PKG00251946-instructions.pdf

Administration for Community Living

Administration on Disabilities

Human Dignity and Civil Rights for People with Disabilities

HHS-2019-ACL-AOD-DNHC-0362

Application Due Date: 08/12/2019

Human Dignity and Civil Rights for People with Disabilities

HHS-2019-ACL-AOD-DNHC-0362

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 Disabilities Funding Opportunity Title: Human Dignity and Civil Rights for

People with Disabilities Announcement Type: Initial Funding Opportunity Number: HHS-2019-ACL-AOD-DNHC-0362 Primary CFDA Number: 93.631 Due Date for Applications: 08/12/2019 Date for Informational Conference Call: N/A

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 Dignity resides in every human being throughout life and every person is unequivocally valuable and deserving of the opportunities and freedom to flourish throughout their life.

People with disabilities are not exceptions, as disability is part of the human experience. Yet as people with disabilities seek medical treatment they routinely confront barriers to equal access to health care from conception through natural death. The U.S. Department of Health and Human Services (HHS) remains committed to defending and protecting all human life. In particular, people with intellectual disabilities and/or developmental disabilities (ID/DD) are often denied life-saving medical treatments as a result of inaccurate predictions of life expectancy and perceptions that lives lived with disability are of a lesser quality. Hospital policies, bioethical standards, and medical protocols all too often are leveraged to limit and deny equal access to care and accurate information about their health and well-being (Carlson, Smith & Wilker, 2012). Through this funding opportunity, the Administration on Disabilities seeks to ensure individuals with ID/DD across the age span have equal access to all forms of health care.

Definition of Intellectual Disabilities and Developmental Disabilities Intellectual disability (ID) is characterized by significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills.

Developmental disability (DD) is, as defined under the Developmental Disabilities Assistance and Bill of Rights Act 2000 (DD Act), a severe, chronic disability of an individual that:

"(i) is attributable to a mental or physical impairment or combination of mental and physical impairments;

(ii) is manifested before the individual attains age 22;

https://www.grants.gov

(iii) is likely to continue indefinitely;

(iv) results in substantial functional limitations in 3 or more of the following areas of major life activity:

o Self-care.

o Receptive and expressive language.

o Learning.

o Mobility.

o Self-direction.

o Capacity for independent living.

o Economic self-sufficiency; and

(v) reflects the individual’s need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated."

Both ID/DD begins during the developmental period, may impact day-to-day functioning, and begin/impact/last throughout a person’s lifetime. Data from the NHIS-D (1994-1995) indicate the prevalence of ID/DD in adults at 1.58% (Larson et al, 2001).

Civil Rights in Health Care for Individuals with ID/DD The major federal disability civil rights laws applicable to health care are the Rehabilitation Act of 1973, the Americans with Disabilities Act (ADA) of 1990 as amended by the ADA Amendments Act of 2008, and Section 1557 of the Affordable Care Act (ACA) of 2010.

Section 504 of the Rehabilitation Act and Section 1557 of the ACA prohibit health care entities from discriminating against persons with disabilities in their programs if the entities receive federal funding. Because Congress exercised its powers under the Commerce Clause and the Fourteenth Amendment to the Constitution in passing the ADA, the ADA prohibit disability-based discrimination by public and private entities, regardless of whether they receive federal funding. While these laws require equitable treatment of approximately sixty-one million Americans with disabilities (including individuals with ID/DD), reports and research studies indicate that this population experiences health care inequities, including discrimination in medical care and treatments such as organ transplants and mental health referrals for severe depression and suicidal ideation.

Need for Resources In the instance of civil rights in health care for individuals with ID/DD, there is an evident dissonance between clinical practice and individual rights. With the disconnect between medical care and individual rights for the ID/DD community, there are some procedures that have processes in place to ensure the civil rights in health care for people with disabilities. For example, Connecticut’s sterilization statute, Conn. Gen. Stat. § 45a-691, requires that a person must be 18 years of age and be able to give informed consent to be able to undergo sterilization.

