Foa_Content_of_HHS-2022-ACL-CIP-DNCW-0086-1.pdf

Administration for Community Living

Center for Innovation and Partnership

Strengthening the Direct Care Workforce: A Technical Assistance and Capacity Building Initiative

HHS-2022-ACL-CIP-DNCW-0086

06/28/2022

Table of Contents Executive Summary

Additional Overview Content/Executive Summary

I. Funding Opportunity Description

II. Award Information

III. Eligibility Information

1. Eligible Applicants

2. Cost Sharing or Matching

3. Responsiveness and Screening Criteria

IV. Application and Submission Information

1. Address to Request Application Package

2. Content and Form of Application Submission

Letter of Intent

Project Narrative

Summary/Abstract

Proposed Intervention

Special Target Populations and Organizations

Outcomes

Evaluation

Organizational Capability

Budget Narrative/Justification

Work Plan

Letters of Commitment from Key Participating Organizations and Agencies

3. Unique Entity Identifier and System for Award Management (SAM)

4. Submission Dates and Times

5. Intergovernmental Review

6. Funding Restrictions

7. Other Submission Requirements

V. Application Review Information

1. Criteria

2. Review and Selection Process

3. Anticipated Announcement Award Date

VI. Award Administration Information

1. Award Notices

2. Administrative and National Policy Requirements

3. Reporting

4. FFATA and FSRS Reporting

VII. Agency Contacts

VIII. Other Information

The Paperwork Reduction Act of 1995 (P.L. 104-13)

Appendix

Instructions for Completing Required Forms

Budget Narrative/Justification- Sample Format

Instructions for Completing the Project Summary/ Abstract

ACL Center:

Center for Innovation and Partnership Funding Opportunity Title:

Strengthening the Direct Care Workforce: A Technical Assistance and Capacity Building Initiative Funding Opportunity Number:

HHS-2022-ACL-CIP-DNCW-0086

Primary CFDA Number:

93.048 Due Date for Letter of Intent:

05/31/2022 Due Date for Applications:

06/28/2022 Date for Informational Conference Call:

05/17/2022 Applications that fail to meet the application due date will not be reviewed and will receive no further consideration. You are strongly encouraged to submit your application a minimum of 3-5 days prior to the application closing date. Do not wait until the last day in the event you encounter technical difficulties, either on your end or, with https://www.grants.gov. Grants.gov can take up to 48 hours to notify you of a successful submission.

Executive Summary Additional Overview Content/Executive Summary The Administration for Community Living (ACL) funds services and supports provided by networks of community-based organizations and with investments in research, education, and innovation, ACL helps make community living a reality for millions of Americans. The ability of older adults and people with disabilities of all ages to live in the community, in the settings of their choice and to participate fully in community life is often dependent upon the availability of services and supports provided by a workforce of Direct Care Workers (DCWs). This workforce includes people identified by a range of different job titles including personal care attendants, https://www.grants.gov/ home health aides, job coaches, direct support professionals, residential workers and others who provide similar supports. While titles, required skills and responsibilities differ, all direct care workers should have access to quality jobs with adequate training and support, compensation, voice in their working environment, an opportunity for growth through a career ladder or lattice, and broad recognition of their value in the long-term supports system.

The current shortage of workers and frequent turnover not only compromises the ability of older adults and people with disabilities to live in the community, but it can also compromise their health and safety. The need for direct care workers, which is great now, is projected to grow significantly in the next decade as the number of older adults increases. The recruitment, retention, and development of a competent workforce is critical to providing home and community services so that older adults and people with disabilities can live, work, and participate in the community. Through this new initiative, ACL will support the establishment of a National Technical Assistance Center designed to strengthen the home and community-based services DCW workforce. The technical assistance center will focus strategies and practices at a systems level as well as at the service provider level.

ACL will award one (1) cooperative agreement from this Notice of Funding Opportunity (NOFO). Applicants should carefully describe the approach they will take to address the requirements of this initiative to strengthen DCW workforce capacity for the older adult population, people with disabilities (PWD).

I. Funding Opportunity Description

A. STATEMENT OF NEED:

Over the past several decades, the public service system has responded to the preference of older adults and people with disabilities to live in their own homes and communities. A majority of the people who receive home and community-based services (HCBS) are older adults and people with disabilities of all ages, including those with intellectual and development disabilities (ID/DD). For example, in 2018 approximately 14 million adults living in the community needed some type of HCBS to do so.[1] The successful provision of HCBS to older adults and people with disabilities of all ages is dependent on the availability of a well-trained, stable direct care workforce.

