75P00124R00083.pdf

COMBINED SYNOPSIS/SOLICITATION FOR COMMERCIAL PRODUCTS AND

SERVICES

General Informa on

Document Type:

Solicita on Number:

Posted Date:

Original Response Date:

Current Response Date:

Product or Service Code:

Set Aside:

NAICS Code:

Combined Synopsis/Solicita on 75P00124R00083 9/19/2024 9/24/2024 9/24/2024 R799 Unrestricted 541611

Contrac ng Office Address

Office of the Assistant Secretary for Administra on Office of Acquisi on Management Services 5600 Fishers Lane, 15E 10D Rockville MD 20857

Descrip on

This is a combined synopsis/solicita on for commercial services prepared in accordance with the format in Federal Acquisi on Regula on (FAR) 12.6 as supplemented with addi onal informa on included in this no ce. This announcement cons tutes the only solicita on; proposals are being requested, and a separate solicita on will not be issued. This solicita on is a request for proposals (RFP).

The associated North American Industrial Classifica on System (NAICS) code for this procurement is 541611, with a small business size standard of $24.5 million.

Point of Contact

Contract Specialist:

Olivia Barksdale olivia.barksdale@psc.hhs.gov

Contrac ng Officer:

Mary Rainey mary.rainey@hhs.gov

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SECTION B - Supplies or Services and Prices/Costs

Section B – Fixed Price

B.1 BRIEF DESCRIPTION OF SERVICES/SUPPLIES

The contractor will serve as the lead entity that will continue the work to coordinate the support of disability grassroots advocacy work, partnering with national organizations to support cross-disability, cross-generational, and culturally diverse state and local advocacy and action coalitions that can more effectively leverage the ACL disability networks in each state and territory to advance quality community living. Grassroots advocates are people with lived experience of disability and their allies.

B.2 TYPE OF CONTRACT

The contract type awarded is a Firm Fixed Price

B.3 SEVERABLE SERVICES

The services acquired under this contract are severable services. Funds are only available for use for the contract line item (CLIN) to which they are obligated. Unused funds from one CLIN may not rollover for use in other periods.

B.4 CONSIDERATION AND PAYMENT (Fixed Price – Severable Services)

In consideration of satisfactory performance of the work as described throughout this contract, the Contractor shall be paid a fixed price for each CLIN (if exercised). If the options are

75P00124R00083 Page 2 of 173 exercised, funding will be obligated by modification to the contract. The base period and option periods are priced as follows:

Contract Period Fixed Price CLIN 1 Base Period CLIN 2 Option Period 1 CLIN 3 Option Period 2 CLIN 4 Option Period 3 CLIN 5 Option Period 4 TOTAL Potential Value inclusive of all

CLINS

Payment shall be made upon the delivery and acceptance of the services required in accordance with the following payment schedule:

The contractor will provide monthly invoices for the services provided. See Section G.6 of this contract for invoicing guidance.

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SECTION C - Description/Specifications/Statement of Work

Grassroots Project

C.1 PROGRAM DESCRIPTION AND BACKGROUND

C.1.1 Background and National Significance

Decades of work by advocates across our nation have resulted in people with disabilities having greater and fairer access to the community and are participating more fully in American society.

Grassroots advocacy efforts have brought to the forefront the multiple ways in which people with disabilities are disenfranchised and discriminated against, leading to many changes for people with disabilities over the last 3 three decades. Such efforts have led to the creation of the

Developmental Disabilities and Independent Living Programs, passage of the Americans with

Disabilities Act, and the Supreme Court’s landmark Olmstead Decision, just to name a few. It has led to more people with disabilities living self-determined lives in the community, more children with disabilities being educated alongside their non-disabled peers, more people with disabilities working alongside people without disabilities as valued co-workers and paid fair wages.

Despite this progress, there still are barriers to remove, minds to change, and millions of people for whom community living is just a promise and not a reality. The hard work of grassroots advocacy must grow and continue until each person with a disability is living where they want to live, with the people they choose to live with, with the services and supports they need, and with the same opportunities for pursuing a career through competitive, integrated employment as everyone else.

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The highly complex policy, practice, and financial systems that drive human services and supports makes it difficult for people with disabilities to effectively engage in grassroots advocacy. Understanding, knowing, and navigating multiple services systems is challenging in and of itself. Being able to effectively advocate for changes within these systems is equally challenging. Yet grassroots advocates have a key role to play in making such changes. They experience the daily lived experience of life with a disability where services and supports often fall short of their intended purpose of assisting each person in meeting their person-centered goals and leading self-determined lives in the community. There is a growing need to arm grassroots advocates with the tools, resources, information, and peer-to-peer networking to continue to engage in system change efforts.

In 2022, ACL funded a small project to partner with national disability organizations for the developmental disabilities (DD) and independent living (IL) programs to connect to and support the identification and activation of disability advocacy groups at the state level. This work was designed to align with the site visits CMS and ACL conducted by creating community and state advocacy to help identify settings covered under the CMS 1915(c), 1915(i), and 1915(k) home and community based (HCBS) programs that may not be fully in compliance with the 2014

HCBS final settings rule.

