citizenship when it shows a U.S. place of birth.

7.5.3.5.4 Medical (clinic, doctor, or hospital) record created at least five (5) years before the initial application date that indicates a U.S. place of birth.

Medical records generally show biographical information for the person including place of birth. The record can be used to establish U.S. citizenship when it shows a U.S. place of birth. (Note: An immunization record is not considered a medical record for purposes of establishing U.S. citizenship.)

7.5.3.5.5 Written affidavit.

7.5.3.5.5.1 Affidavits should only be used in rare circumstances. If the documentation requirement needs to be met through affidavits, the following rules apply:

7.5.3.5.5.1.1 There must be at least two affidavits by two

individuals who have personal knowledge of the event(s) establishing the applicant's or recipient's claim of citizenship.

7.5.3.5.5.1.2 At least one of the individuals making the affidavit cannot be related to the applicant or recipient.

Neither of the two individuals can be the applicant or recipient.

7.5.3.5.5.1.3 The persons making the affidavits must be able to provide proof of their own citizenship and identity.

7.5.3.5.5.1.4 If the individual making the affidavit has

information which explains why documentary evidence establishing the applicant's claim of citizenship does not exist or cannot be readily obtained, the affidavit should contain this information as well.

7.5.3.5.5.1.5 The applicant or representative must make a

separate affidavit explaining why the evidence does not exist or cannot be obtained.

7.5.3.5.5.1.6 The affidavits must be signed under penalty of

perjury and need not be notarized.

7.5.3.5.6 Documentation of identity.

7.5.3.5.6.1 Identity documents described in 8 CFR 274a.2(b)(1)(v)(B)(1).

Exception: Do not accept a voter's registration card or Canadian driver's license as listed in 8 CFR 274a.2(b)(1)(v)(B)(1).

7.5.3.5.6.2 Driver's license issued by a State or Territory either with a photograph of the individual or other identifying information of the individual such as name, age, sex, race, height, weight, or eye color.

7.5.3.5.6.3 School identification card with a photograph of the individual.

7.5.3.5.6.4 U.S. military card or draft record.

7.5.3.5.6.5 Identification card issued by the Federal, State, or local government with the same information included on drivers' licenses.

7.5.3.5.6.6 Military dependent's identification card.

7.5.3.5.6.7 Certificate of Degree of Indian Blood, or other American

Indian/Alaska Native Tribal document with a photograph or other personal identifying information relating to the individual such as age, weight, height, race, sex, and eye color.

7.5.3.5.6.8 U.S. Coast Guard Merchant Mariner card.

7.5.3.5.7 A crossmatch with Office of Vital Statistics.

7.5.3.5.8 Three or more documents that together reasonably corroborate the identity of an individual provided such documents have not been used to establish the individual's citizenship and the individual submitted second or third level evidence of citizenship. Such documents must at a minimum contain the individual's name, plus any additional information establishing the individual's identity. All documents used must contain consistent identifying information. These documents include employer identification cards, high school and college diplomas from accredited institutions (including general education and high school equivalency diplomas), marriage certificates, divorce decrees, and property deeds/titles.

8.0 SERVICE STANDARDS

8.1 Providers facilitating any Nutrition Services funded by the OAA under Title III-C and/or the SSBG are required to adhere to the service standards and requirements as outlined by the OAA and SSBG.

8.1.1 General Requirements.

8.1.1.1 Outreach must be conducted as necessary to reach the target population as detailed in Section 5.2.2.

8.1.1.2 Efforts must be made to recruit volunteers to assist in service delivery.

8.1.1.3 Providers must develop and implement a system to be conducted annually to solicit feedback from participants related to the quality of the service, including the acceptability of the meals provided.

8.1.1.3.1 Participant feedback and menu modifications must be kept on file for all active participants, as well as discontinued participants for a period of (3) three years, to be reviewed by DSAAPD’s Registered Dietitian annually.

8.1.1.4 Federal funds must not be used to supplant existing resources, including funds from nonfederal sources and volunteer support.

8.1.1.5 In the event that a program participant is unable to receive services due to a hospitalization or other issue, the Provider may allow the participant to stay active up to forty-five (45) days. After forty-five (45) days, the participant must be terminated from the program and may be re-enrolled in the program once they are able to accept services.