The population demographics in the United States are shifting, resulting in an increase in the number of older adults needing services and supports. Consequently, competition for workers has intensified. The pipeline of people entering the DCW workforce is not keeping pace with the number of DCWs needed by the populations of individuals who rely on them, further exacerbating the shortage. In fact, DCW professionals are one of the highest in-demand employment categories of professionals in the U.S. The expansion needed in this workforce is unlikely to take place without significant changes in how they are recruited, trained, paid and supported. Nationwide statistics show the gravity of the situation:

In 2021, DCWs providing HCBS were paid a median hourly wage of $14.20.[2] The direct care workforce that provides services in the community is projected to add more than one million new jobs from 2020 to 2030, a growth of 33 percent which is much faster than the average for all occupations. With 600,000 openings projected each year, on average, over the decade, this workforce ranks fifth among all U.S. occupations for total projected job openings.[3]

Because poverty rates are high among DCWs due to low wages, over half rely on some form of public assistance.[4]

Across states, the turnover rate for DCWs ranged from 26.7% to 79.5%; the weighted average turnover rate was 42.8%[5].

The numerous challenges posed by the inadequate number of the DCWs, including high turnover rates, was further exacerbated during the COVID-19 pandemic as a population of mostly low-wage, female workers of color left the workforce.[6] As a result, DCWs and their employers have lacked sufficient resources to deliver quality care through this crisis, which has disproportionately impacted the populations that make up most of their clients and residents:

older adults (specifically those with certain underlying conditions), people with disabilities, and people of color.[7] In addition to high rates of turnover, shifting population demographics, low wages, poor access to health insurance and other benefits, high stress, insufficient training, and lack of professional recognition and status as skilled professionals has led to a publicly recognized caregiving crisis, the addressing of which is a key priority of the Biden-Harris administration.

The exacerbation of the DCW crisis by the pandemic has had a considerable negative impact on HCBS agencies to provide quality services. For example, the American Network of Community Options and Resources’ (ANCOR) 2021 State of America’s Direct Support Workforce Crisis Survey, found that:

77% of providers are turning away new referrals, a 16.7% increase since the beginning of the pandemic.

58% of providers are discontinuing programs and services, a 70.6% increase since the beginning of the pandemic.

81% of providers are struggling to achieve quality standards, a 17.4% increase since the beginning of the pandemic.

92% of providers report that the COVID-19 pandemic continues to complicate their ability to recruit and retain qualified direct support professionals.[8]

[1] Edem Hado and Harriet Komisar, Long-Term Services and Supports (Washington, DC:

AARP Public Policy Institute, August 2019) Retrieved from http://www.advancingstates.org/sites/nasuad/files/LTSS%20Fact%20Sheet%202019.pdf [2] Bureau of Labor Statistics Occupational Employment and Wages, May 2021 31-1120 Home Health and Personal Care Aides. Retrieved from https://www.bls.gov/oes/current/oes311120.htm [3] Bureau of Labor Statistics Occupational Outlook Handbook. Retrieved from https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm [4] McCall, S. (2017). U.S. Home Care Workers: Key Facts. PHI. Retrieved from https://www.phinational.org/resource/u-s-home-care-workers-key-facts/ [5] National Core Indicators. (2022). National Core Indicators Intellectual and Developmental Disabilities 2020 Staff Stability Survey Report. Retrieved from https://www.nationalcoreindicators.org/staff-stability-survey/ [6] Ewing-Nelson, C., & Tucker, J. (2021). A Year into the Pandemic, Women are Still Short Nearly 5.1 Million Jobs [Fact sheet]. National Women’s Law Center. Retrieved from http://www.advancingstates.org/sites/nasuad/files/LTSS%20Fact%20Sheet%202019.pdf https://www.bls.gov/oes/current/oes311120.htm https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm https://www.phinational.org/resource/u-s-home-care-workers-key-facts/ https://www.nationalcoreindicators.org/staff-stability-survey/ https://nwlc.org/wp-content/uploads/2021/03/Feb-Jobs-Day-v2.pdf [7] Campbell, S., Del Rio Drake, A., Espinoza, R., & Scales, K. (2021). Caring for the Future:

The Power and Potential of America’s Direct Care Workforce. Bronx, NY: PHI. Retrieved from https://phinational.org/resource/caring-for-the-future-the-power-and-potential-of-americas-direct-care-workforce/ [8] American Network of Community Options and Resources’ (ANCOR) (2021). State of America’s Direct Support Workforce Crisis Survey. Retrieved from https://www.ancor.org/sites/default/files/the_state_of_americas_direct_support_workforce_crisis _2021.pdf

B. PREVIOUS EFFORTS TO STRENGTHEN THE DCW:

In the past, ACL and other federal partner initiatives to strengthen the DCW have focused on improvement within a specific program, payor source, or for a specific population. Discrete activities targeted improving professional identity and recognition; building skills in recruitment, selection, training and retention of DCWs; fostering innovative provider models (e.g., cooperatives); and using technology-enhanced supports. The scope of the current challenges to recruiting and retaining DCWs requires a more comprehensive approach to meet demand and promote community living. ACL is uniquely positioned to support this effort.