In 2023 ACL significantly enhanced the funding for this work, creating the Grassroots Project

(Project). The first year of Project focused on creating the infrastructure necessary to support state and local advocates and advocacy groups in developing effective strategies for improving outcomes for people with disabilities.

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The results from this work that started in 2022 has influenced activities at the national, state, and local levels. As a result of engagement with state level and grassroots advocates, CMS/ACL teams identified the specific settings visit during their site visits on the HCBS settings rule and identify state specific structural, policy, and financing issues that are directly or indirectly related to non-compliance. It also helped to lay the foundation for supporting state and local advocacy coalitions and building a systems of interconnected grassroots advocates across the nation . This is initial work helped increase interest in the policy and mechanisms governing state HCBS as well as increased participation in advocacy to improve HCBS systems in states.

Overview of the Administration on Disabilities

The Administration on Disabilities (AoD) works with states, communities, and partners in the disability networks to increase the independence, productivity, and community integration of individuals with disabilities. AoD works to improve opportunities for people with disabilities to access quality services and supports, achieve economic self-sufficiency, and experience equality and inclusion in all facets of community life. The priorities for AoD are:

• Achieving economic security and mobility through increased opportunities for competitive integrated employment;

• Increasing life expectancy by addressing health disparities to achieve greater health equity;

• Ensuring quality community living and the protection of rights and prevention of abuse; and

• Empowering individuals, families, and communities.

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AoD includes three offices: Office of Intellectual and Developmental Disability (OIDD), Office of Independent Living Programs (OILP), and the Office of Disability Service Innovations

(ODSI) that provide oversight to the AoD programs and collaborate across the organization to execute the AoD priorities. This contract is being funded under authorities provided by the

Developmental Disabilities Assistance and Bill of Rights Act (DD Act), the Rehabilitation Act, the Public Health Service Act (for the Paralysis Resource Center [PRC], and the Traumatic Brain

Injury Program Reauthorization Act of 2018 (TBI Act).

C.1.2 Project Overview

This project will further the work of the Grassroots Advocacy and Action Project (GAP) established in FY2024 which is using a multi-system (e.g., national, state, local) approach to:

• Build the next generation of cross-disability, cross generational, and culturally diverse leaders within the advocacy movement.

• Connect, grow, and strengthen networks of grassroots advocacy and action coalitions supporting each other and with the skills and knowledge to advocate for improvements in the quality of community living.

The contractor will serve as the lead entity that will continue the work to coordinate the support of disability grassroots advocacy work, partnering with national organizations to support cross-disability, cross-generational, and culturally diverse state and local advocacy and action coalitions that can more effectively leverage the ACL disability networks in each state and territory to advance quality community living. In addition to carrying forward the work in

FY2024 conducted by the Project, the project will build off the ACL funded HCBS advocacy

75P00124R00083 Page 7 of 173 work described above and broaden into other areas of critical importance to living in the community.

Technical assistance will be provided to the ACL disability programs (e.g., DD, IL, TBI, PRC) to leverage these networks and their existing activities by uplifting, amplifying, and strengthening their current advocacy efforts and helping them broaden their outreach and education to individuals with lived experience to create a greater groundswell of advocacy aimed at changing the quality of community living for individuals with disabilities in states and territories. Through this work, the contractor will apply person-centered thinking, planning, and practices by funding activities that encourages participation and engagement at all systems levels. The project will also provide technical assistance (TA) on resources and strategies that will support sustainability of grassroot advocacy.

Through this project, ACL seeks to ultimately position the next generation of cross-disability, cross generational, and culturally diverse grassroots advocates as leaders and catalysts of systems change that hold states and/or providers accountable and responsive to stakeholder input.

Through this project ACL envisions that strengthening grassroots advocacy will contribute to more people with disabilities:

• Experiencing person centered planning / have personal preferences respected

Living in homes of their choosing.

• Living full lives in the community based on their choice and are connected to their community.

• Working in competitive integrated employment instead of in sub-minimum wage/sheltered employment.

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• Affecting state policies that change access to and quality of services and create more connections to their community.

• Being treated with dignity, respect, and are seen as knowledgeable about policy, services, systems, and supports.

• Being supported throughout their lifespan, starting in early childhood, to achieve the life of their choosing.

• Seeing themselves as knowledgeable about policy, services, systems, and supports and as agents of change.

• Being more visible in, more engaged, and connected to their community.

• Taking responsibility for their lives, for the services they are receiving, for creating change.

• Taking control of their destinies and of their lives.

This project advances ACL’s efforts to support grassroots engagement in the implementation of the HCBS settings rule and the following ACL/AoD program priorities:

• Protecting Rights and Preventing Abuse: Working to uphold the civil rights of people with disabilities and reduce/eliminate incidents of abuse.

