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AREA AGENCIES ON AGING
Annual Implementation PlanFor Fiscal Year 2009
INSTRUCTIONS
Michigan Office of Services to the AgingP.O. Box 30676
Lansing, MI 48909-8176(517) 373-8230
TABLE OF CONTENTS
General Instructions and Timetable.........................................................................3
Sections of the Plan
I. Executive Summary...........................................................................4
A. Narrative..................................................................................4B. Fiscal Year 2009 Services Summary......................................4
II. Budget and Organizational Chart.......................................................5
A. FY 2009 Area Plan Grant Budget and Services Detail............6B. FY 2009 Operating Budget, Wages and Salaries
Budget.....................................................................................6C. Organizational Chart...............................................................6
III. Revisions/Additions/Deletions............................................................7
A. Program Development............................................................8Program Development Chart...................................................9
IV. List of Appendices.............................................................................10
A. Public Hearing.........................................................................11B. Membership of the Board of Directors.....................................12C. Membership of the Advisory Council.......................................15C1. Current Provider Demographics..............................................17D. Proposal Selection Criteria (if applicable)................................18E. Planned Entrepreneurial Activities (if applicable)....................19F. Regional Service Definitions (if applicable..............................20G. FY 2009 Transfers (if applicable)............................................21H. FY 2009 Nutrition Budget (if applicable)..................................22I. Supplemental Cash-in-Lieu of Commodities...........................23J. Administration of Direct Services............................................24J1. Care Management...................................................................27
Update Workplan Chart...........................................................29L. Waiver of Minimum Percentage/Priority Service.....................30
V. Assurances and Certifications............................................................31
A. Assurances and Certifications.................................................31B. Assurance of Compliance With Title VI of
the Civil Rights Act of 1964.....................................................33Elliott-Larson Act.....................................................................35
C. Signature Page........................................................................36D. Glossary of Acronyms.............................................................37
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GENERAL INSTRUCTIONS
Rationale: Older Americans Act (OAA) of 1965, as amended, Section 306. (a) states “Each area agency on aging designated...shall, in order to be approved by the State agency, prepare and develop an area plan for a planning and service area.”
Each of Michigan’s sixteen area agencies on aging (AAA) shall submit their plan to the Michigan Office of Services to the Aging (OSA) for review and approval by the Michigan Commission on Services to the Aging. AAAs will utilize this plan in conjunction with the Fiscal Years 2007 - 2009 Multi-Year Plan to guide their work over the coming year. The Area Implementation Plan (AIP) will cover the FY 2009: October 1, 2008 through September 30, 2009.
Format:Beginning in FY 2009, all Multi Year Plan and Annual Implementation Plan (MYP/AIP) documents will need to be submitted in the electronic format provided. This document was created with Microsoft WORD as a FORM. Please type your explanations/descriptions in the gray boxes, they will expand as you type.
Documents to be submitted:1. This WORD FORM document 2. AIP Service Budget -Excel3. Operating Budget and AAA Wages & Salaries Budget-Excel4. Organizational Chart- in any program you wish 5. Direct Service Budget- Excel
These files will be available on http://www.miseniors.net. You can go to the website by clicking the link within the document.
An original signed “Signature Page” must to be sent to your field representative at the following address:
Mailing Address: Michigan Office of Services to the AgingPO Box 306767109 W Saginaw, First FloorLansing, MI 48909-8176
Draft Due to OSA: not required
Final Due to OSA: July 11, 2008
County/Local Unit of Government Review: AAAs must seek approval of the AIP from the local municipalities within their Planning and Service Area (PSA). This may include, but not be limited to: County Boards of Commissioners, city councils, or township boards. The AAA must deliver a letter and a copy of the AIP with delivery and signature confirmation to the Chairperson of each municipal group within the PSA requesting adoption by July 31, 2008. If the AAA does not receive a response, either in writing, via email, or verbally from the county or local unit of government by July 31, 2008, the AIP is deemed passively approved. The AAA must notify their OSA field
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representative by August 1, 2008 whether their counties or local units of government formally approved, passively approved, or disapproved the AIP. An approval from any federally recognized tribes in the PSA is also recommended.
SECTIONS OF THE AREA IMPLEMENTATION PLAN
I. EXECUTIVE SUMMARY
A. Narrative
This section provides an opportunity for AAAs to summarize the major sections and highlights of the FY 2009 AIP. It should include tasks and goals for the upcoming year, including partnerships and collaborative initiatives. In addition, please include major accomplishments and updates to the scope of the AAA’s activities to date as it relates to the FY 2007 – 2009 Multi-Year Area Implementation Plan. Include baseline service data such as a summary of clients and units served by service for the most recent completed fiscal year. Also include the AAAs efforts to distribute the AIP to, and gain support from, the appropriate county or local units of government.
Type your narrative in the gray box:
B. FY 09 Services Summary (formerly Funded Services)
Complete the FY 09 Services Summary page provided. The intent of the summary is to convey the services that the AAA will fund in FY 09 as well as the method by which the services will be provided. The Services Summary page should be based on the most current Statement of Grant Award.
The services are listed in the first column on the left-hand side of the page, in the same order as they are listed in the OSA Operating Standards for Service Programs. AAA Regional Services should be listed in the area designated for region specific services.