Federal agencies have developed resources and guides to promote a stable and reliable direct care workforce. These efforts have strengthened our collective knowledge base, provided important guidance and established a foundation for a more comprehensive effort. The most recent ACL DCW effort, Blazing New Trails for Community-Based Direct Support Professionals Prize Challenge, called on innovators to develop and pilot models that will transform the DCW workforce. Examples of other federal resources include:

DSW Core Competency Project The CMS National Direct Service Workforce Resource Center Coverage of Direct Service Workforce Continuing Education and Training within

Medicaid Policy and Rate Setting - A Toolkit Overviews of Workforce Challenges and Effective Improvement Strategies Strengthening the Entry-Level Health Care Workforce: Finding a Path Visualization tool, Entry-Level Health Care Workforce: Information and Programs BULLETIN 2010- 31 New National Guidelines for Apprenticeship Standards for the

National Alliance for Direct Support Professionals (NADSP) and the American Network of Community Options and Resources (ANCOR)

Workforce Development Through NWD Systems/ADRCs The Need for Monitoring the Long-Term Care Direct Service Workforce and

Recommendations for Data Collection

ACL seeks to address the DCW crisis by establishing a new, National Technical Assistance (TA) Center initiative to catalyze change at a systems level that will address the insufficient supply of trained DCWs, promote promising practices at all levels of the service system and improve data collection to enable a full understanding of the workforce issue. The TA Center will leverage and build off the existing knowledge and resources, including those listed above.

https://nwlc.org/wp-content/uploads/2021/03/Feb-Jobs-Day-v2.pdf https://phinational.org/resource/caring-for-the-future-the-power-and-potential-of-americas-direct-care-workforce/ https://phinational.org/resource/caring-for-the-future-the-power-and-potential-of-americas-direct-care-workforce/ https://www.ancor.org/sites/default/files/the_state_of_americas_direct_support_workforce_crisis_2021.pdf https://www.ancor.org/sites/default/files/the_state_of_americas_direct_support_workforce_crisis_2021.pdf https://acl.gov/DSPchallenge https://acl.gov/DSPchallenge https://www.medicaid.gov/medicaid/long-term-services-supports/workforce-initiative/dsw-core-competency-project/index.html https://publications.ici.umn.edu/impact/20-2/national-direct-support-workforce-resource-center https://www.medicaid.gov/sites/default/files/2019-12/dsw-training-rates-toolkit.pdf https://www.medicaid.gov/sites/default/files/2019-12/dsw-training-rates-toolkit.pdf https://www.medicaid.gov/medicaid/long-term-services-supports/workforce-initiative/overviews-of-workforce-challenges-and-effective-improvement-strategies/index.html https://aspe.hhs.gov/reports/strengthening-entry-level-health-care-work-force-finding-path https://aspe.hhs.gov/entry-level-health-care-workforce-information-programs-visualization-tool https://www.doleta.gov/oa/bul10/Bulletin_2010_31_NADSP_ANCOR.pdf https://www.doleta.gov/oa/bul10/Bulletin_2010_31_NADSP_ANCOR.pdf https://www.doleta.gov/oa/bul10/Bulletin_2010_31_NADSP_ANCOR.pdf https://www.medicaid.gov/medicaid/long-term-services-supports/workforce-initiative/workforce-development-through-nwd-systemsadrcs/index.html https://www.medicaid.gov/sites/default/files/2019-12/monitoring-dsw.pdf https://www.medicaid.gov/sites/default/files/2019-12/monitoring-dsw.pdf

Legislative and Policy Context ACL is grounding this new initiative in separate, but overlapping, legislative and policy contexts.

Because it is funded by Developmental Disabilities Assistance and Bill of Rights Act, Rehabilitation Act, and Older Americans Act dollars, the successful grantee is expected to propose activities across the priority areas that directly address the DCW needs of people with disabilities and older adults. In this regard, applicants should be familiar with and speak to the specific requirements of the authorizing legislation behind this initiative (and their associated policy and practice implications):

Section 411(13) of the Older Americans Act: “In coordination with the Secretary of Labor, the demonstration of new strategies for the recruitment, retention, or advancement of direct care workers, and the soliciting, development, and implementation of strategies— (A) to reduce barriers to entry for a diverse and high quality direct care workforce, including providing wages, benefits, and advancement opportunities needed to attract or retain direct care workers; and (B) to provide education and workforce development programs for direct care workers that include supportive services and career planning;”[9] Section 161 (2) of the Developmental Disabilities Assistance and Bill of Rights Act: Projects of National Significance (PNS) "create opportunities for individuals with developmental disabilities to directly and fully contribute to, and participate in, all facets of community life; and support the development of national and State policies that reinforce and promote, with the support of families, guardians, advocates, and communities, of individuals with developmental disabilities, the self-determination, independence, productivity, and integration and inclusion in all facets of community life of such individuals."[10] Section 21 program of the Rehabilitation Act of 1973: Requires ACL to set aside one percent of its annual appropriations to address traditionally underserved populations. ACL uses the funding to support several projects, including the Native American Independent Living Demonstration Projects and the Independent Living Transition Services for Youth and Young Adults with Significant Disabilities from Minority Backgrounds research project. Additionally, ACL focuses on research capacity building for minority entities, such as Historically Black Colleges and Universities and institutions, serving primarily Hispanic, Asian, and American Indian or Alaska Native students, and non-minority entities with an interest in improving understanding about the needs and outcomes of individuals with disabilities from minority populations.[11] Applicant(s) must include a Memorandum of Understanding (MOU) from one of the following: Minority entities and Indian tribes to carry out activities under the programs authorized under titles II, III, VI, and VII of the Rehabilitation Act of 1973 as amended, minority entities and Indian tribes to conduct research, training, technical assistance, or a related activity, to improve services provided under the Rehabilitation Act of 1973 as amended, especially services provided to individuals from minority backgrounds.