• Empowering Individuals, Families & Communities: Working to help people with disabilities take more control over their lives and thrive in their communities.

It also supports the following HHS Strategic Objective:

• HHS Objective 3.3: Expand access to high-quality services and resources for older adults and people with disabilities, and their caregivers to support increased independence and quality of life.

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C.1.3 Project Goal and Expected Outcomes

This acquisition will be awarded as a performance-based contract. Performance will be measured by the outcomes achieved by the contractor. This statement of objectives (SOO) outlines the desired results and expected outcomes to be achieved for the work performed and is detailed in the logic model for the Project that appears in this SOO (Appendix B). The contractor will be expected to evaluate performance based on the outputs and outcomes in the logic model. Any modifications to the logic model must be approved by the COR.

It is expected that the contractor will, in managing and overseeing the Disability Grassroots

Advocacy and Action Project, achieve the following long-term outcomes:

• Build the next generation of cross-disability, cross generational, and culturally diverse leaders within the advocacy movement.

• Connect, grow, and strengthen networks of grassroots advocacy and action coalitions supporting each other and with the skills and knowledge to advocate for improvements in the quality of community living.

The intermediate outcomes for the project are:

• Grassroots advocates use their knowledge of states services to hold states / providers accountable and responsive to stakeholder input

• Grassroots advocates use their knowledge of state systems and funding streams to navigate to the right state and local systems and advocate for changes in state and local level policies and services.

• Grassroots advocates leverage state and other resources to create new coalitions / new programs / new organizations to do peer to peer outreach and training on how to advocate for community living.

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• Grassroots advocates understand how services are funded, provided, and knows the state and local agencies that funds services and supports.

• Grassroots advocates are organized in the state and have a strategy for how to identify areas where change is needed at the state or local level and taking action to effect that change.

• People with disabilities are supported (including by individuals in their support circle) to advocate and make their own choices.

• State and local advocacy and action coalitions are sustained.

• State coalition relationships with grassroots advocacy coalitions are sustained.

The immediate outcomes for the project are:

• Increase in the knowledge state and local grassroots advocates have of state systems, policies, and funding for services and supports and the state and local agencies that oversee / fund them.

• Increase in the knowledge support circles (parents, siblings, other family members, providers, teachers, etc.) have of the independent living philosophy and disability rights.

• Increase in the number and diversity of individuals actively advocating and participating in coalitions.

• Increase in the number and diversity of advocates serving in leadership roles and participating in leadership training.

• Increase in the number of advocacy and action coalitions representing diverse populations.

• Increase in the number of state and local advocacy and action coalitions.

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• Increase in the number of peer networks to provide training on how to advocate in the six focus areas.

• Increased ability of advocates to engage in state level system advocacy.

• Increase in the number of advocates actively working to affect system and policy changes at the state in the six focus areas to improve quality of life and community living opportunities for people with disabilities.

• Increase in the number of grassroots advocacy partnerships formed.

• Number of state and local policies improved.

• Number of grassroots advocates who become trainers of the Project/ train others (e.g., train the trainers).

It should be noted that the advocacy performed as result of the work of this contract is subject to lobbying restrictions applicable to all federally funded awards.

C.1.4 Project Design

A contract will be awarded to a lead entity (contractor) who will have overall responsibility for overseeing and coordinating the work of the Project. To achieve the outcomes of the project, a key design of the project will be connecting advocates across multiple levels to reach and connect to individuals with disabilities and others at the local level to strengthen and build where needed grassroot advocates. This approach will help with strengthening existing, growing new, and sustaining advocacy coalitions at the state and local levels, both within and across these levels and building the system knowledge and advocacy skills of individuals with disabilities.

The project will provide advocacy supports with a focus on topics key to improving community living for people with disabilities.

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National Level HCBS Advocacy and Action Coalition: The contractor will work in partnership with national organizations to continue the work of creating a national advocacy and action coalition (NAAC). The contractor will partner with the NAAC in all aspects of the project whose members will be the conduit for connecting with state and local coalitions. The NAAC, working in partnership with the contractor, will play a key role in designing and providing the necessary technical assistance (TA), training, and support to the state and local coalitions to meet the project goals, outcomes, and objectives. For the base period of the project, the NAAC will be comprised of the national organizations for the DD, IL, TBI and PRC programs. Over time, the

NAAC will grow to include other organizations, including those representing multiply marginalized communities. To fulfill the outcomes of the contract, it is expected that the contractor shall have established relationships with the NAAC members and disability related grassroots organizations; a proven track record of understanding and applying the functions, National Level HCBS Advocacy and Action

Coalition

State Level Advocacy and Action Coalitions

Local Level Advocacy and Action Coalitions

Individuals with disabilities and allies

State Agency Partnership Group

75P00124R00083 Page 13 of 173 history, values, and philosophy of HCBS as it applies across multiple federally funded programs;

and the ability to develop disability grassroots advocacy and action coalitions.