8.1.1.5.1 Relative documentation is to be maintained for minimum period of three (3) years upon discontinuation of services.

8.1.1.5.2 DSAAPD may request a copy of participant records at any time for purposes of compliance monitoring and auditing.

8.1.2 Subcontracting Requirements.

8.1.2.1 When meal service is subcontracted, the Provider must follow formal procedures for procuring a cost-effective, sanitary, quality meal service and maintain a system for monitoring the service subcontractor on a quarterly basis.

8.1.2.2 For subcontracted services over $25,000, the Provider must follow competitive bid procedures.

8.1.2.3 A signed copy of the contract between the Provider and subcontractor must be made available to DSAAPD within sixty days (60) of the beginning of the contract year.

8.1.2.4 If the Provider coordinates with another organization to perform Nutrition Counseling, a written agreement between the Provider and the outside organization must be developed within the current established budget.

8.1.2.5 Providers must adhere to the most recent State of Delaware Food Code guidelines. A copy of the current State of Delaware Food Code can be found online from the Delaware Division of Public Health (DPH).

8.1.2.6 Providers must document the cost of food items per menu item and per meal, including the cost of USDA commodities utilized.

8.1.2.7 Excess food can be served only as a frozen meal to participants.

8.1.2.7.1 The meal must be assembled and frozen as soon as possible from the date of initial preparation to maintain its quality. The date of meal assembly and freezing may not take place more than seventy-two (72) hours from the initial date of preparation.

8.1.2.7.2 All meals must be marked with the dates of preparation, assembly, and freezing.

8.1.2.7.3 All meals must be assembled and frozen in compliance with the most recent State of Delaware Food Code.

8.1.2.7.4 All meals must be delivered frozen to the participant.

8.1.2.7.5 The meal composition, as served, must meet DSAAPD guidelines for nutrient adequacy.

8.1.2.7.6 No other use of excess food can be incorporated into a reimbursable meal.

8.1.2.8 Providers must develop policies and procedures surrounding the use of planned frozen meals. All steps in food preparation, freezing and serving must adhere to the most recent State of Delaware Food Code.

8.1.2.9 Food containers and utensils for persons with disabilities, including persons with visual impairments, must be made available for use upon request to the greatest extent possible.

8.1.2.10 Foods prepared or canned in the home or in an uninspected facility may not be used for meals. Only commercially prepared canned foods may be used.

8.1.2.11 The Provider must establish a plan for the delivery/availability of meals to participants in preparation for emergencies.

8.1.3 Food Service Management.

8.1.3.1 A nutrition Provider shall require all vendors to immediately alert the Provider in the event of a product recall, which may impact the food served by their program.

8.1.3.1.1 Upon receiving notification of a food recall, the nutrition Provider will immediately notify the DSAAPD Contract Manager.

8.1.3.2 The nutrition Provider will make all reasonable efforts to avoid food product contamination by following the most recent Delaware Food Code and other safe food handling and delivery practices.

https://dhss.delaware.gov/dhss/dph/regs.html#F https://dhss.delaware.gov/dhss/dph/regs.html#F https://statics.teams.cdn.office.net/evergreen-assets/safelinks/2/atp-safelinks.html

8.1.3.2.1 In the event of a suspected problem, the Nutrition Provider will report and cooperate fully with DSAAPD and all regulatory agencies.

8.1.4 Record Keeping Requirements and Monitoring.

8.1.4.1 Providers must develop, implement and keep on file a policy manual containing at minimum the following information:

8.1.4.1.1 Fiscal Management;

8.1.4.1.2 Food Service Management;

8.1.4.1.3 Safety and Sanitation;

8.1.4.1.4 Staff Responsibilities; and

8.1.4.1.5 Emergency Preparedness.

8.1.4.2 Providers are responsible for maintaining the completed “Congregate Nutrition Screening Tool(s),” found in Attachment A, or “Home-Delivered Nutrition Screening Tool(s),” found in Attachment B, for each active participant.