While no new funds were specifically appropriated for this initiative, the House FY 2022 budget report also included the following statement from appropriators: “The agreement encourages ACL to coordinate with the Department of Labor (DOL) to identify and reduce barriers to entry for a diverse and high-quality direct care workforce, and to explore new strategies for the recruitment, retention, and advancement opportunities needed to attract or retain direct care workers.” In this regard, ACL believes this new initiative which will be developed in collaboration with DOL and other federal partners, will be an important first step in addressing an issue of vital importance to state infrastructures, older adults with long-term support needs, https://acl.gov/sites/default/files/about-acl/2020-04/Older%20Americans%20Act%20Of%201965%20as%20amended%20by%20Public%20Law%20116-131%20on%203-25-2020.pdf https://acl.gov/sites/default/files/about-acl/2016-12/dd_act_2000.pdf https://acl.gov/sites/default/files/about-acl/2020-07/rehabilitation-act-of-1973-amended-by-wioa.pdf people with disabilities, and the families and family caregivers who need support in their roles.

[9]Older Americans Act of 1965 [Public Law 89–73] [As Amended Through P.L. 116–131, Enacted March 25, 2020]. Retrieved from https://acl.gov/sites/default/files/about-acl/2020- 04/Older%20Americans%20Act%20Of%201965%20as%20amended%20by%20Public%20Law %20116-131%20on%203-25-2020.pdf [10] An Act to Improve Service Systems for Individuals with Developmental Disabilities, and for Other Purposes. (PL 106-442) U.S. G.P.O., 2000. Retrieved from https://acl.gov/sites/default/files/about-acl/2016-12/dd_act_2000.pdf [11] The Rehabilitation Act of 1973 [As Amended Through P.L. 114–95, Enacted December 10, 2015] Retrieved from https://acl.gov/sites/default/files/about-acl/2020-07/rehabilitation-act-of- 1973-amended-by-wioa.pdf

C. PROGRAM GOALS:

ACL will fund one (1) five-year cooperative agreement to create and maintain a National Technical Assistance Center to expand and strengthen the direct care workforce. When fully operational, ACL envisions the TA center will become a central hub for state, private, and federal entities involved in the hiring and workforce development associated with the delivery of HCBS to access a curated array of model policies, best practices, training materials, technical assistance and learning collaboratives. In developing their proposals, applicants should describe the approaches they will employ to help realize ACL’s vision.

The goal of this initiative is to strengthen the DCW to better meet the needs of older adults and people with disabilities and their families and family caregivers. ACL recognizes that, while many areas of overlap exist between older adult and people with disabilities and their families and family caregivers, there are unique considerations and opportunities posed by each that applicants should consider and address in their applications. Applicants should consider the cross-disability and aging population focus sought by ACL in this initiative and propose activities accordingly.

Outcomes

Through this new initiative, ACL seeks to advance capacity to recruit, train and retain a high-quality, competent, and effective direct care workforce of professionals capable of meeting the growing needs that older adults and people with disabilities have for such supports. To that end, ACL seeks the following outcomes from this initiative:

1. Increase the availability and visibility of tools and resources to attract, train and retain the direct care workforce in quality jobs where they earn livable wages and have voice in their working environment, and have access to benefits and opportunities for advancement.

2. Increase the number of states that develop and sustain collaborations across state systems and workforce agencies to implement strategies that will improve the recruitment, retention, and advancement of high quality DCW jobs.

D. KEY FEATURES:

Applicant(s) should respond to this funding announcement by submitting proposals that describe https://acl.gov/sites/default/files/about-acl/2020-04/Older%20Americans%20Act%20Of%201965%20as%20amended%20by%20Public%20Law%20116-131%20on%203-25-2020.pdf https://acl.gov/sites/default/files/about-acl/2020-04/Older%20Americans%20Act%20Of%201965%20as%20amended%20by%20Public%20Law%20116-131%20on%203-25-2020.pdf https://acl.gov/sites/default/files/about-acl/2020-04/Older%20Americans%20Act%20Of%201965%20as%20amended%20by%20Public%20Law%20116-131%20on%203-25-2020.pdf https://acl.gov/sites/default/files/about-acl/2016-12/dd_act_2000.pdf https://acl.gov/sites/default/files/about-acl/2020-07/rehabilitation-act-of-1973-amended-by-wioa.pdf https://acl.gov/sites/default/files/about-acl/2020-07/rehabilitation-act-of-1973-amended-by-wioa.pdf a well-designed, strategic approach they will take, if funded, to create and maintain a National TA Center focused on expanding and strengthening the direct care workforce. Applicant(s) should explain how they plan to implement the required activities outlined in this subsection along with any other activities they deem necessary to achieve the outcomes listed in Subsection C above.

