Minnesota Minnesota

Manual

Manual


Provision of Title III Services Policy #1: A Listing and Definition of Allowable Services

This content is part of a public comment period. For more information, refer to Minnesota Board on Aging – State Plan on Aging.

Authority Reference

45 CFR 1321(c)(1)ii

OAA, Sec. 306(a)(5)(A), 306(i), 311, 321 Part B, 331 Part C,

336 Part C, 361 Part D, and 371-374 Part E

Operating Category

Provision of Title III Services

Policies

1. General Requirements

A. The resources made available to an AAA under the OAA are to be used to finance those activities necessary to achieve elements of community-based service systems.

2. Allowable Services

A. All services financed under the Area Plan must be in accordance with the provisions of the OAA cited above, programs authorized by the OAA, and the Service Definitions issued by the MBA in this policy.

3. Annual Review

A. MBA will annually review the service definitions included in this policy in consultation with AAAs to determine if any adjustments need to be made. This will occur as part of the September MBA/AAA meeting each fall.

4. OAA Direct Service Definition

Title III-B Services

MBA Service

MBA Unit

MBA Service Definition

Allowable T3 Funds

Registered

Updated?

Chore

1 hour

Performance of heavy household tasks (including but not limited to washing floors, windows and walls; basic home maintenance; or moving or removal of large household furnishings and heavy appliances) provided in a person’s home and possibly other community settings. Tasks may include yard work or sidewalk maintenance in addition to heavy housework.

3B

Yes

Yes

Homemaker

1 hour

Performance of light housekeeping tasks provided in a person’s home and possibly other community settings. Task may include assistance such as preparing meals, shopping for food and other personal items, managing money, answering or making telephone calls /other electronic communication or doing light housework (including but not limited to laundry).

3B

Yes

Yes

Assisted Transportation

1 one-way trip

Services or activities that provide or arrange for the travel, including travel costs, of individuals from one location to another.

This service includes escort or other appropriate assistance for a person who has difficulties (physical or cognitive) using regular vehicular transportation. Provides a gentle arm for assistance from the first door of the rider’s residence, to any type of vehicle and from the vehicle to the first door of the destination. Assistance with mobility devices and other types of assistance to ensure the older individual is supported within this service delivery.

3B

Yes

Yes

Transportation

1 one-way trip

Provision of a means for going from one location to another. Does not include other activity.

3B

No

No

Legal Assistance

1 hour

Legal advice and representation provided by a licensed attorney in good standing to older individuals with economic or social needs as defined in the Older Americans Act, Sections 102 (a) (23 and 24) and in the implementing regulation at 45 CFR Section 1321.93. Legal service includes, to the extent feasible, counseling or other appropriate assistance by a paralegal or law student under the direct supervision of a licensed attorney in good ststanding lawyer and counseling or representation by a non-lawyer where standing permitted by law and counseling or representation by a non-lawyer where permitted by law. (Source: OAA) Service providers shall target individuals with the greatest economic or social needs; however, income information may not be required as a precondition of receiving services from provider. Does not include community legal education.

3B

As per definition of Restricted Service

Yes

Information Assistance

1 contact

A service that:

  • · Provides the individuals with current information on opportunities and services available to the individuals within their communities, including information relating to assistive technology;
  • · Assesses the problems and capacities of the individuals;
  • · Links the individuals to the opportunities and services that are available;
  • · To the maximum extent practicable, ensures that the individuals receive the services needed by the individuals, and are aware of the opportunities available to the individuals, by establishing adequate follow- up procedures; and
  • · Serves the entire community of older individuals, particularly—older individuals with greatest social need; older individuals with greatest economic need; and older individuals at risk for institutional placement.
  • Information and assistance topics include, but are not limited to: Medicare, long- term care insurance, prescription drug programs, forms assistance and pension rights.

    Information and assistance services can be provided through county coordinators on aging, Senior Linkage Line, or individual advocacy.

    3B

    No

    Yes

    Self-Directed Supportive Services

    N/A

    Services and supports directly chosen and purchased by an individual through using an individual budget allocation to meet their identified supportive service needs.