Whenever a person is unable to give informed consent, the probate court has jurisdiction to determine whether sterilization shall be permitted (Carlson, Smith, Wilker, 2012). The state has a multi-tiered application and determination process to define informed consent as it relates to the patient.

While the processes are in place for some medical procedures, many medical treatments and services still lack the protocols and processes in place to ensure civil rights in health care for people with ID/DD. In recent years, a handful of high-profile cases have highlighted the disparities faced by people with developmental disabilities needing organ transplants, leading states, including California, Maryland, and New Jersey to passing laws banning organ transplant discrimination on the basis of disability. In February 2019, the United States Department of Health and Human Services (HHS) successfully resolved a complaint against the University of North Carolina Health Care system after a patient was denied an opportunity to be placed on the United Network for Organ Sharing list on the basis of his intellectual disability.

Research indicates that the lack of protocols around disability diagnosis continues to exist in prenatal testing, raising questions about the adequacy of training for medical professionals to ensure parents receive a representation about the valuable lives of children with disabilities that is not based on stereotypes or discriminatory quality of life assumptions. As a health professional’s communication impacts a parents' understanding and experiences, it is critical for services offering prenatal testing to have guidance/protocols/policies about how to support parents caring for babies and children with disabilities.

As individuals with ID/DD are living longer lives, many unknown health effects related to aging are becoming relevant. Of particular concern to aging people with ID/DD are the effects of long-term use of medications, and the additional risk when such pharmaceuticals are combined with a sedentary lifestyle (Peterson, Gordon & Hurvitz, 2012; Strax et al., 2010). In addition, rates of dementia in aging adults with ID/DD are increasing. This is particularly well documented for people with Down syndrome (DS). Current estimates suggest that more than half of the population of people with Down Syndrome over the age of 50 will experience dementia. (Zigman & Lott, 2007). Women with Down Syndrome appear to enter menopause earlier than their peers, increasing their risks for dementia and early mortality (Coppus et al., 2012). Individuals with ID/DD who have neuromuscular disorders (e.g., cerebral palsy) are more likely to experience a range of problems as they age, including increased pain levels, sarcopenia, osteoporosis, and arthritis (Strax, Luciano, Dunn, & Quevedo, 2010). Osteoporosis is further exacerbated by medications often prescribed to people with ID/DD (e.g., phenytoin, SSRIs). These medications can lead to increased bone loss when coupled with a sedentary lifestyle and poor nutrition (Strax et al., 2010). Health care guidelines and protocols specific for people with ID/DD who experience age-related conditions (e.g., cancer, arthritis, and hypertension) are not currently available (McCallion & McCarron, 2004).

End of life up until natural death care for people with ID/DD deserves more attention (Sinai, Bohnen, & Strydom, 2012). Hospice and palliative care is underutilized by people with ID/DD (Freidman, Helm, & Woodman, 2012). Barriers include ones that are common across populations such as late diagnosis of a terminal illness; however, others are specific to people with ID/DD, such as challenges with obtaining informed consent or lack of knowledge on the part of palliative care professionals (Friedman et al., 2012). In addition, lack of referral and mental health support for counseling to address common occurrence of depression as illness, further limits daily activities for people with disabilities. Disability service providers may also have a hard time meeting the end of life needs of people with ID/DD. In a survey of agencies that provide some type of support service to older adults with ID/DD, only 19% of the respondents reported that their agency had a model to provide effective end of life care up until natural death (Botsford & Heller, 2004).

These are just some examples of existing evidence that show the need to ensure medical professionals have the resources needed to support individuals with ID/DD across the age spectrum and their rights to all forms of health care. The specifics of a particular medical procedure are less important than the legal basis for proposing and ultimately authorizing the use of the procedure (Carlson, Smith, Wilker, 2012). Courts have the ability to respond to new medical procedures while simultaneously remaining true to the rule of law and established Constitutional, statutory and common law requirements.

