Foa_Content_of_HHS-2025-ACL-AOA-CSSG-0034.pdf

Administration for Community Living

Administration on Aging

Advancing Strategies to Deliver and Sustain Evidence-Based Chronic Disease Self-Management Education Programs to Support Older Adults with Behavioral Health Conditions

HHS-2025-ACL-AOA-CSSG-0034

08/15/2025

Table of Contents Executive Summary

Additional Overview Content/Executive Summary

I. Funding Opportunity Description

Background

Purpose

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

Project Abstract

Project Relevance and Current Need

Approach

Outcomes

Organizational Capacity

Letters of Support/Commitment

Budget Narrative/Justification

Work Plan

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

Appendix A: Glossary of Terms

Appendix B: Listing of Evidence-Based CDSME Programs

Appendix C: Listing of Self-Management Support Programs

Appendix D: Required Data Collection Forms

Appendix E: Guidance for Administration for Community Living Chronic Disease Self- Management Education Grant Applicants: Considerations for Estimating Participation and Completion Targets

Appendix F: Resources for Competitive Grant Application Writing

ACL Center:

Administration on Aging Funding Opportunity Title:

Advancing Strategies to Deliver and Sustain Evidence-Based Chronic Disease Self-Management Education Programs to Support Older Adults with Behavioral Health Conditions Funding Opportunity Number:

HHS-2025-ACL-AOA-CSSG-0034

Primary CFDA Number:

93.734 Due Date for Letter of Intent:

08/15/2025 Due Date for Applications:

08/15/2025 Date for Informational Conference Call:

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 Background

The Older Americans Act (OAA) is implemented through the aging network in communities across the United States. The aging network includes State Units on Aging (SUAs), Area Agencies on Aging (AAAs), and local service providers (LSPs). This network provides services, referrals, and programs to older adults, such as evidence-based chronic disease self-management education (CDSME) and support programs.

CDSME is used in this announcement as an umbrella term for community-based education programs designed to enhance the self-management of chronic diseases. These programs focus on building healthy behaviors and skills – such as goal setting, decision-making, problem-solving, and self-monitoring.

Benefits for Older Americans

This funding opportunity will encourage positive outcomes to improve the health and well-being of older Americans with behavioral health condition(s) or behavioral health stressor(s). The CDSME programs have proven to maintain or improve health outcomes of older adults with chronic conditions, including behavioral health conditions. One study showed significant reductions in ER visits and hospitalizations after taking the program. This equals a potential net savings of $364 per participant. If just 5% of adults with one or more chronic conditions were reached, there would be a national savings of $3.3 billion. [1]

While CDSME programs have proven to be beneficial to older adults with behavioral health conditions, previous reach has focused on individuals with conditions such as diabetes, chronic pain, and hypertension. Older adults with behavioral health disorders often experience worse health and functional outcomes, have higher rates of emergency department visits, use more medications, and have higher health care costs than those without a behavioral health disorder. [2]

The critical knowledge gained through this funding announcement goes beyond the older adults served by this project. The outcomes from this funding opportunity will be shared across the nation, in the form of resources, that will help foster innovation and accelerate future implementation. This will result in a greater reach of older adults with chronic conditions, including behavioral health conditions, and improve access to services that will contribute to better health outcomes and make America healthier.

Funding Opportunity Details

Through a statewide initiative, awardees of this funding opportunity will develop capacity for, deliver, and sustain evidence-based CDSME and support programs to improve the behavioral health of older adults and adults with disabilities.

The target populations are:

• older adults (age 60 and older) and individuals with disabilities with one or more behavioral health conditions, and https://www.grants.gov/

• older adults (age 60 and older) and individuals with disabilities with one or more stressors that are negatively impacting their behavioral health

As specified in the Older Americans Act (Sec 206 (a)), you must target older individuals with the greatest economic need and with the greatest social need. You should ensure the targeted population reflects the needs of your local communities and population demographics.

This funding opportunity has three deliverables:

• Increase the number of individuals who participate in evidence-based CDSME programs, while reaching the target population

• Increase partnerships and collaboration between the Aging and Disability Services Networks and behavioral health providers

• Increase the knowledge of the field by developing and disseminating resources and learnings on the outcomes of your grant for other organizations to replicate similar projects in their communities

The Administration for Community Living (ACL) plans to award five cooperative agreements with a three-year (36-month) project period, subject to the availability of funds. To help ensure a wider geographic reach, it is unlikely that more than one applicant per state will be funded.