    3B/ 3E

    Yes

    Yes

    Home Modification

    1 project

    Home Modification: Physical adaptations to the home that are necessary to ensure the health and safety of an individual or that enables the individual to function with greater independence in their home.

    Up to $500 of Title III-B or III-E Supplemental funds may be spent per client at the discretion of the AAA. Proposed projects using between $501 and $1,000 may be submitted to MBA through a waiver request. No home modifications above $1,000 may be considered. See Supportive Services Policy.

    3B, 3E

    Supplem ental

    No

    Yes

    Consumable Supplies

    1 delivery

    Provision of consumable supplies or material aid to an older adult to meet basic necessities such as groceries, cleaning supplies, incontinence items or personal protective equipment (PPE) (i.e., masks, disposable gloves, face shield).

    3B

    No

    No

    Consultation

    1 hour

    Assistance provided to an individual who is seeking support services to enable them to live independently in their own home. May include assistance in setting goals, identifying needs, determining potential sources of support (informal and formal), and determining if private pay for services is an option. This assistance may also include support planning (the development and implementation of a self-directed service option) and/or the development of a risk management action plan.

    3B

    No

    No

    Counseling

    1 session

    Via interview, discussion or supportive listening to advise and to enable the other person and/or their family to resolve problems or to relieve temporary stress. May be done on a 1-to-1 basis or on a group basis.

    3B

    No

    No

    Education/Training

    1 session

    Providing formal or informal opportunities for individuals to acquire knowledge, experience or skills. Includes individual or group sessions designed to increase awareness in such areas as crime or accident prevention; promote personal enrichment, for example, through continuing ed; to increase or gain skills in a specific craft, trade, job or occupation. Does not include wages or stipends.

    3B

    No

    No

    Guardianship

     

    Performing legal and financial transactions on behalf of a client based upon a legal transfer or responsibility (e.g., as part of protective services). Includes conservatorship.

    3B

    No

    No

    Community Legal Education

    1 session

    A presentation for older adults by an individual authorized to provide legal assistance, which informs individuals about legal rights or benefits and how to access legal services statewide.

    A session may include various formats, including the following:

  • · A virtual presentation (if recorded, it only counts the first time it is presented);
  • · An in-person session, with an opportunity for participants to ask questions; or
  • · A newsletter, which counts as one session at the time of publication, provided that readers may pose follow up questions or offer feedback.
  • 3B

    No

    No

    Outreach

    1 contact

    Interventions initiated by an agency or organization for the purpose of identifying potential clients (or their caregivers) and encouraging their use of existing services and benefits. [Note: service units for outreach refer to individual, 1-on-1 contacts between a service provider and an elderly client or caregiver. An activity that involves a contact with several current or potential clients/caregivers (what is considered group services) should not be counted as a unit of outreach.]

    3B

    No

    No

    Special Access

    1 hour

    Activities that link elders to community and government services that are not easily accessible due to language and/or cultural barriers.

    Individual services - information and referral, advocacy, outreach, phone contact, escort, translation, home visit, form completion, and service coordination.

    3B

    Yes as of 4.2020

    No

    Technology

    1 project

    Technology that enables an individual or family caregiver to improve their ability to perform activities of daily living; perceive, control, interact or communicate with their environment; monitor for safety or self- management of chronic conditions; or facilitate safe medication use.

    3B, 3E

    Supplem ental

    No

    No

    Telephone Reassurance

    1 call

    Regular telephone contacts with isolated older persons or family caregivers to ensure continued well-being of the individual and to provide social contact.

    3B, 3E

    Supplem ental

    No

    No

    Visiting

    1 visit

    Providing regular visits to isolated, homebound or institutionalized elderly to reduce their isolation and loneliness. Letter writing, reading letters and conversation and typical activities of friendly visitors.

    3B

    No

    No

    Title III-C Services

    MBA Service

    MBA Unit

    MBA Service Definition

    Allowable T3 Funds

    Registered

    Updated?