State Level Advocacy and Action Coalitions: The contractor working in partnership with the

NAAC will connect to existing and create as necessary new state level advocacy and action coalitions (STAAC) for the purpose of growing and sustaining national grassroots advocacy coalitions. The STAAC will be the conduit to local advocacy and action coalitions and will play a key role in identifying and supporting existing local advocacy coalitions and potential advocacy groups to create local grassroots advocacy and action coalitions, including those that can become a part of the STAAC.

Local Level Advocacy and Action Coalitions: the NAAC and STAACs will provide TA support to create effective local Advocacy and Action Coalitions (LAACs). NAAC and STAACs will provide support to assist LAACs in identifying settings, programs, and practices that prevent people from realizing their person-centered goals and preferences and to bring those issues to the

STAAC and NAAC. The LAAC will be the conduit to individuals with disabilities who are currently connected to grassroots advocacy efforts, and they will be responsible for bringing new advocates into the LAAC, with a particular focus on multiply marginalized individuals.

Coalition Members: The contractor will target specific audiences and groups for each of the advocacy and action coalitions. The primary target groups for the NAAC, STAAC, LAACs for the base period are the ACL funded disability programs (DD, IL, TBI, and PRC). In addition, the contractor shall, working in partnership with the NAAC and through the STAACs and LAACs, target over time other groups, including:

• National, state, and local disability-led organizations across the disability spectrum (e.g., People First, other state and local self-advocacy organizations)

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• State and local advocates / advocacy groups for older adults

• Direct Care Workers / Support Professionals

• Families / other caregivers

The contractor shall also target secondary groups to be a part of or connected to each of the coalitions, including:

• State level agency leaders

• Provider organizations

State Agency Partnership Group: To connect grassroots efforts as well as state advocacy activities to state leaders and policymakers, the project design will include a State Agency

Partnership Group (SAPG). This group will offer key insights on efforts to promote systems change and improve HCBS. The contractor and NAAC will ensure STAACs and LAACs are connected to the State Agency Partnership Group to streamline systems change efforts.

Focus Areas: The contractor will conduct a variety of activities to support state and local advocacy and action coalitions engaging in grassroots advocacy in the following focus areas:

• Person-centered competencies, consumer direction, and self-direction

• Caregiver crisis

• Health and safety in community living

• HCBS, to include such topics as the Settings Rule, HCBS state plans, and HCBS waiting lists

• Civil Rights

• Community integration through employment

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The contractor shall include advocates drawn from the NAAC and STAAC to drive planning for this activity as equal members of the team for each of the six focus areas. The contractor is expected to with and maintain a network of national experts who can provide direct TA and guidance across the six focus areas. Whenever possible the national experts shall be drawn from the National, State, and Local Advocacy Coalitions.

C.1.5 Key Personnel

The contractor shall provide key personal with the following experience and competencies.

Senior Level Program Manager(s): Must have direct experience working to develop disability grassroots advocacy in states.

Project Manager(s): Must have direct experience working to develop disability grassroots advocacy in states.

C.2 STATEMENT OF WORK - Severable Services

The Contractor shall furnish all of the necessary personnel, materials, services, facilities, (except as otherwise specified herein), and otherwise do all the things necessary for or incident to the performance of the work as set forth below:

C.2.1 TASKS

C.2.1.1 Task 1: Project Management and Evaluation

The contractor is expected to achieve the project goals by managing and evaluating the activities carried out.

C.2.1.1.1 Project Management Plan: The contactor shall develop and maintain a project management plan that clearly and concisely identifies the expected goals, objectives, tasks, and

75P00124R00083 Page 16 of 173 activities that will lead to the achievement of the project outcomes, to the maximum extent possible. The project management plan shall include specific activities needed to carry out the tasks along with a timeline for their achievement for the length of the contract. The project management plan is to be guided by the following principles:

i. Outcome-driven results: Planning for and conducting project activities that are evaluated based on the metrics described in the in the project Logic Model for measuring outcomes in the performance of the contract.

ii. High-quality, efficient, and effective delivery of contract activities: Maintaining the highest levels of services to the greatest number of entities, consistent with cost effectiveness.

iii. Innovation: Applying new and creative techniques and methods that promote efficiency and effectiveness while not compromising quality.

iv. Assessment of need: Using an ACL approved assessment process to regularly identify needs across the target audiences / coalitions and analysis of issues impacting implementation of

HCBS.

v. Continuous learning approach: Learnings from the activities performed in this contract are continuously analyzed and refined to improve outcomes. The project management plan shall be submitted to the COR and ACL SME for review within the first 30 days of the contract.