8.1.4.2.1 The completed “Congregate Nutrition Screening Tool(s)” of “Home-Delivered

Nutrition Screening Tool(s)” for any participant discontinued from DSAAPD’s Nutrition programming is to be maintained for a minimum period of three (3) years upon discontinuation of services.

8.1.4.2.2 DSAAPD may request a copy of participant records at any time for purposes of compliance monitoring and auditing.

8.1.4.3 Providers are responsible for maintaining the completed “Nutrition Program Monthly Report(s),” found in Attachment C, for each Nutrition Services Site.

8.1.4.3.1 The completed “Nutrition Program Monthly Report(s)” for any Nutrition Services

Site are to be maintained for minimum period of three (3) years.

8.1.4.3.2 DSAAPD may request a copy of participant records at any time for purposes of compliance monitoring and auditing.

8.1.5 Referrals/Recommendations for Additional Services.

8.1.5.1 Providers’ staff/volunteers will inform program participants that information regarding additional supports and services may be obtained by contacting the DSAAPD Aging & Disability Resource Center (ADRC) at 1-800-223-9074 and refer them as appropriate as determined by the “Congregate Nutrition Screening Tool or “Home-Delivered Nutrition Screening Tool.”

8.1.5.2 If a participant is in immediate danger, Providers’ staff/volunteers will call 911.

8.1.5.3 Should Providers’ staff/volunteers have concerns regarding potential abuse, neglect, or financial exploitation of a participant, they are to report to Adult Protective Services (APS) at 1-888-277-4302 (1-888-APS-4302).

8.1.5.4 Provisions must be made by Providers’ staff/volunteers for participants to take advantage of the benefits available under the Supplemental Nutrition Assistance Program (SNAP).

8.1.6 Prohibited Activities.

8.1.6.1 For purposes of DSAAPD planning and reimbursement, any Nutrition Services may not include any of the following components:

8.1.6.1.1 providing meals to ineligible persons;

8.1.6.1.2 providing financial, legal, or other similar service or advice (except for referral to qualified agencies or programs); nor

8.1.6.1.3 denying services to eligible persons because of his/her inability or failure to contribute to the cost of meals.

https://delawareadrc.com/ https://delawareadrc.com/ https://www.dhss.delaware.gov/dhss/dsaapd/aps.html https://assist.dhss.delaware.gov/

8.1.7 Staffing Requirements.

8.1.7.1 Each Provider must have on-staff a full-time, Program Director who will be responsible for the overall daily operation of the Nutrition Program.

8.1.7.1.1 Responsibilities include supervision of staff, ensuring compliance with DSAAPD specifications, and maintaining contact with DSAAPD staff and participants.

8.1.7.2 All site staff and volunteers must be fully trained, qualified, and background checked per

Provider’s company policy to assure the safety of all program participants.

8.1.7.3 In the event that there is a staffing change in either the Program Director or the Registered

Dietitian, those changes must be communicated immediately to DSAAPD.

8.1.7.4 Each Provider must have on-staff, or have access to, the services of a Registered Dietitian, licensed to practice in the State of Delaware.

8.1.7.5 If the agency is directly responsible for producing meals, a full-time person must oversee directing, monitoring, and supervising the food service production and staff.

8.1.7.5.1 This person must be qualified by education and/or experience.

8.1.7.5.1.1 Educational requirements include a degree in Foods and Nutrition, Food Service or Hotel and Restaurant Management, or a minimum of three (3) years’ experience managing food service production.

8.1.8 Training.

8.1.8.1 Providers are responsible for facilitating routine training to all staff and volunteers.

8.1.8.2 Training topics should include, but are not limited to, food safety, sanitation, and other topics per DSAAPD’s discretion.

8.1.8.3 Appropriate staff members will be trained to provide all information and reports required by DSAAPD.

8.2 Congregate Nutrition.

8.2.1 Providers specifically facilitating Congregate Nutrition must also adhere to the additional service standards are requirements as outlined by the OAA below.

8.2.1.1 General Requirements.

8.2.1.1.1 Congregate meals must be made available at least five (5) days per week allowing adequate time for participants to eat and enjoy a leisurely meal, social contact, and to take advantage of other services at the center, which may include supportive, educational and/or recreational activities.