    Home Delivered Meals

    1 meal

    A meal provided to a eligible individual in his/her place of residence or otherwise outside of a congregate setting. The meal is served in a program that is administered by SUAs and/or AAAs and meets all the requirements of the Older Americans Act and State/Local laws and complies with the most recent Dietary Guidelines for Americans (published by the Secretaries of the Department of Health and Human Services and the United States Department of Agriculture).

    Additionally, the meal provides to each participating individual a minimum of one- third of the Dietary Reference Intakes, established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences, if one meal is served, two-thirds if two meals are served, and 100 percent if 3 meals are served; and meets all of the requirements as above. Meals provided to individual through means-tested programs may be included in the total meal count. These meals are to be identified by the funding source.

    3C-2

    Yes

    Yes

    Congregate Meals

    1 meal

    A meal provided by a qualified nutrition project provider to an eligible individual in a congregate or group setting. Up to 25% of C-1 funds may be used for shelf-stable, pick-up, carry-out, drive-through, or similar meals (also referred to as “grab and go” meals). The meal is served in a program that is administered by SUAs and/or AAAs, meets all the requirements of the Older Americans Act and State/Local laws, and complies with the most recent Dietary Guidelines for Americans (published by the Secretaries of the Department of Health and Human Services and the United States Department of Agriculture).

    Additionally, the meal provides to each participating individual a minimum of one-third of the Dietary Reference Intakes, established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences, if one meal is served, two-thirds if two meals are served, and 100 percent if 3 meals are served; and meets all of the requirements as above.

    Meals provided to individual through means- tested programs may be included in the total meal count. These meals are to be identified by the funding source.

    3C-1

    Yes

    Yes

    Nutrition Counseling

    Hours (partial hour may be reported to two decimal places, e.g., 0.25 hours.)

    A standardized service as defined by the Academy of Nutrition & Dietetics (AND) that provides individualized guidance to individuals who are at nutritional risk because of their health or nutrition history, dietary intake, chronic illness, or medication use, or to caregivers. Counseling is provided one-on-one by a registered dietitian, and addresses the options and methods for improving nutrition status with a measurable goal.

    3C-1, 2

    Yes

    Yes

    Nutrition Education

    1 session per participant (a session is typically 15 minutes to an hour)

    A targeted program to promote better health by providing accurate and culturally sensitive nutrition, physical fitness, or health (as it relates to nutrition) information that is consistent with the current Dietary Guidelines for Americans and instruction to participants, caregivers, or participants and caregivers in a group or individual setting overseen by a dietitian or individual of comparable expertise.

    3C1 or C2 (or 3B)

    No

    Yes

    Title III-D Services

    MBA Service

    MBA Unit

    MBA Service Definition

    Allowable T3 Funds

    Registered

    Updated?

    Evidence-Based Health Promotion Program

    N/A

    Activities related to the prevention and mitigation of the effects of chronic disease (including osteoporosis, hypertension, obesity, diabetes, and cardiovascular disease), alcohol and substance abuse reduction, smoking cessation, weight loss and control, stress management, falls prevention, physical activity, and improved nutrition).

    OAA Title III-D funding may be used only for programs and activities demonstrated to be evidence-based.

    a. The program meets the requirements for ACL's Evidence-Based Definition (see below)

    i. Demonstrated through evaluation to be effective for improving the health and well-being or reducing disease, disability and/or injury among older adults; and

    ii. Proven effective with older adult population, using Experimental or Quasi-Experimental Design;* and

    iii. Research results published in a peer-review journal; and

    iv. Fully translated** in one or more community site(s); and

    v. Includes developed dissemination products that are available to the public.

    *Experimental designs use random assignment and a control group. Quasi-experimental designs do not use random assignment.

    **For purposes of the Title III-D definitions, being “fully translated in one or more community sites” means that the evidence-based-program in question has been carried out at the community level (with fidelity to the published research) at least once before. Sites should only consider programs that have been shown to be effective within a real-world community setting,

    or

    b. The program is considered to be an "evidence-based program" by any operating division of the U.S. Department of Health and Human Services (HHS) and is shown to be effective and appropriate for older adults.

