oppHHS-2018-ACL-AOA-ADPI-0307-cfda93.470-cidHHS-2018-ACL-AOA-ADPI-0307-instructions.pdf

Administration for Community Living

Administration on Aging

Alzheimer's Disease Programs to States and Communities

HHS-2018-ACL-AOA-ADPI-0307

Application Due Date: 07/16/2018

Alzheimer's Disease Programs to States and Communities

HHS-2018-ACL-AOA-ADPI-0307

TABLE OF CONTENTS

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

3. Submission Dates and Times

4. Intergovernmental Review

5. Funding Restrictions

6. 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

Department of Health & Human Services

ACL Center: Administration on Aging Funding Opportunity Title: Alzheimer's Disease Programs to States and Communities Announcement Type: Initial Funding Opportunity Number: HHS-2018-ACL-AOA-ADPI-0307 Primary CFDA Number: 93.470 Due Date for Letter of Intent: 05/26/2018 Due Date for Applications: 07/16/2018 Date for Informational Conference Call: 05/24/2018

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 Cooperative agreements under this Alzheimer’s Disease Programs Initiative (ADPI) funding opportunity announcement (FOA), are intended to support and promote the development and expansion of dementia-capable home and community-based service (HCBS) systems in States and Communities. There are two application options contained in this single FOA:

Grants to States (Option A) and Grants to Communities (Option B). No entity is eligible to apply for both State and Community options. The dementia-capable systems resulting from program activities under either option are expected to provide quality, person-centered services and supports that help individuals remain independent and safe in their communities.

OPTION A: Grants to States Cooperative agreements issued under Option A (Grants to States) will be for one of two possible sub-options (A.1 & A.2).

Applicants for Option A.1 are the governmental entities within states and territories designated as the state agency for dementia-capability and that have working relationships with their state agencies that enable creating and sustaining a dementia-capable HCBS System. Option A.1 has two required objectives, the first of which is the creation, expansion and sustainability of a dementia-capable state HCBS system that includes Single Entry Point/No Wrong Door (SEP/NWD) access for people with dementia and their family caregivers. The second objective is to ensure access to a comprehensive, sustainable set of quality state HCBS that are dementia-capable and provide innovative services to the population with dementia and their family caregivers.

States and territories eligible for Option A.1 are those that do not have active ACL State dementia-capability grants. All states without active grants are eligible apply, however those https://www.grants.gov states that have not benefited from ADSSP grants since before 2011 will be given priority consideration in the post-review decision making process.

Applicants for Option A.2 (18 month expansion cooperative agreements) are those states that received ACL Alzheimer’s disease supportive service program grants for systems integration in 2011, 2013, 2014, 2015, 2016 and 2017. The expansion grants provide the opportunity for existing or recent state program grantees to build on a specific component of their ongoing project that shows potential but for which expansion would otherwise not be feasible. States grantees that have already received a previous expansion grant are not eligible to receive a second expansion grant.

OPTION B: Grants to Communities Cooperative agreements under Option B are available to private and/or public community-based entities that are able to: 1) demonstrate their operation within an existing dementia-capable HCBS service system dedicated to the population that they serve; and 2) articulate opportunities and additional services in the targeted gap areas that would enhance and strengthen the existing system. Option B cooperative agreements are to the designed to aid Community HCBS providers in addressing three specific service gaps in existing dementia-capable HCBS systems for persons living with or those at high risk of developing Alzheimer’s disease and related dementias (ADRD) and their caregivers. Option B applicants must address each of the following three gap areas:

1. Provision of effective supportive services to persons living alone with ADRD in the community;

2. Improvement of the quality and effectiveness of programs and services dedicated to individuals aging with intellectual and developmental disabilities with ADRD or those at high risk of developing ADRD; and

3. Delivery of behavioral symptom management training and expert consultations for family caregivers.

Additional Application Elements Highlights of additional program requirements to which Option A & B applicants are subject are noted below with further information outlined in the full funding opportunity description:

Inclusion of a minimun of one dementia specific evidence-based or evidence-informed intervention;

25% Cost sharing/match;

A minimum of 50% of TOTAL grant funds to the provision of direct services;

Initial and then annual dementia capability assessment;

Inclusion of anticipated program outcomes and measures;

Robust, third party, program evaluation;

Phased program implementation;

Data collection, and Participation in technical assistance opportunties.

Emailed Letters of Intent are requested (but not required) to be submitted 10 days after the funding opportunity announcement posting date.

ACL will host two informational conference calls in relation to this FOA, one for Option A and one for Option B.