C.2.1.1.2 Coordination, Guidance, and Oversight plan: As part of project management, the contractor shall establish a coordination, guidance, and oversight plan for working with the

NAAC to manage the Project. The contractor shall propose an approach that positions the NAAC members in a key leadership and guidance role that supports active involvement on matters related to developing the STAACs and LAACs, including the ability to provide funds to the state/local advocacy groups. The plan should include the sub-contractual requirements for the

75P00124R00083 Page 17 of 173 activities each member of the NAAC will implement to support achievement of the Project outcomes. The contractor shall maintain authority on ensuring the administrative and reporting functions are carried out and for the overall performance of the contract. The COR and ACL

SME may be contacted in the case of any disputes that cannot be resolved by the parties, and in all cases a spirit of collaboration, and compromise are expected. The contractor shall include the coordination, guidance, and oversight plan as part of its overall Project Management plan.

C.2.1.1.3 Recruitment plan: The contractor working in partnership with the NAAC shall develop a plan for recruiting for STAACs and LAACs that will receive support from the Project.

The STAACs and LAACs shall have the following characteristics to the degree possible:

• Focused on quality of life for people with disabilities across the lifespan.

• Composed of at least 51% people with disabilities.

• Can activate members to advocate for improving policy and programming consistent with the HCBS final rule and other programs and needs for people with disabilities across the lifespan.

• Can identify promising/best practices for participant engagement and support implementation.

• Able to collect and use statistics on advocacy activities.

• Represent cross disability groups, Tribal groups, racial/ethnic groups, sexual orientation/gender identity, capacity, and other diversity areas.

The contractor shall also create a plan for recruiting states to participate in the SAPG that includes an application process for selecting up to 20 states to participate in this the SAPG work.

Preferences in selection criteria shall include:

• States representing each region of the country

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• Reflect the racial and ethnic diversity in the state

• Specific outreach to Tribal entities

• State offices across the disability and lifespan spectrum

The COR shall review and approve of the SAPG application and the selection processes.

C.2.1.1.4 Reporting and Evaluation: Throughout the duration of this contract, the contractor shall demonstrate high quality performance, reliability, and cost-effectiveness of the services delivered by developing and implementing an on-going self-evaluation process for assessing progress of project activities and the extent to which the project activities have achieved the outcomes of the contract; and reporting formative results to ACL monthly. Monthly reports shall include the following:

i. Participant evaluation of project activities and resources.

ii. Status of the development of the NAACs, STAACs, and LAACs, including activities to broaden participation by other groups and efforts to target multiply marginalized groups.

iii. Status of the State Agency Partnership Group and their activities with the STAACs and

LAACs.

iv. Expenditures for each task including unit costs for specific activities (e.g. webinars, resources, trainings, TA, etc.).

v. Progress on immediate, intermediate, and long-term goals listed in the logic model.

The contractor shall plan for summative evaluation activities and submit an annual performance report to ACL on the extent to which the outputs in the logic model and outcomes listed below have been achieved.

Immediate outcomes for the Project are:

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• Increase in the knowledge state and local grassroots advocates have of state systems, policies, and funding for services and supports and the state and local agencies that oversee / fund them.

• Increase in the knowledge support circles (parents, siblings, other family members, providers, teachers, etc.) have of the independent living philosophy.

• Increase in the number and diversity of individuals actively advocating and participating in coalitions.

• Increase in the number and diversity of advocates serving in leadership roles and participating in leadership training.

• Increase in the number of advocacy and action coalitions representing diverse populations.

• Increase in the number of state and local advocacy and action coalitions.

• Increase in the number of peer networks to provide training on how to advocate in the six focus areas.

• Increased ability of advocates to engage in state level system advocacy.

• Increase in the number of advocates actively working to affect system and policy changes at the state in the six focus areas to improve quality of life and community living opportunities for people with disabilities.

• Increase in the number of grassroots advocacy partnerships formed.

• Number of state and local policies improved.

• Number of grassroots advocates who become trainers of the Project/ train others (e.g., train the trainers).

• The contractor shall also plan for evaluating and reporting a summative assessment to

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ACL at the end of the contract period on the extent to which the project has achieved the following.

Intermediate outcomes:

• Grassroots advocates use their knowledge of states services to hold states / providers accountable and responsive to stakeholder input.

• Grassroots advocates use their knowledge of state systems and funding streams to navigate to the right state and local systems and advocate for changes in state and local level policies and services.

• Grassroots advocates leverage state and other resources to create new coalitions / new programs / new organizations to do peer to peer outreach and training on how to advocate for community living.

• Grassroots advocates understand how services are funded, provided, and knows the state and local agencies that funds services and supports.

• Grassroots advocates are organized in the state and have a strategy for how to identify areas where change is needed at the state or local level and taking action to effect that change.

• People with disabilities are supported and centered by individuals in their support circle to advocate and make their own choices.

• State and local advocacy and action coalitions are sustained.

• State coalition relationships with grassroots advocacy coalitions are sustained.

Long-term outcomes:

• Build the next generation of cross-disability, cross generational, and culturally diverse leaders within the advocacy movement.

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• Connect, grow, and strengthen networks of grassroots advocacy and action coalitions supporting each other and with the skills and knowledge to advocate for improvements in the quality of community living.

