1.01Introduction and Program Description
The Department of Health and Social Services (DHSS or Department), Division of Senior and Disabilities Services (DSDS, SDS or the Division), is requesting proposals from eligible applicants to provide Senior In-Home Services (SIH) as a sole provider for the State of Alaska in FY2021 through FY2022 in Region 6: Aleutians East and Aleutians West. Program Services are authorized under 7 AAC 78 Grant Programs. Additional governing statutes are AS 47.05.010 (17) Duties of the Department and AS 47.65 Service Programs for Older Alaskans and Other Adults. State of Alaska statutes and regulations are accessible at http://www.law.state.ak.us/doclibrary/doclib.html or through the contact person identified on the cover page of this Request for Proposals (RFP).
The State of Alaska, DHSS, SDS provides funding for Case Management and In-Home services to low income seniors who experience Alzheimer’s Disease or a Related Dementia (ADRD), frailty due to aging, or other cognitive or physically disabling conditions in order to help them remain in their homes and living independently for as long as possible, forestalling or preventing more costly institutional care.
The SIH services grant program offers older individuals, 60 years of age or older who are low income and need assistance with activities of daily living (ADLs) or instrumental activities of daily living (IADLs), a menu of services to best meet their needs. Services include case management, chore, respite, extended respite and supplemental services (as further described in Section 1.03 Program Services/Activities). Senior In-Home grantees utilize funds that are matched with individual resources to maximize services statewide.
1.02Program Goal and Anticipated Outcomes
The goal of the Senior In-Home program is to support older individuals to maintain their independence while prioritizing those individuals with the highest need.
The anticipated outcomes for this grant program are:
- ensure program participants remain living in their place of choice,
- increase the number of individuals with Alzheimer's Disease and Related Dementias (ADRD) and other disabling conditions served through Senior In-Home services, and
- increase or maintain client satisfaction with services.
The proposed project and required Logic Model (refer to Section 1.04 for additional information) must demonstrate a thorough understanding and support of the grant program's goal and outcomes anticipated by the Department. Proposed projects must meet or exceed anticipated minimums described in this RFP.
Services provided under the grant must meet the above stated goal and result in measurable outcomes. Proposals must include the following:
- Description of the activities for each service that the applicant will provide under this program, and the description must support the goals and outcomes as described above.
- Plan for Services using the attached FY2021 Senior In-Home (SIH) Planned Services and Expenditures form.
- Timeline showing the proposed initiation and implementation of services and activities.
The applicant must either provide confirmation they will use the attached SIH Case Management Assessment/Plan of Care form to assess each individuals need for assistance or must submit a draft of the Assessment form they propose to use to be approved by the SIH Grant Program Manager for use.
The Senior In-Home Services grant program includes the following menu of services and activities. Applicants must clearly identify in their proposal which of these services they will provide to the target population in Region 6: Aleutians East and Aleutians West.
Case Management services provide assistance to persons in gaining access to needed medical, social, educational, other programs and services. Case Management ensures coordination of services, and adequate follow-up and monitoring. Through comprehensive assessment of the physical, emotional, cognitive, and social needs, Case Managers develop a network of services, both formal and informal, unique to the specific individual. Case Managers complete Plans of Care acceptable to the client and family and assist the client in obtaining the specified services. While receiving services, Case Managers provide ongoing monitoring of the client's situation to assure that the Plan of Care meets the individuals changing needs in order to remain in their home and community of choice for as long as possible. Case Management services may be short-term or long-term.
The list of items below involved Case Management activities under this grant program:
- Assessing an individual's needs require the provision of services by formal service providers, family caregivers, and other formal supports using SIH Case Management Assessment/Plan of Care form, home safety and falls prevention;
- Developing a plan of care that identifies a course of action to respond to the assessed needs of the eligible individual using the standardized SDS Plan of Care form or one approved for use by the SIH Program Manager;
- Client monitoring that includes the scope and frequency of contact to ensure the plan of care is implemented and adequately addresses the recipient’s needs (For clients receiving ongoing, longer-term case management, at least one contact by phone or face to face per month is expected); and
- Annual review and update of the assessment and plan of care.