Option A (Grants to States)

May 24, 2018 from 1:00 pm – 2:00 pm EST. The dial-in information is below:

Toll Free Number: 800-593-8979 Passcode: 6121210 A recording will be available approximately 48 hours after the call concludes at the following number:

Toll Free Playback Number: 800-645-7408 Passcode: 34679 Playback will be available until July 15, 2018

Option B (Grants to Communities)

May 24, 2018 from 2:30pm – 3:30 pm EST. The dial-in information is below:

Toll Free Number: 800-988-9634 Passcode: 84679 A recording will be available approximately 48 hours after the call concludes at the following number:

Toll Free Playback Number: 800-839-9318 Passcode: 53479 Playback will be available until July 15, 2018

Please direct any questions about the programmatic goals and objectives of this FOA to ;erin.long@acl.hhs.gov.

I. Funding Opportunity Description Dementia, the loss of cognitive functioning, thinking, remembering, and reasoning and behavioral abilities, to the extent that it interferes with a person’s daily life and activities, is the major cause of impairment among older adults. Impairment, as a result of dementia, ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living. Estimates of the percentage of older persons with dementia vary, but the prevalence of the disease increases with age.

A number of conditions can mimic dementia, including dehydration, malnutrition, hearing loss, and depression. Medication mismanagement can result in the appearance of dementia. People with dementia (70 percent of whom live in the community) and their caregivers use the full spectrum of home and community-based services (HCBS) available from a variety of public and private sector programs. Community dwelling individuals with Alzheimer’s disease and related dementias (ADRD) are at an increased risk of, among other things, unmet needs, malnutrition and injury and various forms of neglect and exploitation.[1]1 The complexity of care of persons with advanced dementia is defined by the severity of functional and cognitive mailto:erin.long@acl.hhs.gov impairment, reliance on surrogate decision-making, inability to live alone and tremendous family/caregiver burden. Behavioral symptoms such as repetitive speech, wandering, and sleep disturbances are a core clinical feature of Alzheimer disease and related dementias. If untreated, these behaviors can accelerate disease progression, worsen functional decline and quality of life, cause significant caregiver distress, and result in earlier nursing home placement.[2]2 Alzheimer's disease is responsible, at least in part, for an estimated 60 percent of cases of dementia.[3]3 An estimated 5.7 million individuals in the United States are living with Alzheimer’s disease, that number is projected to triple by 2050.[4]4 The anticipated increase is attributed to individuals living longer as a result of advances in medicine and technology, as well as social and environmental conditions[5]5 and thus advancing to ages at which they are at increased risk of developing ADRD.

Estimates are that about half of older persons with dementia do not have an accurate diagnosis or any diagnosis at all[6]6. It is critically important to identify these conditions correctly to provide for appropriate referrals to dementia-capable services supportive for individuals living with dementia and their family caregivers. Given the impact of the dementia on people and communities, state and community service systems that wish to be dementia-capable should consider adopting key aspects of a dementia-capable HCBS model.

A dementia-capable HCBS system should:

1. Identify people with possible dementia and recommend that they see a physician for a timely, accurate diagnosis and to rule out reversible causes of dementia or conditions that resemble it.

2. Ensure that program eligibility and resource allocation take into account the impact of cognitive disabilities.

3. Ensure that staff communicate effectively with people with dementia and their caregivers and provide services that are person- and family-centered, offer self-direction of services, and are culturally appropriate.

4. Educate workers to identify possible dementia, and understand the symptoms of dementia and appropriate services.

5. Educate the public about brain health, including information about the risk factors associated with developing dementia, first signs of cognitive problems, management of symptoms if individuals have dementia, support programs, and opportunities to participate in research.

6. Implement quality assurance systems that measure how effectively providers serve people with dementia and their caregivers.

7. Encourage development of dementia-friendly communities, which include key parts of dementia-capability.

Information on how states and communities can become dementia-capable, thus increasing their ability to help people with dementia and their caregivers can be found in ACL’s issue brief entitled “Dementia-capable States and Communities: the Basics”.Dementia-capable services within a home and community-based system (HCBS) are those that build upon and integrate existing programs from both private and public sectors. Public sector partners include, but are not limited to, tribes or tribal organizations, the Administration for Intellectual and Developmental Disabilities (AIDD); the Centers for Medicare & Medicaid Services (CMS); and the Department of Veterans Affairs.

The ACL’s Alzheimer’s Disease Programs Initiative (ADPI) is informed by the work and recommendations of National Alzheimer's Project Act Advisory Committee and is dedicated to filling services gaps, through the provision of HCBS to both targeted special populations and targeted training at both the State and Community levels. The ADPI is implemented with authority contained within Title IV of the Older Americans Act.

