State Unit on Aging State Plan on Aging

Office of Management and Budget (OMB) #

Guidance for Developing State Plans on Aging

Purpose

This guidance replaces State Unit on Aging (SUA) Directors Letter #01-2021 and serves as a guide for any new State Plan on Aging (State Plan) taking effect on or after October 1, 2025. This guidance is consistent with the Older Americans Act (OAA) as amended in 2020 and reflects changes to the OAA program regulations (effective date – March 15, 2024) at 45 Code of Federal Regulations (CFR) part 1321 et seq.

Background

Congress originally passed the OAA in 1965 in response to concerns by policymakers about a lack of community social services for older adults. The original legislation established authority for grants to States for community planning and social services, research and development projects, and personnel training in the field of aging. The OAA also provides the foundation for the National Aging Network, which includes the Administration on Aging (AoA), SUAs, area agencies on aging (AAAs), Tribal organizations, service providers and volunteers.

SUAs, an integral part of the network, are the designated agencies responsible for developing and administering a multi-year State Plan that provides goals and objectives related to assisting older residents, their families, and caregivers. Additionally, the State Plan:

• Documents the tangible outcomes expected from State long-term care reform efforts;

• Translates activities, data, and outcomes into proven best practices, which can be used to leverage additional funding;

• Provides a blueprint for coordination and advocacy activities the State will undertake to meet the needs of older adults, including integrating health and social services delivery systems; and

• Builds capacity for long-term care efforts in the State.

Action Required

States (through the SUA) may elect to develop a new State Plan for a two, three or four-year period. SUAs must use this updated guidance when creating new State Plans. Each new State

Paperwork Reduction Act Public Burden Statement:

According to the Paperwork Reduction Act of 1995 5 CFR § 1320.8(b)(3), no persons are required to respond to a collection of information unless such collection displays a valid OMB control number (OMB 0985-008X). Public reporting burden for this collection of information is estimated to average 80 hours per response, including time for gathering, maintaining the data needed, completing, and reviewing the collection of information. The obligation to respond to this collection is required to retain or maintain benefits under the Older Americans Act (P.L. 116-131). Information collected is planned for use by ACL to: document and provide the opportunity for public comment of achievements and planned activities for the multi-year plan period. ACL uses information collected to monitor federal funds. Data will be kept private to the extent allowed by law. There are no assurances of confidentiality.

Plan, signed by the Governor or the Governor’s designee, is due to the appropriate Administration for Community Living (ACL) Regional Administrator by July 1 of the calendar year in which the new State Plan begins. Following the Regional Administrator’s review of that submission for compliance with ACL’s requirements, the signed State Plan will be forwarded by the Regional Administrator to the Assistant Secretary for Aging (ASA) to be considered for approval. All State Plans require the written approval of the ASA.

To help ensure a successful submission, each State shall submit a complete draft of the new State Plan to the appropriate ACL Regional Office by June 1 of the calendar year in which the new State Plan is due to begin (45 CFR §1321.33). The SUA shall work with the ACL Regional Office in reviewing the new State Plan for compliance with requirements.

States that fail to meet these timeframes will be in violation of 45 CFR §1321.33 and risk the new State Plan not being approved by the ASA prior to the expiration of the current State Plan. See chart with time frames below:

State Plans effective 10/1/25

Suggested Public Hearing(s) to be completed	150 Days prior	4/1/2025
Draft version submitted to Regional Office	120 Days prior	6/1/2025
Final version, signed by Governor, submitted to Regional Office	90 Days prior	7/1/2025
Effective Date	Federal Fiscal Year (FFY) ‘26	10/1/2025

New Four-year State Plan

Year 1	FFY 2026	10/1/25 – 9/30/26
Year 2	FFY 2027	10/1/26 – 9/30/27
Year 3	FFY 2028	10/1/27 – 9/30/28
Year 4	FFY 2029	10/1/28 – 9/30/29

State Plan Content

To facilitate a timely review of the State Plan, please provide a table of contents with page numbers. Please include the following sections:

• Signed Verification of Intent page;

• Narrative; and

• Attachments A-E

Signed Verification of Intent Page from State Governor or Designee:

The State Plan must be signed by the Governor or the individual (designee) to whom the Governor has granted signatory authority. If the State Plan is signed by a designee, include documentation of designation. The documentation may be a letter signed by the Governor or the designee may include a written representation in the State Plan that they have signatory authority.

Narrative:

The narrative portion of the State Plan should be no more than 30 pages. To stay within this maximum, the SUA may wish to submit lengthy survey information, demographics, organizational charts, maps, etc., as separate attachments. The narrative should clearly address the following areas:

1. Executive Summary – The executive summary stands alone in summarizing the State’s planned efforts on behalf of older individuals over the State Plan cycle. A well-written summary can aid the State in educating the public, lawmakers, and other agencies and can assist in securing additional resources.

2. Context – The context sets the stage for the State Plan and describes the issues addressed in the remainder of the document. A summary of needs assessment activities undertaken by the State, as well as the findings of such activities, should be included here. This includes the methods used to conduct the needs assessment, data showing the representativeness of the data collected, and how those data were used to guide plan development. Needs assessment findings should correspond to the outlined goals and objectives in paragraph “4” below. Indicate how the State Plan is informed by and based on area plans, except for single planning and service area (PSA) States, and solicited input for development of the plan, e.g., public hearings, surveys, website, etc. This section must also include how the State defines greatest economic need and greatest social need.

3. Stewardship and Oversight – Stewardship and oversight of OAA programs support the aging network to meet the mission and vision of the OAA through holistic program management. Such program management includes having appropriate program, fiscal, data, evaluation, training, and communications policies and procedures that are in alignment with one another; maintaining the integrity of advocacy activities; and assessing and adjusting to support ongoing program implementation of targeted, effective, efficient activities.

An ideal way to explain the SUA’s stewardship and oversight plans and activities is to include information about the level and frequency of services provided; the number and percentages of different demographic groups of people and organizations receiving services, along with the percentage of overall population and the percentage of people with the greatest economic and social need formed by each demographic group; and documentation of program quality (e.g., status as an evidence-based program, solicitation of participant feedback). Describe the details of stewardship and oversight activities the State will undertake during the State Plan cycle, and how the SUA develops, issues, and implements its policies and procedures.

4. Goals, Objectives, Strategies, and Outcomes – Goals are visionary statements that describe the strategic direction in which the State is moving. Objectives are the specific, measurable, attainable, relevant, and timely steps the State will take to achieve its goals. Strategies outline how the State will achieve the goals and objectives. Outcomes document the measurable benefit older individuals should derive from the State Plan goals, objectives, and strategies. To the extent possible, outcome measures should include short-, intermediate-, and long-term outcomes:

   • Short-term outcomes typically include improvements in knowledge, awareness, or perceptions (such as increased knowledge about the benefits of exercise or increased awareness of residents’ rights among staff at long-term care facilities).

   • Intermediate outcomes typically include changes in behaviors, policies, or processes (such as eating a healthier diet or better coordination of services).

   • Long term outcomes should reflect the goals of the OAA and/or specific programs (such as individuals who receive OAA services being able to remain in the community longer).

States should have at least one goal, objective, strategy, and outcome measure for each key topic. If States are collecting data for measures that align with the goals, objectives, strategies, and outcomes that are also inclusive in the key topic areas, States do not need to collect new data. Rather, States should report on the data they are already collecting.

State Plan Key Topic Areas:

State Plans must explicitly incorporate all areas to address in each State Plan key topic area. In developing objectives, consider the role these topic areas serve in optimizing the State’s long- term services and supports system (LTSS) for older adults and their caregivers.

Older Americans Act (OAA) Core Programs Key Topic Area

Overview

OAA core programs are found in Titles III (Supportive Services, Nutrition, Disease Prevention/Health Promotion and Caregiver Programs), VI (Native American Programs), and VII (Elder Rights Programs) and serve as the foundation of the national aging services network. All core programs by each subtitle of Title III and VII must be addressed in the State Plan.

Areas to Address

Describe plans and include objectives and the measures (i.e., data elements from the State Program Report and other sources) that will be used to demonstrate progress towards: Coordinating Title III programs with Title VI Native American programs (Section 307(a)(21)); Addressing malnutrition (Sec. 330); Preventing, detecting, assessing, intervening, and/or investigating elder abuse, neglect, and financial exploitation (Sec. 721(a)); Supporting and enhancing multi-disciplinary responses to elder abuse, neglect and exploitation to involve essential partners across the State including adult protective services, long-term care ombudsman programs, social service providers, health care professionals, financial institutions, and criminal and civil justice system partners (Sec. 721(b)(10)(C)(v)); Age and dementia friendly efforts; Dissemination of information about State assistive technology entity and access to assistive technology options for serving older individuals (Sec. 321(a)(11)) Strengthening and/or expanding Title III & VII services; Improving coordination between the Senior Community Service Employment Program (SCSEP) and other OAA programs; and Integrating core programs with ACL’s non formula-based grant programs.