Research recommends solutions such as medical entities establishing and implementing due process protections to ensure the civil rights of a person with a disability when medical procedures are performed based on the presence of a disability, and must be in place for instances of withholding life-saving treatment from those with ID/DD (Carlson, Smith, Wilker, 2012).

I. Funding Opportunity Description The Administration on Disabilities (AOD) seeks to fund a three-year cooperative agreement for the development, testing and dissemination of resources for the medical community to better support the rights of all individuals with ID/DD to access all forms of health care. The goal of this project is to ensure that Americans with ID/DD experience improved access to health care, life-saving treatments, and to mental health care - leading to greater equitable health care across our nation free from discrimination by carrying out the following three main activities:

Conduct gap analysis of existing data and research, medical curricula, policies, guidelines, and protocols around medical discrimination issues that exist for the ID/DD population, including in areas such as organ transplants, pre-natal counseling, aging, end of life, mental health referrals, suicide ideation and any others identified by the applicant;

Convene a panel of partners and stakeholders to use findings from gap analysis to develop and validate protocols to support medical professionals treating patients with ID/DD without discrimination; and

Conduct national disseminate of protocols to multiple professionals in the medical and allied health fields to raise awareness of the issue and the resources.

Applicants must address the following components into the project proposal:

Partnerships in the design and implementation of the project: Partnering with local, state, and national level organizations, agencies and other relevant stakeholders, including at least one self-advocacy organization and one family led organization, to conduct all three project activities. The DD Act defines “advocacy” as an active support of policies and practices that promote self-determination and inclusion in the community and workforce for individuals with ID/DD and their families. Successful applicants will propose a coordinated approach across various partners. A signed Memorandum of

Understanding (MOU) between the members of the partnership must be submitted as part of the application. The agreement should describe how the entities participated in the development of the application and more importantly, how they plan to work together to ensure the goals and objectives included in the application are achieved.

Applicants should demonstrate support of civil rights across the lifespan for people with disabilities.

Meaningful and active engagement with self-advocates and family members throughout all phases and aspects of this project. In addition to the partnership requirement above, it is expected that self-advocates and family members will be fully engaged throughout the life cycle and in all aspects of this project, including in conducting the gap analysis, developing and testing protocols, and national dissemination efforts. Self-advocates and family members are expected to serve in various roles and capacities in the project.

Meaning and active engagement with the medical community and subject matter experts throughout all phases and aspects of this project. In addition to the partnership requirement above, it is expected that members of the medical community, including the health and allied health professions, will be fully engaged throughout the life cycle and in all aspects of this project. Medical professionals should inform the gap analysis, the development and testing of protocols, and national dissemination efforts. Medical professionals are expected to serve in various roles and capacities in the project.

Partners should demonstrate support of civil rights across the lifespan for people with disabilities.

Conceptual Framework for the Design of the Project. The project should be guided by a conceptual framework that incorporates a civil rights framework, the core values in the Developmental Disabilities Assistance and Bill of Rights (DD Act) and other relevant evidence or theories related to discrimination and equal access to health care. The application should describe how the conceptual framework will be used to guide all aspects of the project.

Evaluation to assess progress and determine outcomes from the project. It is expected that the project will use process evaluation techniques to analyze how the project activities are delivered to determine, among other things, the extent to which the project is being implemented as planned, how the project activities are being received by the target group, the barriers to implementation, and areas for project improvements/refinements. It is also expected that the project will use summative evaluation techniques to determine project success in meeting the intended outcome of enhancing the health and safety of individuals by increasing their independence, social capital, self-determination, community integration, productivity and participation.

Sustainability: An expected outcome of this project will be sustainability of the efforts to raise awareness about the issue of medical discrimination experienced by the ID/DD and of the resources available to ensure equal access to health care. During the course of the project, efforts should be made to generate the sufficient resources and strategies for organizational sustainability, financial sustainability and/or community sustainability to continue and refine the work.