In the second column, indicate the percentage of funding allocated to each service as it relates to the total amount of funding. In addition, in the title rows for Access, In-home, Community, and Region-specific services, indicate the percentage for the entire category of services. At the bottom of the percent column, the total of all percentages should equal 100%. You do not need to limit your entries to whole numbers.
The third, fourth and fifth columns indicate the method by which the service is provided: Contracted, Purchased, Direct. For each service, indicate an X in the appropriate column. Do not place an X in the rows that are shaded gray.
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The bottom row on the page is for funding. Indicate the total amount of funding and the amount for Contracted, Purchased, and Direct Services.
Attach a narrative describing any major deviation (10% or greater) from the current fiscal year. For example, a service that was funded in FY 08 that will not be funded in FY 09 should be explained in a narrative. Similarly, if the AAA is funding a new service in FY 09, narrative should be included to explain the rationale.
Type your explanation of any 10% deviation, or additional services, in the gray box:
BUDGET AND ORGANIZATIONAL CHART
Rationale: Older Americans Act, Section 306, #2 “and assurances that the area agency on aging will report annually to the State agency in detail the amount of funds expended for each such category during the fiscal year most recently concluded; “
A. FY 09 Area Plan Grant Budget and Services Detail (This is a separate document to be emailed to field representative)
The Area Plan Grant Budget consists of three pages. Page one of the Area Plan Grant Budget is a summary of services and administration funds received from OSA and the general allocation of those funds. It is intended that the various entries on this page will agree with the figures shown on the most recent Statement of Grant Award (SGA).
Page two provides detail on the allocation of support services funds.
Page three provides detail on nutrition, ombudsman, and respite services. Complete the detail for nutrition and ombudsman. Detail on respite care must be completed if the amount received is greater than or equal to $5,000.00.
When the agency is using the Excel spreadsheet provided by OSA, the identifying information entered at the top of page two will automatically appear at the top of pages one and three. Likewise, the subtotals of figures entered on the Support and Nutrition Services Detail pages are automatically carried forward to the Services Summary on page one. The total column in the Services Summary section must equal the various amounts indicated on the SGA.
The Support Services Detail Budget should reflect the entire Tobacco Settlement Respite (TSR) Grant in the State Tobacco Column. Detail should be broken down between respite and adult day services; the two should equal the total grant. The total amount will also be reflected on the Area Plan Grant Budget (page one) in the Services Summary section in row 19. - State Tobacco Respite Care.
Funds used to pay for TSR administration (the administration amount is limited to 9% of total funds expended) should be shown in the Administration table on page
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one. While these funds may pay for the costs of administration, they are not required to be matched and they may not be used to match federal administration. Match for TSR funds is accounted for in the Services Summary table on page one and the Support Services Detail on page two.
In addition, discrete budget lines have also been added to the Nutrition Services Detail Budget for Nutrition Counseling and Nutrition Education Services. Funding for these services can come from Title III-C1, Title III-C2, State Congregate Meals, and State Home Delivered Meals. Nutrition Counseling and Nutrition Education can also be funded by of Title III-E (Family Caregiver Support Program). When funded by Title III-E, the service should be identified on the Support Service Detail (page two) under Section 6 Region Specific.
The federal and state entries in the Administration-Revenues section must equal the amounts shown on the SGA for administration. Local Cash and Local In-Kind entries in the Administration-Revenues section are automatically carried forward from the boxes at the bottom of the page. Any Care Management funds retained by the agency for the administration of a care management contract should be indicated on the “Other” line.
The Administration-Expenditures section must account for and equal all revenues shown in the Administration-Revenues Total column. The number of full time equivalent positions supported with the total revenues must be indicated in the appropriate space.
B. FY 09 AAA Operating Budget and AAA Wages & Salaries Budget (This is a SEPARATE document to be emailed to field representative)
The AAA Operating Budget and the AAA Wages & Salaries Budget should be completed and included with the AIP. In budget please identify all agency personnel, indicating those supported by funding from all sources, including the MIChoice waiver.
Key management positions for the respective area agency must be identified specifically. These positions include; AAA Director, AAA Deputy Director, Financial Manager, Department Heads/Division Managers, etc. All other positions may be grouped as appropriate i.e., program managers, nurses, social workers, etc. SCSEP program management staff and related expenses should be identified. SCSEP enrollees should not be identified as area agency staff. SCSEP enrollee wages and other expenses should be included under Contractual Services.
C. Organizational Chart(This is a SEPARATE download to be emailed to field representative)
Your organizational chart may be created in any program you choose.
The AAA organizational chart must accompany the budget. All positions listed in the AAA Wages & Salaries budget must be reflected on the organizational chart. List names of key staff on the organizational chart.
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REVISIONS/ADDITIONS/DELETIONS
In this section, include any revisions, additions and/or deletions made to the Advocacy Strategy, Service Delivery Plan, and/or Community Focal Points selection criteria sections of the MYP. Changes in specific Focal Point designations must be reflected. It should be understood that it is not routinely necessary to revise these sections of the MYP. As originally written, these sections should be valid for the entire three years. However, if during the course of the past year it has become evident that a major change in direction is required, a revision/addition/deletion must be submitted. The rationale for the action taken must also be included. Explain your revisions, additions, and deletions here.