Chore services assist the client in keeping a safe and clean environment to live independently in their own home. Chore services may be provided to assist individuals with activities such as meal preparation, grocery shopping, managing money, using the telephone, laundry, performing light housekeeping, performing heavier housekeeping, yard work, chopping wood, hauling water, sidewalk maintenance or other chore-type tasks as approved by the SDS Program Manager.
Allocation of Chore services
- Chore services are available up to a maximum of 25 hours per month per client or household; and
- Chore services may not be provided in a household when an able-bodied adult resides in the home.
Respite and Extended Respite Care
Respite and Extended Respite Care services provide support, relief to families and other caregivers. Additionally, Respite is intended to promote the optimum level of independence and functioning to assist the client to remain living at home. Respite Care services provide substitute care for adults with declining physical and cognitive functions to allow intermittent or temporary relief or rest to a primary caregiver who is most often a family member. Services may be provided on either a planned or emergency basis in a variety of settings such as in the family or caregiver's home, the respite worker's home, a licensed assisted living home, residential care facility, hospital or nursing facility. Extended Respite is the provision of 24 hour care usually out of the home in a licensed facility.
Allocation of Respite services
- Respite services are available up to a maximum of 40 hours per month;
- Extended Respite services are available up to a maximum of one week per year of 24 hour care;
- Extended Respite hours may not be utilized in the same manner as regular Respite hours;
- The intent of extended Respite is to provide the caregiver with 24 hour relief; and
- Individuals living in the same home as the recipient may not be employed to provide Respite.
Service Coordination services involve using the SIH Case Management Assessment/Plan of Care form, or one developed by the service provider and approved by SDS, to coordinate chore and respite services which includes evaluating the individual's daily living activities and instrumental activities of daily living, developing a service plan, monthly monitoring to ensure that the service plan is executed and meets the individuals needs, and an annual review to evaluate whether any adjustments to the existing service plan needs to be made.
Supplemental Services assist the "low-income" senior in attaining or maintaining a safe and healthy environment to avoid a crisis that would jeopardize their ability to remain independently in their own home.
For the purposes of this RFP, "low income" refers to an individual 60 years of age or older whose income is at or below the Medicaid long term care eligibility for seniors. This limit is currently $2,349 per month per individual and each additional individual residing in the home is allowed up to $1,072 per month. Other resources for funding should always be explored before application is made for this service. Supplemental services are not meant to take the place of ADRD mini-grants, but rather provide similar mechanism for individuals who do not have ADRD. Individuals who have ADRD must first apply for an ADRD mini-grant. Individuals who receive an ADRD mini-grant may not be eligible for Supplemental services depending upon circumstances, but will be considered on a case-by-case basis. This service can be provided as a stand-alone service (it does not need to accompany the other services described in this RFP) and is available to any senior who is eligible under this grant program and who resides within the grantee’s service area.
Eligible items and services may include, but are not limited to the following: assistive devices, home safety interventions, personal emergency response alarm systems, minor home modifications, access to medical, dental and vision care, or special health care needs such as personal care assistance for an anticipated short-term use after hospital discharge for up two weeks (must be approved by the SDS Program Manager and may be approved for up to a maximum of one month depending upon circumstances). Assistance with items or services to avert a crisis that are not covered by another funding source may be allowable (e.g., medical transportation and winter clothing).
Allocation of Supplemental services
- Approved on a case-by-case basis by the SDS Program Manager on the prescribed form;
- Limited to $500 annually per client or household depending upon the request, and
- Provider agencies will purchase services or goods for the client, a voucher system will not be allowed.
Service Principles, Case Notes, Service Standards, and Policies and Procedures for Services
By making application, applicants agree to comply with all of the following additional program requirements:
- SDS Service Principles adopted by Senior and Disabilities Services can be found at the following link: http://dhss.alaska.gov/dsds/Pages/mission.aspx;
- Case Notes are required for all recipients receiving services. The Case Notes must follow standard Human Services Practice and be sufficient for liability protection and historical tracking;
- Current Standards of Practice for Services found within “Conditions of Participation” (COP) located in the following link: http://dhss.alaska.gov/dsds/Pages/regulationpackage.aspx; and
- Grantees will be required to submit a copy of their Policy and Procedure Manual for Services upon grant award.
1.04Program Evaluation Requirements and Reporting
Results Based Budgeting Framework
Results Based Budgeting provides a framework in which allocated resources are supported and justified by a set of outputs and expected results. Within this framework, actual performance and achieved outcomes are measured by objective performance measures.