The ADPI is not intended as a program funding "research", in fact “research” projects will not be funded. The program is designed to pilot much needed dementia-capable HCBS programs to states and communities, evaluation of program outcomes and using program outcome data to garner support to sustain successful initiatives beyond the federal program period. It is through programs such as this that the Administration for Community Living (ACL) demonstrates its commitment to its mission to maximize the independence, well-being, and health of older adults, people with disabilities, and their families and caregivers.

[1] Gould, E., Maslow,K.,LePore,M.,et al. Identifying and Meeting the Needs of Individuals With Dementia Who Live Alone. Accessed March 28, 2017 at https://nadrc.acl.gov/sites/default /files/uploads/docs/PWD_Living_Alone%202015.pdf.

[2] Gitlin LN, Kales HC, Lyketsos CG. Non-pharmacologic Management of Behavioral Symptoms in Dementia. JAMA. 2012;308(19):2020-2029.oi:10.1001/jama.2012.36918.

[3] Alzheimer’s Association. 2018 Alzheimer’s Disease Facts and Figures. Accessed March 27, 2018 at ;https://www.alz.org/documents_custom/2018-facts-and-figures.pdf.

[4] Alzheimer’s Association. 2018 Alzheimer’s Disease Facts and Figures. Accessed March 27, 2018 at ;https://www.alz.org/documents_custom/2018-facts-and-figures.pdf.

[5] Vincent, GK, Velkof, VA. The Next Four Decades: The Older Population in the United States: 2010-2050. Washington, DC. US Census Bureau, 2010. Accessed February 28, 2018 at https://www.census.gov/prod/2010pubs/p25-1138.pdf .

[6] Boustani M, Peterson B, Hanson L, Harris R, Lohr, KN. Screening for dementia in primary care: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2003; 138(11):927-37.

Funding Opportunity Requirements

Applicants for Options A and B of this cooperative agreement funding must describe their current system as related to the goals, objectives, and core components of this FOA, including but not limited to, the identification of a lead agency, and development of partnerships designed to achieve program goals (i.e. Community stakeholders, Area Agencies on Aging, Evaluators, etc).

https://nadrc.acl.gov/sites/default/files/uploads/docs/Dementia-Capable%20States%20and%20Communities-Basics%202014.pdf https://aspe.hhs.gov/report/national-plan-address-alzheimers-disease-2017-update file:///U:/Alzheimers/2018%20ADPI/FOA%20narrative.docx#_ftnref1 https://nadrc.acl.gov/sites/default/files/uploads/docs/PWD_Living_Alone%202015.pdf https://nadrc.acl.gov/sites/default/files/uploads/docs/PWD_Living_Alone%202015.pdf file:///U:/Alzheimers/2018%20ADPI/FOA%20narrative.docx#_ftnref2 file:///U:/Alzheimers/2018%20ADPI/FOA%20narrative.docx#_ftnref3 https://www.alz.org/documents_custom/2017-facts-and-figures.pdf file:///U:/Alzheimers/2018%20ADPI/FOA%20narrative.docx#_ftnref4 https://www.alz.org/documents_custom/2017-facts-and-figures.pdf file:///U:/Alzheimers/2018%20ADPI/FOA%20narrative.docx#_ftnref5 https://www.census.gov/prod/2010pubs/p25-1138.pdf file:///U:/Alzheimers/2018%20ADPI/FOA%20narrative.docx#_ftnref6

Option A: Grants to States A.1: New Grants to States New state applicants, those that did not receive ACL Alzheimer's grants between 2011 and 2017, must agree to and propose a plan to implement dementia-capable HCBS systems that meet the two FOA objectives outlined below, including the accompanying core components.

Those states that have completed ACL Alzheimer's grants received between 2011 and 2015 and are already implementing programs meeting those requirements must propose activities to build upon the work of their ongoing program that can expand on the FOA objectives outlined below and the accompanying core components. All applicants are expected to fully describe their methods for achieving the following two objectives and their core components:

Objective 1: Create and sustain a dementia-capable HCBS system that includes Single Entry Point/No Wrong Door (SEP/NWD) access for people with Alzheimer's disease and related dementias (ADRD) and their caregivers.

In such systems, people with ADRD and their family caregivers have streamlined access to the full array of dementia-capable person-centered, public and private sector HCBS that promote community living and independence.