8.2.1.1.2 Congregate Meal Services must be provided in a suitable environment which meets the following criteria established by DSAAPD:

8.2.1.1.2.1 The site must meet the minimum standard of the State of Delaware’s

Building, Fire and Environmental Services Regulation.

8.2.1.1.2.2 The site must have a pleasant environment and adequate lighting.

8.2.1.1.2.3 Site must follow Section 504 of the Rehabilitation Act.

8.2.1.1.2.4 The site must make special provisions as necessary for the service of meals to eligible individuals with disabilities.

8.2.1.1.2.5 The site must be available for a minimum of four (4) hours daily.

8.2.1.1.2.6 The site manager, as advised by the Program Director, must have a plan of operation, describing coordination with other community resources and programs.

8.2.1.1.2.7 The site must make provision for the recipients of services to assist the site staff in planning and developing relevant programs.

8.2.1.1.2.8 Sites must have a Site Manager, paid, volunteer or in-kind. This person is responsible for site operations relating to the nutrition program.

8.2.1.1.3 The specific role of the sponsor in the nutrition site must be defined by the Provider through written agreement.

8.2.1.1.4 Sponsorship should include a minimum of the following standards:

8.2.1.1.4.1 Provide office/desk space and telephone for the use of the site manager.

8.2.1.1.4.2 Provide utilities and custodial service.

8.2.1.1.4.3 Be responsible for recruiting volunteers to assist with the meal program.

8.2.1.1.4.4 Provide use of service and dining area for the distribution of meals.

8.2.1.1.4.5 Provide a clear, convenient entrance to the building for food delivery, which includes snow removal, if meals are served.

8.2.1.1.4.6 Allow staff of the sponsoring agency to attend

appropriate training or staff meetings.

8.2.1.2 Food Service Management.

8.2.1.2.1 All meal sites must be approved by the appropriate Public Health and Fire officials. State and local fire, health, sanitation, and safety regulations must be adhered to by the Nutrition Program Providers.

8.2.1.2.2 Meal site programs must maintain current files of the appropriate certifications and/or visitation reports for each site under their management.

8.2.1.3 Prohibited Activities.

8.2.1.3.1 For purposes of DSAAPD planning and reimbursement, Congregate Nutrition

Services may also not include any of the following components:

8.2.1.3.1.1 providing a take-out meal in addition to a regular meal; nor

8.2.1.3.1.2 with the exception of for fresh fruit and meals approved by the

Nutrition Program Director, any food or beverage be removed from any congregate nutrition site by any guest, participant, or staff member.

8.2.1.3.1.2.1 Furthermore, each program has the option of further extending this policy to cover the removal of fresh fruit from the sites if so desired.

8.3 Home-Delivered Nutrition.

8.3.1 Providers specifically facilitating Home-Delivered Nutrition must also adhere to the additional service standards are requirements as outlined by the OAA and SSBG below.

8.3.1.1.1 General Requirements.

8.3.1.1.1.1 Home-Delivered meals must be made available at least five (5) days per week according to participant needs.

8.3.1.1.1.2 Information and activities must be provided to participants receiving Home- Delivered meals that will promote improved nutrition and health.

8.3.1.1.2 Food Service Management.

8.3.1.1.2.1 At least once a month, each nutrition Provider offering Home-Delivered meals will monitor delivery food temperatures.

8.3.1.1.2.1.1 An additional meal will be plated, packed and transported to the last home on a delivery route.

8.3.1.1.2.1.2 The (received) temperatures for this meal will be recorded by the Provider, documented and kept on file for DSAAPD review.

8.3.1.1.2.2 Delivery time for foods must not exceed four (4) hours.

8.3.1.1.3 SSBG Documentation.

8.3.1.1.3.1 All SSBG funded participants must have a letter from a healthcare practitioner, an award letter from the Social Security Disability Insurance Office, or have an Activity of Daily Living (ADL)/Instrumental Activity of Daily Living (IADL) deficit(s) as identified by the Provider via the “Home-Delivered Nutrition Screening Tool” that certifies their homebound status.

8.3.1.1.3.2 Meals cannot be served to the SSBG funded participant until the letter from the certifying healthcare practitioner has been received.