Greatest Economic Need and Greatest Social Need Key Topic Area

Overview

The OAA requires services to be targeted to older individuals and family caregivers with the greatest economic need and greatest social need. The State Plan must address activities to reach those in greatest economic need and greatest social need.

Areas to Address

Describe plans and include objectives and the measures (data elements and sources) that will be used to demonstrate progress towards: Targeting services to those that meet the SUA’s definitions of greatest economic need and greatest social need, as defined in 45 CFR § 1321.3; Determining services needed and effectiveness of programs, policies and services for older individuals whose needs were the focus of all centers funded under Title IV in fiscal year 2019 (Sec. 307(a)(30)(A))1;

¹ In 2019, ACL/AoA funded via Title IV the National Resource Centers on Native American Elders which provides research and technical information on health, long-term services and supports, elder abuse, mental health, and other issues relevant to older Native Americans as well as National Minority Aging Organizations Technical Assistance Centers that provide culturally and linguistically appropriate information on health promotion and disease prevention for specified populations. See “Older Americans Act: Overview and Funding,” updated May 17,2023, available at: https://crsreports.congress.gov/product/pdf/R/R43414. Also see https://acl.gov/programs/diversity-and- cultural-competency/oaec

Engagement in outreach with older individuals whose needs were the focus of all centers funded under Title IV in fiscal year 2019 (Sec. 307(a)(30)(C)); Impacting social determinants of health of older individuals (Sec. 301(a)(1)(E)); Ensuring meals can be adjusted for cultural considerations and preferences and providing medically tailored meals to the maximum extent practicable (Sec. 339(2)(A)(iii); Offering home-delivered meal participants the option to participate in to attend congregate meal sites and other health and wellness activities, as feasible, based on a person-centered approach and local service availability 45 CFR § 1321.87(a)(2)(ii); Serving older adults living with HIV/AIDS; Supporting participant-directed/person-centered planning for older adults and their caregivers across the spectrum of LTSS, including home, community, and institutional settings; Incorporating innovative practices that increased access to services particularly for those with mobility and transportation issues as well as those in rural areas; and Educating about the prevention of, detection of, and response to negative health effects associated with social isolation (Sec. 321(a)(8)).

Expanding Access to Home- and Community-Based Services (HCBS) Key Topic Area

Overview

HCBS are fundamental to making it possible for older adults to age in place.

Areas to Address

Describe plans and include objectives and the measures (data elements and sources) that will be used to demonstrate progress towards: Securing the opportunity for older individuals to receive managed in- home and community-based long-term care services (Sec. 301(a)(2)(D)); Promoting the development and implementation of a State system of long- term care that is a comprehensive, coordinated system that enables older individuals to receive long-term care in home and community-based settings, in a manner responsive to the needs and preferences of the older individuals and their family caregivers (Sec. 305(a)(3)); Ensuring that AAAs will conduct efforts to facilitate the coordination of community-based, long-term care services for older individuals who: reside at home and are at risk of institutionalization because of limitations on their ability to function independently; are patients in hospitals and are at risk of prolonged institutionalization; or are patients in long-term care facilities, but who can return to their homes if community-based services are provided to them (Sec. 307(a)(18(A)-(C)); and Incorporating aging network services with HCBS funded by other entities such as Medicaid.

Caregiving Key Topic Area

Overview

Enhancing services and supports for caregivers.

Areas to Address

Describe plans and include objectives and the measures (data elements and sources) that will be used to demonstrate progress towards: Strengthening and supporting the direct care workforce; Implementing the actions in the National Strategy to Support Family Caregiving that can advance your State’s ability to better recognize and support family caregivers; Coordinating Title III caregiving efforts with the Lifespan Respite Care program; and Coordinating with the National Technical Assistance Center on Grandfamilies and Kinship Families.

Attachments to the State Plan document:

Attachment A – State Plan Assurances and Required Activities includes statutory assurances and activities related to the development/implementation of State Plans. It must be reviewed, signed (by the SUA director), and included as part of the State Plan. In addition, documentation of how the State will address each assurance must be maintained at the State and made available for review by ACL, as requested and appropriate.

Attachment B – Information Requirements includes specific information requirements related to development/implementation of the State Plan. The State’s detailed responses to these requirements must be listed within the Attachment and submitted as part of the State Plan.

Attachment C – Intrastate Funding Formula (IFF)/Funds Distribution Plan Requirements is a guide to the development of new or revised IFFs and funds distribution plans. It also includes information on setting aside funds to address disasters, revised IFFs and funds distribution plans during the State Plan cycle, and State Plan amendments.

Attachment D - Identification of the geographic boundaries of each PSA and of AAAs designated for each PSA, if applicable, must be included with each State Plan.

Attachment E – Evidence of Providing the Minimum Public Comment Period must be included with each State Plan. The State Plan must include information that demonstrates the SUA’s compliance with the minimum time period (i.e., at least thirty (30) calendar days, absent a waiver from the ASA) for public review and comment on the new State Plan, pursuant to 45 CFR § 1321.29(c).

Note: Other attachments to the plan could include demographic data, needs analysis, special initiatives, etc.

State Plan Guidance Attachment A

STATE PLAN ASSURANCES AND REQUIRED ACTIVITIES

Older Americans Act, As Amended in 2020

By signing this document, the authorized official commits the State Agency on Aging to performing all listed assurances and activities as stipulated in the Older Americans Act, as amended in 2020.

Sec. 305, ORGANIZATION

(a) In order for a State to be eligible to participate in programs of grants to States from allotments under this title—. . .

(2) The State agency shall—

1. except as provided in subsection (b)(5), designate for each such area after consideration of the views offered by the unit or units of general purpose local government in such area, a public or private nonprofit agency or organization as the area agency on aging for such area;

2. provide assurances, satisfactory to the Assistant Secretary, that the State agency will take into account, in connection with matters of general policy arising in the development and administration of the State plan for any fiscal year, the views of recipients of supportive services or nutrition services, or individuals using multipurpose senior centers provided under such plan; . . .

5. provide assurance that preference will be given to providing services to older individuals with greatest economic need and older individuals with greatest social need (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas), and include proposed methods of carrying out the preference in the State plan;

6. provide assurances that the State agency will require use of outreach efforts described in section 307(a)(16); and

(G)(i) set specific objectives, in consultation with area agencies on aging, for each planning and service area for providing services funded under this title to low-income minority older individuals and older individuals residing in rural areas;

2. provide an assurance that the State agency will undertake specific program development, advocacy, and outreach efforts focused on the needs of low-income minority older individuals;

3. provide a description of the efforts described in clause (ii) that will be undertaken by the State agency; . . .

(c) An area agency on aging designated under subsection (a) shall be—…

(5) in the case of a State specified in subsection (b)(5), the State agency;

and shall provide assurance, determined adequate by the State agency, that the area agency on aging will have the ability to develop an area plan and to carry out, directly or through contractual or other arrangements, a program in accordance with the plan within the planning and service area. In designating an area agency on aging within the planning and service area or within any unit of general purpose local government designated as a planning and service area the State shall give preference to an established office on aging, unless the State agency finds that no such office within the planning and service area will have the capacity to carry out the area plan.

(d) The publication for review and comment required by paragraph (2)(C) of subsection

(a) shall include—

1. a descriptive statement of the formula’s assumptions and goals, and the application of the definitions of greatest economic or social need,

2. a numerical statement of the actual funding formula to be used,

3. a listing of the population, economic, and social data to be used for each planning and service area in the State, and

4. a demonstration of the allocation of funds, pursuant to the funding formula, to each planning and service area in the State.

Note: States must ensure that the following assurances (Section 306) will be met by its designated area agencies on agencies, or by the State in the case of single planning and service area states.