Applicants must fully describe how they plan to implement the following core components of Objective 1 by the end of the cooperative agreement period. If the applicant has held an ADSSP grant between 2011 and 2017, they must explain the work of their previous dementia systems project. The application will detail how the proposed project will enhance what presently exists in their dementia-capable State HCBS system. Core SEP/NWD components include:

1.a. Information, Referral and Access This component requires that the grantee have a highly visible and trusted place for people with ADRD and their family caregivers to seek objective information on HCBS that maximizes their ability to remain independent in the community. Applicants must fully describe their method(s) for achieving this and providing access to a full range of services, which may include, but are not limited to dementia-capable person-centered home and community-based services; care transitions; and family caregiver support programs.

Applicants must provide measurable targets for achieving maximum population coverage of dementia-capable information, referral and access for each year of the cooperative agreement period. For example, applicants might propose to have a dementia-capable HCBS system available in geographic areas where 25% of the state's population lives in the first year, 35% in the second year and 50% in the third year.

1.b. Options Counseling and Assistance Options counseling enables persons with dementia and their family caregivers to understand and use the services available in their communities by assisting in:

o Identification of the person with dementias strengths, values, needs, and preferences;

o Person-centered service plan development;

o Enrollment in self-directed programs or seamless transfer into this process, as appropriate o Service initiation;

o On-going assistance and follow-up.

Applicants must provide measurable targets for achieving maximum population coverage for Options Counseling during each year of the cooperative agreement period.

1.c. Person-Centered Care Transitions Across Multiple Settings Care transitions models are person-centered, interdisciplinary approaches to integrating health care and social support services for individuals and their caregivers as they move across settings, such as hospitals, nursing homes, and home. Care transition service models identify individual needs and preferences, develop and activate comprehensive service plans, empower people to take an active role in their health care, and connect them to available resources.

Objective 2: Ensure access to a comprehensive, sustainable set of quality services/interventions that are dementia-capable and provide innovative services to the population with dementia and their family caregivers.

Applicants must describe the dementia-capable services/interventions proposed to meet Objective 2. At least one of the proposed services/interventions must be dementia-specific, evidence-based or evidence-informed, and designed for implementation with individuals living with or at risk of developing Alzheimer's or a related dementia and/or their family caregivers.

Applicants must fully describe how they plan to implement the following three core components of Objective 2 by the end of the cooperative agreement period. These components include the following:

2.a Comprehensive set of services Applicants must fully describe how people with ADRD and their family will have access to a wide range of dementia-capable person-centered HCBS that promote independence in the community. The comprehensive set of services must identify and indicate intent to implement at least one evidence-based or evidence informed service/intervention, as well as HCBS supports for family caregivers, and related supportive services. All applications must identify and indicate intent to implement at least one dementia-specific, evidence-based or evidence informed service/intervention.

2.b Quality assurance system Applicants must fully describe their implementation and use of a quality assurance and improvement process that will help ensure delivery of quality, dementia- capable services.

Applicants must propose measurable performance goals and indicators related to the quality assurance systems visibility, ease of access, responsiveness to persons with dementia and their family caregivers, efficiency and effectiveness. ACL's NADRC's compendium of Evaluation Measures Resources may provide assistance in identifying desired measurable outcomes of program activities.

2.c Sustainable service system Applicants must fully describe how they plan to ensure sustainability of the grantees dementia-capable HCBS system. Sustainability involves leveraging existing traditional Federal and State level resources, as well as other private and public innovations underway.

https://nadrc.acl.gov/node/70

Grantees must maintain the infrastructure and capacity to deliver programs throughout the state including partnerships that have effectively embedded dementia-capability within HCBS systems, and an adequate number of delivery sites and workforce to deliver the programs.

As program outcomes are a key to sustainability, all applicants must identify program outcomes as well as measures to demonstrate program impact and evaluation strategies.

Identified outcomes will document progress toward implementing and sustaining a comprehensive, dementia-capable system.

A.2: Expansion Grants to States Applicants for expansion grants must describe their current system and the core program component grant activities implemented through a State dementia-capable systems integration cooperative agreement awarded between 2011 and 2017. Core components are outlined above in the section for new state grants. The application will describe the program component proposed for expansion as it relates to the existing project, the rationale for the expansion, the target consumers, the methodology and the desired outcomes for the proposed expansion.

Applications for expansion cooperative agreements are expected to include quality assurance, sustainability and dissemination plans.

Option B: Grants to Communities Grants under this option are dedicated to filling services gaps identified through the work of and recommendations from the National Alzheimer's Project Act Advisory Committee. Option B projects are designed to provide dementia-capable home and community-based services to targeted special populations as well as targeted dementia capability training.