You must request a total budget between $1,100,000 to $1,250,000 in federal funds for the three-year project. All awards are subject to the availability of federal funds.

These awards will be Cooperative Agreements. Cooperative Agreements allow for collaboration with AoA and the National Chronic Disease Self-Management Education Resource Center throughout the project period. There is an expected start date of September 1, 2025.

I. Funding Opportunity Description

Background This section has information about the prevalence of chronic conditions among older adults and how CDSME programs can help address the problem.

Chronic Conditions and Behavioral Health Conditions Among Older Adults

Approximately 95% of older adults have at least one chronic condition, such as hypertension, diabetes, and arthritis, and nearly 80% have two or more. [3] Behavioral health is the promotion of mental health and well-being, the treatment of mental and substance use disorders, and the support of those who experience and/or are in recovery from these conditions.

As of 2022, an estimated 9.8 million older adults (12.5%) had a mental illness, and 7.1 million older adults (9.1%) had a substance use disorder (SUD) in the past year. [4] Behavioral health conditions among older adults are often underrecognized and undertreated. [5]

Stressful life events, such as the loss of a spouse, major illness, and loss of independence, are linked to the onset of depression. [6] In the United States, 90% of adults have had at least one traumatic event, and having multiple traumatic events is common. As trauma survivors age, their trauma symptoms may resurface and evolve when stressful life events happen. [7]

Many older adults have both chronic conditions and behavioral health conditions. Research shows us:

• People with a chronic condition have a higher risk of developing depression due to anxiety, stress, or other challenges caused by the condition, brain changes, and medications.

• People with depression have a higher risk for developing some chronic diseases like heart disease, diabetes, stroke, and osteoporosis. [8]

• People who have a chronic disease and depression tend to have more severe symptoms of both illnesses.

• As adults age, they often are more sensitive to substances, which can cause injury, complicate existing medical conditions, or interact with medications. [9]

To cope with multiple chronic diseases and worsening behavioral health conditions is a challenge for older adults, their caregivers, and their families. Efforts are more impactful when they include the community and include coordinated strategies across multiple sectors that include public health, healthcare, behavioral health, and other stakeholders. By addressing both chronic conditions and behavioral health, we can better meet the needs of the whole person.

Increasing Participation in Evidence-Based Community Programs to Mitigate the Chronic Disease and Behavioral Health Burden

Empowering older adults to engage in evidence-based chronic disease self-management education (CDSME) programs to better manage their conditions can ease the chronic disease and behavioral health burden.

Evidence-based CDSME programs improve health and well-being and reduce disease and injury. In addition to the outcomes noted earlier, CDSME program participants also have improved health literacy, better psychological well-being, better health-related quality of life, improved physical activity, and reduced loneliness, social role limitations, and health distress.

[10-12] CDSME programs are also associated with long-term improvements in depression. [13] Evidence-based programs such as Healthy IDEAS (Identifying Depression & Empowering Activities for Seniors) and PEARLS (Program to Encourage Active, Rewarding Lives) (see Appendix C for more information) are designed to combat depression among older adults.

Learn more about past awardees here - https://acl.gov/programs/health-wellness/chronic-disease-self-management-education-programs.

Purpose This section provides details about the Target Population and Goals.

The purpose of this funding opportunity is to develop and implement a thorough strategy to deliver and sustain evidence-based CDSME programs through a statewide initiative.

Deliverables will include:

• Increase the number of individuals who participate in evidence-based CDSME programs, while reaching the target population

• Increase partnerships and collaboration between the Aging and Disability Services Networks and behavioral health providers https://acl.gov/programs/health-wellness/chronic-disease-self-management-education-programs https://acl.gov/programs/health-wellness/chronic-disease-self-management-education-programs

• Increase the knowledge of the field by developing and disseminating resources and learnings on the outcomes of your grant for other organizations to replicate similar projects in their communities

Target Population

For this project, the target population is:

• Older adults (60 years and older) and individuals with disabilities who have one or more behavioral health conditions, such as:

o Depression o Anxiety disorders o Bipolar disorder o PTSD o Substance use disorder

• Older adults (60 years and older) and individuals with disabilities who have one or more stressors that negatively impact their behavioral health. Stressors are defined in this Notice of Funding Opportunity (NOFO) as:

o Experienced a traumatic event o New diagnosis of a chronic condition or disability o Being a caregiver o A change in finances or work status o Loss of a loved one, including through divorce o Sudden change in housing status (i.e., homelessness)

Goals

This funding opportunity has two goals:

• Goal 1: Through a statewide initiative, develop capacity (e.g., instructors, partnerships, and referral networks) to increase the number of older adults and adults with disabilities in the target population who participate in evidence-based chronic disease self-management education (CDSME) and support programs.