Projects must align with program objectives expressing Department priorities and core services. Projects will use performance measures to evaluate progress toward meaningful outcomes and to initiate data collection and reporting consistent with Department priorities.
The Department Priorities, Core Services, Objectives and Performance Measures of Effectiveness and Efficiency for this program are:
- 1 Health & Wellness Across the Life Span
Department Core Services
- 1.2 Provide Quality of Life in a Safe Living Environment for Alaskan
- 1.2.3 Increase the number of Older Alaskans who live safely in their communities
- Number of individuals who receive services
- Grant expenditure per individual
The additional Effectiveness Performance Measures for this program are:
- Number of individuals with ADRD served,
- Number of individuals with 2 or more ADLs,
- Number of individuals surveyed for satisfaction, and
- Out of those surveyed 80% or better rated services good to excellent.
SIH Logic Model
As an attachment to the proposal, the applicant must complete and submit the predesigned logic model that includes goals, outcomes, resources, activities and outputs compliant with the grant project and program intent. The applicant must indicate the resources and activities applicable to their proposed project. Utilizing this framework, SDS Program Managers and grantees will use predetermined performance measures to evaluate progress in order to meet meaningful outcomes and initiate data collection and reporting consistent with Department priorities.
In addition to the Effectiveness and Efficiency Performance Measures required by the Department, the Senior In-Home grantees will be responsible for reporting to the Division of Senior and Disabilities Services the additional performance measures specific to the grant program as listed on the Performance Measure Framework, including final fiscal year data to be submitted in the final 4th quarter reports.
Required reporting will include:
- Cumulative Fiscal Report (overall grant and match expenditures are reported quarterly by budget line item);
- Program Reports in the format/time frame prescribed by the grantor:
- CFR2 (quarterly expenditures by funding source and service on the Expenditures by Services Category);
- Biannual Narrative Progress Report;
- Annual Performance Measure Framework (includes data from Annual Consumer Survey),
- Monthly Data entry of service delivery and consumer characteristics into the WellSky Aging and Disability database (formerly SAMS).
Changes to Approved Grant Project
As per 7AAC 78.260, any changes to the service plan must be submitted in writing to the SDS Program Manager for approval prior to implementation of the change. The SDS Program Manager must be notified immediately whenever it becomes known to the grantee that a key staff position will become vacant. The grantee must submit a copy of the resume for the new hires for positions supported in whole or in part by the grant funds, matching funds, or with grant income earned through this program.
1.05Target Population and Service Area
Applicants must clearly describe the population targeted by the project. Proposals will be evaluated for compatibility with the program’s intended target population identified in this solicitation. Applicants must clearly describe their ability to provide services in the service area being solicited in this RFP. In addition, applicants must complete and submit the attached Outreach Plan form in order to outline how they plan to advertise the grant services being provided in the selected area.
- Person of any age with Alzheimer’s Disease or Related Dementias,
- Individuals 60 years of age or older who experience physical or cognitive impairments, or
- Adults 18 years of age or older with similar disabilities and service needs to older Alaskans when the provision of care to such persons does not diminish services to primary groups of person being served.
Note: All persons under the age of 60 must be approved by the SDS Program Manager prior to being served on the prescribed form.
Meeting eligibility will be determined by the grantee with consultation provided by the SDS Program Manager as needed. Individuals who potentially meet income and level of care eligibility to receive services under the Home Community Based (HCB) Medicaid Waiver program must provide documentation of denial in order to be eligible for In-Home services under this grant. Services are prioritized within the eligibility requirements listed below, taking into consideration the individual’s increased need for assistance with Activities of Daily Living (ADL) to remain living independently. In addition, these services are not intended for individuals entering the program requiring serious immediate specialized medical care.
Eligibility for Case Management, Respite, and Supplemental Services:
- Individuals of any age who have ADRD, or
- Individuals 60 years of age or older who experience physical or cognitive impairments, personal conditions or other characteristics which require the provision of services by formal service providers or family caregivers, and
- Have a need that cannot be met through another program or informal support.
Eligibility for Chore services:
- Individuals of any age who have ADRD, or
- Individual’s 60 years of age or older who experience physical or cognitive impairments, personal conditions or other characteristics which require the provision of services by formal service providers or family caregivers,
- Have a need that cannot be met through another program or informal support, and
- Require assistance with at least one ADL, or one of the following Instrumental Activities of Daily Living (IADL): meal preparation, shopping, light housework, or laundry.
