Medicaid Program: Real Choice Systems Change Grants

The summary for the Medicaid Program: Real Choice Systems Change Grants grant is detailed below. This summary states who is eligible for the grant, how much grant money will be awarded, current and past deadlines, Catalog of Federal Domestic Assistance (CFDA) numbers, and a sampling of similar government grants. Verify the accuracy of the data FederalGrants.com provides by visiting the webpage noted in the Link to Full Announcement section or by contacting the appropriate person listed as the Grant Announcement Contact. If any section is incomplete, please visit the website for the Centers for Medicare and Medicaid Services, which is the U.S. government agency offering this grant.

Medicaid Program: Real Choice Systems Change Grants: In 1990, Congress enacted the Americans with Disabilities Act (ADA) (Pub. L. 101-336). The ADA recognized that "society has tended to isolate and segregate individuals with disabilities, and, despite improvements, such forms of discrimination against individuals with disabilities continue to be a serious and pervasive social problem" (42 U.S.C. %90112101(a)(2)). The ADA gave legal expression to the desires and rights of Americans to lead lives as valued members of their own communities despite the presence of disability. Fulfillment of the ADA has been the subject of further State and Federal leadership through the President's New Freedom Initiative. In February 2001, President George W. Bush announced this broad new initiative to "tear down the barriers to equality" and grant a "new freedom" to children and adults of all ages who have a disability or long-term illness so that they may live and prosper in their communities. For more information on the Centers for Medicare & Medicaid Services (CMS) activities related to the President's New Freedom Initiative, visit http://www.cms.hhs.gov/NewFreedomInitiative. Congress has recognized that States face formidable challenges in their efforts to fulfill their legal responsibilities under the ADA. Since fiscal year 2001, Congress appropriated funds for Real Choice Systems Change (RCSC) grants, specifically to improve community-integrated services. The RCSC grants are designed to assist States and others in building infrastructure that will result in effective and enduring improvements in long-term support systems. These system changes are designed to enable children and adults of any age, with any payer source, who have a disability or long-term illness to: %901 Live in the most integrated community setting appropriate to their individual support requirements and preferences; %901 Exercise meaningful choices about their living environment, the providers of services they receive, the types of supports they use, and the manner by which services are provided; and, %901 Obtain quality services in a manner as consistent as possible with their community living preferences and priorities. Through fiscal years 2001- 2006, CMS has awarded grants totaling approximately $256.5 million to all 50 States, the District of Columbia, and two territories. With this support, States are continuing to address issues such as personal assistance services, direct service worker shortages, transitions from institutions to the community, respite service for caregivers and family members, better transportation options, access to HCBS, and quality improvement and quality assurance initiatives. CMS has also implemented an ambitious national technical assistance strategy to support States' efforts to improve community-based service systems and enhance employment supports, providing support to States by posting a repository of "Promising Practices" on its Web site at http://www.cms.hhs.gov/PromisingPractices and by supporting the dissemination of technical assistance materials at http://www.hcbs.org. The passage of the Deficit Reduction Act of 2005 (DRA) bolstered States' efforts to continue to improve and expand community-based services systems. By offering State plan options for self-directed care, expanded home- and community-based services, and an expansion of Title XIX (coverage for families of children with disabilities), the DRA of 2005 expanded on the groundwork of the RCSC grant program. Additionally, the DRA offers almost $2 billion in demonstration grants over the next five years including, Money Follows the Person, Family-to-Family Health Information Centers, and Community-based Alternatives to Psychiatric Residential Treatment Facilities. This significant investment parallels and expands the goals of the RCSC grants program and will provide a more stable funding source for the initiative. In FY 2006, CMS developed a plan for long-term care reform to improve care for Medicare and Medicaid beneficiaries now and throughout the 21st century (http://www.cms.hhs.gov/MedicaidGenInfo/07_LTCReform.asp#TopOfPage). The plan establishes overarching principles for long-term care and offers a vision to guide current and future reform activities to make long-term care sustainable in the coming decades. The central concept of CMS's vision for long-term care is that the system will be person-centered; that is, the system will be organized around the needs of the individual, rather than around the settings where care is delivered. The person-centered system of the future will: %901 optimize choice and independence; %901 be served by an adequate workforce; %901 be transparent, encouraging personal responsibility; %901 provide coordinated, high quality care; %901 be financially sustainable; and, %901 utilize health information technology. Optimizing choice and independence will enable beneficiaries to have greater flexibility to choose from a broad spectrum of long-term care services, including greater access to home and community-based services as well as institutional services. A number of States have taken steps to develop and implement strategies to reform the financing and service designs of their long-term support systems to decrease reliance on institutional forms of care and increase the utilization of community-based long-term supports. CMS has defined "rebalancing" as 'adjusting the State's Medicaid programs and services to achieve a more equitable balance between the proportion of total Medicaid long-term support expenditures used for institutional services (Nursing Facilities [NF] and Intermediate Care Facilities for the Mentally Retarded [ICF-MR]) and Hospitals, and expenditures for community-based services under a State plan and waiver options. CMS has stated that "a balanced long-term support system offers individuals a reasonable array of options, particularly, adequate choices of community and institutional options." CMS is currently working with a contractor to examine States that are in the process of "rebalancing", and research the program management techniques used by these States to provide adequate home and community-based services while effectively managing aggregate costs. See http://www.cms.hhs.gov/NewFreedomInitiative/035_Rebalancing.asp#TopOfPage for more information. In this solicitation the term "Balancing" will be used to describe the process defined above. Although States have engaged in various State-specific initiatives to reform their systems, including tools to assess their progress, CMS has not adopted a set of common indicators for use across all States. CMS anticipates developing indicators that can assess the capacity of a State to offer home and community-based services that assure an individual's health and quality of life. Our challenge is to work collaboratively among disability groups and older Americans, with a broad array of public and private partners, to set a national expectation for a "balanced" system that is also "person centered".