    MBA reserves the right to incorporate additional state specific Title III D requirements.

    3D

    No

    Yes

    Health Promotion: Non-Evidence-Based

    1 hour

    Health Promotion: non Evidence-based Health promotion and disease prevention activities that do not meet ACL/AoA’s definition for an evidence-based program as defined at ACL's website. Activities may include those defined in the OAA (Section 102(14)) for example:

    (A) health risk assessments;

    (B) routine health screening;

    (C) nutritional counseling and educational services for individuals and their primary caregivers;

    (E) programs regarding physical fitness, group exercise, and music therapy, art therapy, and dance- movement therapy;

    (F) home injury control services;

    (G) screening for the prevention of depression, coordination of community mental and behavioral health services, provision of educational activities,

    and referral to psychiatric and psychological services;

    (H) educational programs on the

    availability, benefits, and appropriate use of preventive health services covered under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.);

    (I) medication management screening and education;

    (J) information concerning diagnosis, prevention, treatment, and rehabilitation concerning age-related diseases and chronic disabling conditions;

    (K) gerontological counseling; and

    (L) counseling regarding social services and follow-up health services based on any of the services described in subparagraphs (A) through (K). The term shall not include services for which payment may be made under titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq., 1396 et seq.). (Source: OAA)

    3B only

    No

    Yes

    Title III-E Services

    MBA Service

    MBA Unit

    MBA Service Definition

    Allowable T3 Funds

    Registered

    Updated?

    Self-Directed Caregiver Support Services

    N/A

    Services and supports directly chosen and purchased by an individual through using an individual budget allocation to meet their identified caregiver support service needs.

    3E

    Yes

    No

    Caregiver Counseling

    Hours (partial hour may be reported to two decimal places, e.g., 0.25 hours.)

    A service designed to support caregivers and assist them in their decision-making and problem solving. Counselors are service providers that are degreed and/or credentialed as required by state policy, trained to work with older adults and families and specifically to understand and address the complex physical, behavioral and emotional problems related to their caregiver roles. Title III-E funded Caregiver Consultants will conduct a Caregiver Minimum Assessment with caregivers receiving ongoing support. Caregiver Consultants meet the Minnesota Board on Aging Title III-E Caregiver Consultant Standards and Competencies. This includes counseling to individuals or group sessions. Counseling is a separate function apart from support group activities or training.

    3E

    Yes

    Yes

    Caregiver Support Groups

    1 session

    A service that is led by a trained individual, moderator, or professional, as required by state policy, (moderators should have experience working with family, friends and/or neighbors caregiving and older adults, strong interpersonal skills, and access to regular supervision or consultation from a trained professional with comparable training or experience), to facilitate caregivers to discuss their common experiences and concerns and develop a mutual support system. Support groups are typically held on a regularly scheduled basis and may be conducted in person, over the telephone, or online. For the purposes of Title III-E funding, caregiver support groups would not include “caregiver education groups,” “peer-to-peer support groups,” or other groups primarily aimed at teaching skills or meeting on an informal basis without a facilitator that possesses training and/or credentials as required by state policy. (See also definitions for training and counseling).

    3E

    Yes

    Yes

    Caregiver Training

    Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.)

    A service that provides caregivers with instruction to improve knowledge and performance of specific skills relating to their caregiving roles and responsibilities and builds caregiver capacity to provide, manage and cope with the caregiving role. Skills may include activities related to health, nutrition, and financial management; providing personal care; disease management; managing risk factors; mental health; navigating long-term care systems and communicating with health care providers and other family members. Training may include use of evidence-based programs; be conducted in-person or on-line, and be provided in individual or group settings.

    3E

    Yes

    Yes

    Caregiver Respite

    Hours (partial hour may be reported to two decimal places, e.g., 0.25 hours.)

    A service which offers temporary, substitute supports, care, supervision or living arrangements for care recipients. It provides a brief period of relief or rest for caregivers.

    3E

    Yes

    Yes

    Caregiver Respite in Home

    Hours (partial hour may be reported to two decimal places, e.g., 0.25 hours.)