Sec. 306, AREA PLANS

1. Each area agency on aging designated under section 305(a)(2)(A) shall, in order to be approved by the State agency, prepare and develop an area plan for a planning and service area for a two-, three-, or four-year period determined by the State agency, with such annual adjustments as may be necessary. Each such plan shall be based upon a uniform format for area plans within the State prepared in accordance with section 307(a)(1). Each such plan shall—

   1. provide, through a comprehensive and coordinated system, for supportive services, nutrition services, and, where appropriate, for the establishment, maintenance, modernization, or construction of multipurpose senior centers (including a plan to use the skills and services of older individuals in paid and unpaid work, including multigenerational and older individual to older individual work), within the planning and service area covered by the plan, including determining the extent of need for supportive services, nutrition services, and multipurpose senior centers in such area (taking into consideration, among other things, the number of older individuals with low incomes residing in such area, the number of older individuals who have

greatest economic need (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas) residing in such area, the number of older individuals who have greatest social need (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas) residing in such area, the number of older individuals at risk for institutional placement residing in such area, and the number of older individuals who are Indians residing in such area, and the efforts of voluntary organizations in the community), evaluating the effectiveness of the use of resources in meeting such need, and entering into agreements with providers of supportive services, nutrition services, or multipurpose senior centers in such area, for the provision of such services or centers to meet such need;

2. provide assurances that an adequate proportion, as required under section 307(a)(2), of the amount allotted for part B to the planning and service area will be expended for the delivery of each of the following categories of services—

   1. services associated with access to services (transportation, health services (including mental and behavioral health services), outreach, information and assistance (which may include information and assistance to consumers on availability of services under part B and how to receive benefits under and participate in publicly supported programs for which the consumer may be eligible) and case management services);

   2. in-home services, including supportive services for families of older individuals with Alzheimer's disease and related disorders with neurological and organic brain dysfunction; and

   3. legal assistance;

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;

(3)(A) designate, where feasible, a focal point for comprehensive service delivery in each community, giving special consideration to designating multipurpose senior centers (including multipurpose senior centers operated by organizations referred to in paragraph (6)(C)) as such focal point; and

(B) specify, in grants, contracts, and agreements implementing the plan, the identity of each focal point so designated;

(4)(A)(i) (I) provide assurances that the area agency on aging will—

(aa) set specific objectives, consistent with State policy, for providing services to older individuals with greatest economic need, older individuals with greatest social need, and older individuals at risk for institutional placement;

(bb) include specific objectives for providing services to low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas; and

(II) include proposed methods to achieve the objectives described in items (aa) and (bb) of sub-clause (I);

2. provide assurances that the area agency on aging will include in each agreement made with a provider of any service under this title, a requirement that such provider will—

   1. specify how the provider intends to satisfy the service needs of low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas in the area served by the provider;

   2. to the maximum extent feasible, provide services to low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas in accordance with their need for such services; and

   3. meet specific objectives established by the area agency on aging, for providing services to low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas within the planning and service area; and

3. with respect to the fiscal year preceding the fiscal year for which such plan is prepared —

   1. identify the number of low-income minority older individuals in the planning and service area;

   2. describe the methods used to satisfy the service needs of such minority older individuals; and

   3. provide information on the extent to which the area agency on aging met the objectives described in clause (i).

2. provide assurances that the area agency on aging will use outreach efforts that

will—

1. identify individuals eligible for assistance under this Act, with special emphasis on—

   1. older individuals residing in rural areas;

   2. older individuals with greatest economic need (with particular attention to low-

income minority individuals and older individuals residing in rural areas);

3. older individuals with greatest social need (with particular attention to low-income minority individuals and older individuals residing in rural areas);

4. older individuals with severe disabilities;

5. older individuals with limited English proficiency;

6. older individuals with Alzheimer’s disease and related disorders with neurological and organic brain dysfunction (and the caretakers of such individuals); and

7. older individuals at risk for institutional placement, specifically including survivors of the Holocaust; and

1. inform the older individuals referred to in sub-clauses (I) through (VII) of clause (i), and the caretakers of such individuals, of the availability of such assistance; and

2. contain an assurance that the area agency on aging will ensure that each activity undertaken by the agency, including planning, advocacy, and systems development, will include a focus on the needs of low-income minority older individuals and older individuals residing in rural areas.

5. provide assurances that the area agency on aging 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 individuals at risk for institutional placement, with agencies that develop or provide services for individuals with disabilities;

6. provide that the area agency on aging will—

1. 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;

2. serve as the advocate and focal point for older individuals within the community by (in cooperation with agencies, organizations, and individuals participating in activities under the plan) monitoring, evaluating, and commenting upon all policies, programs, hearings, levies, and community actions which will affect older individuals;

(C)(i) where possible, enter into arrangements with organizations providing day care services for children, assistance to older individuals caring for relatives who are children, and respite for families, so as to provide opportunities for older individuals to aid or assist on a voluntary basis in the delivery of such services to children, adults, and families;

2. if possible regarding the provision of services under this title, enter into arrangements and coordinate with organizations that have a proven record of providing services to older individuals, that—

(I) were officially designated as community action agencies or community action programs under section 210 of the Economic Opportunity Act of 1964 (42U.S.C. 2790) for fiscal year 1981, and did not lose the designation as a result of failure to comply with such Act; or

(II) came into existence during fiscal year 1982 as direct successors in interest to such community action agencies or community action programs;

and that meet the requirements under section 676B of the Community Services Block Grant Act; and

2. make use of trained volunteers in providing direct services delivered to older individuals and individuals with disabilities needing such services and, if possible, work in coordination with organizations that have experience in providing training, placement, and stipends for volunteers or participants (such as organizations carrying out Federal service programs administered by the Corporation for National and Community Service), in community service settings;

2. establish an advisory council consisting of older individuals (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, family caregivers of such individuals, representatives of older individuals, service providers, representatives of the business community, 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;

3. establish effective and efficient procedures for coordination of—

   1. entities conducting programs that receive assistance under this Act within the planning and service area served by the agency; and

   2. entities conducting other Federal programs for older individuals at the local level, with particular emphasis on entities conducting programs described in section 203(b), within the area;

4. in coordination with the State agency and with the State agency responsible for mental and behavioral health services, increase public awareness of mental health disorders, remove barriers to diagnosis and treatment, and coordinate mental and behavioral health services (including mental health screenings) provided with funds expended by the area agency on aging with mental and behavioral health services provided by community health centers and by other public agencies and nonprofit private organizations;

5. if there is a significant population of older individuals who are Indians in the planning and service area of the area agency on aging, the area agency on aging shall conduct outreach activities to identify such individuals in such area and shall inform such individuals of the availability of assistance under this Act;

6. in coordination with the State agency and with the State agency responsible for elder abuse prevention services, increase public awareness of elder abuse, neglect, and exploitation, and remove barriers to education, prevention, investigation, and treatment of elder abuse, neglect, and exploitation, as appropriate; and

7. to the extent feasible, coordinate with the State agency to disseminate information about the State assistive technology entity and access to assistive technology options for serving older individuals;

7. provide that the area agency on aging shall, consistent with this section, facilitate the areawide development and implementation of a comprehensive, coordinated system for providing long-term care in home and community-based settings, in a manner responsive to the needs and preferences of older individuals and their family caregivers, by—

1. collaborating, coordinating activities, and consulting with other local public and private agencies and organizations responsible for administering programs, benefits, and services related to providing long-term care;

2. conducting analyses and making recommendations with respect to strategies for modifying the local system of long-term care to better—

   1. respond to the needs and preferences of older individuals and family caregivers;

   2. facilitate the provision, by service providers, of long-term care in home and community-based settings; and

   3. target services to older individuals at risk for institutional placement, to permit such individuals to remain in home and community-based settings;

3. implementing, through the agency or service providers, evidence-based programs to assist older individuals and their family caregivers in learning about and making behavioral changes intended to reduce the risk of injury, disease, and disability among older individuals; and

4. providing for the availability and distribution (through public education campaigns, Aging and Disability Resource Centers, the area agency on aging itself, and other appropriate means) of information relating to—

   1. the need to plan in advance for long-term care; and

   2. the full range of available public and private long-term care (including integrated long-term care) programs, options, service providers, and resources;

8. provide that case management services provided under this title through the area agency on aging will—

1. not duplicate case management services provided through other Federal and State programs;

2. be coordinated with services described in subparagraph (A); and

3. be provided by a public agency or a nonprofit private agency that—

   1. gives each older individual seeking services under this title a list of agencies that provide similar services within the jurisdiction of the area agency on aging;

   2. gives each individual described in clause (i) a statement specifying that the individual has a right to make an independent choice of service providers and documents receipt by such individual of such statement;

   3. has case managers acting as agents for the individuals receiving the services and not as promoters for the agency providing such services; or

   4. is located in a rural area and obtains a waiver of the requirements described in clauses (i) through (iii);

(9)(A) provide assurances that the area agency on aging, in carrying out the State Long-Term Care Ombudsman program under section 307(a)(9), will expend not less than the total amount of funds appropriated under this Act and expended by the agency in fiscal year 2019 in carrying out such a program under this title;

(B) funds made available to the area agency on aging pursuant to section 712 shall be used to supplement and not supplant other Federal, State, and local funds expended to support activities described in section 712;

10. provide a grievance procedure for older individuals who are dissatisfied with or denied services under this title;

11. provide information and assurances concerning services to older individuals who are Native Americans (referred to in this paragraph as "older Native Americans"), including—

    1. information concerning whether there is a significant population of older Native Americans in the planning and service area and if so, an assurance that the area agency on aging will pursue activities, including outreach, to increase access of those older Native Americans to programs and benefits provided under this title;

    2. an assurance that the area agency on aging will, to the maximum extent practicable, coordinate the services the agency provides under this title with services provided under title VI; and

    3. an assurance that the area agency on aging will make services under the area plan available, to the same extent as such services are available to older individuals within the planning and service area, to older Native Americans;

12. provide that the area agency on aging will establish procedures for coordination of services with entities conducting other Federal or federally assisted programs for older individuals at the local level, with particular emphasis on entities conducting programs described in section 203(b) within the planning and service area.