• Goal 2: Develop and disseminate Section 508-compliant resources specific to your grant learnings on the outcomes of your grant, to enhance knowledge in serving the target population and aid in the sustainability of programs.

To be considered for funding, you must include the following components in the proposal to accomplish the goals of this funding opportunity

1. You must propose to deliver one or more CDSME programs in Appendix B AND at least one self-management program in Appendix C. Explain how the programs selected will help improve the behavioral health of the target population.

The programs selected MUST be on the list of pre-approved interventions found in Appendices B and C of this funding opportunity. Please refer to Appendix A (Glossary of Terms) for definitions of CDSME and self-management support programs.

• You should begin to deliver your selected CDSME and self- management support programs within three to six months after receiving your Notice of Award.

• You may propose to implement one or more of the identified programs in a remote format. You should contact the program developer/administrator for any program(s) you are interested in delivering remotely to confirm that: 1) the programs are allowed for remote delivery; and 2) training is available readily.

• Anyone who doesn’t have existing capacity (i.e., trained leaders, licensing, etc.) for any program(s) they propose must include a letter from the program developer/administrator in their application. The letter should indicate that they will be able to be trained no later than three months after the start date of the grant. Information about each program can be found in Appendices B and C.

2. You must identify the total target number of older adults and adults with disabilities throughout the state that you will reach with this funding. You must define which behavioral health condition(s) and behavioral health stressor(s) listed above will be prioritized and propose how 50% of the program's total participant target will be from the target population.

3. The proposed project must include partnerships across the state to support this application.

At least two of those partnerships must specialize in serving older adults with behavioral health conditions.

4. Evidence-based CDSME and support program delivery needs to be person-centered, trauma-informed, and culturally appropriate. Training on these topics should be provided to staff and program leaders.

5. Participant recruitment for evidence-based CDSME programs must include older adults in greatest economic need and greatest social need consistent with the Older Americans Act.

References

[1] Ahn, S., Basu, R., Smith, M. L., Jiang, L., Lorig, K., Whitelaw, N., & Ory, M. G. (2013).

The impact of chronic disease self-management programs: healthcare savings through a community-based intervention. BMC Public Health, 13(1141).

https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-1141

[2] Toth, M., Gibbons, B., Levinson, A., Kar, N., Keyes, V., Nye., E., Jacobus Kantor, L., and Creedon, T. Behavioral Health Diagnosis, Service Utilization, and Spending Among Older Adult Medicare Beneficiaries: A Chartbook. Washington, DC: The Office of the Assistant Secretary for Planning and Evaluation. U.S. Department of Health and Human Services. January 15, 2025.

[3] National Council on Aging. (2024, August 16). Get the Facts on Healthy Aging.

ncoa.org. https://www.ncoa.org/article/get-the-facts-on-healthy-aging/

[4] Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health (HHS Publication No. PEP24-07-021, NSDUH Series H-59). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2023-nsduh-annual-national-report https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-1141 https://www.ncoa.org/article/get-the-facts-on-healthy-aging/ https://www.samhsa.gov/data/report/2023-nsduh-annual-national-report

[5] Mental Health America. (n.d.). Depression in Older Adults. Mental Health in Older Adults. https://mhanational.org/depression-older-adults

[6] Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants. Annu Rev Clin Psychol. 2005;1:607-28. doi:

10.1146/annurev.clinpsy.1.102803.144141. PMID: 17716101; PMCID: PMC2568977.

[7] Center on Aging and Trauma. (n.d.). Aging and Trauma. The Jewish Federations of North America. https://cdn.fedweb.org/fed- 42/2/AgingAndTrauma_FactSheet_CenterOnAgingAndTrauma_2fdbr.pdf

[8] National Institute of Mental Health. (2024). Understanding the Link Between Chronic Disease and Depression. National Institute of Mental Health.

https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health

[9] Substance Abuse and Mental Health Services Administration (SAMHSA). (2020).

Treating Substance Use Disorder in Older Adults. SAMHSA.

https://store.samhsa.gov/sites/default/files/tip-26-pep20-02-01-011.pdf

[10] Smith ML, Chen E, Lau C, Davis D, Simmons J, Merianos AL. Effectiveness of chronic disease self-management education (CDSME) programs to reduce loneliness. Chronic Illness.