Applicants for Option B are those public or private community-based organizations that are able to demonstrate their operation within an existing dementia-capable HCBS system dedicated to the population they serve with the ability to articulate opportunities and additional services that would enhance and strengthen the existing system.

Successful applicants under this program will be leaders in existing dementia-capable HCBS systems designed to improve the quality and effectiveness of programs and services for individuals living with dementia and their caregivers. Applications will demonstrate intent to support individuals with ADRD and their caregivers, that address each of the three identified dementia-care service gap areas:

1. Develop and deliver supportive services to persons living alone with ADRD in communities:

Individuals living alone are at an increased risk of, among other things, unmet needs, malnutrition and injury and various forms of neglect and exploitation. Applicants will describe actions they will take to identify and support individuals living alone.

2. Improve the quality and effectiveness of programs and services dedicated to individuals aging with intellectual and developmental disabilities (IDD) with ADRD or those at high risk of developing ADRD:

Advances in medicine and technological advances are extending the lives of individuals living with IDD and those at high risk of developing dementia. Program activities designed to target the unqiue circumstances of these populations are imparative to this https://aspe.hhs.gov/report/national-plan-address-alzheimers-disease-2017-update growing population.

3. Deliver behavioral symptom management training and expert consultation to family caregivers:

Behaviors associated with ADRD can impact disease progression, functional decline and quality of life. Such outcomes may result in significant caregiver distress, impacting the ability to provide care. Provision of symptom management training and caregiver consultations are demonstrated to have positive outcomes.

Please see ACL's dementia-capability issue brief Dementia-capable States and Communities : the Basics for more information on model dementia-capable systems.

GENERAL PROGRAM REQUIREMENTS/COMPONENTS

All applicants to this funding opportunty announcement (Options A and Option B (State and Community)) are subject to the General program items listed below and will consider and include all of them in the development of their application, work and evaluation plans.

Phased Implementation Successful applicants will propose a phased approach for implementation of their projects. The pahses are described as follows:

Planning Phase: The period during which the grantee refines their proposed program implementation and evaluation plans, based on the plans contained in their original application.

The resulting plans will be the ACL/AoA approved roadmap for the grantee to accomplish the goals, objectives, and core components of ACL/AoA funded program. During the planning phase, and prior to entering the implementation phase, all grantees and partners will complete a dementia capability assessment to establish a baseline from which their program activities can be evaluated.

Applicants are to propose a planning phase of not more than 6 months from the notification date of the grant award. During this planning phase, grantees will be able to access no more than 15% of total grant funding to refine and expand on the work and evaluation plans submitted with their applications. ACL/AoA will be actively involved during the planning phase of the grant. At the conclusion of the planning phase, the grantee must receive ACL/AoA's approval of their work and evaluation plans, upload those plans into the reporting system, completion (by the grantee and partners) of the initial dementia-capability assessment and participate in a “Planning Phase Exit Conference”. Upon completion of those steps, grantees will progress to the Implementation Phase and access the remaining 85 percent of cooperative agreement funding.

Implementation Phase: The period during which the grantee’s implement their approved plan for accomplishing the goals, objectives, and core components of these objectives, as well as the evaluation of planned program activities. All grantees will complete annual dementia capability assessments each Fall, over the course of the grant period.

The grantee may not advance to the Implementation Phase without ACL/AoA staff approved work and evaluation plans, initial dementia capability assessments completed by the grantee and each partner, as well as a “Planning Phase Exit Conference”. Upon ACL/AoA approval of the aforementioned documents and completion of the assessments and the exit conference, the grantee will begin the implementation phase of the grant period.

https://nadrc.acl.gov/node/93 https://nadrc.acl.gov/node/93 https://nadrc.acl.gov/node/93

Use of Evidence-Based/Evidence Informed Intervention All programs must identify, by name, and describe the dementia specific evidence-based or evidence informed intervention they propose to implement, how it fits into their proposed overall program and the intended beneficiaries.

Applicants must identify in the project narrative and in the project work plan the intended, measureable outcomes (i.e. improved quality of life, reduced depression, stress/burden) of the proposed dementia specific intervention, as well as providing estimates of persons served by each programmatic component. ACL's National Alzheimer's and Dementia Resource Center (NADRC) created a compendium of Evaluation Measures Resources that could provide assistance in identifying desired measurable outcomes of program activities.