13. provide assurances that the area agency on aging will—

    1. maintain the integrity and public purpose of services provided, and service providers, under this title in all contractual and commercial relationships;

    2. disclose to the Assistant Secretary and the State agency—

       1. the identity of each nongovernmental entity with which such agency has a contract or commercial relationship relating to providing any service to older individuals; and

       2. the nature of such contract or such relationship;

    3. demonstrate that a loss or diminution in the quantity or quality of the services provided, or to be provided, under this title by such agency has not resulted and will not result from such contract or such relationship;

    4. demonstrate that the quantity or quality of the services to be provided under this title by such agency will be enhanced as a result of such contract or such relationship; and

    5. on the request of the Assistant Secretary or the State, for the purpose of monitoring compliance with this Act (including conducting an audit), disclose all sources and expenditures of funds such agency receives or expends to provide services to older individuals;

14. provide assurances that preference in receiving services under this title will not be given by the area agency on aging to particular older individuals as a result of a contract or commercial relationship that is not carried out to implement this title;

15. provide assurances that funds received under this title will be used—

    1. to provide benefits and services to older individuals, giving priority to older individuals identified in paragraph (4)(A)(i); and

    2. in compliance with the assurances specified in paragraph (13) and the limitations specified in section 212;

16. provide, to the extent feasible, for the furnishing of services under this Act, consistent with self-directed care;

17. include information detailing how the area agency on aging will coordinate activities, and develop long-range emergency preparedness plans, with local and State emergency response agencies, relief organizations, local and State governments, and any other institutions that have responsibility for disaster relief service delivery;

18. provide assurances that the area agency on aging will collect data to determine—

    1. the services that are needed by older individuals whose needs were the focus of all centers funded under title IV in fiscal year 2019; and

    2. the effectiveness of the programs, policies, and services provided by such area agency on aging in assisting such individuals; and

19. provide assurances that the area agency on aging will use outreach efforts that will identify individuals eligible for assistance under this Act, with special emphasis on those individuals whose needs were the focus of all centers funded under title IV in fiscal year 2019.

(b)(1) An area agency on aging may include in the area plan an assessment of how prepared the area agency on aging and service providers in the planning and service area are for any anticipated change in the number of older individuals during the 10-year period following the fiscal year for which the plan is submitted.

2. Such assessment may include—

area;

1. the projected change in the number of older individuals in the planning and service

2. an analysis of how such change may affect such individuals, including individuals

with low incomes, individuals with greatest economic need, minority older individuals, older individuals residing in rural areas, and older individuals with limited English proficiency;

3. an analysis of how the programs, policies, and services provided by such area agency can be improved, and how resource levels can be adjusted to meet the needs of the changing population of older individuals in the planning and service area; and

4. an analysis of how the change in the number of individuals age 85 and older in the planning and service area is expected to affect the need for supportive services.

2. An area agency on aging, in cooperation with government officials, State agencies, tribal organizations, or local entities, may make recommendations to government officials in the planning and service area and the State, on actions determined by the area agency to build the capacity in the planning and service area to meet the needs of older individuals for—

   1. health and human services;

   2. land use;

   3. housing;

   4. transportation;

   5. public safety;

   6. workforce and economic development;

   7. recreation;

   8. education;

   9. civic engagement;

   10. emergency preparedness;

   11. protection from elder abuse, neglect, and exploitation;

   12. assistive technology devices and services; and

   13. any other service as determined by such agency.

(c) Each State, in approving area agency on aging plans under this section, shall waive the requirement described in paragraph (2) of subsection (a) for any category of services described in such paragraph if the area agency on aging demonstrates to the State agency that services being furnished for such category in the area are sufficient to meet the need for such services in such area and had conducted a timely public hearing upon request.

(d)(1) Subject to regulations prescribed by the Assistant Secretary, an area agency on aging designated under section 305(a)(2)(A) or, in areas of a State where no such agency has been designated, the State agency, may enter into agreement with agencies administering programs under the Rehabilitation Act of 1973, and titles XIX and XX of the Social Security Act for the purpose of developing and implementing plans for meeting the common need for transportation services of individuals receiving benefits under such Acts and older individuals participating in programs authorized by this title.

(2) In accordance with an agreement entered into under paragraph (1), funds appropriated under this title may be used to purchase transportation services for older individuals and may be pooled with funds made available for the provision of transportation services under the Rehabilitation Act of 1973, and titles XIX and XX of the Social Security Act.

(e) An area agency on aging may not require any provider of legal assistance under this title to reveal any information that is protected by the attorney-client privilege.

(f)(1) If the head of a State agency finds that an area agency on aging has failed to comply with Federal or State laws, including the area plan requirements of this section, regulations, or policies, the State may withhold a portion of the funds to the area agency on aging available under this title.

(2)(A) The head of a State agency shall not make a final determination withholding funds under paragraph (1) without first affording the area agency on aging due process in accordance with procedures established by the State agency.

2. At a minimum, such procedures shall include procedures for—

   1. providing notice of an action to withhold funds;

   2. providing documentation of the need for such action; and

   3. at the request of the area agency on aging, conducting a public hearing concerning the action.

(3)(A) If a State agency withholds the funds, the State agency may use the funds withheld to directly administer programs under this title in the planning and service area served by the area agency on aging for a period not to exceed 180 days, except as provided in subparagraph (B).

(B) If the State agency determines that the area agency on aging has not taken corrective action, or if the State agency does not approve the corrective action, during the 180-day period described in subparagraph (A), the State agency may extend the period for not more than 90 days.

7. Nothing in this Act shall restrict an area agency on aging from providing services not provided or authorized by this Act, including through—

   1. contracts with health care payers;

   2. consumer private pay programs; or

   3. other arrangements with entities or individuals that increase the availability of home and community-based services and supports.

Sec. 307, STATE PLANS

1. Except as provided in the succeeding sentence and section 309(a), each State, in order to be eligible for grants from its allotment under this title for any fiscal year, shall submit to the Assistant Secretary a State plan for a two, three, or four-year period determined by the State agency, with such annual revisions as are necessary, which meets such criteria as the Assistant Secretary may by regulation prescribe. If the Assistant Secretary determines, in the discretion of the Assistant Secretary, that a State failed in 2 successive years to comply with the requirements under this title, then the State shall submit to the Assistant Secretary a State plan for a 1-year period that meets such criteria, for subsequent years until the Assistant Secretary determines that the State is in compliance with such requirements. Each such plan shall comply with all of the following requirements:

   1. The plan shall—

      1. require each area agency on aging designated under section 305(a)(2)(A) to develop and submit to the State agency for approval, in accordance with a uniform format developed by the State agency, an area plan meeting the requirements of section 306; and

      2. be based on such area plans.

   2. The plan shall provide that the State agency will—

      1. evaluate, using uniform procedures described in section 202(a)(26), the need for supportive services (including legal assistance pursuant to 307(a)(11), information and assistance, and transportation services), nutrition services, and multipurpose senior centers within the State;

      2. develop a standardized process to determine the extent to which public or private programs and resources (including volunteers and programs and services of voluntary organizations) that have the capacity and actually meet such need; and

      3. specify a minimum proportion of the funds received by each area agency on aging in the State to carry out part B that will be expended (in the absence of a waiver under section 306(c) or 316) by such area agency on aging to provide each of the categories of services specified in section 306(a)(2).

   3. The plan shall—

      1. include (and may not be approved unless the Assistant Secretary approves) the statement and demonstration required by paragraphs (2) and (4) of section 305(d) (concerning intrastate distribution of funds); and

      2. with respect to services for older individuals residing in rural areas—

         1. provide assurances that the State agency will spend for each fiscal year, not less than the amount expended for such services for fiscal year 2000…

         2. identify, for each fiscal year to which the plan applies, the projected costs of providing such services (including the cost of providing access to such services); and

         3. describe the methods used to meet the needs for such services in the fiscal year preceding the first year to which such plan applies.