2022. DOI: 10.1177/17423953221113604

[11] Kennedy A, Reeves D, Bower P, et al. The effectiveness and cost effectiveness of a national lay-led self-care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. Journal of Epidemiology & Community Health 2007;61:254-261.

[12] Muscat DM, Song W, Cvejic E, Ting JHC, Medlin J, Nutbeam D. The impact of the chronic disease self-management program on health literacy: A pre-post study using a multi-dimensional health literacy instrument. Int J Environ Res Public Health. 2019 Dec 19;17(1):58. doi: 10.3390/ijerph17010058. PMID: 31861752; PMCID: PMC6982295.

[13] Ritter PL, Ory MG, Laurent DD, Lorig K. Effects of chronic disease self-management programs for participants with higher depression scores: secondary analyses of an on-line and a small-group program. Transl Behav Med. 2014 Dec;4(4):398-406. doi:

10.1007/s13142-014- 0277-9. PMID: 25584089; PMCID: PMC4286546.

Statutory Authority The statutory authority for grants under this Notice of Funding Opportunity is contained in the Older Americans Act, Title IV; and the Patient Protection and Affordable Care Act, 42 U.S.C. § 300u-11 (Prevention and Public Health Fund).

II. Award Information

Funding Instrument Type:

CA (Cooperative Agreement) Estimated Total Funding:

$6,203,143 Expected Number of Awards:

https://mhanational.org/depression-older-adults https://cdn.fedweb.org/fed-42/2/AgingAndTrauma_FactSheet_CenterOnAgingAndTrauma_2fdbr.pdf https://cdn.fedweb.org/fed-42/2/AgingAndTrauma_FactSheet_CenterOnAgingAndTrauma_2fdbr.pdf http://www.nimh.nih.gov/health/publications/chronic-illness-mental-health https://store.samhsa.gov/sites/default/files/tip-26-pep20-02-01-011.pdf

Award Ceiling:

$1,250,000 Per Project Period

Award Floor:

$1,100,000 Per Project Period

Length of Project Period:

Other Additional Information on Project Periods and Explanation of 'Other' 36-month project and 36 month budget periods (fully funded)

Cooperative Agreement Terms

As provided by the terms of the Federal Grant and Cooperative Agreement Act of 1977 (P.L. 95- 224), Cooperative agreements require our substantial involvement after an award is made. There are specific roles for both you and ACL.

The grantee agrees to execute the responsibilities outlined below:

1. Fulfill all grant requirements outlined in this Funding Opportunity, and carry out project activities as reviewed, approved, and awarded.

2. Through a statewide initiative, 1) commit to engage partners to help implement the proposal, with two or more organizations specializing in behavioral health 2) commit to establish a statewide approach to reach those in greatest economic need and greatest social need and 3) serve older adults and adults with disabilities, prioritizing those with at least one behavioral health condition and at least one behavioral health stressor.

3. Reach 25% of target completers (for CDSME programs) and participants (for self-management support programs) by the end of Year 1, 50% by the end of Year 2, and 100% by the end of Year 3.

4. Develop resources based on learnings throughout the grant with 25% developed by the end of Year 1, 50% by the end of Year 2, and 100% by the end of Year 3.

5. Develop a strategy to ensure that by the end of the project period, 50% of the program's total participants will be from the target population.

6. You must budget each year for two people to attend the National CDSME Resource Center’s annual CDSME conference (including any no-cost extension period, if applicable).

7. Provide person-centered, trauma-informed, and culturally appropriate training for all grant staff and program leaders.

8. Comply with all requirements (training, licensing, fees, etc.) for the selected CDSME and self-management support programs.

9. The grant Project Investigator/Director must attend all regularly scheduled calls and communicate with the AoA Project Officer monthly, or at another agreed cadence.

10. Collect required program data for all program participants (see Appendix D for the specific data collection forms). You must compile and report the data to the CDSME National Database within 30 days of participants’ completion of the program. Grantees should plan to train workshop leaders on data collection practices and the use of these forms.

11. Participate in any of our sponsored research and/or evaluations.

12. Participate in our relevant education (e.g., webinars, workgroups, symposiums) provided that ACL/ National CDSME Resource Center provides reasonable notice of the subject, date, and time of the event.

13. Comply with all other reporting requirements, as outlined in Section VI (Award Administration Information) of this Funding Opportunity and the Notice of Award.