Direct Service Requirement All successful applicants are required to dedicate 50% of the total program budget to the provision of direct services to persons living with dementia and caregivers. A definition of direct service is provided in the funding opportunity announcement Appendix. Budget narratives included in the program application should include clear identification of the lines with the budget where the funds for the required direct services will reside.

Data Collection Grantees are required to collect information on services provided under the authority of existing or future approved data collections.

Evaluation All successful grant applications MUST include a plan for a robust, third party evaluation.

At the onset of the project, grantees and their partners will be required to conduct a baseline assessment of the dementia-capability of their existing systems, using either the National Alzheimer’s and Dementia Resource Center's (NADRC) 2017 Dementia Capability Assessment ;Tool created by the NADRC or another tool approved by ACL program staff. The assessment will afford grantees the opportunity to create metrics for use in future service program evaluations, as well as a basis for setting goals, objectives and milestones for program monitoring and reporting throughout the program period. In an effort to track program progress toward enhanced dementia-capability and document progress toward systems change, grantees will agree to conduct annual follow-up assessments in each year of program funding throughout the duration of the program. The annual follow-up assessment will be submitted with each Fall Semi-Annual Report. Use of a progressive assessment model will ensure that, at the conclusion of the grant period, programs will be able to document their progress by reporting on the aspects of their project that were successful and those that were not, as well as the lessons learned.

Applications will be scored on the inclusion of robust, third party, project evaluation plan.

Evaluations should, at a minimum, determine the effectiveness and impact of the strategies and processes used for execution of project goals at both the systems development and consumer (service provision) level. Applicants should include outcome measures in the proposed program and evaluation plans (ACL will NOT fund any project that does not include measurable outcomes).

More information on evaluation expectations can be found in Section V of this funding https://nadrc.acl.gov/node/70 https://nadrc.acl.gov/node/117 https://nadrc.acl.gov/node/117 opportunity announcement.

Technical Assistance Successful applicants are to draw on the expertise of ACL/AoA program staff and existing AoA- sponsored resources to develop, implement, and sustain their strategic work plans. All grantees are required to participate in technical assistance activities as they pertain to the program development, management and integration. This includes, but is not limited to, participation in regularly scheduled technical assistance conference calls, web casts, learning collaboratives and one-on-one technical assistance opportunities initiated by ACL/AoA staff, resource center staff or the grantees.

Statutory Authority Title IV of the Older Americans Act.

II. Award Information Funding Instrument Type: Cooperative Agreement Estimated Total Funding: $20,400,542 Expected Number of Awards: 22 Award Ceiling: $1,000,000 Per Project Period Award Floor: $350,000 Per Project Period Length of Project Period: 36-month project period with three 12-month budget periods This program is comprised of two options for applicants, Option A is States, Option B is for Communities.

There are two Options for grants to States. Option A.1 is for 36 month grants to States to develop or expand its dementia capable home and community based system. Grants to new States will be for a minimum of $450,000 and a maximum of $650,000. Option A.2 is for States that presently hold 36 month grants, have not previously benefitted from an expansion grant and have identified a component within their existing program that would benefit from additional resources in the form of an 18 month expansion grant. Expansion grants will be for a minimum of $350,000 and a maximum of $400,000.

Option B, Community grants are for public or private community-based entities with awards ranging between $800,000 and $1,000,000.

No organization would be eligible to submit applications for both the State and the Community programs.

Awards made under both Options A and B are subject to terms provided for in the Federal Grant and Cooperative Agreement Act of 1977 (P.L. 95-224). The Cooperative Agreement provides for the substantial involvement and collaboration of ACL/AoA in activities that the recipient organization will carry out in accordance with the provisions of the approved award.

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 as long as it stays within the original confines of the proposed project description. 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. When an award is issued the cooperative agreement terms and conditions from the program announcement are incorporated by reference unless ACL is authorized under the Terms and Conditions of award, 45 CFR Part 75, or other applicable regulation or statute to make unilateral amendments.

The grantee agrees to execute the responsibilities outlined below:

1. Fulfill all of the requirements of the grant initiative as outlined in this funding opportunity announcement (FOA), as well as carry out project activities as reviewed, approved, and awarded;

2. Communicate with the AoA project officer and/or the assigned technical assistance liaison regularly to improve the effectiveness of the activities carried out under this Agreement;

3. Conduct a baseline assessment of the dementia capability in collaboration with Project Officer and technical assistance team, with annual reassessments to be conducted each Fall in alignment with semi-annual report submission through the duration of the project;

4. Produce and submit to the ACL/AoA Project Officer, at the conclusion of the project, a summary report/manual and an independent evaluation report describing how the project was conducted and goals, program outcomes that were achieved. The report would also include ways in which barriers to goal achievement were addressed;