Project Impact

The development and dissemination of the medical protocols will ensure that Americans with ID/DD experience improved access to health care, life-saving treatments, and to mental health care, leading to greater equitable health care across our nation free from discrimination by:

Enhancing the health and safety of individuals with ID/DD by ensuring equal access to medical care and interventions.

Strengthening the knowledge, skills, retention, and advancement of the health care professionals treating patients with ID/DD as well as strengthening the knowledge of community partners who serve individuals with ID/DD.

Strengthening and elevating the leadership roles that self-advocacy organizations, family led organizations, and other peer support networks working together with families and others must play in improving and ensuring equal health care access for individuals with

ID/DD.

Enhancing the effectiveness and coordination of efforts by the state, the DD Act network and others to anticipate, avoid, investigate, reduce and remediate civil rights violations in the health care system for people with ID/DD.

Engaging self-advocates and family members in meaningful ways to carry out the project.

Statutory Authority The Developmental Disabilities Assistance and Bill of Rights Act of 2000 (DD Act of 2000), Section 161(2) (D) (v) (42U.S.C. 15081)

II. Award Information Funding Instrument Type: Cooperative Agreement Estimated Total Funding: $442,868 Expected Number of Awards: 1 Award Ceiling: $442,868 Per Budget Period Award Floor: $380,000 Per Budget Period Length of Project Period: 36-month project period with three 12-month budget periods

The ACL project officer agrees to execute the responsibilities of the cooperative agreement outlined below:

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. Conduct monthly conference calls to ensure goals and objectives are being met.

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

3. Share information with the grantee about other federally sponsored projects and other activities relevant to the interests of the grantee and their activities.

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

5. Provide technical advice on grantee work products to ensure they are accurate, objective, unbiased, and of high professional quality, and that they do not violate federal, departmental, or agency grant rules.

6. Attend and participate in major project events as appropriate.

The grantee will agree to execute the responsibilities of the cooperative agreement outlined below:

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

2. Collaborate with ACL in any in-scope modifications and execution of the work plan initially within 45 days of the award.

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

4. Share information with ACL, the ID/DD network, national, state and local partner organizations, and other entities as appropriate.

5. Work with the ACL Projects of National Significance project officer to evaluate performance results reported semi-annually and jointly develop strategies to address those areas requiring improvement.

6. Submit resumes of potential key staff hires as detailed under HHS grants prior approval requirements.

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

8. Work with the ACL Projects of National Significance program project officer to brand this work in such a way that appropriately recognizes and acknowledges ACL’s financial contributions to its activities.

The Government retains all rights to all data and reports compiled as a result of this grant. No information furnished to or generated by the grantee in the performance of this grant shall be released to the public by the grantee without the prior approval of the project officer.

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.

III. Eligibility Information

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

2. Cost Sharing or Matching

Cost Sharing / Matching Requirement: No

3. Responsiveness and Screening Criteria

Application Responsiveness Criteria Applicants must address the following criteria:

Partnerships in the design and implementation of the project: Partnering with local, state, and national level organizations, agencies and other relevant stakeholders, including at least one self-advocacy organization and one family-led organization, to conduct all three project activities. The DD Act defines “advocacy” as an active support of policies and practices that promote self-determination and inclusion in the community and workforce for individuals with ID/DD and their families. Successful applicants will propose a coordinated approach across various partners. A signed Memorandum of Understanding (MOU) between the members of the partnership must be submitted as part of the application. The agreement should describe how the entities participated in the development of the application and more importantly, how they plan to work together to ensure the goals and objectives included in the application are achieved.

Applicants should demonstrate support of civil rights across the lifespan for people with disabilities.

