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DEPARTMENT of HEALTH and HUMAN SERVICES Fiscal Year 2023 Administration for Community Living Justification of Estimates for Appropriations Committees DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Community Living Washington, DC 20201 I am pleased to present the Administration for Community Living (ACL) FY 2023 Budget, which includes a discretionary request for $2.986 billion in budget authority. The request reflects ACL’s prioritization of direct services for people with disabilities and older adults; innovation and collaboration to improve program effectiveness and sustainability; protecting rights and preventing abuse; and advancing the President’s priorities of expanding home and community-based services, supporting family caregivers and advancing equity. It also continues ACL’s focus on bolstering the infrastructure that supports program administration and oversight, as well as ACL’s increasing leadership responsibilities as an advocate for older adults and people with disabilities. The populations served by ACL’s programs are growing, and the need for the services and supports that make community living possible is growing along with them. In addition, the pandemic created a spike in demand for services that has stabilized at a level below the peak, but well above pre-pandemic levels. To help meet the needs of this “new normal,” the request includes funding increases across a number of programs that collectively expand our country’s overall capacity to support community living, with a particular focus on programs that provide services directly to people with disabilities and older adults. For example, increases are requested for Protection and Advocacy (P&A) programs and Centers for Independent Living, which play critical roles in protecting the rights of people with disabilities. The services they provide are key to ensuring that people with disabilities have equal access and opportunity to fully participate in their communities. They are also at the forefront of helping people with disabilities move back to the community from nursing homes and other institutions. Increases also are requested for ACL’s Nutrition and Home and Community-Based Supportive Services, which similarly provide the core services that make it possible for millions of older adults to age in place. ACL’s request also includes funding to continue programs that address abuse and neglect, which rob people of their fundamental human rights, erode equal opportunity, harm health and well-being, and pose a significant barrier to equity and inclusion. In addition to the increased funding for P&A programs, which also investigate and address abuse, ACL’s request includes funding for grants to support state adult protective services programs and increased funding for state Long-Term Care Ombudsman programs. While increased funding for direct services is necessary, it is not sufficient to meet growing needs. Ongoing innovation, coordination of efforts across programs and partnerships between networks, and alignment of resources to meet greatest needs, also are needed to continually improve the capacity, effectiveness and sustainability of interventions and service delivery. Therefore, ACL is requesting authority to fund cross-program demonstrations to address issues and needs that are common to both older people and disabled people of all ages. In addition, with many programs returning to in-person service delivery, the request restores the traditional balance of funding between home-delivered and congregate meals for older adults. The request also includes modest investments in innovation, including a cross-cutting initiative to better meet the needs of older adults and people with disabilities during disasters. Finally, the request reflects ACL’s need to establish adequate infrastructure to properly administer programs and carry out the agency’s advocacy responsibilities. ACL has faced staffing challenges almost from its creation; with the significant increase in its scope of responsibilities in recent years, addressing staffing gaps and other administrative needs has become critically important. In closing, our communities are stronger when everyone is included, everyone is valued, and everyone can contribute. This requires equitable access to health care, education, transportation, recreation, and other systems, resources and opportunities. ACL and I remain committed to making community living an option for every American, regardless of age or disability, race or ethnicity, gender identity or sexual orientation, income or any other factor, and this budget aligns with that commitment. i DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Community Living Washington, DC 20201 Alison Barkoff Acting Administrator and Assistant Secretary for Aging ii Table of Contents Table of Contents.........................................................................................................................ii Organization Chart......................................................................................................................iv Introduction and Mission.............................................................................................................1 Overview of the Budget Request.................................................................................................3 Overview of Performance..........................................................................................................11 All Purpose Table.......................................................................................................................18 Mandatory Proposals Summary Table.......................................................................................21 Appropriations Language..........................................................................................................22 Appropriations Language Analysis............................................................................................26 Amounts Available for Obligation.............................................................................................30 Summary of Changes.................................................................................................................31 Budget Authority by Activity.....................................................................................................33 Authorizing Legislation.............................................................................................................34 Appropriations History..............................................................................................................37 Appropriations Not Authorized by Law....................................................................................39 Health and Independence for Older Adults...............................................................................40 Home and Community-Based Supportive Services..................................................................45 Nutrition Services......................................................................................................................56 Preventive Health Services........................................................................................................74 Chronic Disease Self-Management Education..........................................................................81 Falls Prevention.........................................................................................................................85 Native American Nutrition and Supportive Services.................................................................88 Aging Network Support Activities............................................................................................93 Caregiver and Family Support Services..................................................................................102 Family Caregiver Support........................................................................................................106 Native American Caregiver Support Services.........................................................................115 Alzheimer’s Disease Program..................................................................................................119 Lifespan Respite Care..............................................................................................................122 Protection of Vulnerable Adults...............................................................................................128 Long-Term Care Ombudsman Program..................................................................................131 Prevention of Elder Abuse and Neglect...................................................................................138 Health Care Fraud and Abuse Control/Senior Medicare Patrol Program................................143 Elder Rights Support Activities...............................................................................................147 Elder Justice/Adult Protective Services...................................................................................152 Disability Programs, Research and Services...........................................................................161 State Councils on Developmental Disabilities........................................................................164 Developmental Disabilities – Protection and Advocacy.........................................................171 University Centers for Excellence in Developmental Disabilities..........................................180 Developmental Disabilities – Projects of National Significance.............................................185 Independent Living..................................................................................................................190 Limb Loss Resource Center.....................................................................................................202 Paralysis Resource Center.......................................................................................................205 iii
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