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PROGRAM DEVELOPMENT
Rationale: Older Americans Act, Section 306, (4)(A)(i) “provide assurances that the area agency on aging will set specific objectives for providing services to older individuals with greatest economic need and older individuals withgreatest social need, include specific objectives for providing services to low-income minority individuals and older individuals residing in rural areas, and include proposed methods ofcarrying out the preference in the area plan;”
New program development initiatives for FY 09 and updates to the FY 07 –09 objectives should be included in this section. If the AAA utilizes program development funds, the Program Development form must be completed. The objectives must be written so that they are measurable, verifiable and time-limited. Specific outcomes, activities to achieve the desired outcomes and time lines are required for each objective. This information can be provided in either narrative form and/or in a chart.
As a reminder, program development initiatives should reflect the changing demographics of the older population in the PSA and must, at a minimum, seek to enhance service coordination, build public/private partnerships and increase the capacity to deliver needed services in the PSA.
Program Development Objectives: For FY 09, you must include at least four (4) program objectives. The objectives must reflect the four (4) OSA State Plan Objectives, which are:
1). Work to improve the health and nutrition of older adults Please create an objective that continues the Evidence Based Disease Prevention objective from 2008. This should also address the expansion of the coalition formed in 2008.2). Ensure that older adults have a choice in where they live through increased access to information and services Please create an objective that builds upon, or is a continuation of a 2008 objective; OR Write a new objective that addresses this State Plan Objective.3). Protect older adults from abuse and exploitation Please create an objective that builds upon, or is a continuation of a 2008 objective; OR Write a new objective that addresses this State Plan Objective.4). Improve the effectiveness, efficiency and quality of services provided through the Michigan Aging Network and its partners. Please create an objective that builds upon, or is a continuation of a 2008 objective; OR Write a new objective that addresses this State Plan Objective.
Additionally, program development objectives must be included for unresolved compliance issues identified through the OSA assessment process.
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Note: OSA will complete a detailed review of the agency’s program development activities through the implementation of a Program Development Assessment.
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PROGRAM DEVELOPMENTFiscal Year: 2009
State Objective:AAA Goal:AAA Objective:
Desired Outcome Activities Timeline
To add program development pages, hit “Enter”, then “Alt F8” Select “AddProgramDevPages”. for each page needed.
List of AppendicesPlease indicate with a checkmark which appendices are included
Appendix A Public Hearing ..........................................13 Required
Appendix B Membership: Board of Directors...................14 Required
Appendix C Membership: Advisory Board.......................15 Required
Appendix C1 Current Provider Demographics...................16 Required
Appendix D Proposed Selection Criteria..........................17 If Applicable
Appendix E Planned Entrepreneurial Activities................18 If Applicable
Appendix F Regional Service Definitions.........................19 If Applicable
Appendix G FY 2009 Transfers........................................20 If Applicable
Appendix H FY 2009 Nutrition Program ..........................21 If Applicable
Appendix I Supplemental Cash in Lieu of Commodity. . .22 Required
Appendix J Administration of Direct Services..................23 If Applicable
Appendix J (enter service in gray area)................25 If Applicable
Appendix J (enter service in gray area)................25 If Applicable
Appendix J (enter service in gray area)................25 If Applicable
Appendix J (enter service in gray area)................25 If Applicable
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APPENDIX APUBLIC HEARINGS
Fiscal Year: 2009
Rationale: Older Americans Act, Section 306, (6) “provide that the area agency on aging will—(A) take into account in connection with matters of general policy arising in the development and administration of the area plan, the views of recipients of services under such plan;”
In order to gather information regarding the needs of older persons in the PSA, a public hearing on the AIP must be held in the PSA. The hearing should be held in an accessible facility. Persons need not be present at the hearing in order to provide testimony; written testimony provided at a time other than at the public hearings must be accepted. The public hearing notice should be available at least thirty (30) days in advance of the scheduled hearing. This notice must indicate the availability of a summary of the AIP at least fifteen (15) days prior to the hearing, and information on how to obtain the summary. Persons who should be notified of the public hearing include elected officials, service providers, older persons, and the general public.
The following items, at a minimum, should be available in the summary for the public hearing:
FY 2009 Services Summary FormFY 2009 Area Plan Grant Budget (cover page)Program Development Objectives
Appendix F, Regional Service DefinitionsAppendix G, FY 2009 TransfersAppendix J, Administration of Direct Services
Include the date, time, location and accessibility of the public hearing, the number of attendees and complete the narrative section.
DATE LOCATION TIMEBARRIER FREE
(Y or N)NUMBER of ATTENDEES
Narrative:
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APPENDIX BBOARD OF DIRECTORS MEMBERSHIP
Fiscal Year: 2009
Provide the information requested for the AAA Board of Directors. This includes the total number of members, number of members aged sixty (60) and over, demographics, and affiliation. Also, indicate the number of vacancies that exist on Board membership. This information should be accurate as of the date the AIP is submitted to OSA.
DEMOGRAPHICS
Asian/Pacific Island
African American Arab/Chaldean
Native American/Alaska Native
Hispanic Origin
Persons with
DisabilitiesFemale
Total
Total Membership
Aged 60 or Over
NAME of BOARD MEMBER GEOGRAPHIC AREA
AFFILIATION CHECK THOSE THAT ARE APPROPRIATE
Elected Official
Appointed Community Rep.