Note: Chore is only available in cases when no willing, able-bodied person lives in the household.
Eligibility for Individuals under 60 Years of Age:
- Individuals under the age of 60 years old must meet the same requirements as individuals 60 years of age or older;
- The services they receive must not diminish services of the target population and priority of service; and
- Require approval by the SDS Program Manager, on the prescribed forms, before services may begin. This is a statewide program with an emphasis toward providing services in underserved communities through local providers.
Applicants must indicate the number of individuals to be served on Planned Services form. It is expected that services delivered by the successful applicants will be performed within the service area(s) awarded.
Funds available for a sole provider of this program in FY2021 are estimated at $51,532 in State General Funds. The award made for FY2021 shall not be considered a guarantee that the same amount will be awarded in the final year of this RFP. Awards in continuing grant years are dependent upon the conditions stated in Section 3.05 of this RFP. Applicants must not request a funding amount that exceeds the available funds for the region being proposed. The methodology for allocation of funds is based on the regional funding formula in the Alaska State Plan for Senior Services using 2017 data.
Match Requirement: The budget must include matching funds equal to 10.00% of the proposed DHSS funds. Calculate your required match using the following formula:
Total Requested Grant Award x Required Match Percentage = Required Match
State grant funds may not be used to match State funds awarded through this grant program.
Eligible sources of matching funds include:
- Local Cash-local sources, including local tax receipts, municipal revenue sharing, cash donations
- Local In-Kind-donated items of value for which the applicant incurs no cost, including volunteer labor and donations of supplies, equipment, space
- Other Sources-government and non-government grant awards, third party receipts, direct receipts such as gaming or sales of goods
- Grant Income-earnings anticipated as a result of this project proposal receiving award, and Medicaid reimbursements if award of this grant is required for the applicant to bill Medicaid for awarded services
- Medicaid-Medicaid which is not Grant Income, as well as other third party receipts
Proposed Budget: The applicant must submit a budget proposal for the first fiscal year of the project. The proposed budget detail and narrative, (including required match), will support the program’s results based service delivery and staffing requirements stated in this RFP.
*A sliding fee scale for Chore and Respite services based on the most current Federal Poverty Guidelines for Alaska https://www.healthcare.gov/glossary/federal-poverty-level-FPL/, as well as a sliding fee scale policy, and the application or worksheet to evaluate the recipient's income in determining the co-pay will need to be submitted at the time of award. Grant Income includes receipts from recipients or their family through the sliding fee scale. Grant income must be reported each quarter.
The proposed budget will be fully compliant with the limitations described in this RFP, and those detailed in 7 AAC 78.160 (Costs). Regulations are provided under the GEMS Documents tab.
Resources specific to budgeting are also available under the GEMS Documents tab. DHSS Grant Budget Preparation Guidelines provide information and guidance about budget lines, cost detail groupings, and narrative requirements. Grantee User Manual Part I provide detailed instructions for entering a budget proposal in the chapter "Responding to a Solicitation."
Other Agency Funding: Prior to submitting a proposal, applicants are required to list all other agency funding received and applied for. This task must be completed by an Agency Power User in the Other Funding section of the Agency Administration tab. This is part of the pre-award risk assessment required under Uniform Guidance 2 CFR 200.
Indirect Costs: If the proposed budget includes indirect costs, 7 AAC 78.160(p) requires a copy of the agency’s current federally approved Indirect Cost Rate Agreement. The agreement must be uploaded in the Agency Administration tab. Lapsed agreements can be used if uploaded with the negotiating federal agency’s written approval to continue using the rate until a new agreement is negotiated.
Payment for Services/Grant Income: If applicable to the services proposed in response to this solicitation, awarded grantees must have a Medicaid Provider Number or apply to obtain one, and will make reasonable effort to bill all eligible services to Medicaid and any other available sources of payment before seeking grant support for delivery of the proposed services. DHSS funds are the payer of last resort.
In the applicant’s proposed budget, anticipated receipts and expenditures for all grant income must be evident in the detail and narrative. Fiscal reports for awarded income generating projects will include the receipts and expenditure of all grant income.