Meaningful and active engagement with self-advocates and family members throughout all phases and aspects of this project. In addition to the partnership requirement above, it is expected that self-advocates and family members will be fully engaged throughout the life cycle and in all aspects of this project, including in conducting the gap analysis, developing and testing protocols, and national dissemination efforts. Self-advocates and family members are expected to serve in various roles and capacities in the project.

Meaning and active engagement with the medical community and subject matter experts throughout all phases and aspects of this project. In addition to the partnership requirement above, it is expected that members of the medical community, including the health and allied health professions, will be fully engaged throughout the life cycle and in all aspects of this project. Medical professionals should inform the gap analysis, the development and testing of protocols, and national dissemination efforts. Medical professionals are expected to serve in various roles and capacities in the project.

Partners should demonstrate support of civil rights across the lifespan for people with disabilities.

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 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 75 pages. Project Narratives that exceed 75 pages will have the additional pages removed and only the first 75 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 75-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 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/ https://www.grants.gov/web/grants/applicants/workspace-overview.html https://www.grants.gov/web/grants/applicants/workspace-overview.html http://www.grants.gov/ 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. Effective June 11, 2018, when registering or renewing your registration, you must submit a notarized letter appointing the authorized Entity Administrator. Please be sure to read the FAQs located at www .sam.gov to learn more. Applicants should allot sufficient time prior to the application deadline to finalize a new, or renew an existing registration. This action should allow you time to resolve any issues that may arise. Failure to comply with these requirements may result in your inability to submit your application or receive an award. 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.gov /sam/ transcript/ SAM_Quick_ Guide_Grants_ Registrations-v1.6. ;pdf.

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 DUNS number in each application or plan to submit to the OPDIV.

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

Since October 1, 2003, The Office of Management and Budget has required applicants to provide a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number when applying for federal grants or cooperative agreements. It is entered on the SF-424. It is a unique, nine-digit identification number, which provides unique identifiers of single business entities. The DUNS number is free and easy to obtain.

Organizations can receive a DUNS number at no cost by calling the dedicated toll-free DUNS Number request line at 866-705-5711

You must submit all documents electronically, including all information included on the SF424 and all necessary assurances and certifications.

After you electronically submit your application, you will receive an automatic acknowledgement from http://www.grants.gov that contains http://www.grants.gov http://fedgov.dnb.com/webform/ http://www.sam.gov/ http://www.sam.gov/ http://www.sam.gov/ https://www.sam.gov/sam/transcript/SAM_Quick_Guide_Grants_Registrations-v1.6.pdf https://www.sam.gov/sam/transcript/SAM_Quick_Guide_Grants_Registrations-v1.6.pdf tracking number. The Administration for Community Living will retrieve your application form from http://www.grants.gov

U.S. Department of Health and Human Services

Katherine Cargill-Willis Administration for Community Living Phone Number: (202) 795-7322 E-mail: katherine.cargill-willis@acl.hhs.gov

2. Content and Form of Application Submission

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

You can use smaller font sizes to fill in the Standard Forms and Sample Formats. The suggested length for the Project Narrative is 60 to 75 pages; 75 pages is the maximum length allowed.

Project Narratives that exceed 75 pages will have the additional pages removed and only the first 75 pages of the Project Narrative will be provided to the merit reviewers for funding consideration. The Project Work Plan, Letters of Commitment, and Vitae of Key Personnel are not counted as part of the Project Narrative for purposes of the 75-page limit, but all of the other sections noted below are included in the limit.

The sample components of the Project Narrative counted as part of the 75 page limit include:

Summary/Abstract Problem Statement Goal(s) and Objective(s) Proposed Intervention Special Target Populations and Organizations Outcomes Project Management Evaluation Dissemination Organizational Capability

The Project Narrative is the most important part of the application, since it will be used as the primary basis to determine whether your project meets the minimum requirements for grants under the authorizing statutes. The Project Narrative should provide a clear and concise description of your project. ACL recommends that your project narrative include the following components:

Summary/Abstract mailto:katherine.cargill-willis@acl.hhs.gov

All applications for grant funding must include a summary/abstract that concisely describes the proposed project, including goals, objectives, overall approach (including target population and significant partnerships), anticipated outcomes, products to be developed, and duration. It should be written for an audience that includes the general public. To ensure uniformity, please limit the length to 265 words or less on a single page with a font size of not less than 11, doubled-spaced.