14. If sub-awarding, you should use a transparent and open process to solicit, review, select, and make required sub-awards to organizations. You should describe how the process will be designed and administered, and how you will conduct required oversight of sub-awardees.

15. Include the following disclaimers on all products produced using this grant funding:

HHS Cooperative Agreement that is NOT funded with other non- governmental sources:

"This [project/publication/program/website, etc.] [is/was] supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $XXwith 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS or the U.S. Government.”

The HHS Cooperative Agreement that IS partially funded with other nongovernmental sources:

"This [project/publication/program/website, etc.] [is/was] supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $XX with XX percentage funded by ACL/HHS and $XX amount and XX percentage funded by non-government source(s). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, ACL/HHS, or the U.S. Government.”

The AoA Project Officer agrees to execute the responsibilities outlined below:

1. Perform the day-to-day Federal responsibilities of managing a Cooperative Agreement and work with you to ensure that minimum grant requirements for the grant are met.

2. Work cooperatively with you to clarify the program and budget issues, and, as necessary, mutually agree on how to meet any needs identified by you or us.

3. Help you understand the strategic goals and objectives, policy perspectives, and priorities of AoA and the U.S. Department of Health and Human Services; and about other federally-sponsored projects and activities relevant to activities funded under this announcement.

4. In collaboration with the National Chronic Disease Self-Management Education Resource Center, provide technical advice related to the fulfillment of grant goals and objectives of this grant.

5. Attend and participate in major project events, as appropriate.

6. Communicate with your project director monthly, or other agreed times, to improve project effectiveness.

https://www.ncoa.org/professionals/health/center-for-healthy-aging/national-cdsme-resource-center/ https://www.ncoa.org/professionals/health/center-for-healthy-aging/national-cdsme-resource-center/

Once a Cooperative Agreement is in place, requests to modify or amend the Agreement or the work plan may be made by us or you at any time if the request stays within the scope of work. Major changes may affect the integrity of the competitive review process.

Modifications and/or amendments of the Cooperative Agreement or work plan shall be effective upon the execution of an award notice. Unless we are authorized under the Terms and Conditions of award, 45 CFR Part 75, 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 by reference.

III. Eligibility Information

1. Eligible Applicants Domestic public or private non-profit entities including state governments, county governments, city or township governments, special district governments, independent school districts, public and state controlled institutions of higher education, Native American tribal governments, public housing authorities/Indian housing authorities, Native American tribal organizations, nonprofits having a 501(c)(3) status, private institutions of higher education, faith-based organizations, and community-based organizations.

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

No 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 Not Applicable

Application Screening Criteria All applications will be screened to assure a level playing field for all applicants. Applications that fail to meet the five screening criteria described below will not be reviewed and will receive no further consideration.

In order for an application to be reviewed, it must meet all the following screening requirements:

• Applications must be submitted electronically via https://www.grants.gov by 11:59 p.m., Eastern Time, by the due date listed in section IV under Submission Dates and Times.

http://www.grants.gov/

• The Project Narrative section of the Application must be double-spaced, on 8.5” x 11” plain white paper with 1” margins on all sides, and a standard font size of no less than 11 point, preferably Times New Roman or Arial.

• The Project Narrative must not exceed twenty (20) pages. NOTE: The Project Work Plans, Letters of Support/Commitment, Project Map, Organizational Chart, Budget Narrative/Justifications and Vitae of Key Project Personnel are not counted as part of the Project Narrative for purposes of the 20-page limit.

• Applications must include a proposed Budget Narrative/Justification for years 1, 2, and 3, as well as a combined Budget Narrative/Justification for the proposed 36-month budget period. The proposed combined Budget Narrative/Justification must not exceed the total federal 3- year award ceiling of $1,250,000.

• Applications must include a Project Work Plan for years 1, 2, and 3. Project Work Plans must be consistent with the proposed Project Narrative and Budget Narrative/ Justifications.

• You can use smaller font sizes to fill in the Standard Forms and Sample Formats outside the Project Narrative section, such as the Project Work Plans and Budget Narrative/Justifications.

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 https://www.grants.gov/ https://www.acl.gov/grants/applying-grants http://www.grants.gov/ https://www.grants.gov/web/grants/applicants/workspace-overview.html https://www.grants.gov/ mailto:support@grants.gov https://www.grants.gov/ http://www.sam.gov/ with these requirements may result in your inability to submit your application or receive an award. Maintain documentation (with dates) of your efforts to register or renew at least two weeks before the deadline. See the SAM Quick Guide for Grantees at:

SAM.GOV Quick Start Guide for Financial Assistance Registrations.