   4. The plan shall provide that the State agency will conduct periodic evaluations of, and public hearings on, activities and projects carried out in the State under this title and title VII, including evaluations of the effectiveness of services provided to individuals with greatest economic need, greatest social need, or disabilities (with particular attention to low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas).

   5. The plan shall provide that the State agency will—

      1. afford an opportunity for a hearing upon request, in accordance with published procedures, to any area agency on aging submitting a plan under this title, to any provider of (or applicant to provide) services;

      2. issue guidelines applicable to grievance procedures required by section 306(a)(10);

and

3. afford an opportunity for a public hearing, upon request, by any area agency on

aging, by any provider of (or applicant to provide) services, or by any recipient of services under this title regarding any waiver request, including those under section 316.

6. The plan shall provide that the State agency will make such reports, in such form, and containing such information, as the Assistant Secretary may require, and comply with such requirements as the Assistant Secretary may impose to insure the correctness of such reports.

(7)(A) The plan shall provide satisfactory assurance that such fiscal control and fund accounting procedures will be adopted as may be necessary to assure proper disbursement of, and accounting for, Federal funds paid under this title to the State, including any such funds paid to the recipients of a grant or contract.

2. The plan shall provide assurances that—

   1. no individual (appointed or otherwise) involved in the designation of the State agency or an area agency on aging, or in the designation of the head of any subdivision of the

State agency or of an area agency on aging, is subject to a conflict of interest prohibited under this Act;

2. no officer, employee, or other representative of the State agency or an area agency on aging is subject to a conflict of interest prohibited under this Act; and

3. mechanisms are in place to identify and remove conflicts of interest prohibited under this Act.

(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—

1. provision of such services by the State agency or the area agency on aging is necessary to assure an adequate supply of such services;

2. such services are directly related to such State agency’s or area agency on aging’s administrative functions; or

3. such services can be provided more economically, and with comparable quality, by such State agency or area agency on aging.

2. Regarding case management services, if the State agency or area agency on aging is already providing case management services (as of the date of submission of the plan) under a State program, the plan may specify that such agency is allowed to continue to provide case management services.

3. The plan may specify that an area agency on aging is allowed to directly provide information and assistance services and outreach.

9. The plan shall provide assurances that—

1. the State agency will carry out, through the Office of the State Long-Term Care Ombudsman, a State Long-Term Care Ombudsman program in accordance with section 712 and this title, and will expend for such purpose an amount that is not less than an amount expended by the State agency with funds received under this title for fiscal year 2019, and an amount that is not less than the amount expended by the State agency with funds received under title VII for fiscal year 2019; and

2. funds made available to the State agency pursuant to section 712 shall be used to supplement and not supplant other Federal, State, and local funds expended to support activities described in section 712.

10. The plan shall provide assurances that the special needs of older individuals residing in rural areas will be taken into consideration and shall describe how those needs have been met and describe how funds have been allocated to meet those needs.

11. The plan shall provide that with respect to legal assistance —

1. the plan contains assurances that area agencies on aging will (i) enter into contracts with providers of legal assistance which can demonstrate the experience or capacity to deliver legal assistance; (ii) include in any such contract provisions to assure that any recipient of funds under division (i) will be subject to specific restrictions and regulations promulgated under the Legal Services Corporation Act (other than restrictions and regulations governing eligibility for legal assistance under such Act and governing membership of local governing boards) as determined appropriate by the Assistant Secretary; and (iii) attempt to involve the private bar in legal assistance activities authorized under this title, including groups within the private bar furnishing services to older individuals on a pro bono and reduced fee basis;

2. the plan contains assurances that no legal assistance will be furnished unless the grantee administers a program designed to provide legal assistance to older individuals with social or economic need and has agreed, if the grantee is not a Legal Services Corporation project grantee, to coordinate its services with existing Legal Services Corporation projects in the planning and service area in order to concentrate the use of funds provided under this title on individuals with the greatest such need; and the area agency on aging makes a finding, after assessment, pursuant to standards for service promulgated by the Assistant Secretary, that any grantee selected is the entity best able to provide the particular services.

3. the State agency will provide for the coordination of the furnishing of legal assistance to older individuals within the State, and provide advice and technical assistance in the provision of legal assistance to older individuals within the State and support the furnishing of training and technical assistance for legal assistance for older individuals;

4. the plan contains assurances, to the extent practicable, that legal assistance furnished under the plan will be in addition to any legal assistance for older individuals being furnished with funds from sources other than this Act and that reasonable efforts will be made to maintain existing levels of legal assistance for older individuals; and

5. the plan contains assurances that area agencies on aging will give priority to legal assistance related to income, health care, long-term care, nutrition, housing, utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination.

12. The plan shall provide, whenever the State desires to provide for a fiscal year for services for the prevention of abuse of older individuals —

1. the plan contains assurances that any area agency on aging carrying out such services will conduct a program consistent with relevant State law and coordinated with existing State adult protective service activities for—

   1. public education to identify and prevent abuse of older individuals;

   2. receipt of reports of abuse of older individuals;

   3. active participation of older individuals participating in programs under this Act through outreach, conferences, and referral of such individuals to other social service agencies or sources of assistance where appropriate and consented to by the parties to be referred; and

   4. referral of complaints to law enforcement or public protective service agencies where appropriate;

2. the State will not permit involuntary or coerced participation in the program of services described in this paragraph by alleged victims, abusers, or their households; and

3. all information gathered in the course of receiving reports and making referrals shall remain confidential unless all parties to the complaint consent in writing to the release of such information, except that such information may be released to a law enforcement or public protective service agency.

13. The plan shall provide assurances that each State will assign personnel (one of whom shall be known as a legal assistance developer) to provide State leadership in developing legal assistance programs for older individuals throughout the State.

14. The plan shall, with respect to the fiscal year preceding the fiscal year for which such plan is prepared—

1. identify the number of low-income minority older individuals in the State, including the number of low-income minority older individuals with limited English proficiency; and

2. describe the methods used to satisfy the service needs of the low-income minority older individuals described in subparagraph (A), including the plan to meet the needs of low- income minority older individuals with limited English proficiency.

15. The plan shall provide assurances that, if a substantial number of the older individuals residing in any planning and service area in the State are of limited

English-speaking ability, then the State will require the area agency on aging for each such planning and service area—

1. to utilize in the delivery of outreach services under section 306(a)(2)(A), the services of workers who are fluent in the language spoken by a predominant number of such older individuals who are of limited English-speaking ability; and

2. to designate an individual employed by the area agency on aging, or available to such area agency on aging on a full-time basis, whose responsibilities will include—

   1. taking such action as may be appropriate to assure that counseling assistance is made available to such older individuals who are of limited English-speaking ability in order to assist such older individuals in participating in programs and receiving assistance under this Act; and

   2. providing guidance to individuals engaged in the delivery of supportive services under the area plan involved to enable such individuals to be aware of cultural sensitivities and to take into account effectively linguistic and cultural differences.

16. The plan shall provide assurances that the State agency will require outreach efforts that will—

on—

1. identify individuals eligible for assistance under this Act, with special emphasis

1. older individuals residing in rural areas;

2. older individuals with greatest economic need (with particular attention to low-

income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas);

3. older individuals with greatest social need (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas);

4. older individuals with severe disabilities;

5. older individuals with limited English-speaking ability; and

6. older individuals with Alzheimer’s disease and related disorders with neurological and organic brain dysfunction (and the caretakers of such individuals); and

1. inform the older individuals referred to in clauses (i) through (vi) of subparagraph (A), and the caretakers of such individuals, of the availability of such assistance.

17. The plan shall provide, with respect to the needs of older individuals with severe disabilities, assurances that the State will coordinate planning, identification, assessment of needs, and service for older individuals with disabilities with particular attention to individuals with severe disabilities with the State agencies with primary responsibility for individuals with disabilities, including severe disabilities, to enhance services and develop collaborative programs, where appropriate, to meet the needs of older individuals with disabilities.

18. The plan shall provide assurances that area agencies on aging will conduct efforts to facilitate the coordination of community-based, long-term care services, pursuant to section 306(a)(7), for older individuals who—

1. reside at home and are at risk of institutionalization because of limitations on their ability to function independently;

2. are patients in hospitals and are at risk of prolonged institutionalization; or

3. are patients in long-term care facilities, but who can return to their homes if community-based services are provided to them.

19. The plan shall include the assurances and description required by section 705(a).

20. The plan shall provide assurances that special efforts will be made to provide technical assistance to minority providers of services.

21. The plan shall—

1. provide an assurance that the State agency will coordinate programs under this title and programs under title VI, if applicable; and

2. provide an assurance that the State agency will pursue activities to increase access by older individuals who are Native Americans to all aging programs and benefits provided by the agency, including programs and benefits provided under this title, if applicable, and specify the ways in which the State agency intends to implement the activities.