Addressing the Knowledge Gap To date, considerable work has been done to understand and address the factors associated with the current DCW crisis. As a result, there exists a considerable array of information, research, and analysis around this issue in different locations. ACL believes there is an opportunity for this initiative to curate, analyze, and synthesize the “best of the best” knowledge in this area and present it in a way that is accessible and usable by state, private, and federal entities involved in hiring and workforce development as well as older adults, individuals with disabilities, family caregivers and DCW -the intended audiences of the TA Center.

Applicants should describe how they plan to identify, review, analyze and synthesize resources to support the development of a stable, reliable, and well-trained direct care workforce and how they will curate this information to maximize its usefulness to state agencies, employers and other stakeholders. Applicants should describe the specific activities they will undertake to identify and curate information and the scope of knowledge, resources and materials targeted for the search. Such activities may include (but are not limited to): environmental scans, literature reviews and meta-analyses, requests for information, focus groups, key informant and stakeholder interviews, consultation with subject matter experts, and engagement of federal agencies across the federal government, including with Department of Labor and the Department of Health and Human Services.

ACL is interested in the current state of knowledge, gaps that might exist, and recommendations to address knowledge gaps. This may include the analysis and synthesis of research findings, state workforce policies, replicable state service system initiatives, agency-based and self-directed models, independent contractor and co-op strategies including labor-management partnerships, codes of ethics, training and credentialing programs, and effective organizational infrastructure models to support workers. Additionally, ACL and its stakeholders are interested in strategies to support and expand the direct care workforce through models of collaboration across agencies, apprenticeships, culturally responsive management, practices to that build positive work cultures, knowledge transfer of positive behavior, augmentative/alternative communication and other technologies to support DCWs and enable individuals to maximize their independence.

Information Dissemination and Technical Assistance Information dissemination, direct technical assistance, and capacity building support to the HCBS system will be a central component of this five-year initiative. Technical assistance is needed regarding strategies to ensure a robust and sustainable workforce. These strategies may include (but are not limited to): strengthening financing and rate and payment practices that produce livable employee wages commensurate with labor demand, improved access to employment-related training and supports, and enhanced planning, collaboration and leveraging the full range of available workforce funding.

ACL believes the primary focus of technical assistance efforts should address the three key principles necessary for ensuring an adequate DCW: recruitment, training, and retention.

Proposed technical assistance should span a wide variety of approaches with respect to their design, delivery, and evaluation, such as:

Learning collaboratives E-learning programs, discussion platforms and other self-directed learning programs Webinars, online/web-based materials Training materials and curriculum

Website A DCW website will be the central structure for curating and disseminating information. ACL will develop and make available the necessary pages on the ACL.gov website for all materials, products, and other information related to the project. In this regard, a new dedicated page on the ACL website will be the primary web presence for this project. ACL requires that information and materials provided by the grantee and partners for dissemination, regardless of method, will be fully accessible (i.e., 508-compliant), and meet the cultural and linguistic needs of the intended audience.

When fully operational, ACL envisions the technical assistance center will become a central hub for state, private, and federal entities engaged in the delivery of services, DCWs, older adults, people with disabilities, and families to access a curated array of model policies, best practices, training materials, technical assistance and learning collaboratives. With the ACL.gov web page as the primary vehicle for presenting and organizing public-facing information, ACL anticipates that the successful grantee will develop and employ a robust and far-reaching dissemination strategy designed to ensure that project information, existing federal resources, best practices, and other information are available and shared broadly. Applicants should describe their dissemination plans and articulate the methods (e.g., electronic/web-based, in-person, print, etc.)

by which such activities will occur.

Support for Cross-System Collaborations to Address DCW Crisis ACL believes that meaningfully addressing the DCW crisis will require direct support for collaboration across the multiple systems that interface to create and sustain this workforce.

Applicants should propose approaches that promote collaborations to develop and maintain comprehensive state strategies for workforce development that will increase wages, recruitment, training, retention, and advancement through the development of career ladders, modifications to compensation strategies and the use of data to drive change.

To support such cross-system collaboration and systems change, ACL recommends that applicants consider awarding subgrants/subcontracts to test approaches to facilitate partnership development among state aging and disability agencies, state departments of labor or state workforce agencies, apprenticeship sponsors or agencies, economic development agencies, and others. If the applicant intends to employ subgrants/subcontracts, applicants should fully describe how they plan to use them, the rationale and selection criteria, and how they plan to monitor subgrantee/subcontractor progress and ensure successful completion of all tasks.

IMPORTANT: The successful grantee, including any sub-grantees, will not be permitted to use project funds for construction and/or rehabilitation of buildings; basic research; medical care;

income maintenance; or equipment purchases, unless such equipment is demonstrated to be necessary to carry out an activity otherwise fundable under Title IV of the Older Americans Act, the Rehabilitation Act, and the Developmental Disabilities Act.