5. Cooperate with any federal evaluation efforts and comply with the timeline, content and format of all required data collection and reporting requirements (see Section VI-3 for more detail). Submit to the ACL/AoA project officer a final, clean copy of all data developed or supported with these grant funds, in the format in which it was developed or produced, as provided for in the HHS Grants Policy Statement (http://www.hhs.gov /sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf) and referenced in the Notice of Award. The HHS Grants Policy Statement defines “data” as: “recorded information, regardless of the form or media on which it may be recorded, and includes writings, films, sound recordings, pictorial reproductions, drawings, designs or other graphic representations, procedural manuals, forms, diagrams, work flow charts, equipment descriptions, data files, data processing or computer programs (software), statistical records, and other research data” (p. II-69, Footnote 18);

6. Participate in program collaborative activities as organized by the ACL/AoA Project Officer and the technical assistance team. Collaborative program activity participants will mentor one another in their efforts to fulfill the aims of the ADI-SSS program; and

7. Include the following disclaimer on all products produced using this grant funding:

"This project was supported, in part by grant number 90XXXX####, from the U.S.

Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy."

The ACL/AoA project officer agrees to execute the responsibilities outlined below:

http://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf http://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf

1. Perform the day-to-day federal responsibilities of managing a grant initiative and work with the grantee to ensure that the minimum requirements for the grant are met;

2. Work cooperatively with the grantee to clarify the programmatic and budgetary issues to be addressed by the grantee project, and, as necessary, negotiate with grantee to achieve a mutually agreed upon solution to any needs identified by the grantee or ACL/AoA;

3. Assist the grantee project leadership in understanding the strategic goals and objectives, policy perspectives, and priorities of AoA, ACL, 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. Provide technical advice to the grantee on the provision of technical support and associated tasks related to the fulfillment of the goals and objectives of this grant;

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

6. Communicate with the grantee project director regularly to improve the effectiveness of the activities carried out under this Agreement.

III. Eligibility Information

1. Eligible Applicants Option A (A.1 and A.2) is extended to eligible state government agencies. Option B is open to eligible domestic community-based public and/or private entities.

Option A (A.1 and A.2) of this Funding Opportunity Announcement is designed to build and expand the dementia-capability of state systems and programs by embeding dementia-capability in to their service networks.

Option A.1: is for those entities within states and territories designated as the state agency for dementia-capability and have working relationships with their state agencies that enable creating and sustaining a dementia-capable HCBS System that States eligible for this option are those states that do not have active State dementia-capability grants. All states without active grants are eligible to apply, however those states that have not benefited from ADSSP grants since before 2011 will be given priority consideration in the post-review decision making process.

Option A.2: is for 18 month expansion grants and is limited to those states that received ACL Alzheimer’s disease state program grants for systems integration in 2011, 2013, 2014, 2015, 2016 and 2017 that desire to expand on a specific component of those programs and have not already received expansion grants for programs in the noted years.

The states that already have received expansion grants are not eligible to receive a second one. The expansion grants provide the opportunity for the existing or recent state program grantees to build on a specific component of their ongoing project that shows potential but for which expansion would otherwise not be feasible.

Option B of this Funding Opportunity Announcement is designed to extend existing dementia-capable home and community based services (HCBS) to the special populations targeted and outlined within this announcement. Eligible entities are those that are able to 1) demonstrate their operation within an existing dementia-capable HCBS system dedicated to the population that they serve, and 2) articulate opportunities and additional services that would enhance and strengthen the existing dementia- capable HCBS system within which they are operating .

This funding opportunity is not extended to entities that are unable to 1) demonstrate their operation within an existing dementia-capable HCBS system dedicated to the population that they serve, and 2) articulate opportunities and additional home and community-based services that would enhance and strengthen the existing dementia-capable HCBS system in which they are operating.

This funding opportunity is not extended to entities not operating within an existing dementia-capable HCBS system or those organizations that received awards as a result of the following funding opportunity announcements in 2014, 2015, 2016 and 2017 (HHS-2014-ACL-AOA-AL- 0090, HHS-2015-ACL-AOA-AL-0104, HHS-2016-ACL-AOA-ALGG-0152 and HHS-2017-

ACL-AOA-ALGG-0227).

There are no entities that would be eligible to submit applications for both Option A and Option B.

2. Cost Sharing or Matching

Cost Sharing / Matching Requirement: Yes The federal match required for the State and Community (Options A & B) program is 25% (cash and/or in-kind). All applicants are required to comply with the 25% match requirement outlined in the funding opportunity announcement (FOA). Applicants have the opportunity to apply for waivers of a portion of the match. Waivers to match requirements under this program will not result in requirements below 15%.