More detailed instructions for completing the summary/abstract, including simple descriptions of terms and a sample abstract, are included in the “Instructions for Completing the Project Summary/Abstract" in Section VIII of this funding opportunity announcement.

Challenges and Opportunities This section should describe, in both quantitative and qualitative terms, the nature and scope of the particular problem or issue the proposed intervention is designed to address, including how the project will potentially affect older adults and /or people with disabilities, their families and caregivers and the health care and social services systems.

Goals and Objectives This section should consist of a description of the project's goal(s) and major objectoves. Uness the project involves multiple, complex interventions, we recommend you only have one overall goal.

Approach This section should provide a clear and concise description of the intervention you are proposing to use to address the problem described in the "Problem Statement". You should also provide the rationale for using the particular intervention, including factors such as: "lessons learned" for similar projects previously tested in your communuty, or in other areas of the country; factors in the larger environment that have created the "right conditions" for the intervention (e.g., exisitng social or economic factors that you'll be able to take advantage of, etc.). Also note any major barriers you anticipate encountering, and how your project will be able to overcome those barriers. Be sure to describe the role and makeup of any strategic partnerships you plan to involve in implementing the intervention, including other organizations, supporters, and/or consumer groups.

Special Target Populations and Organizations This section should describe how you plan to involve organizations in a meaningful way in the planning and implementation of the proposed project. This section should also describe whether, and if so, how the proposed intervention will target disadvantaged populations, including limited-English speaking populations, those of greatest economic need and those of greatest social need.

Outcomes This section of the project narrative must clearly identify the measurable outcome(s) that will result from the project. (NOTE: ACL will not fund any project that does not include measurable outcomes). This section should also describe how the project’s findings might benefit the field at large, (e.g., how the findings could help other organizations throughout the nation to address the same or similar problems.) List measurable outcomes in the optional work plan grid (“Project Work Plan – Sample Template”) under “Measurable Outcomes” in addition to any discussion included in the narrative along with a description of how the project might benefit the field at large.

A “measurable outcome” is an observable end-result that describes how a particular intervention benefits consumers. It demonstrates the functional status, mental well-being, knowledge, skill, attitude, awareness or behavior.) It can also describe a change in the degree to which consumers exercise choice over the types of services they receive, or whether they are satisfied with the way a service is delivered. Additional examples include: a change in the responsiveness or cost-effectiveness of a service delivery system; a new model of support or care that can be replicated in the ACL network; new knowledge that can contribute to the field of community living; a measurable increase in community awareness; or a measurable increase in persons receiving services. A measurable outcome is not a measurable “output”, such as: the number of clients served; the number of training sessions held; or the number of service units provided.

You should keep the focus of this section on describing what outcome(s) will be produced by the project. You should use the Evaluation section noted below to describe how the outcome(s) will be measured and reported.

Your application will be scored on the clarity and nature of your proposed outcomes, not on the number of outcomes cited. It is totally appropriate for a project to have only ONE outcome that it is trying to achieve through the intervention reflected in the project’s design.

Project Management This section should include a clear delineation of the roles and responsibilities of project staff, consultants and project organizations, and how they will contribute to achieving the project's objectives and outcomes. It should specify who would have the day-to-day responsibility for key tasks such as leadership of project; monitoring the project's on-going progress (i.e., measure of performance towards the goals stated in the funding opportunity announcement and for your specific intervention/activities), preparation of reports; communications with other partners and ACL. It should also describe the approach that will be used to monitor and track progress on the project's tasks and objectives.