22. If case management services are offered to provide access to supportive services, the plan shall provide that the State agency shall ensure compliance with the requirements specified in section 306(a)(8).

23. The plan shall provide assurances that demonstrable efforts will be made—

1. to coordinate services provided under this Act with other State services that benefit older individuals; and

2. to provide multigenerational activities, such as opportunities for older individuals to serve as mentors or advisers in child care, youth day care, educational assistance, at-risk youth intervention, juvenile delinquency treatment, and family support programs.

24. The plan shall provide assurances that the State will coordinate public services within the State to assist older individuals to obtain transportation services associated with access to services provided under this title, to services under title VI, to comprehensive counseling services, and to legal assistance.

25. The plan shall include assurances that the State has in effect a mechanism to provide for quality in the provision of in-home services under this title.

26. The plan shall provide assurances that area agencies on aging will provide, to the extent feasible, for the furnishing of services under this Act, consistent with self-directed care.

(27)(A) The plan shall include, at the election of the State, an assessment of how prepared the State is, under the State’s statewide service delivery model, for any anticipated change in the number of older individuals during the 10-year period following the fiscal year for which the plan is submitted.

2. Such assessment may include—

   1. the projected change in the number of older individuals in the State;

   2. an analysis of how such change may affect such individuals, including individuals with low incomes, individuals with greatest economic need, minority older individuals, older individuals residing in rural areas, and older individuals with limited English proficiency;

   3. an analysis of how the programs, policies, and services provided by the State can be improved, including coordinating with area agencies on aging, and how resource levels can be adjusted to meet the needs of the changing population of older individuals in the State; and

   4. an analysis of how the change in the number of individuals age 85 and older in the State is expected to affect the need for supportive services.

28. The plan shall include information detailing how the State will coordinate activities, and develop long-range emergency preparedness plans, with area agencies on aging, local emergency response agencies, relief organizations, local governments, State agencies responsible for emergency preparedness, and any other institutions that have responsibility for disaster relief service delivery.

29. The plan shall include information describing the involvement of the head of the State agency in the development, revision, and implementation of emergency preparedness plans, including the State Public Health Emergency Preparedness and Response Plan.

30. The plan shall contain an assurance that the State shall prepare and submit to the Assistant Secretary annual reports that describe—

    1. data collected to determine the services that are needed by older individuals whose needs were the focus of all centers funded under title IV in fiscal year 2019;

    2. data collected to determine the effectiveness of the programs, policies, and services provided by area agencies on aging in assisting such individuals; and

    3. outreach efforts and other activities carried out to satisfy the assurances described in paragraphs (18) and (19) of section 306(a).

Sec. 308, PLANNING, COORDINATION, EVALUATION, AND ADMINISTRATION OF STATE PLANS

(b)(3)(E) No application by a State under subparagraph (A) shall be approved unless it contains assurances that no amounts received by the State under this paragraph will be used to hire any individual to fill a job opening created by the action of the State in laying off or terminating the employment of any regular employee not supported under this Act in anticipation of filling the vacancy so created by hiring an employee to be supported through use of amounts received under this paragraph.

Sec. 705, ADDITIONAL STATE PLAN REQUIREMENTS

1. ELIGIBILITY.—In order to be eligible to receive an allotment under this subtitle, a State shall include in the state plan submitted under section 307—

   1. an assurance that the State, in carrying out any chapter of this subtitle for which the State receives funding under this subtitle, will establish programs in accordance with the requirements of the chapter and this chapter;

   2. an assurance that the State will hold public hearings, and use other means, to obtain the views of older individuals, area agencies on aging, recipients of grants under title VI, and other interested persons and entities regarding programs carried out under this subtitle;

   3. an assurance that the State, in consultation with area agencies on aging, will identify and prioritize statewide activities aimed at ensuring that older individuals have access to, and assistance in securing and maintaining, benefits and rights;

   4. an assurance that the State will use funds made available under this subtitle for a chapter in addition to, and will not supplant, any funds that are expended under any Federal or State law in existence on the day before the date of the enactment of this subtitle, to carry out each of the vulnerable elder rights protection activities described in the chapter;

   5. an assurance that the State will place no restrictions, other than the requirements referred to in clauses (i) through (iv) of section 712(a)(5)(C), on the eligibility of entities for designation as local Ombudsman entities under section 712(a)(5).

   6. an assurance that, with respect to programs for the prevention of elder abuse, neglect, and exploitation under chapter 3—

      1. in carrying out such programs the State agency will conduct a program of services consistent with relevant State law and coordinated with existing State adult protective service activities for—

         1. public education to identify and prevent elder abuse;

         2. receipt of reports of elder abuse;

         3. active participation of older individuals participating in programs under this Act through outreach, conferences, and referral of such individuals to other social service agencies or sources of assistance if appropriate and if the individuals to be referred consent; and

         4. referral of complaints to law enforcement or public protective service agencies if appropriate;

      2. the State will not permit involuntary or coerced participation in the program of services described in subparagraph (A) by alleged victims, abusers, or their households; and

      3. all information gathered in the course of receiving reports and making referrals shall remain confidential except—

         1. if all parties to such complaint consent in writing to the release of such information;

         2. if the release of such information is to a law enforcement agency, public protective service agency, licensing or certification agency, ombudsman program, or protection or advocacy system; or

         3. upon court order…

Signature and Title of Authorized Official Date

State Plan Guidance Attachment B

INFORMATION REQUIREMENTS

Except as indicated where optional or only applicable to States with multiple planning and service areas, the State Plan must state how the following provision(s) will be met:

Greatest Economic and Greatest Social Need

45 CFR § 1321.27 (d) requires each State Plan must include a description of how greatest economic need and greatest social need are determined and addressed by specifying:

1. How the State agency defines greatest economic need and greatest social need, which shall include the populations as set forth in the definitions of greatest economic need and greatest social need, as set forth in 45 CFR § 1321.3; and

2. The methods the State agency will use to target services to such populations, including how OAA funds may be distributed to serve prioritized populations in accordance with requirements as set forth in 45 CFR § 1321.49 or 45 CFR § 1321.51, as appropriate.

“Greatest economic need” means “the need resulting from an income level at or below the Federal poverty level and as further defined by State and area plans based on local and individual factors, including geography and expenses” (45 CFR § 1321.3).

“Greatest social need” means the need caused by the following noneconomic factors as defined in 45 CFR § 1321.3.

A State agency’s response must establish how the State agency will:

1. identify and consider populations in greatest economic need and greatest social need;

2. describe how they target the identified the populations for service provision;

3. establish priorities to serve one or more of the identified target populations, given limited availability of funds and other resources;

4. establish methods for serving the prioritized populations; and

5. use data to evaluate whether and how the prioritized populations are being served.

RESPONSE:

Native Americans: Greatest Economic and Greatest Social Need

45 CFR § 1321.27 (g):

Demonstration that the determination of greatest economic need and greatest social need specific to Native American persons is identified pursuant to communication among the State agency

and Tribes, Tribal organizations, and Native communities, and that the services provided under this part will be coordinated, where applicable, with the services provided under Title VI of the Act and that the State agency shall require area agencies to provide outreach where there are older Native Americans in any planning and service area, including those living outside of reservations and other Tribal lands.

RESPONSE:

Activities to Increase Access and Coordination for Native American Older Adults

OAA Section 307(a)(21): The plan shall —

. . .

2. provide an assurance that the State agency will pursue activities to increase access by older individuals who are Native Americans to all aging programs and benefits provided by the agency, including programs and benefits provided under this title, if applicable, and specify the ways in which the State agency intends to implement the activities.

45 CFR § 1321.53:

1. For States where there are Title VI programs, the State agency’s policies and procedures, developed in coordination with the relevant Title VI program director(s), as set forth in § 1322.13(a), must explain how the State’s aging network, including area agencies and service providers, will coordinate with Title VI programs to ensure compliance with sections 306(a)(11)(B) (42 U.S.C. 3026(a)(11)(B)) and 307(a)(21)(A) (42 U.S.C. 3027(a)(21)(A)) of the

Act. State agencies may meet these requirements through a Tribal consultation policy that includes Title VI programs.

2. The policies and procedures set forth in (a) of this provision must at a minimum address:

   1. How the State’s aging network, including area agencies on aging and service providers, will provide outreach to Tribal elders and family caregivers regarding services for which they may be eligible under Title III and/or VII;

   2. The communication opportunities the State agency will make available to Title VI programs, to include Title III and other funding opportunities, technical assistance on how to apply for Title III and other funding opportunities, meetings, email distribution lists, presentations, and public hearings;

   3. The methods for collaboration on and sharing of program information and changes, including coordinating with area agencies and service providers where applicable;

   4. How Title VI programs may refer individuals who are eligible for Title III and/or VII services;

   5. How services will be provided in a culturally appropriate and trauma-informed manner; and

   6. Opportunities to serve on advisory councils, workgroups, and boards, including area agency advisory councils, as set forth in § 1321.63.