Applicants desiring to apply for a match waiver should include their desire for the waiver in their application. Applicants requesting match waiver must provide a compelling reason for the necessity of the desired waiver. There are no guarantees that an applicant requesting a match waiver will receive one. Applicants desiring a match waiver should plan their budget using the 25% full match and include in their application package a letter outlining their waiver request which includes a compelling rationale for a match waiver.

The match waiver application would include the proposed percentage of the match to be waived, as well as the compelling reason for the request. The desired waiver request should not result in a match level that falls below 15%. If the grant application that includes a waiver request is successful and the waiver request is also approved, the appropriate budget modification will occur during the budget negotiation period.

If a match waiver request included in a successful grant application is not approved, there will not be an opportunity for a budget revision and the grantee will be expected to supply the full 25% match provided in the original application budget.

Waiver requests not included in the application process will not be considered.

There are two types of match: 1) non-federal cash and 2) non-federal in-kind. In general, costs borne by the applicant and cash contributions of any and all third parties involved in the project, including sub-grantees, contractors and consultants, are considered matching funds.

Volunteered time and use of facilities to hold meetings or conduct project activities may be considered in-kind (third-party) donations.

Budgetary funds provided from the applicant agency’s budget for costs associated with the project are an example of a non-federal cash match.

ACL discourages applicant agencies exceeding the minimum match requirement. Applications with a match greater than the minimum required will not receive more favorable consideration under the review. Match is one of the responsiveness criteria as noted in Section III, 3 Application Disqualification Factors.

3. Responsiveness and Screening Criteria

Application Responsiveness Criteria All applications will go through an initial programmatic screening to verify that the applicant meets the minimal responsiveness criteria.

Applications will be reviewed to establish responsiveness to the following criteria.

All applications will go through an initial programmatic screening to verify that the applicant meets the funding opportunity announcement criteria.

The responsive State and Community (Option A & B) project applicant:

1. Is an eligible State Unit on Aging (Option A) or Community based organization that demonstrates operation within an existing dementia-capable home and community-based service system (Option B);

2. Demonstrate intent and a plan to address each of the required targeted gap areas (including a well-articulated implementation work plan in each target area)(Option B);

3. Include work and evaluation plans that demonstrate the intent to meet program direct service and outcome measure requirements;

4. Include outcome measures in the proposed program and evaluation plans (ACL will NOT fund any project that does not include measurable outcomes);

5. Name at least one dementia specific evidence-based or evidence informed intervention directed at persons with dementia and/or caregivers and demonstrate intent to implement it in the proposed work and evaluation plans;

6. Demonstrate capacity to serve persons of all ages with dementia, including those with intellectual and developmental disabilities;

7. Include a robust, third party, evaluation plan;

8. Include a work plan

9. Include budget and budget narrative/justification that demonstrate intent to meet cost sharing/match requirements;

10. Not propose conduit or pass-through funding for another agency to lead the project.

Application Screening Criteria All applications will be screened to assure a level playing field for all applicants. Applications that fail to meet the three 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 the following screening requirements:

1. Applications must be submitted electronically via http://www.grants.gov by 11:59 p.m., Eastern Time, by the due date listed in section IV.3 Submission Dates and Times.

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

3. The Project Narrative must not exceed X pages. Project Narratives that exceed 20 pages will have the additional pages removed and only the first X pages of the Project Narrative will be provided to the merit reviewers for funding consideration. NOTE: The Project Work Plan, Letters of Commitment, and Vitae of Key Project Personnel are not counted as part of the Project Narrative for purposes of the X-page limit.

Unsuccessful submissions will require authenticated verification from http://www.grants.gov indicating system problems existed at the time of your submission. For example, you will be required to provide an http://www.grants.gov submission error notification and/or tracking number in order to substantiate missing the application deadline.

IV. Application and Submission Information

1. Address to Request Application Package Application materials can be obtained from http://www.grants.gov or https://www.acl.gov/grant s/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 http://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 http://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 DUNS number (http://fedgov.dnb.com/webform/) 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. Applicants should finalize a new, or renew an existing, registration at least two weeks before the application deadline. 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.

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: https://www.sam http://www.grants.gov/ http://www.grants.gov/ http://www.grants.gov/ http://www.grants.gov/ https://www.acl.gov/grants/applying-grants https://www.acl.gov/grants/applying-grants http://www.grants.gov/…