Con’t.
NAME of BOARD MEMBER GEOGRAPHIC AREA
AFFILIATION CHECK THOSE THAT ARE APPROPRIATE
Elected Official
Appointed Community Rep.
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APPENDIX CADVISORY COUNCIL MEMBERSHIP
Fiscal Year: 2009
Rationale: Older Americans Act, Section 306 (6) (D) “establish an advisory council consisting of olderindividuals (including minority individuals and older individuals residing in rural areas) who are participants or who are eligible to participate in programs assisted under this Act, representatives of older individuals, local elected officials, providers of veterans’ health care (if appropriate), and the general public, to advise continuously the area agency on aging on all matters relating to the development of the area plan, the administration of the plan and operations conducted under the plan;”
Provide the information requested for the AAA Advisory Council membership. This includes the total number of members, number of members aged sixty (60) and over, demographics, and affiliation. Also indicate the number of vacancies that exist in Advisory Council membership. This information should be accurate as of the date the AIP is submitted to OSA.
DEMOGRAPHICS
Asian/Pacific Island
AfricanAm
ArabChaldean
Native American/Alaskan
Hispanic Origin Persons with
DisabilitiesFemale
Total
Total Membership
Age 60 or Over
NAME of ADVISORY COUNCIL MEMBER GEOGRAPHIC AREA AFFILIATION
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APPENDIX C1CURRENT PROVIDERS DEMOGRAPHICS
Fiscal Year 2009
Cluster 1providers
DEMOGRAPHICS
Asian/Pacific Island
African American Arab/Chaldean
Native American/Alaskan
Hispanic Origin
Persons with Disabilities
Female Total
Number of contractors1
Number of employees of contractors2
The above table should reflect contractors/staff that are funded by the AAA only.
The information gathered from this document will be used in the cultural competency work that is being conducted by OSA. Please contact your field representative for more information on the cultural competency work.
1 These numbers should reflect either the demographics of the owner, such as a “female owned business” or, if a non-profit, 501C3, should be listed under the demographics that most describe the board of directors.
2 Please ask your contractors to pick a specific day and report the breakdown of demographic categories. (i.e. on” April 1st, 2009 the breakdown was…” ). The date should be consistent for all contractors.
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APPENDIX DPROPOSAL SELECTION CRITERIA (if applicable)
Fiscal Year: 2009
D. Proposal Selection Criteria (if applicable)
If the criteria that will be used to select agencies that will receive contracts for service provision has changed from what was submitted in the FY 07 – 09 MYP, then updated information should be submitted.
Date Proposal Selection Criteria Approved by AAA Policy Board
Outline the criteria that will be used to select agencies that will receive contracts for service provision.
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APPENDIX EPLANNED ENTREPRENEURIAL ACTIVITIES (if applicable)
Fiscal Year: 2009
In the MYP, the entrepreneurial/fund raising activities in which the agency proposes to engage were listed for each year of the MYP. If these activities have changed for FY 09 the AAA should list the new activities, estimated amount(s) of revenue to be gained and the purpose for which the funds will be used.
New Activities Expected Revenue Funding Purpose
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APPENDIX FREGIONAL SERVICE DEFINITION(S) (if applicable)
Fiscal Year: 2009
AAAs must complete Appendix F for any new Regional Service Definitions proposed for FY 09 that were not previously approved in the FY 07 – 09 MYP. For each regional service definition, provide the Service Category, Service Definition, Unit of Service, and Minimum Standards.
Service Category Service Definition Unit of Service
Minimum Standards
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APPENDIX GREQUEST TO TRANSFER FUNDS (if applicable)
Fiscal Year 2009Rationale: Older Americans Act, Section 307 (7) “The Assistant Secretary shall annually collect, and include in the report required by section 207(a), data regarding the transfers described in paragraphs (4)(A) and (5)(A), including—(A) the amount of funds involved in the transfers, analyzed by State; (B) the rationales for the transfers; (C) in the case of transfers described in paragraphs (4)(A) and (5)(A), the effect of the transfers of the provision of services, including the effect on the number of meals served, under— (i) subpart 1 of part C; and (ii) subpart 2 of part C; and (D) in the case of transfers described in paragraph (5)(A)— (i) in the case of transfers to part B, information on the supportive services, or services provided through seniorcenters, for which the transfers were used; and (ii) the effect of the transfers on the provision of services provided under—(I) part B; and (II) part C, including the effect on the number of meals served.”
Indicate the amount of FY 09 funds that the AAA requests to transfer from Title III-B Supportive Services to Title III-C Nutrition Services, Title III-C1 Congregate Nutrition Services to Title III-B Supportive Services for in-home services, and/or from Title III-C1 Congregate Nutrition to Title III-B Supportive Services for participant transportation to and from meal sites to possibly increase participation in the congregate nutrition program. Provide rationale for the transfer request.
1) The AAA requests approval to transfer $ _______________ from Title III-B Supportive Services to Title III-C Nutrition Services. The agency assures that this action will not result in a reduction in support for in-home services and senior center staffing. The rationale for this request is listed below.