RESPONSE:

Low Income Minority Older Adults

OAA Section 307(a)(14):

(14) The plan shall, with respect to the fiscal year preceding the fiscal year for which such plan is prepared—

1. identify the number of low-income minority older individuals in the State, including the number of low income minority older individuals with limited English proficiency; and

2. describe the methods used to satisfy the service needs of the low-income minority older individuals described in subparagraph (A), including the plan to meet the needs of low- income minority older individuals with limited English proficiency.

RESPONSE:

Rural Areas – Hold Harmless

OAA Section 307(a)(3): The plan shall—

...

2. with respect to services for older individuals residing in rural areas—

   1. provide assurances the State agency will spend for each fiscal year not less than the amount expended for such services for fiscal year 2000;

   2. identify, for each fiscal year to which the plan applies, the projected costs of providing such services (including the cost of providing access to such services); and

   3. describe the methods used to meet the needs for such services in the fiscal year preceding the first year to which such plan applies.

RESPONSE:

Rural Areas – Needs and Fund Allocations

OAA Section 307(a)(10):

The plan shall provide assurance that the special needs of older individuals residing in rural areas are taken into consideration and shall describe how those needs have been met and describe how funds have been allocated to meet those needs.

RESPONSE:

Assistive Technology

OAA Section 306(a)(6)(I):

Describe the mechanism(s) for assuring that each Area Plan will include information detailing how the area agency will, to the extent feasible, coordinate with the State agency to disseminate information about the State assistive technology entity and access to assistive technology options for serving older individuals;

RESPONSE:

Minimum Proportion of Funds

OAA Section 307(a)(2):

The plan shall provide that the State agency will —…

2. specify a minimum proportion of the funds received by each area agency on aging in the State to carry out part B that will be expended (in the absence of a waiver under sections 306

3. or 316) by such area agency on aging to provide each of the categories of services specified in section 306(a)(2). (Note: those categories are access, in-home, and legal assistance. Provide specific minimum proportion determined for each category of service.)

RESPONSE:

Assessment of Statewide Service Delivery Model

OAA Section 307(a)(27):

1. The plan shall include, at the election of the State, an assessment of how prepared the State is, under the State’s statewide service delivery model, for any anticipated change in the number of older individuals during the 10-year period following the fiscal year for which the plan is submitted.

2. Such assessment may include—

   1. the projected change in the number of older individuals in the State;

   2. an analysis of how such change may affect such individuals, including individuals with low incomes, individuals with greatest economic need, minority older individuals, older individuals residing in rural areas, and older individuals with limited English proficiency;

   3. an analysis of how the programs, policies, and services provided by the State can be improved, including coordinating with area agencies on aging, and how resource levels can be adjusted to meet the needs of the changing population of older individuals in the State; and

   4. an analysis of how the change in the number of individuals age 85 and older in the State is expected to affect the need for supportive services

RESPONSE:

Shelf Stable, Pick-Up, Carry-Out, Drive-Through, or Similar Meals Using Title III Congregate Nutrition (C-1) Service Funding (Optional, only for States that elect to pursue this activity)

45 CFR § 1321.87(a)(1)(ii):

Title III C-1 funds may be used for shelf-stable, pick-up, carry-out, drive-through, or similar meals, subject to certain terms and conditions:

1. Such meals must not exceed 25 percent of the funds expended by the State agency under Title III, part C-1, to be calculated based on the amount of Title III, part C-1 funds available after all transfers as set forth in 45 CFR § 1321.9(c)(2)(iii) are completed;

2. Such meals must not exceed 25 percent of the funds expended by any area agency on aging under Title III, part C-1, to be calculated based on the amount of Title III, part C-1 funds available after all transfers as set forth in 45 CFR § 1321.9(c)(2)(iii) are completed;

3. Such meals are to be provided to complement the congregate meal program:

   1. During disaster or emergency situations affecting the provision of nutrition services;

   2. To older individuals who have an occasional need for such meal; and/or

   3. To older individuals who have a regular need for such meal, based on an individualized assessment, when targeting services to those in greatest economic need and greatest social need; and

45 CFR § 1321.27 (j):

If the State agency allows for Title III, part C-1 funds to be used as set forth in

§1321.87(a)(1)(i), the State agency must include the following:

1. Evidence, using participation projections based on existing data, that provision of such meals will enhance and not diminish the congregate meals program, and a commitment to monitor the impact on congregate meals program participation;

2. Description of how provision of such meals will be targeted to reach those populations identified as in greatest economic need and greatest social need;

3. Description of the eligibility criteria for service provision;

4. Evidence of consultation with area agencies on aging, nutrition and other direct services providers, other stakeholders, and the general public regarding the provision of such meals; and

5. Description of how provision of such meals will be coordinated with area agencies on aging, nutrition and other direct services providers, and other stakeholders.

RESPONSE:

Funding Allocation – Ombudsman Program

45 CFR Part 1324, Subpart A:

How the State agency will coordinate with the State Long-Term Care Ombudsman and allocate and use funds for the Ombudsman program under Title III and VII, as set forth in 45 CFR part 1324, subpart A.

RESPONSE:

Funding Allocation – Elder Abuse, Neglect, and Exploitation

45 CFR § 1321.27 (k):

How the State agency will allocate and use funds for prevention of elder abuse, neglect, and exploitation as set forth in 45 CFR part 1324, subpart B.

RESPONSE:

Monitoring of Assurances

45 CFR § 1321.27 (m):

Describe how the State agency will conduct monitoring that the assurances (submitted as Attachment A of the State Plan) to which they attest are being met.

RESPONSE:

State Plans Informed By and Based on Area Plans

45 CFR § 1321.27 (c):

Evidence that the State Plan is informed by and based on area plans, except for single planning and service area States.

RESPONSE:

Public Input and Review

45 CFR § 1321.29:

Describe how the State agency considered the views of older individuals, family caregivers, service providers and the public in developing the State Plan, and how the State agency considers such views in administering the State Plan. Describe how the public review and comment period was conducted and how the State agency responded to public input and comments in the development of the State Plan.

RESPONSE:

Program Development and Coordination Activities (Optional, only for States that elect to pursue this activity)

45 CFR § 1321.27 (h):

Certification that any program development and coordination activities shall meet the following requirements:

1. The State agency shall not fund program development and coordination activities as a cost of supportive services under area plans until it has first spent 10 percent of the total of its combined allotments under Title III on the administration of area plans;

2. Program development and coordination activities must only be expended as a cost of State Plan administration, area plan administration, and/or Title III, part B supportive services;

3. State agencies and area agencies on aging shall, consistent with the area plan and budgeting cycles, submit the details of proposals to pay for program development and coordination as a cost of Title III, part B supportive services to the general public for review and comment; and

4. Expenditure by the State agency and area agency on program development and coordination activities are intended to have a direct and positive impact on the enhancement of services for older persons and family caregivers in the planning and service area.

RESPONSE:

Legal Assistance Developer

45 CFR § 1321.27 (l):

How the State agency will meet responsibilities for the Legal Assistance Developer, as set forth in part 1324, subpart C.

RESPONSE:

Emergency Preparedness Plans – Coordination and Development

OAA Section 307(a)(28):

The plan shall include information detailing how the State will coordinate activities, and develop long-range emergency preparedness plans, with area agencies on aging, local emergency

response agencies, relief organizations, local governments, State agencies responsible for emergency preparedness, and any other institutions that have responsibility for disaster relief service delivery.

RESPONSE:

Emergency Preparedness Plans – Involvement of the head of the State agency

OAA Section 307(a)(29):

The plan shall include information describing the involvement of the head of the State agency in the development, revision, and implementation of emergency preparedness plans, including the State Public Health Emergency Preparedness and Response Plan.

RESPONSE:

State Plan Guidance Attachment C

INTRASTATE FUNDING FORMULA/FUNDS DISTRIBUTION PLAN REQUIREMENTS

For States with AAAs, each new State Plan submission must include a copy of the State’s current IFF and must include the required information set forth in this attachment.

For single PSA States, each new State Plan submission must include a copy of the State’s current funds distribution plan and must include the required information set forth in this attachment.

Note: ACL will thoroughly review all IFFs and funds distribution plans. If any required information is not included in the current IFF or funds distribution plan, as applicable, or if any corrections or changes are needed to the current IFF or funds distribution plan, please consult with your Regional Office as to how to proceed in order to properly make any needed additions, changes or corrections. Failure to follow the required process for such additions, changes or corrections may result in a delay in the State Plan approval process.