    A respite service provided in the home of the caregiver or care receiver and allows the caregiver time away to do other activities.

    During such respite, other activities can occur which may offer additional support to either the caregiver or care receiver, including homemaker or personal care services. Trained volunteers may be utilized to provide companionship respite (e.g., assistance with meals, medication reminders and general supervision). Respite volunteers are screened and trained, per Minnesota State Policy, and matched with older adults and supervised by provider.

    3E

    Yes

    Yes

    Caregiver Respite Out of Home Day

    Hours (partial hour may be reported to two decimal places, e.g., 0.25 hours.)

    A respite service provided in settings other than the caregiver/care receiver’s home, including adult day care, senior center or other non-residential setting (in the case of older relatives raising children, day camps), where an overnight stay does not occur that allows the caregiver time away to do other activities. This option may be provided on a group or individual basis and includes licensed Adult Day Services, licensed adult foster care, a senior center, services by a family, friend, neighbor, or volunteer in a non-licensed private residence, or escorted transportation to medical appointments or community activities.

    3E

    Yes

    Yes

    Caregiver Respite – Out- of-Home Overnight

    Hours (partial hour may be reported to two decimal places, e.g., 0.25 hours.)

    A respite service provided in residential settings such as nursing homes, assisted living facilities, and adult foster homes (or, in the case of older relatives raising children, summer camps), in which the care receiver resides in the facility (on a temporary basis) for a full 24 hour period of time. This includes services provided in a licensed nursing facility, hospital, or registered housing site that has services provided by a licensed home care agency. The service provides the caregiver with time away to do other activities.

    3E

    Yes

    Yes

    Caregiver Respite – Other Respite

    Hours (partial hour may be reported to two decimal places, e.g., 0.25 hours.)

    A respite service provided using Older Americans Act funds in whole or in part, that does not fall into the previously defined respite service categories. Services must contain structured activities, facilitated by an experienced individual. Services may include: virtual respite (may include but is not limited to virtual reality (VR) experiences, virtual tours, and virtual concerts, customized experiences, interactive storytelling, music activities).

    3E

    Yes

    Yes

    Supplemental Services

    N/A

    Services provided on a limited basis to ease the burden of care or to complement the care provided by caregivers. Domains for “supplemental services” provided under Title III-E include:

  • · Assistive technology/durable equipment/emergency response
  • · Consumable supplies
  • · Home modifications/repairs
  • · Legal and/or financial consultation
  • · Homemaker/chore/personal care
  • · Transportation
  • · Nutrition services
  • · Other
  • 3E

    Yes

    Yes

    Caregiver Assistance – Information and Assistance

    1 contact

    A service that links the individuals to opportunities and services that are available. To the maximum extent practicable, ensures that the individuals receive the services needed by the individuals, and are aware of the opportunities available to the individuals, by establishing adequate follow-up procedures.

    Information and Assistance Caregiver:

  • · Provides the individuals with current information on opportunities and services available to the individuals within their communities, including information relating to assistive technology;
  • · Assesses the problems and capacities of the individuals; and
  • · Serves the entire community of older individuals particularly — caregivers who are older individuals with greatest social need; older individuals with greatest economic need; older relative caregivers of children with severe disabilities, or individuals with disabilities who have severe disabilities; family caregivers who provide care for individuals with Alzheimer’s disease and related disorders with neurological and organic brain dysfunction; and caregivers of “frail” individuals defined as: unable to perform at least two activities of daily living without substantial human assistance, including verbal reminding, physical cueing, or supervision; and/or cognitive or other mental impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to the individual or to another individual.
  • 3E

    No

    Yes

    Caregiver Public Information Services

    1 activity

    A public and media activity that conveys information to caregivers about available statewide services, which can include an in-person interactive presentation to the public conducted; a booth/exhibit at a fair, conference, or other public event; and a radio, TV, or Web site event. Unlike Caregiver Assistance – Information and Assistance, this service is not tailored to the needs of the individual.

    3E

    No

    Yes

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