2) The AAA requests approval to transfer $ _______________ from Title III-C1 Congregate Nutrition Services to Title III-B Supportive Services for in-home services. The rationale as to why congregate participation cannot be increased is listed below.
3) The AAA requests approval to transfer $ _______________ from Title III-C1 Congregate Nutrition to Title III-B Supportive Services for participant transportation to and from meal sites to possibly increase participation in the congregate nutrition program.
The rationale for your transfers should include as much detail as possible. Be specific as to why you are making the request.
Rationale:
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APPENDIX HNUTRITION BUDGET (If Applicable)
Fiscal Year 2009
FTE: ________Congregate Home Delivered
Local Match TotalFederal State Federal State
Salary/Wages
Fringe Benefits
Travel
Conferences
Office
Utilities
Equipment
Audit
Other (Specify):
a.
b.
c.
TOTAL
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APPENDIX IAGREEMENT FOR RECEIPT OF SUPPLEMENTAL CASH-IN-LIEU OF
COMMODITY PAYMENTS FOR THE NUTRITION PROGRAMFOR THE ELDERLY (if applicable)
Fiscal Year 2009
Please check one: WE DO NOT ANTICIPATE “NSIP ONLY” MEALS WE DO ANTICIPATE “NSIP ONLY” MEALS
If you DO anticipate “NSIP ONLY” meals, please complete this agreement.
The (enter AAA name) (hereinafter referred to as the GRANTEE), under contract with
the Michigan Office of Services to the Aging (OSA), affirms that it has contractor(s) that have
secured local funding for additional meals for senior citizens which is not included in the FY
2009 application and contract as approved by the GRANTEE. These funds will be used to
produce a total of (enter number) meals during the fiscal year ending September 30,
2009. These meals are administered by the contractor(s) as part of the Nutrition Program for
the Elderly, and the meals served are in compliance with all State and Federal requirements
applicable to Title III, Part C of the Older Americans Act of 1965, as amended.
Therefore, the GRANTEE agrees to report monthly on a separate OSA Financial Status
Report the number of meals served utilizing the local funds, and in consideration of these
meals will receive separate reimbursement at the authorized per meal level cash-in-lieu of
United States Department of Agriculture commodities, to the extent that these funds are
available to OSA.
The GRANTEE also affirms that the cash-in-lieu reimbursement will be used exclusively to
purchase domestic agriculture products, and will provide separate accounting for receipt of
these funds.
APPENDIX J and J1 WAIVER FOR DIRECT PROVISION OF SERVICE
Fiscal Year: 2009
Rationale: Older Americans Act Section 307 (8)(A) “The plan shall provide that no supportive services, nutrition services, or in-home services will be directly provided by the State agency or an area agency on aging in the State, unless, in the judgment of the State agency— (i) provision of such services by the State agency or the area agency on aging is necessary to assure an adequatesupply of such services; (ii) such services are directly related to such State agency’s or area agency on aging’s administrative functions; or (iii) such services can be provided more economically, and with comparable quality, by such State agency or areaagency on aging.”
Please check one:
Updates for the waivers approved in the MYP 07-09 are attached and no new services are requested.
Updates for the waivers approved in the MYP 07-09 are attached no services are requested.
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APPENDIX JWAIVER FOR DIRECT PROVISION OF NEW SERVICES
FISCAL YEAR 2009
If the area agency administers a MIChoice Waiver and directly provides any of the 13 waiver services the Waiver for Direct Provision of Service (Appendix J) must be requested for each of the direct service(s) provided. Please indicate which waiver services will be provided by the AAA during the FY 09 and the funding source:
Agency DOES NOT offer Waiver Services
SERVICE OSA-FUNDED WAIVERChoreHome Care AssistanceHome Injury ControlHomemakingHome Delivered MealsHome Health AideMedication ManagementPersonal CarePers Emer. Response (PERS) Respite CareFriendly ReassuranceAdult Day ServicesCongregate MealsHealth Promotion/PreventionVision/HearingPrevention of Elder AbuseCounselingRespiteKinship CareCaregiver Ed/Supp/TrainingNursing Home TransitionFiscal Intermediary
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Personal Duty Nursing
If the AAA proposes to administer services, other than access services, directly in FY 09 that were not previously approved in the FY 07-09 MYP, the services should be described in the section below. Include justification why the AAA should administer the service(s) directly.
Service to Be Provided:
Amount of Federal/State Funds(Please type your response in gray area)
Geographic Area Served
(Please type your response in gray area)
Rationale for Service
(Please type your response in gray area)
If you are requesting more than 1 new waiver service, please place the cursor at the end of the page and hit “Enter” then “Alt F8”. Select “AddAppendixJ”
Repeat this as many times as you need additional pages. To update your previously approved waiver services, please scroll down to Appendix J1.
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APPENDIX J1Work Plan Update
Previously Approved Waiver Services, Care Management
Previously Approved Waiver Services
Please submit your Work Plan Update on the form that follows. If you need additional forms, please see the instructions that follow the form.
Care Management
Rationale: Older Americans Act, Section 306 (7)”provide that the area agency on aging will facilitate the coordination of community-based, long-term care services designed to enable older individuals to remain in their homes, by means including— (A) development of case management services as a component of the long-term care services, consistent with the requirements of paragraph (8)
Please complete the Work Plan Update (Appendix J1) and the Direct Services Budget.