Further, the successful grantee shall adhere to all requirements, including those for making and monitoring sub-awards, as outlined in 45 CFR Part 75. As with other demonstration programs that seek to test innovations or build capacity, the activities conducted in this priority area should closely align with those undertaken in response to the previous priority areas, as applicable.

Applicants should describe their approaches for ensuring that activities undertaken by sub-grantees will help strengthen the DCW.

Partnerships and Stakeholder Collaboration ACL expects that no single organization will be able to completely fulfill the priority areas addressed in this project. Therefore, applicants should describe how they plan to partner with other organizations, including those representing the needs of traditionally unserved and underserved, including those from racially and ethnically diverse populations, with intersectional identities.

While the applicant organization must be the fiscal and programmatic lead, applicants should clearly define their key partners’ roles throughout the application materials (e.g., work plan, budget, project narrative). Applicants should include letters of commitment from initial partners in this application. Applicants should also describe how they will engage with external stakeholders such as those on the non-exhaustive list below:

People with disabilities and older adults People who are or aspire to be DCWs National agencies representing state aging and disability organizations, state workforce development entities and/or Medicaid program directors Organizations representing direct care workforce and HCBS providers Organizations that have piloted worker co-ops or labor-management partnerships Aging and disability-led organizations, including those that provide training, technical assistance, and peer to peer support Other national organizations representing individuals with disabilities, families, and advocates, including those focused on health equity ACL-funded aging and disability network organizations and other grantees Key researchers and subject matter experts

Advisory Committee A project advisory committee can be an ideal vehicle for informing the work of the project and ensuring broad stakeholder engagement in all aspects of the initiative. Applicants for this opportunity should explain how they will use an advisory committee to assist their efforts. The application should describe how an advisory committee will be diverse in experience and background and with regard to race, religion, age, ethnicity, disability, gender, gender identity, sexual orientation, location, and lived experience. An advisory group can provide opportunities to access knowledge and skills through smaller groups focused on specific topics or areas of exploration. Applicants may wish to consider the following when proposing advisory committee members:

People with disabilities, older adults, and their family caregivers who have experienced or need services http://www.ecfr.gov/cgi-bin/text-idx?SID=e9e43be8e59e0a85f4ac8ee5b8ef7716&node=pt45.1.75&rgn=div5

Direct care workers and other personnel such as supervisors, trainers, and job recruiters

Provider agencies/employers, managed care organizations Worker co-ops and organizations with labor-management partnerships Subject matter experts in workforce development and management practices including workforce professionals at the local level Leaders from federal and state agencies with experience in designing and operating HCBS systems, developing the workforce and determining methods to increase pay for DCW

Other organizations (research, training, advocacy, universities) whose purpose is the promotion and development of a stable and reliable workforce

As this is a cooperative agreement, ACL will work with the grantee and their partners to finalize the advisory committee to ensure broad representation of interested groups and stakeholders. The grantee is permitted to provide stipends to steering committee members and other SMEs, as necessary, to appropriately reimburse for their time and expertise on work directly related to this project.

Advancements in Direct Care Workforce Data Collection and Measurement Federal and state data collection systems remain inadequate in tracking and measuring key workforce dimensions such as size, stability, credentials, and compensation. This data, along with measures to evaluate the experience of both DCW and older adults and people with disabilities, are critical for policymakers, industry leaders, and other HCBS stakeholders to make sound decisions that would improve the DCW and ultimately the lives of older adults and people with disabilities. These metrics are also needed to conduct research, establish policy, and improve practice[12].

ACL seeks to begin addressing the inadequacies in measuring key workforce dimensions as part of this initiative. Applicants should propose approaches for supporting the improvement of DCW data collection activities and how that data will be used. Applicants should consider the need for minimum data sets as it relates to DCW quality measures and other factors that are key to advancing the provision of HCBS, consumer experiences, and workforce reliability and sustainability.

[12] PHI. Federal Policy Priorities for the Direct Care Workforce. (2021). Retrieved from http://www.phinational.org/resource/federal-policy-priorities-for-the-direct-care-workforce/

Project Evaluation A project of this scope and reach is expected to achieve measurable results and lasting impact.

Therefore, applicants should propose a robust third-party, evaluation of their efforts resulting in a final report at the end of the project. Applicants should anticipate substantial involvement by the ACL Program Officer, with input from the ACL Office of Performance and Evaluation in the design of the evaluation, per the terms of the Cooperative Agreement. In this regard, applicants should focus on developing a broad evaluation framework, with the understanding that it will be finalized post award and with input from ACL.

http://www.phinational.org/resource/federal-policy-priorities-for-the-direct-care-workforce/ http://www.phinational.org/resource/federal-policy-priorities-for-the-direct-care-workforce/ http://www.phinational.org/resource/federal-policy-priorities-for-the-direct-care-workforce/

Project Sustainability ACL expects to realize tangible, measurable and sustainable outcomes from the grantee and its partners. Additionally, ACL expects all products and materials to remain widely available and indefinitely, once federal funding ends. Applicants will be scored, in part, on the extent to which a plan for the project’s sustainability beyond the period of federal funding is articulated and appears feasible and likely.