C.2.1.1.5 Regular Communication: As part of project management, the contractor shall plan for regular communication with the ACL COR and ACL SMEs. This shall include a

Orientation meeting with ACL within the first 2 weeks of the contract where the entire project will be discussed.

C.2.1.2 Task 2: Coalitions and Partnership Group

The contractor is expected to achieve the project goals by developing and providing support to

National, State, and Local Grassroots Advocacy and Action Coalitions.

C.2.1.2.1 National Advocacy and Action Coalition: Building off the advocacy and engagement work started in 2022 and the contract in FY2024, the contractor shall, during the contract base period enhance the National Advocacy and Action Coalition by continuing to subcontract with the following organizations representing the ACL disability programs:

• National Disability Rights Network (NDRN)

• Association of University Centers on Disability (AUCD)

• National Association of Councils on Developmental Disabilities (NACDD)

• Autistic Self-Advocacy Network/Self Advocacy Resource and Technical Assistance

Center (ASAN/SARTAC)

• National Association of Statewide Independent Living Council (NASILC)

• Association of Programs for Rural Independent Living (APRIL)

• National Council on Independent Living (NCIL)

• Paralysis Resource Center (PRC)

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• National Association of State Head Injury Administrators (NASHIA)

During the base period, the contractor shall in partnership with the NAAC expand the membership to include cross-disability, lifespan national advocacy groups, including those representing multiply marginalized communities.

The NAAC shall have the following functions:

• Have a leadership role in the project and informs and guides the work of the contractor in all the activities in this contract.

• Assist in creating a coordinated cross-disability, lifespan advocacy presence in each state by serving as a conduit to state and local entities and providing support to develop state and local advocacy and action coalitions.

• Work in partnership with the contractor to identify, recommend, and carry out cross-cutting activities such as resource identification and development, webinars, peer learning models (e.g., learning collaboratives), and direct TA for building the capacity for grassroots advocacy efforts in the six focus areas that will work towards reforming delivery systems and improving HCBS.

• Identify additional organizations, including those representing multiply marginalized communities, to join the NAAC.

The contractor working with the NAAC shall carry out at least the following activities in the base period:

• Continuously updating the environmental scan that includes:

o Address any additional gaps in advocacy groups across disability groups, levels of advocacy (national, state, local), Tribal groups, racial/ethnic groups, sexual orientation/gender identity, capacity and other areas as needed;

75P00124R00083 Page 23 of 173 o Ongoing assessment of existing resources and resource needs for grassroots advocacy, including resources for members of support circles (e.g., parents, siblings, other family members, providers, teachers, etc.) on the independent living philosophy; and o Continue to Identify existing infrastructure and promising approaches to building advocacy capacity.

• Developing a plan that meets ACL’s expectations for the base period and option periods.

The plan shall explain how the contractor will identify and work with a minimum of 10 states and territories each year to address the gaps identified in the assessment and supporting STAACs to develop and recruit additional advocacy groups. A process that can be informed using the following NCAPPS resources: Engaging People Who Receive

Services, and Toolkit for Stakeholder Asset Mapping.

• Replicating existing models or creating new approaches to building advocacy skills of individuals with disabilities and others.

• Leading monthly meetings in the base period and each option period of the STAACs and

LAACs to share success stories, best practices, and challenges.

• Providing web-based trainings and technical assistance tailored to the needs to each advocacy and action coalition (addressed in more detail in Task 3 below).

• Providing direct TA support to each STAAC to create an advocacy action plan for at least one of the focus areas.

• Holding monthly open office hours through each year of the contract for STAACs and

LAACs that need additional assistance.

75P00124R00083 Page 24 of 173 https://ncapps.acl.gov/docs/Participant%20Engagement%20Guide%20200904.pdf https://ncapps.acl.gov/docs/Participant%20Engagement%20Guide%20200904.pdf https://ncapps.acl.gov/docs/AssetMappingToolkit_200827_linked.pdf

C.2.1.2.2 State Advocacy and Action Coalitions: The contractor working in partnership with the NAAC shall:

• Strengthen and grow existing STAACs, continuing any support that was provided during

FY2024.

• Support the development of new STAACs where needed.

• Target all state chapters and affiliates (e.g., State Councils, Protection and Advocacy

Systems, University Centers, Centers for Independent Living, TBI State Partnerships, PRC affiliates) of the NAAC to create a foundation for the STAACs.

Where there are gaps in participation among disability groups across the lifespan, the NAAC shall provide support to develop and recruit additional state and local advocacy groups to create cohesive cross-disability, culturally diverse, lifespan advocacy presence in each state.

The contractor and NAAC shall use a variety of strategies and resources to build capacity for

Grassroots Advocacy efforts in the six focus areas described in Task 3 that will work towards reforming delivery systems and improving the quality of community living. The contractor and the NAAC shall plan for and provide a variety of activities that will build where needed and strengthen existing State Coalitions, carrying out at least the following:

• Supporting efforts to enhance diversity of their membership, including strategies for assessing gaps and recruiting new partners.