Evaluation This section should describe the specific outcomes (e.g., changes in clients, organizations, and/or communities) expected as a result of this funding as well as method(s), techniques and tools that will be used to: 1) determine whether the proposed intervention achieved its anticipated outcome(s), and 2) document the "lessons learned" - both positive and negative -from the project that will be useful to people interested in replicating the intervention, if it proves successful.

Dissemination This section should describe the method that will be used to disseminate the project's results and findingd in a timely manner and in easily understandable formats, to parties who might be interested in using the results of the project to inform practice, service delivery, program development, and/or policy-making, including those partied who would be interested in replicating the project.

Organizational Capacity Statement Each application should include an organizational capability statement and vitae for key project personnel. The organizational capability statement should describe how the applicant agency (or the particular division of a larger agency which will have responsibility for this project) is organized, the nature and scope of its work and/or the capabilities it possesses. It should also include the organization’s capability to sustain some or all project activities after federal financial assistance has ended.

This description should cover capabilities of the applicant agency not included in the program narrative, such as any current or previous relevant experience and/or the record of the project team in preparing cogent and useful reports, publications, and other products. If appropriate, include an organization chart showing the relationship of the project to the current organization.

Please attach short vitae for key project staff only. Neither vitas nor an organizational chart will count towards the narrative page limit. Also include information about any contractual organization(s) that will have a significant role(s) in implementing project and achieving project goals.

Budget Narrative/Justification The Budget Narrative/Justification can be provided using the format included in the document, “Budget Narrative/Justification – Sample Format.” Applicants are encouraged to pay particular attention to this document, which provides an example of the level of detail sought. A combined multi-year Budget Narrative/Justification, as well as a detailed Budget Narrative/Justification for each year of potential grant funding is required Below you will find standard language that can be used, or modified as needed, for a one year grants program.

Work Plan

The Project Work Plan should reflect and be consistent with the Project Narrative and Budget and should cover all three (3) years of the project period. It should include a statement of the project’s overall goal, anticipated outcome(s), key objectives, and the major tasks / action steps that will be pursued to achieve the goal and outcome(s). For each major task / action step, the work plan should identify timeframes involved (including start- and end-dates), and the lead person responsible for completing the task. Please use the “Project Work Plan - Sample Template” format as a reference and resource, if desired.

Letters of Commitment from Key Participating Organizations and Agencies

Include confirmation of the commitments to the project (should it be funded) made by key collaborating organizations and agencies in this part of the application. Any organization this is specifically named to have a significant role in carrying out the project should be considered an essential collaborator. For applications submitted electronically via http://www.grants.gov, signed letters of commitment should be scanned and included as attachments. Applicants unable to scan the signed letters of commitment may fax them to the ACL Office of Grants Managemenrt at 202-357-3467 by the application submission deadline. In your fax, be sure to http://www.grants.gov include the funding opportunity number and your agency name.

3. Submission Dates and Times Due Date for Applications: 08/12/2019 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 http://www.grants.gov.

Grants.gov can take up to 48 hours to notify you of a successful submission.

In addition, if you are submitting your application via Grants.gov, you must (1) be designated by your organization as an Authorized Organization Representative (AOR) and (2) register yourself with Grants.gov as an AOR. Details on these steps are outlined at the following Grants.gov web page: http://www.grants.gov/web/grants/register.html.

After you electronically submit your application, you will receive from Grants.gov an automatic notification of receipt that contains a Grants.gov tracking number. (This notification indicates receipt by Grants.gov only.) If you are experiencing problems submitting your application through Grants.gov, please contact the Grants.gov Support Desk, toll free, at 1-800-518-4726.

You must obtain a Grants.gov Support Desk Case Number and must keep a record of it.