Additional and Optional Activities as Identified Through this NOFO and the resources being made available to support this initiative, ACL has outlined key activities and areas of focus it deems necessary to address. Applicants are encouraged to propose additional complementary activities and undertake other training and technical assistance activities to address the desired outcomes listed in Subsection C.

Statutory Authority Assistance and Bill of Rights Act of 2000 (DD Act of 2000), Section 161(2) (D) (v) (42U.S.C.

15081), Section 21 of the Rehabilitation Act of 1973, and Title IV, Sec. 411(13), of the Older Americans Act of 1965, as amended.

II. Award Information Funding Instrument Type:

CA (Cooperative Agreement) Estimated Total Funding:

$1,300,000 Expected Number of Awards:

Award Ceiling:

$1,300,000 Per Budget Period

Award Floor:

$1,200,000 Per Budget Period

Length of Project Period:

60-month project period with five 12-month budget periods Additional Information on Project Periods and Explanation of 'Other'

This funding opportunity will be administered as a Cooperative Agreement. As such, the successful applicant should expect substantial ACL involvement in grant activities as appropriate or requested, including reviewing products for compliance with federal grant rules and participating in planning and training activities, which will be determined by the needs and priorities of the grantee and ACL. The terms and conditions for this cooperative agreement are as follows and will be incorporated by reference in the Notice of Award (NOA).

The ACL will carry out the following activities for the cooperative agreement:

Perform the day-to-day Federal responsibilities of grants management while working with the grantee to ensure that the minimum requirements for the grant are met.

Assist the grantee project leadership in understanding the policy concerns and/or priorities of ACL by conducting periodic briefings and by carrying out ongoing consultations.

Work cooperatively with the grantee to clarify the programmatic and budgetary issues to be addressed by the project.

Within 30 days post-award, meet with the grantee to finalize the workplan to the mutual agreement of all parties to this cooperative agreement

Provide guidance to the grantee, as necessary, in making sub-awards (i.e., sub-grants/contracts) as permitted in this funding opportunity announcement.

Provide guidance to the grantee on the provision of technical support and associated tasks related to the fulfillment of the goals and objectives of this grant.

Establish and maintain the primary webpage for this project on the ACL.gov website.

Review and provide technical advice to the grantee on all work products and other project deliverables and processes.

Provide consultation to the grantee in identifying emerging issues as they relate to the goals and objectives of this grant program.

Work with the grantee on the development and implementation of evaluation and quality assurance systems to ensure that performance is measured, and continuous improvement occurs.

Attend and participate in major project events as appropriate.

The grantee will execute the responsibilities of the cooperative agreement, as listed below:

Immediately inform and collaborate with ACL on any in-scope modification of the work plan.

Within 30 days post award, meet with ACL to finalize the project work plan to the mutual satisfaction of all parties to this agreement.

Participate in monthly check-in calls with the ACL Program Officer.

Provide drafts of all press releases, social media announcements and similar materials for approval prior to posting or release.

Provide preliminary and other working drafts of all products and deliverables to the ACL

Program Officer for review.

Prior to dissemination, provide final accessible and 508-compliant drafts of all products and deliverables to the ACL Program Officer for final review.

Use the ACL-established web site/web page for this project as the primary location for all web-based materials associated with this project.

Collaborate with ACL on the identification and selection of advisory committee members and any subject matter experts/advisory consultants to the project.

Evaluate the impact of overall project activities and ensure quality assurance systems are in place.

Share information with ACL, national and local organizations, and other entities as appropriate.

Fulfill all requirements of the grant initiative as detailed in this program announcement.

Report semi-annually on project accomplishments, challenges, and progress towards measurable objectives.

Work with the ACL Program Officer to evaluate performance results reported semiannually and jointly develop strategies to address those areas requiring improvement.

ACL will assist the grantee in understanding the strategic goals and objectives, policy perspectives, and priorities of the ACL Administrator/Assistant Secretary for Aging and the Department of Health and Human Services, by sharing such information via email, conference calls, briefings, memos, and other consultations. The ACL Program Officer will provide technical assistance and guidance on issues related to grant management and implementation, including the execution of the cooperative agreement. The program officer will also share information with the grantee about other federally sponsored projects and activities relevant to activities funded under this announcement.

Once a cooperative agreement is in place, requests to modify or amend it or the work plan may be made by ACL or the awardee at any time. Modifications and/or amendments of the Cooperative Agreement or work plan shall be effective upon the mutual agreement of both parties, except where ACL is authorized under the Terms and Conditions of award, 45 CFR Part 74 or 92, or other applicable regulation or statute to make unilateral amendments. When an award is issued, the cooperative agreement terms and conditions from the program announcement are incorporated into the Notice of Award by reference.