Note: Once your SAM registration is active, allow 24 to 48 hours for the information to be available in Grants.gov before you can submit an application through Grants.gov. 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.

• Note: Failure to submit the correct EIN Suffix can lead to delays in identifying your organization and access to funding in the Payment Management System.

• Effective October 1, 2010, HHS requires all entities that plan to apply for and ultimately receive federal grant funds from any HHS Operating/Staff Division (OPDIV/STAFFDIV) or receive subawards directly from the recipients of those grant funds to:

1. Register in SAM prior to submitting an application or plan;

2. Maintain an active SAM registration with current information at all times during which it has an active award or an application or plan under consideration by an OPDIV; and

3. Provide its UEI number in each application or plan to submit to the OPDIV.

Additionally, all first-tier subaward recipients must have a UEI number at the time the subaward is made.

• The Federal Government will transition from the DUNS Number to the New Unique Entity Identifier. As of April of 2022, the federal government stopped using the DUNS number to uniquely identify entities. At that point, entities doing business with the federal government will use a Unique Entity Identifier (SAM) created in SAM.gov. It is entered on the SF-424. It is a unique, nine-digit identification number, which provides unique identifiers of single business entities.

• You must submit all documents electronically, including all information included on the SF424 and all necessary assurances and certifications. In accordance with the Federal Government’s efforts to reduce reporting burden for recipients of federal financial assistance, the general certification and representation requirements contained in the Standard Form 424B (SF-424B) – Assurances – Non-Construction Programs, and the Standard Form 424D (SF-424D) – Assurances – Construction Programs, have been standardized federal-wide. Effective January 1, 2020, the updated common certification and representation requirements will be stored and maintained within SAM.

Organizations or individuals applying for federal financial assistance as of January 1, 2020, must validate the federally required common certifications and representations annually through SAM located at SAM.gov.

• After you electronically submit your application, you will receive an automatic acknowledgment from https://www.grants.gov that contains https://www.grants.gov tracking number. The Administration for Community Living will retrieve your application form from https://www.grants.gov.

U.S. Department of Health and Human Services Administration for Community Living https://www.fsd.gov/sys_attachment.do?sys_id=54e0016fdb3bbd90a8cb4a3913961934 https://www.grants.gov https://www.grants.gov https://www.grants.gov

Kari Benson

Email: AOA.OAA@acl.hhs.gov

Administration on Aging

2. Content and Form of Application Submission

Letter of Intent Number of Days from Publication 18

08/15/2025 Applicants are requested, but not required, to submit a letter of intent to apply for this funding opportunity to assist ACL in planning for the application independent review process. The purpose of the letter of intent is to allow our staff to estimate the number of independent reviewers needed and to avoid potential conflicts of interest in the review. Letters of intent should be sent to:

U.S. Department of Health and Human Services

Administration for Community Living

Administration on Aging

Email: AOA.OAA@acl.hhs.gov

Project Narrative The Project Narrative must be double-spaced, on 8 ½” x 11” paper with 1” margins on all sides, and a standard font size of no less than 11, Times New Roman or Arial. The entirety of the Project Narrative, including tables, graphics, and headings must be double-spaced. You can use smaller font sizes to fill in the Standard Forms and Sample Formats outside the Project Narrative section, such as the Project Work Plans and Budget Narrative/Justifications. Twenty

(20) pages is the maximum length allowed.

NOTE: The Project Work Plans, Letters of Support/Commitment, Vitae of Key Project Personnel, Project Map, Organizational Chart, and Budget Narrative/Justifications are not counted as part of the Project Narrative for purposes of the 20-page limit.

You must document all source materials. If any text, language, and/or materials are from another source, you must make it clear the material is being quoted and where the text comes from. You must also cite any sources when they include numbers, ideas, or other material that are not their own.

The Project Narrative is the most important part of the application. It is the primary basis to determine whether your project meets the minimum requirements for grants under the authorizing statutes. The Project Narrative should have a clear and concise description of your project. See Appendix F for resources on writing a grant application.

Your Project Narrative must include the following components and be clearly labeled:

• Project Abstract

• Project Relevance and Current Need mailto:AOA.OAA@acl.hhs.gov

• Approach

• Outcomes and Evaluation

• Organizational Capacity

To help reviewers score your application, you are required to organize your proposal using the headings above.

Project Abstract This section should include a brief description (no more than 265 words) of the proposed project.

Detailed instructions for completing the summary/abstract are included in the “Instructions for Completing the Project Summary/Abstract.”