9.0 WAITING LISTS

9.1 When the demand for a service exceeds the ability to provide the service, a waiting list is required.

9.2 Applicants will be placed on the waiting list until services can be provided, the applicant no longer desires services, or the applicant becomes eligible for services.

9.3 The waiting list must be managed in accordance with the “DSAAPD Policy Manual for Contracts,” “Policy

Number X-K, Participant Service Waiting Lists.”

9.4 In all cases, the reason for the selection of an individual ahead of others on the waiting list must be documented (e.g., in writing and available for review).

10.0 REPORTING REQUIREMENTS

10.1 OAA Title III-C Funded.

10.1.1 Providers must collect and compile all information required by the Older Americans Act Performance System (OAAPS).

10.1.1.1 Failure to provide the required information will result in non-payment of services.

10.1.2 Providers using an integrated automatic system must utilize the identified site and process for uploading participant data to DSAAPD.

10.1.2.1 If the Provider is not using an integrated automatic system, data must be submitted in an electronic format that can be easily uploaded into DSAAPD’s system (acceptable formats include .XML, .XLS/XLSX, .CSV) or data may also be entered into the Provider Portal within the DSAAPD case management system.

10.1.3 Providers must collect and compile all information required by the “Nutrition Program Monthly Report,” found in Attachment C, to submit to DSAAPD on a monthly basis.

10.2 SSBG Funded.

10.2.1 Providers must collect and compile all information required by DSAAPD.

10.2.1.1 Failure to provide the required information will result in non-payment of services.

11.0 INVOICING REQUIREMENTS

11.1 The Provider will invoice DSAAPD utilizing the appropriate Invoicing Workbook for program participants, pursuant to the “DSAAPD Policy Manual for Contracts,” “Policy Number X-Q, and Invoicing.”

11.2 The Provider will only invoice DSAAPD for meals provided to DSAAPD approved OAA Title III-C and SSBG participants.

11.2.1 Meals provided to Medicaid recipients are not reimbursable under the OAA Senior Nutrition

Program.

11.3 Classification of Meals by Funding Source.

11.3.1 OAA Title III C1 Funding.

11.3.1.1 Congregate Meals.

11.3.1.1.1 Meals that meet the requirements specified previously in Subsection 5.1 and consumed on-site while congregating in-person.

11.3.1.1.1.1 Meals consumed off-site may be considered Congregate if congregation via virtual means takes place.

11.3.1.2 Grab-and-Go Meals.

11.3.1.2.1 Meals that complement the Congregate Nutrition program, meet the requirements specified previously in Subsection 5.2, and are picked-up on-site, providing the participant the opportunity for in-person or virtual socialization, and later consumed off-site.

11.3.1.2.1.1 These meals are not delivered.

11.3.1.2.1.2 These meals may not exceed 25% of the total OAA Title III C1 funding expended.

11.3.1.2.1.3 Examples of grab-and-go meals that complement congregate nutrition per 45 CFR 1321.87 (1) (iii) (a-c):

11.3.1.2.1.3.1 “during disaster or emergency situations affecting the provision of nutrition services;

11.3.1.2.1.3.2 to older individuals who have an occasional need for such meal; and/or

11.3.1.2.1.3.3 to older individuals who have a regular need for such meal, based on an individualized assessment, when targeting services to those in greatest economic need and greatest social need.”

11.3.2 OAA Title III C2 and/or SSBG Funding.

11.3.2.1 Home-Delivered Meals.

11.3.2.1.1 Meals that meet the requirements specified previously in Subsection 5.3 and are delivered to the participant for consumption off-site.

11.3.3 NSIP Funding.

11.3.3.1 Meals funded by NSIP may only be used to purchase domestically produced foods used in an eligible meal (i.e. Congregate, Grab-and-Go, Home-Delivered).

11.4 Supporting Documentation.

11.4.1 Service Units.

11.4.1.1 The Provider must supply supporting documentation for the service units charged for the selected month of the Invoice Review. These records must indicate:

11.4.1.1.1 unduplicated participants served; and

11.4.1.1.2 the Total Service Units provided including…