III. Eligibility Information

1. Eligible Applicants For FY 2022 the below guidance is provided to advance the Administration’s policy, as stated in E.O. 13985, to “pursue a comprehensive approach to advancing equity for all, including people of color and others who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality.” This guidance is intended to begin to address inequities in HHS programs, processes, and policies that may serve as barriers to equal opportunity. By advancing equity in our NOFOs, we can “create opportunities for the improvement of communities that have been historically underserved, which benefits everyone.”

Domestic public or private non-profit entities including state and local governments, Indian tribal governments and organizations (American Indian/Alaskan Native/Native American), faith-based organizations, community-based organizations, hospitals, and institutions of higher education.

Priority will be given to national public, national private non-profit agencies, national organizations including national faith and community-based organizations (FBOs and CBOs), and national Indian tribal organizations.

For the purposes of this competition, national organizations are defined as those entities established with headquarters and administration for an organized group of bodies (local chapters, affiliates, faith and community-based and tribal organizations) dedicated to improving the DCW for a major, nationwide segment of the older adult and persons with disabilities population.

Applicants must demonstrate that they have demonstrated experience and a proven track record in promoting improvements in the DCW with respect to the needs of people with disabilities and older adults as well as demonstrated experience in partnering with key national stakeholder groups that are involved in the DCW for these target populations. Only one application per agency/organization will be accepted.

2. Cost Sharing or Matching Cost Sharing / Matching Requirement:

No For awards that require matching or cost sharing by statute, recipients will be held accountable for projected commitments of non-federal resources (at or above the statutory requirement) in their application budgets and budget justifications by budget period, or by project period for fully funded awards. The applicant will be held accountable for all proposed non-federal resources as shown in the Notice of Award (NOA). A recipient's failure to provide the statutorily required matching or cost sharing amount (and any voluntary committed amount in excess) may result in the disallowance of federal funds. Recipients will be required to report these funds in the Federal Financial Reports.

For awards that do not require matching or cost sharing by statute, recipients are not expected to provide cost sharing or matching. However, recipients are allowed to voluntarily propose a commitment of non-federal resources. If an applicant decides to voluntarily contribute non-federal resources towards project costs and the costs are accepted by ACL, the non-federal resources will be included in the approved project budget. The applicant will be held accountable for all proposed non-federal resources as shown in the Notice of Award (NOA). A recipient's failure to meet the voluntary amount of non-federal resources that was accepted by ACL as part of the approved project costs and that was identified in the approved budget in the NOA, may result in the disallowance of federal funds. Recipients will be required to report these funds in the Federal Financial Reports.

3. Responsiveness and Screening Criteria Application Responsiveness Criteria Applications that fail to meet each of the responsiveness criteria described below will not be reviewed and will receive no further consideration:

Documented history of working at the national level;

Included a Memorandum of Understanding (MOU) from one of the following: Minority entities and Indian tribes to carry out activities under the programs authorized under titles II, III, VI, and VII of the Rehabilitation Act of 1973 as amended, minority entities and

Indian tribes to conduct research, training, technical assistance, or a related activity, to improve services provided under the Rehabilitation Act of 1973 as amended, especially services provided to individuals from minority backgrounds; and

The commitment of (at least) a full-time project director with recognized expertise in the field of DCW and associated issues.

Application Screening Criteria The successful applicant will be an organization that meets the criteria listed below. Applicants must conform to the following elements:

Applicants must meet the criteria for national organizations as defined above.

Applicants must have demonstrated experience in addressing the issues associated with the direct care workforce as outlined in this NOFO, while responding to the needs of people with disabilities and older adults.

IV. Application and Submission Information

1. Address to Request Application Package Application materials can be obtained from https://www.grants.gov or https://www.acl.gov/grants/applying-grants.

Please note, ACL requires applications for all announcements to be submitted electronically through http://www.grants.gov in Workspace. Grants.gov Workspace is the standard way for organizations and individuals to apply for federal grants in Grants.gov. An overview and training on Grants.gov Workspace can be found here at:

https://www.grants.gov/web/grants/applicants/workspace-overview.html

The Grants.gov registration process can take several days. If your organization is not currently registered, please begin this process immediately. For assistance with https://www.grants.gov, please contact them at support@grants.gov or 800-518-4726 between 7:00 a.m. and 9:00 p.m.

Eastern Time.

At the https://www.grants.gov website, you will find information about submitting an application electronically through the site, including the hours of operation. ACL strongly recommends that you do not wait until the application due date to begin the application process because of the time involved to complete the registration process.

All applicants must have a UEI and be registered with the System for Award Management (SAM, www.sam.gov) and maintain an active SAM registration until the application process is complete, and should a grant be made, throughout the life of the award. Effective June 11, 2018, when registering or renewing your registration, you must submit a notarized letter appointing the authorized Entity Administrator. Please be sure to read the FAQs located at www.sam.gov to learn more. Applicants should allot sufficient time prior to the application deadline to finalize a new, or renew an existing registration. This action should allow you time to resolve any issues that may arise. Failure to comply with these requirements may result in your inability to submit your application or receive an award.