In your abstract, clearly specify:

1. The objectives and outcomes of the proposed project;

2. One or more selected evidence-based CDSME program(s) and at least one self-management support program you plan to implement, with why you selected the program and how it will positively impact the behavioral health of the target population:

o Programs selected MUST be on the pre-approved list found in Appendices B and C of this funding opportunity.

o You may propose to implement one or more of the identified programs in a remote format.

o You are expected to begin delivering your selected CDSME and self-management support programs within three to six months after receiving your Notice of Award.

3. Projected number of program completers (CDSME programs) and participants (self-management support program[s]) for your selected programs (reference Appendix E) broken down by program and grant year;

4. Number of key partners, identifying which partnerships are across the state and at least two or more of those partnerships who specialize in serving older adults with behavioral health conditions; and

5. A statewide strategy that reaches the target population and defines which behavioral health condition(s) and behavioral health stressor(s) will be prioritized. Affirm that the geographic area is statewide.

Project Relevance and Current Need This section should describe, in both quantitative and qualitative terms, the nature and scope of the problem your proposed project will address.

In this section:

1. Describe and cite (using reliable and relevant data sources) the impact of chronic conditions and behavioral health conditions in your state among older adults and adults with disabilities, especially from the target population, and how your project will improve this impact.

2. Explain the gap in the availability of your selected CDSME and self-management programs across the state. This should include the current delivery status of CDSME and self-management support programs by your organization or other organizations across the state and program sustainability efforts.

3. Describe why your organization is well-positioned to fill the gap. Include your experience partnering with behavioral health organizations, and experience reaching individuals in the target population.

4. Include a Project Map of your state that shows where your selected programs are already being offered (if applicable), and where programming will be offered for this grant. The map should identify from the target population the number of older adults and adults with disabilities that will be reached with this funding and how the target population will be prioritized. The map of the statewide initiative should be included as an appendix to your application. It doesn’t count toward the 20-page maximum.

Approach A. Capacity Building and Program Implementation

In this sub-section, you should describe how you will develop capacity to deliver CDSME and self-management support programs through a statewide initiative to reach the target population.

In this section:

1. State the project’s major goals and objectives that align with Goal 1 of this funding opportunity.

Goal 1: Through a statewide initiative, develop capacity (e.g., instructors, partnerships, and referral networks) to increase the number of older adults and adults with disabilities in the target population who participate in evidence-based chronic disease self-management education (CDSME) and support programs.

2. Describe how you intend to identify, market to, recruit, and prioritize participants from the target population (noted below). Strategies should consider the target population, and how they can be best reached, as well as platforms, marketing strategies, campaigns, brand messaging, referral systems, media platforms, and/or partner involvement.

The target population for this NOFO is:

• Older adults (60 years and older) and individuals with disabilities who have one or more behavioral health conditions, such as:

o Depression o Anxiety disorders o Bipolar disorder o PTSD o Substance use disorder

• Older adults (60 years and older) and individuals with disabilities who have one or more stressors that are negatively impacting their behavioral health. Stressors are defined in this NOFO as:

o Experienced a traumatic event o New diagnosis of a chronic condition or disability o Being a caregiver o A change in finances or work status o Loss of a loved one, including through divorce o Sudden change in housing status (i.e., homelessness)

Recruitment and reach should reflect the state demographics of older adults and adults with disabilities.

Please note, the majority focus of your grant should be older adults 60 and older.

3. Identify one or more evidence-based CDSME program(s) in Appendix B and at least one self-management support program in Appendix C and a rationale for selecting the programs. The rationale should relate to the project’s relevance and how the programs will help improve the behavioral health of the target population. Only select programs that are included in Appendix B and Appendix C.

a. You may implement one or more of the identified programs in a remote format. You should contact the program developer/administrator for any program(s) you are interested in delivering remotely to confirm that: 1) the programs are allowed for remote delivery; and 2) training is readily available. If implementing remote programs, describe your experience. If you have never delivered remote programs on a statewide scale, describe the IT equipment and support required to deliver the selected remote program(s).

4. State the projected total number of participants and completers for your selected CDSME and self-management support programs, broken down by program and year.

a. Describe how you will engage approximately 25% of your target completers (CDSME programs) and target participants (self-management support programs) by the end of Year 1, 50% by the end of Year 2, and 100% of your target by the end of Year 3.

b. Define which behavioral health condition(s) and behavioral health stressor(s) will be prioritized and describe how at least 50% of the program's total number of participants will be from the target population by the end of the project period.

c. Targets should be realistic and achievable. Appendix E is available for additional guidance.