For Care Management (CM), utilize the work plan provided. It must include the following information contracted for current year and projected for FY 09: number of client prescreenings, number of initial client assessments, number of initial client care plans, and total number of clients (carry-over plus new), and the staff to client ratios for active and maintenance clients per full-time care manager.
Allowable costs against state CM funds include wages/salaries and fringe benefits of direct staff, travel, training, supplies, occupancy, communications, equipment, administration, purchased services and other. Administration may not exceed 10% of direct labor costs (wages/benefits only of direct staff), except when the agency has an OSA approved cost allocation plan documenting that the agency’s administrative cost for this program exceeds 10%. Attach the agency’s approved cost allocation plan, if applicable.
Non-allowable costs include equipment items defined as tangible items with a value of $5000 or more, with a life expectancy greater than one year. All proposed equipment purchases must be detailed in a budget narrative.
OSA CM funds require matching contributions of at least 10%. Matching funds may consist of cash or the documented fair market value of in-kind contributions. Provide a breakdown of matching funds by line item. A description of the source and intended use of
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match is required on the Schedule of Match (Form A) as described below. If in-kind match consists of care provided by unpaid caregivers indicated how agency will document.
A description of Other Resources is required on the Schedule of Other Resources (Form A) as described below.
Schedule of Match and Other Resources (Form A): Indicate the source (e.g. Local government) and value of match resources that will be directly allocated to the program. For t
The Schedule of Other Resources indicate and itemize the source and value of other resources that will be directly allocated to the program. Other resources include, but are not limited to, Targeted Case Management (TCM), purchase of service funds, miscellaneous grant funds, Older Americans Act funds, and program income.
TCM funds must be used to offset CM expenditures during the fiscal year in which the approved date of service occurred. OSA CM funding will be reduced by the amount of unspent TCM at fiscal year end.
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APPENDIX J1DIRECT PROVISION OF SERVICES
WORK PLANService: Time Period: 2007-2009 2009 Only
Goals and Activities Planned Time Frame Accomplishments
If you are requesting more than 1 new waiver service, please place the cursor at the end of the page and hit “Enter” then “Alt F8”. Select “AddAppendixJ1”Repeat this as many times as you need additional pages.
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APPENDIX L
WAIVER OF MINIMUM PERCENTAGEFOR A PRIORITY SERVICE CATEGORY
Fiscal Year: 2009
Priority Service Category for which waiver is being requested: ______________
By completing this appendix, the area agency assures that priority services to be provided with other resources will meet the requirements of the Operating Standards for Service Programs for each respective service category listed.
Service Category Source of Funds Amount of Funds Amount of Title 3-B
______________ ______________ ______________ ______________
______________ ______________ ______________ ______________
______________ ______________ ______________ ______________
Rational Statement: (Explain how waiving the respective required minimum percentage will enhance the service delivery system to be implemented under the MYP.)
Write your rationale statement in the gray area:
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FY 2009 Annual Implementation PlanASSURANCES & CERTIFICATIONS
The undersigned agency, designated by the Michigan Commission on Services to the Aging to act as the Area Agency on Aging within a given planning and service area, agrees to the following:
1. To administer its Annual Implementation Plan in accordance with the Older Americans Act (OAA), the Older Michiganians Act (OMA), federal and state rules, and policies of the Michigan Commission on Services to the Aging (CSA) as set forth in publications and policy directives issued by the Michigan Office of Services to the Aging (OSA).
2. To make revisions necessitated by changes in any of the documents listed in point two in accordance with directives from the Michigan Office of Services to the Aging.
3. That any proposed revisions to the Annual Implementation Plan initiated by the Area Agency on Aging will be made in accordance with procedures established by the Michigan Office of Services to the Aging.
4. That funds received from the Michigan Office of Services to the Aging will only be used to administer and fund programs outlined in the Annual Implementation Plan approved by the Michigan Commission on Services to the Aging.
5. That the Area Agency on Aging will undertake the duties and perform the project responsibilities described in the Annual Implementation Plan in a manner that provides service to older persons in a consistent manner over the entire length of the Annual Implementation Plan and to all parts of the planning and service area.
6. That program development funds will be used to expand and enhance services in accordance with the initiatives and activities set forth in the approved Area Implementation Plan.
7. That all services provided under the Annual Implementation Plan are in agreement with approved service definitions and are in compliance with applicable minimum standards for program operations as approved by the Michigan Commission on Services to the Aging and issued by the Michigan Office of Services to the Aging, including Care Management.
8. That the Area Agency on Aging will comply with all conditions and terms contained in the Statement of Grant Award issued by the Michigan Office of Services to the Aging.
9. That the Area Agency on Aging may appeal actions taken by the Commission on Services to the Aging with regard to the Annual Implementation Plan, or related matters, in accordance with procedures issued by the Michigan Office of Services to the Aging in compliance with the requirements of the Older Michiganians Act and Administrative Rules.
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10. That the AAA will coordinate planning, identification, assessment of needs, and provision of services for older individuals with disabilities, with particular attention to individuals with severe disabilities, and with agencies that develop or provide services for individuals with disabilities.