• Supporting coalition building within and across state groups.

• Providing training and TA to the STAACs and LAACs on the six focus areas

• Supporting the STAACs in developing local grassroots advocates across each state using promising approaches such as Partners in Policymaking.

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• Developing at least one written resource to assist STAACs in leveraging resources to support and sustain grassroots advocacy efforts and peer-to-peer networking.

C.2.1.2.3 Local Advocacy and Action Coalitions: The contractor, working in partnership with the NAAC, and STAACs, shall plan activities for connecting with and growing LAACs.

Strategies shall include:

• Using the gaps assessment created by the NAAC as a basis to assess gaps at the local levels in states. Similarly, the STAAC will develop a plan to for local areas across the state to address the gaps identified in the assessment and support LAACs to develop and recruit additional advocacy groups. The STAAC shall consider use the following

NCAPPS resources to support this effort: Engaging People Who Receive Services, and

Toolkit for Stakeholder Asset Mapping. The STAAC shall consider use the following

NCAPPS resources to support this effort: Engaging People Who Receive Services, and

Toolkit for Stakeholder Asset Mapping.

• Developing and maintaining local networks of self-advocacy groups, self-advocates, family members, direct care workers / support professionals, community-based organizations (CBOs), and allies.

• Providing training and resources to LAACs on state specific issues related to the six (6) focus areas.

• Holding monthly meetings to support peer-to-peer learning to strategize, discuss issues, and brainstorm ideas for identifying issues related to the six focus areas, problematic settings, service providers, how the effectively advocate at the federal, state, and local levels, and others as identified by the State Coalitions.

75P00124R00083 Page 26 of 173 https://ncapps.acl.gov/docs/Participant%20Engagement%20Guide%20200904.pdf https://ncapps.acl.gov/docs/AssetMappingToolkit_200827_linked.pdf https://ncapps.acl.gov/docs/Participant%20Engagement%20Guide%20200904.pdf https://ncapps.acl.gov/docs/AssetMappingToolkit_200827_linked.pdf

• Provide ongoing feedback to grassroots advocates on the status of the settings and other advocacy issues reported to state and federal agencies.

C.2.1.2.4 State Agency Partnership Group: The contractor will maintain a State Agency

Partnership Group (SAPG) based on planning work that was done during the FY2024 contract to facilitate connections of the State and Local Advocacy and Action Coalitions to the state agencies and advise the NAAC on state issues related to supporting grassroots advocacy.

This will support collaboration between advocacy coalitions and state agencies to ensure state compliance with the HCBS final rule, and other HHS HCBS programs, and will assist with identifying areas for opportunity for advocacy. The contractor shall plan for recruiting and maintaining the SAPG and must develop a partnership plan that outlines the roles and responsibilities of the SAPG and how the SAPG will connect with State and Local Advocacy and Action Coalitions.

State agency participants must represent a population served under a CMS Medicaid waiver or state plan option subject to the settings rule such as agencies serving people with intellectual/developmental disabilities, physical disabilities, mental health, traumatic brain injury, or older adults. States shall also be encouraged to include state agency representatives of other non-Medicaid funded HCBS programs (e.g., mental health/substance use disorders, older adults, vocational rehabilitation, child welfare, etc.)

C.2.1.3 Task 3: Building the Next Generation of Grassroots Advocacy Leaders and Coalitions

The contractor, working in partnership with the NAAC, shall implement a variety of activities to achieve the outcome of the project of creating the next generation of cross-generational, cross-

75P00124R00083 Page 27 of 173 disability, culturally diverse grassroots advocacy leaders. Such activities may include conducting national stakeholder calls on various topics of importance to advocacy groups, creating a centralized list of grassroots advocacy orgs by population, implementing learning communities or collaboratives supporting peer-to-peer learning, organizing in-person meetings and presentations at various conferences (e.g. HCBS), and documentation of successful strategies, and approaches at state and local levels STAACs, and LAACs.

Conference presentations shall be approved by the COR. Contract funds cannot be used for conference fees, travel, lodging, meals, other transportation, or other incidentals unless explicitly approved by the COR.

C.2.1.3.1 Advocacy Focus Areas: The contractor is expected to achieve the project outcome by providing resources and using other strategies to support HCBS grassroots advocacy efforts and the STAACs and LAACs in specific areas of focus:

i. Person-centered planning, consumer direction, and self-direction:

1. Promoting state adoption and use of NCAPPS PCP Competency Domains for implementing high quality and consumer and self-directed services,

2. Promoting the use of consumer and self-directed services in states and at the local levels, and

3. Addressing barriers that are often present in self-direction programs, including lack of affordable housing, lack of adequate support for people with significant disabilities to participate, barriers caused by the tacit requirement of family support, barriers created by the Electronic Visit Verification requirement and others.

ii. Caregiver crisis:

1. Identifying strategies for providing support for family caregivers and promoting state

75P00124R00083 Page 28 of 173 and local adoption of such approaches.