5. Describe how the delivery of the evidence-based CDSME and support programs will be person-centered, trauma-informed, and culturally appropriate, and what training will be provided on these topics for grant staff and program leaders.

6. Identify and describe a thorough strategy for implementing the selected CDSME and self-management support programs and reaching the target population.

a. Include information on partnering with behavioral health services, coalitions, and/or organizations across the state. The proposed project must include cross-sector partnerships across the state to reach all intended populations (as noted in the Purpose section).

b. At least two or more of those partnerships must specialize in serving older adults with behavioral health conditions. Examples include behavioral health services organizations (e.g., National Alliance on Mental Illness (NAMI)), Certified Community Behavioral Health Clinic (CCBHC), mental health association, Substance Abuse and Mental Health Services Administration (SAMHSA) block grant recipients. As part of partnership efforts, you should build out or enhance the infrastructure for state and local aging and mental health coalitions.

c. Note: You should include a Letter of Support/Commitment from each of the key partners and organizations described and attach as an appendix. See Letters of Support/Commitment section. Of note, Letters of Support/Commitment are not counted as part of the 20-page limit for the Project Narrative.

7. Describe whether your existing infrastructure for implementing the selected programs is adequate for a statewide initiative. Include the existing number of program host sites, implementation sites, and delivery personnel (such as trainers and leaders/coaches), etc.

a. If your existing infrastructure is inadequate, provide a rationale for including trainings in your proposed project to increase the existing number of program host sites, implementation sites, and delivery personnel (such as trainers and leaders/coaches), etc.

b. If you require training for one or more of the selected programs, you must include a Letter of Commitment from the program developer(s)/administrator(s) with your application. The letter should state that the program developer(s)/administrator(s) will provide the training no more than three months after you receive the Notice of Award from us.

8. Determine how you will identify individuals who are in the target population, such as what screenings and assessments your agency already conducts and what measures they will add because of this project. Examples of screening and assessments include SDOH assessments, social isolation screeners, depression screening, suicide risk screening, substance use disorder screening, etc. Describe why you selected these screening tools and why they are appropriate for the target population.

• Note: Individuals don’t need to have a formal diagnosis of a behavioral health condition.

9. Describe how you will develop or utilize bi-directional referral pathways to CDSME programs to help the target population better manage their behavioral health. Include what additional services such as support groups, therapy, connection to community resources, etc.

will be made available.

10. Describe the major challenges and barriers you expect to encounter, and how you will address those challenges and barriers.

B. Sustainability and Tracking Lessons Learned

Identify and describe how you will implement one or more strategies that will promote the sustainability of the selected CDSME and self-management support programs and the ability to continue to serve the target population.

The goal of sustainability is to integrate and embed evidence-based programs into a community’s services so they are available and easily accessible over time. Evidence-based CDSME programs can be a tool for individuals to achieve better outcomes. Sustainability strategies can include a combination of approaches, including the development of bi-directional referral partnerships, philanthropy, public or other federal funding, Older Americans Act Title IIID funding (for those participants 60 and older only), funding from healthcare entities, etc.

Additionally, documenting lessons learned, and best practices can assist others in replicating similar strategies in their communities.

In this sub-section:

1. State the project’s goals and major objectives that align with Goal 2 of this funding opportunity.

Goal 2: Develop and disseminate Section 508-compliant resources specific to your grant learnings on outcomes of this grant to enhance knowledge in serving the target population and aid in the sustainability of programs.

2. State the projected number of Section 508-compliant resources that you will develop.

Describe the number of resources created based on grant outcomes, including type (webinar, tip sheet, article, etc.) and focus area. For example, focus areas could include implementation, sustainability, lessons learned, and/or project results and findings.

a. Resources should be produced and disseminated promptly and easily understandable Section 508-compliant formats.

b. The audience for resources can include parties who might be interested in using the results to inform practice, service delivery, program development, and/or policymaking, including and especially those parties who would be interested in replicating the project.

3. Describe how you will develop 25% of your target resources by the end of Year 1, 50% by the end of Year 2, and 100% of your target by the end of Year 3.

4. Describe how you will ensure an emergency plan is in place for a range of emergencies (e.g., natural disasters) to ensure consistency across partners statewide.

5. Describe your sustainability strategies to support the selected programs and partnerships during and beyond the grant period.

6. Describe the development of a capstone project.