11. That the AAA has in place a grievance procedure for eligible individuals who are dissatisfied with or denied services.
12. That the AAA will send copies of the Annual Implementation Plan to all local units of government seeking approval as instructed in the Plan Instructions.
13. That the Area Agency on Aging Governing Board and Advisory Council have reviewed and endorsed the Annual Implementation Plan.
The undersigned hereby submit the FY 2009 Annual Implementation Plan that describes the initiatives and activities which will be undertaken on behalf of older persons within the planning and service area. We assure that these documents and subsequent Annual Implementation Plans represent a formal commitment to carry out administrative and programmatic responsibilities and to utilize federal and state funds as described.
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ASSURANCE OF COMPLIANCE with
TITLE VI of the CIVIL RIGHTS ACT of 1964
ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964, SECTION 504 OF THE REHABILITATION ACT OF 1973, TITLE IX OF THE EDUCATION AMENDMENTS OF 1972, AND THE AGE DISCRIMINATION ACT OF 1975
The Applicant provides this assurance in consideration of and for the purpose of obtaining Federal grants, loans, contracts, property, discounts or other Federal financial assistance from the Department of Health and Human Services.
THE APPLICANT HEREBY AGREES THAT IT WILL COMPLY WITH:
1. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 80), to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department.
2. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 84), to the end that, in accordance with Section 504 of that Act and the Regulation, no otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department.
3. Title IX of the Educational Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Department.
4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 91), to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department.
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The Applicant agrees that compliance with this assurance constitutes a condition of continued receipt of Federal financial assistance, and that it is binding upon the Applicant, its successors, transferees and assignees for the period during which such assistance is provided. If any real property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the Applicant by the Department, this assurance shall obligate the Applicant, or in the case of any transfer of such property, any transferee, for the period during which the real property or structure is used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. If any personal property is so provided, this assurance shall obligate the Applicant for the period during which it retains ownership or possession of the property. The Applicant further recognizes and agrees that the United States shall have the right to seek judicial enforcement of this assurance.
The person whose signature appears below is authorized to sign this assurance, and commit the Applicant to the above provisions.
Form HHS-690 (05/97)
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ASSURANCE OF COMPLIANCEwith the
ELLIOT LARSEN CIVIL RIGHTS ACT
ASSURANCE OF COMPLIANCE WITH THE ELLIOT LARSEN CIVIL RIGHTS ACT, PA 453 OF 1976 AND THE PERSONS WITH DISABILITIES CIVIL RIGHTS ACT, PA 220 OF 1976.
The Applicant provides this assurance in consideration of and for the purpose of obtaining State of Michigan and Federal grants, loans, contracts, property, discounts or other State and Federal financial assistance from the Michigan Office of Services to the Aging.
THE APPLICANT HEREBY AGREES THAT IT WILL COMPLY WITH:
Non-Discrimination: In the performance of any grant, contract, or purchase order resulting herefrom, the Contractor agrees not to discriminate against any employee or applicant for employment or service delivery and access, with respect to their hire, tenure, terms, conditions or privileges of employment, programs and services provided or any matter directly or indirectly related to employment, because of race, color, religion, national origin, ancestry, age, sex, height, weight, marital status, physical or mental disability unrelated to the individual’s ability to perform the duties of the particular job or position. The Contractor further agrees that every subcontract entered into for the performance of any grant, contract, or purchase order resulting here from will contain a provision requiring non-discrimination in employment, service delivery and access, as herein specified binding upon each subcontractor. This covenant is required pursuant to the Elliot Larsen Civil Rights Act, 1976 PA 453, as amended, MCL 37.2201 et seq, and the Persons with Disabilities Civil Rights Act, 1976 PA 220, as amended MCL 37.1101 et seq, and any breach thereof may be regarded as a material breach of the grant, contract, or purchase order.
The person or persons whose signature(s) appear(s) below is/are authorized to sign this assurance, and commit the Applicant to the above provisions.
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SIGNATURE PAGEOF THE
FY 09 ANNUAL IMPLEMENTATION PLAN OF
(Agency Name)
This Annual Implementation Plan (AIP) for FY 09. It covers the period of October 1, 2008 through September 30, 2009.
This Multi-Year Plan becomes valid upon approval by the Michigan Commission on Services to the Aging (CSA) it may be conditionally approved subject to all General and/or Special Conditions established by the Michigan Commission on Services to the Aging.
This AIP Signature Page MUST be filled and signed by THE AAA BOARD CHAIRPERSON, and the Area Agency on Aging director.
The Signatories below acknowledge that they have reviewed the entire Annual Implementation Plan including all budgets, assurances, and appendices and that they commit [Agency Name] to all provisions and requirements of the Annual Implementation Plan.