Requirements Applicable to IFF Revisions:

OAA, Sec. 305(a)(2)(C)

“States shall,

3. in consultation with area agencies, in accordance with guidelines issued by the Assistant Secretary, and using the best available data, develop and publish for review and comment a formula for distribution within the State of funds received under this title that takes into account-

   1. the geographical distribution of older individuals in the State; and

   2. the distribution among planning and service areas of older individuals with greatest economic need and older individuals with greatest social need, with particular attention to low-income minority older individuals.”

OAA, Sec. 305(d)

3. The publication for review and comment required by paragraph (2)(C) of subsection (a) shall include—

1. a descriptive statement of the formula’s assumptions and goals, and the application of the definitions of greatest economic or social need,

2. a numerical statement of the actual funding formula to be used,

3. a listing of the population, economic, and social data to be used for each planning and service area in the State, and

4. a demonstration of the allocation of funds, pursuant to the funding formula, to each planning and service area in the State.

All IFFs must contain the following:

• A descriptive statement of the formula’s assumptions and goals, and the application of the definitions of greatest economic need and greatest social need, including addressing the populations identified pursuant to 45 CFR § 1321.27(d)(1).

• A list of the data used by PSA.

• A descriptive statement of each factor (i.e. 60+ living alone – number of people who are 60 and older that live alone) and weight/percentage used for each factor (i.e. 60+ living alone = 5%).

• Allocations of funds by PSA based on the IFF segmented by Part of Title III (e.g., chart of PSA X, IIIB Supportive Services, $900,000).

• States must provide the source of the data used to run in the IFF. States must use the “best available data.” In most cases, the best available data is the most current US Census. A State also may use more recent US Census estimates from the American Community Survey; other more recent data of equivalent quality available in the State also may be considered.

• A numerical/mathematical statement of the formula is required for Parts B, C-1, C-2, D and E. Definitions of the terms used in the numerical/mathematical statement are required.

• A separate descriptive and numerical/mathematical statement may be provided for Title III Part D – Evidence Based Disease Prevention and Health Promotion Services, to target the medically underserved and which there are a large number of older individuals who have the greatest economic need for such services, per Section 362 of the OAA. If a separate formula is used for Part D, a separate descriptive and numerical/mathematical statement is required.

• A statement explaining how Nutrition Services Incentive Program (NSIP) funds are distributed.

• States may use a base amount in their IFFs to ensure viable funding across the entire State.

• Statement that discloses if, prior to distribution under the IFF to the AAAs, funds are deducted from Title III funds for: State Plan Administration, Area Plan Administration, disaster set-aside funds as set forth in 45 CFR § 1321.99, and/or Long-Term Care Ombudsman allocations.

• The IFF should include information on how the formula affects funding to each PSA.

Please see 45 CFR § 1321.49 for more information. Note: If any required information is not included in a current IFF or if any corrections or changes are needed to a current IFF, please consult with your Regional Administrator as to how to proceed in order to properly make any needed additions, changes or corrections. Failure to follow the required process for such additions, changes or corrections may result in a delay in the State Plan approval process.

Requirements Applicable to Single Planning and Service Area States

Per 45 CFR § 1321.51(b), as part of their State Plan submission, single PSA States must provide a funds distribution plan which includes:

1. A descriptive statement as to how the SUA determines the geographical distribution of the Title III and NSIP funding;

2. How the SUA targets the funding to reach individuals with greatest economic need and greatest social need, with particular attention to low-income minority older individuals;

3. At the option of the SUA, a numerical/mathematical statement as a part of their funds distribution plan; and

4. Justification if the SUA determines it meets requirements to provide services directly where:

   1. As set forth in OAA section 307(a)(8)(A), no supportive services, except as set forth in paragraph (B) below, nutrition services, disease prevention and health promotion, or family caregiver services will be directly provided by the SUA, unless, in the judgment of the SUA:

      1. Provision of such services by the SUA is necessary to assure an adequate supply of such services;

      2. Such services are directly related to such SUA’s administrative functions; or

      3. Such services may be provided more economically, and with comparable quality, by such State agency.

   2. The SUA may directly provide case management, information and assistance services, and outreach.

   3. Approval of the SUA to provide direct services may only be granted for a maximum of the State Plan period. For each time that approval is granted to a State agency to provide direct services, the State agency must demonstrate the SUA’s efforts to identify service providers prior to being granted a subsequent approval.

(c) Single PSA States must adhere to use of the funds distribution plan for Title III and NSIP funds within the State.

Note: If any required information is not included in the current funds distribution plan, or if any corrections or changes are needed to the current funds distribution plan, please consult with your Regional Administrator as to how to proceed in order to properly make any needed additions, changes or corrections. Failure to follow the required process for such additions, changes or corrections may result in a delay in the State Plan approval process.

Setting Aside Funds to Address Disasters

New 45 CFR §§ 1321.99 and 1321.101 allow SUAs to set aside funds for disaster relief. When implementing this authority, a SUA may set aside funds, up to five percent of their total Title III allocations, provided that these funds are specified as being allowed to be withheld for this purpose in the SUA’s approved IFF or funds distribution plan, as applicable, or with prior approval from the ASA. If funds are set aside for this purpose, the SUA must have policies and procedures in place to award the funds through the IFF or funds distribution plan if the funds are not awarded within 30 days of the end of the fiscal year in which the funds were received. Other terms and conditions apply to this authority granted to SUAs. See 45 CFR § 1321.99 and § 1321.101 for more information.

Revised IFFs/Funds Distribution Plans during this State Plan cycle

Any revisions to the IFF/Funds Distribution Plan must be clearly indicated and take into consideration the statutory and regulatory requirements listed in this attachment. Any change to IFF/Funds Distribution Plan factors or weights requires approval by the ASA. States must submit IFF/Funds Distribution Plan revisions that do not coincide with a new State Plan submittal as a State Plan amendment.

Public Comment Period: SUAs should be aware that, absent a waiver from the ASA, 45 CFR § 1321.49 requires that proposed IFF/Funds Distribution Plan revisions be available for a minimum of thirty (30) calendar days for public review and comment.

State Plan Amendments:

1. Subject to prior approval by the ASA, a State must amend the State Plan whenever necessary to reflect:

   1. New or revised statutes or regulations as determined by the ASA;

   2. An addition, deletion, or change to a State’s goal, assurance, or information requirement statement;

   3. A change in the State’s IFF or funds distribution plan for Title III funds, as set forth in 45 CFR § 1321.49 or § 1321.51;

   4. A request to waive State Plan requirements as set forth in section 316 of the OAA, or as required by guidance as set forth by the ASA; or

   5. Other changes as required by guidance as set forth by the ASA.

Absent a waiver from the ASA, 45 CFR § 1321.29 requires that proposed State Plan amendments that require the approval of the ASA must be available for a minimum of thirty (30) calendar days for public review and comment. State Plan amendment submissions should demonstrate compliance with this requirement.

Each State Plan amendment which requires approval of the ASA as set forth above shall be signed by the Governor, or the Governor's designee, and submitted to the ASA to be considered for approval at least 90 calendar days before the proposed effective date of the plan or plan amendment. Each such amendment shall be submitted to the ASA to be considered for approval via the applicable Regional Administrator. The State shall submit a draft of the amendment to the appropriate ACL Regional Office at least 120 calendar days before the proposed effective date of plan amendment, The SUA shall work with the ACL Regional Office in reviewing the plan amendment for compliance.

2. The action(s) listed in (1) through (6) below do not require prior approval of the ASA. A State must amend the State Plan and notify the ASA, via the applicable Regional Administrator, of an amendment not requiring prior approval whenever necessary and within 30 days of the action(s) listed in (1) through (6) below:

   1. A significant change in a State law, organization, policy, or SUA operation;

   2. A change in the name or organizational placement of the SUA;

   3. Distribution of State Plan administration funds for demonstration projects;

   4. A change in PSA designation, as set forth in 45 CFR § 1321.13;

   5. A change in AAA designation, as set forth in 45 CFR § 1321.19; or

   6. Exercising of major disaster declaration flexibilities, as set forth in 45 CFR § 1321.101.

See 45 CFR § 1321.29 and § 1321.31 for more information regarding requirements with respect to State Plan amendments.

State Plan Guidance Attachment D

Attachment D – Include the identification of the geographic boundaries of each PSA, as well as of AAAs designated for each PSA, if applicable.

State Plan Guidance Attachment E

Attachment E - Evidence of Providing the Minimum Public Comment Period must be included with each State Plan. The State Plan must include information that demonstrates the SUA’s compliance with the minimum time period (i.e., at least thirty (30) calendar days, absent a waiver from the ASA) for public review and comment on the new State Plan, pursuant to 45 CFR § 1321.29(c).