2. Identifying promising approaches to attracting and retaining qualified caregiver and promoting state and local adoption of such approaches.

3. Supporting STAACs and LAACs in finding solutions to the caregiver crisis, including identifying innovative models for accessing funding streams to pay for caregiver services.

4. Using the ACL 2022 National Strategy to Support Family Caregivers as a guide.

iii. Health and safety in community living:

1. Utilizing information from the evaluation of the Living Well Grant Program and other innovative approaches to create resources for translating knowledge into policy action that will reduce the incidence of abuse and neglect, improve health and safety in community living, and promote the use of person-centered principles.

2. Support STAACs and LAACs to:

a. Identify conditions that increase the likelihood of abuse and neglect and take action;

b. Identify specific instances of likely abuse/neglect and take action;

c. Report suspected abuse/neglect;

d. Support people who have been victims of abuse/neglect; and

e. Set up feedback loops on the outcomes of advocacy work.

iv. HCBS settings rule:

1. Promoting the implementation of the 2014 CMS HCBS Settings rule

2. Supporting states to meet requirements of the rule that people live full lives in the community by requiring program participants to have full access to broader

75P00124R00083 Page 29 of 173 community, seek competitive employment, have control over their homes and possessions, and receive support necessary to achieve their person-centered goals and preferences.

3. Continuously monitor HCBS waivers, state plan options, 1115 demonstrations, and

HCBS managed care renewals due within a continuous 6 month time frame.

a. Notify NAAC to encourage state and local advocates to engage in advocacy to CMS about compliance issues, including participating in public comment periods.

b. Analyze public comments for each waiver and provide a summary to ACL and state and local advocacy groups.

c. Submit a report on changes each state made post public comment period and describe the stakeholder engagement strategies.

v. Civil Rights:

1. Building foundational knowledge and awareness of civil rights laws and their applicability to people needing HCBS.

2. Raising awareness supporting specific advocacy activities about the Supreme Court

Olmstead decision, the Americans with Disabilities Act, Section 504 of the

Rehabilitation Act final rule, “Discrimination on the Basis of Disability in Health and

Human Service Programs or Activities,” and Section 1557 of the Affordable Care Act final rule “Nondiscrimination in Health Programs and Activities” and such basic rights as freedom of movement and association.

a. Specifically address the following requirements in the ADA Section 504 and

Section 1557 rules:

75P00124R00083 Page 30 of 173 https://www.federalregister.gov/public-inspection/2024-09237/nondiscrimination-on-the-basis-of-disability-in-programs-or-activities-receiving-federal-financial https://www.federalregister.gov/public-inspection/2024-09237/nondiscrimination-on-the-basis-of-disability-in-programs-or-activities-receiving-federal-financial https://www.federalregister.gov/documents/2024/05/06/2024-08711/nondiscrimination-in-health-programs-and-activities

• Prohibition on basing treatment on negative biases or stereotypes about people with disabilities.

• Prohibition on using measures, assessments, or tools that discounts the value of a life extension on the basis of disability.

• Definition of what accessibility means for websites and mobile applications, and sets technical standards for the Department of Health and Human Services (HHS) for accessible platforms.

• Definition of requirements ensuring nondiscrimination by HHS-funded child welfare agencies in areas of child foster care placement, parent-child visitation, reunifications services, child placement, parenting skills programs, and in- and out-of-home services.

• Clarification that services must be delivered in the most integrated setting.

• Requirement that health care providers, insurers, grantees, and others, to proactively let people know that language assistance services are available at no cost to patients.

• Requirement that covered health care providers, insurers, grantees, and others to let people know that accessibility services are available to patients at no cost.

• Clarification that covered health programs and activities offered via telehealth must also be accessible to individuals with limited English proficiency, and individuals with disabilities.

• Protections against discrimination by codifying that Section 1557’s prohibition against discrimination based on sex includes LGTBQI+ patients.

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• Respect for federal protections for religious freedom and conscience and makes clear that recipients may simply rely on those protections or seek assurance of them from HHS.

• Respect for the clinical judgement of health care providers.

• Protection of patients from discriminatory health insurance benefit designs made by insurers.

• Clarification of the application of Section 1557 nondiscrimination requirements to health insurance plans.

• Application that the nondiscrimination principles under Section 1557 to the use of patient care decision support tools in clinical care.

• Requirement that those covered by the rule to take steps to identify and mitigate discrimination when they use AI and other forms of decision support tools for care.

b. Raise Awareness and Identify Support : Develop and implement materials, webinars, and other activities to help raise awareness of Sections 504 and 1557, and where to find support for potential rights violations among people with disabilities at the national, state, and local levels. .

i.Create an outreach development plan in partnership with NAAC/STAACs/LAACs that provides effective messaging about the provisions of the rules, and relevant sources of support for rights violations.

ii.Implement the plan through NAAC/STAACs/LAACs throughout the contract period.

iii.Provide updates on progress and challenges, and shift strategies and tactics accordingly.

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