If you are prevented from electronically submitting your application on the application deadline because of technical problems with the Grants.gov system, please contact the person listed under For Further Information Contact in section VII of this notice and provide a written explanation of the technical problem you experienced with Grants.gov, along with the Grants.gov Support Desk Case Number. ACL will contact you after a determination is made on whether your application will be accepted.

Note: We will not consider your application for further review if you failed to fully register to submit your application to Grants.gov before the application deadline or if the technical problem you experienced is unrelated to the Grants.gov system.

If for any reason (including submitting to the wrong funding opportunity number or making corrections/updates) an application is submitted more than once prior to the application due date, ACL will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

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 cut off date.

Grants.gov (http://www.grants.gov) will automatically send applicants a tracking number and date of receipt verification electronically once the application has been successfully received and validated in http://www.grants.gov.

http://www.grants.gov/web/grants/register.html http://www.grants.gov/ http://www.grants.gov/

4. Intergovernmental Review This funding opportunity announcement is not subject to the requirements of Executive Order 12372, "Intergovernmental Review of Federal Programs."

5. Funding Restrictions The following activities are not fundable:

Construction and/or major rehabilitation of buildings Basic research (e.g. scientific or medical experiments) Continuation of existing projects without expansion or new and innovative approaches

Note: A recent Government Accountability Office (GAO) report has raised considerable concerns about grantees and contractors charging the Federal Government for additional meals outside of the standard allowance for travel subsistence known as per diem expenses. Executive Orders on Promoting Efficient Spending (E.O. 13589) and Delivering Efficient, Effective and Accountable Government (E.O. 13576) have been issued and instruct Federal agencies to promote efficient spending. Therefore, if meals are to be charged in your proposal, applicants should understand such costs must meet the following criteria outlined in the Executive Orders and HHS Grants Policy Statement:

Meals are generally unallowable except for the following:

o For subjects and patients under study (usually a research program);

o Where specifically approved as part of the project or program activity, e.g., in programs providing children’s services (e.g. Head Start);

o When an organization customarily provides meals to employees working beyond the normal workday, as a part of a formal compensation arrangement, o As part of a per diem or subsistence allowance provided in conjunction with allowable travel; and o Under a conference grant, when meals are necessary and integral part of a conference, provided that meal costs are not duplicated in participants' per diem or subsistence allowances. (Note: conference grant means the sole purpose of the award is to hold a conference.)

6. Other Submission Requirements Letters of intent should be emailed to: katherine.cargill-willis@acl.hhs.gov

Katherine Cargill-Willis AoD Washington, DC

V. Application Review Information

1. Criteria

Applications are scored by assigning a maximum of 100 points across the desired review criteria:

a. Project Relevance & Current Need (15 points)

b. Approach (45 points)

c. Evaluation Plan (15 points)

d. Dissemination (10 points)

e. Organizational Capacity (10 points)

f. Budget (5 points)

Budget Maximum Points:5 Provides a narrative budget justification that describes how the categorical costs are derived and discusses the necessity, reasonableness, and appropriateness of the costs. (3 points) Provides a budget with line-item detail and detailed calculations for each budget object class identified on the Budget Information form; detailed calculations that include estimation methods, quantities, unit costs and other similar quantitative detail sufficient for the calculation to be duplicated; a breakout by the funding sources identified in Block 15 of the SF-424. (2 points)

Project Relevance & Current Need Maximum Points:15 Clearly establishes the need to develop comprehensive protocols and guidelines for medical discrimination issues that exist throughout the entire life span for the ID/DD population using relevant and current research and data, including that collected through planning studies and/or focus groups with individuals with intellectual and developmental disabilities (ID/DD), families and medical providers. (4 points) Describes how individuals with ID/DD and their family members were consulted in the development of the application and provides evidence that feedback from such representatives was utilized in developing the project proposal, including the goals and goal-related activities.

(3 points) Shows a direct relationship between the needs identified based on research, data and planning studies and feedback from individuals with ID/DD and their family members and the goals and goal-related activities in the project proposal.