Signature Section:
__________________________________________Name of Area Agency on Aging
__________________________________________ ________________Signature - Chairperson, Board of Directors Date
__________________________________________Name (Please Type)
__________________________________________ _________________Signature – Area Agency on Aging Director Date
__________________________________________Name (Please Type)
MULTI-YEAR DOCUMENTS REFERENCED BY THE SIGNATURE PAGE:
Budget Documents: FY 2009 Area Plan Grant Budget Appendix J - FY 2009 Direct Service Budget
Assurances: Assurances and Certifications Assurance of Compliance with Title VI of the Civil Rights Act of 1964 Assurance of Compliance with the Elliot Larsen Civil Rights Act
Appendices: Appendix F - Regional Service Definitions Appendix G - Request to Transfer Funds Appendix I - Agreement for Receipt of Supplemental Cash-in-lieu of Commodity Payments for the Nutrition
Program for the Elderly Appendix J - Waiver for Direct Provision of Service Appendix L: Waiver of Minimum Percentage for a Priority Service Category
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ACRONYMS IN AGING
AAA Area Agency on Aging
AAAAM Area Agency on Aging Association of Michigan
AARP American Association of Retired Persons
AD Alzheimer’s disease
ADC Adult Day Care
ADRC Aging and Disability Resource Center
ADS Adult Day Service
ADL Activities of Daily Living
AFC Adult Foster Care
AG Attorney General
AI/AAA Forum American Indian/Area Agency on Aging Forum
AIP Annual Implementation Plan
AIS Aging Information System
ALF Assisted Living Facility
4AM Area Agencies on Aging Association of Michigan
AoA Administration on Aging
APS Adult Protective Services
BEAM Bringing the Eden Alternative to the Midwest
ASA American Society on Aging
CAP Community Action Program
CBC Citizens for Better Care
CM Care Management
CMIS Client Management Information System
CMS Center for Medicare & Medicaid Services (formerly HCFA)
CNS Corporation for National Service
COA Commission on Aging/Council on Aging
CPHA Community Public Health Agency
CR Caregiver Respite (state)
CSA Commission on Services to the Aging
DCH Department of Community Health
DHHS/HHS U.S. Department of Health and Human Services
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DHS MI Dept. of Human Services (formerly the Family Independence Agency)
DMB Department of Management and Budget
DoE Department of Education
DoL Department of Labor
DoT Department of Transportation
DV Domestic Violence
EBDP Evidence Based Disease Prevention
ELM ElderLaw of Michigan
FGP Foster Grandparent Program
FTC Federal Trade Commission
FY Fiscal Year
GAO General Accounting Office
HB House Bill (state)
HCBS/ED Home & Community Based Services for the Elderly and Disabled Waiver
(HCBS/ED) program commonly known as MIChoice
HDM Home Delivered Meals
HMO Health Maintenance Organization
HR House Bill (federal)
HSA Health Systems Agency
I&A Information and Assistance
I&R Information and Referral
IADL Independent Activities of Daily Living
IM Information Memorandum
IoG Institute of Gerontology
LEP Limited English Proficiency
LSP Legal Services Program
LTC Long-Term Care
MADSA Michigan Adult Day Services Association
MASC Michigan Association of Senior Centers
MADSA Michigan Association of Directors of Services to the Aging
MCO Managed Care Organization
MHSCC Michigan Hispanic Senior Citizens Coalition MICAFE Michigan’s Coordinated Access to Food for the Elderly
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MICIS MI Choice Information System
MIS Management Information System
MLSC Michigan Legal Services Corporation
MLTCO Michigan Long Term Care Ombudsman
MMAP Medicare/Medicaid Assistance Program
MSA Medical Services Administration
MSAC Michigan Senior Advocates Council
MSC Michigan Senior Coalition (formerly Senior Power Day)
MSHDA Michigan State Housing Development Authority
MSG Michigan Society of Gerontology
MQCCC Michigan Quality Community Care Council
MYP Multi-Year Plan
N4A National Association of Area Agencies on Aging
NAPIS National Aging Programs Information System
NASUA National Association of State Units on Aging
NCBA National Center on Black Aged
NCOA National Council on Aging
NCSC National Council of Senior Citizens
NF Nursing Facility
NFA Notification of Financial Assistance
NFCSP National Family Caregiver Support Program
NFT Nursing Facility Transition
NHDP Nursing Home Diversion Program
NIA National Institute on Aging
NISC National Institute of Senior Citizens
NSSC National Senior Service Corps
NSIP Nutrition Services Incentive Program
OAA Older Americans Act
OAVP Older American Volunteer Program
OHDS Office of Human Development Services
OLTCSS Office of Long Term Care Supports and Services
OMA Older Michiganians Act
OMB Office of Management and Budget (federal)
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OSA Office of Services to the Aging
OWL Older Women's League
PA Public Act
PI Program Instruction
PRR Program Revision Request
PSA Planning and Service Area
PY Program Year
RFP Request For Proposal
RSVP Retired & Senior Volunteer Program
SAC State Advisory Council
SB Senate Bill (state)
SCP Senior Companion Program
SCSEP Senior Community Service Employment Program
SEAQRT Senior Exploitation and Abuse Quick Response Team
SGA Statement of Grant Award
SMSA Standard Metropolitan Statistical Area
SNF Skilled Nursing Facility
SPE Single Point of Entry
SPF Senior Project FRESH
SR Senate Bill (federal)
SS Social Security
SSA Social Security Administration
SSI Supplemental Security Income
SUA State Unit on Aging
TA Technical Assistance
TCM Targeted Case Management
TSR Tobacco Settlement Respite (state)
USDA United States Department of Agriculture
VA Veterans' Administration
WHCoA White House Conference on Aging
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