DEPARTMENT OF HEALTH & HUMAN SERVICES 
Health Care Financing Administration  
Center for Medicaid and State Operations 7500 Security Boulevard Baltimore, MD 21244-1850  
May 31, 2000  
Dear State Medicaid Director:  
As we continue our efforts to improve the quality of care for nursing home residents, we also want to 
continue to ensure that beneficiaries have community-based alternatives to nursing home care, if that is 
their choice. Over the past 25 years, the Medicaid home health benefit, the personal care option, the 
Home and Community Based Waiver Service (HCBWS) program and the Program of All-Inclusive Care 
for the Elderly (PACE) have been used successfully by States to provide beneficiaries with alternatives to 
nursing home care, and to help people live in community-based settings. With further developments in 
community supports and technological advances, there is an increased opportunity for individuals at 
many levels of disability to be effectively served in the community.  
Both President Clinton and the U.S. Department of Health and Human Services' (HHS) Secretary 
Shalala have expressed their commitment to expanding access to home and community-based services 
for people with disabilities of all ages. The Olmstead decision--affirming the right of individuals with 
disabilities to receive services in the most integrated setting appropriate to their needs--further 
underscores the need for HHS to work with States in identifying and implementing cost effective 
approaches for achieving these goals. For these reasons, we are eager to continue to work with States to 
help more people become aware of services and supports available to them in the community, and 
transition out of nursing homes if that is their choice.  
The Health Care Financing Administration (HCFA) is interested in working collaboratively with States 
and other key stakeholders to enhance choices available to Medicaid beneficiaries who are currently 
residing in nursing homes. Therefore, a grants initiative is being sponsored to assist States in developing 
processes and infrastructure for the purpose of transitioning beneficiaries out of nursing homes and into 
the community. The total amount of funding available for the Federal Fiscal Year (FFY) 2000 grants is 
$2,000,000. If HCFA receives more proposals of exceptional quality in either category than it has funds  
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to award this fiscal year, it may consider deferring awarding some grants to FFY 2001.  
Page 2- State Medicaid Director  
The Nursing Home Transition 2000 grant's purpose is twofold: the program grant will provide 
administrative and service resources to States to help them develop transition programs; and the State 
technical assistance grant will set aside funds for at least one State that is willing to collaborate with one 
or more Independent Living Center(s). A State that receives a technical assistance grant will help host, 
together with HCFA and the HHS' Assistant Secretary for Planning and Evaluation (ASPE), a National 
Technical Assistance conference on consumer directed services and nursing home transition, and will  provide certain other forms of technical assistance. HCFA will award grants to four to six State 
Medicaid agencies under the program initiative, and at least one under the technical assistance grant 
initiative. The enclosed grants announcement provides information regarding general policy 
considerations, special areas of interest, application procedures, eligibility requirements, and review 
criteria. As identified in the announcement, States should mail Proposals to the HCFA grants office 
(address provided below). In order to be considered for a grant award, Proposals must be postmarked on 
or before July 26, 2000.  
Grant funds may be used either to assist awardees with developmental activities, or to fund transitional 
services not otherwise funded under the Medicaid program. Program grant awards of up to $455,000 
will be available to each applicant selected to participate in this project (a total of $1,820,000). These 
awards are intended to cover a developmental period that will not exceed 18 months. A technical 
assistance grant amount of up to $180,000 will be awarded to the applicant(s) selected.  
It is important to note that the grants are special project funds which do not require State matching 
funds. Accordingly, States that are awarded grants will not report the grant amount on the HCFA-64 
expenditure report, but will report these funds on the Financial Status Report, SF269A.  
If you have any questions regarding this grant announcement, please call Thomas Shenk at (410) 786-
3295, or E-mail at tshenk@hcfa.gov; or Andrew Mack at (410) 786-3005, or E-mail at amack@hcfa.gov.  
We look forward to receiving your application.  
Sincerely,  
Timothy M. Westmoreland 
Director  
Enclosure  
Page 3- State Medicaid Director  
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cc:  
All HCFA Regional Administrators 
 
All HCFA Associate Regional Administrators for Medicaid and State Operations  
Lee Partridge Director, Health Policy Unit American Public Human Services Association  
Joy Wilson Director, Health Committee National Conference of State Legislatures  
Matt Salo Director of Health Legislation National Governors' Association   Centers for Independent Living  
 
DEPARTMENT OF HEALTH & HUMAN SERVICES Health Care Financing 
Administration Center for Medicaid and State Operations 7500 Security 
Boulevard Baltimore, MD 21244-1850  
Nursing Home Transition Grant 2000  
To Assist Nursing Home Residents with the Transition  
to Home and Community-Based Settings  
Sponsored By  
:  
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The Health Care Financing Administration CFDA No. 93.779  
May 2000  
Nursing Home Transition Grant 2000  
Table of Contents  
Solicitation Document  
I. Purpose  
II. Background and Goals  
III. The Initiative 
The Program Grant  The State Technical Assistance Grant 
 
  IV. General Provisions  
  V. Applying for Grants  
 
VI. Application Review  
VII. Additional Information  
Appendix One--Application Guidelines Appendix Two--Review Criteria for Program Grant 
Appendix Three--Review Criteria for State Technical Assistance Grant  
I. Purpose  
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The Health Care Financing Administration (HCFA) is soliciting proposals from States for the 
development of programs that assist current nursing home residents with the transition to home and 
community-based settings. While many States have developed procedures for diverting prospective 
nursing home residents from institutions, far fewer States have attempted to design programs that assist 
nursing home residents in returning to the community. The Nursing Home Transition 2000 grant's 
purpose is twofold: the program grant will provide administrative and service resources to help States 
develop transition programs; and theState technical assistance grant will set aside funds for at least one 
State that is willing to collaborate together with one or more Independent Living Centers (ILCs). A State 
that receives a technical assistance grant will help host, together with HCFA and the Department of 
Health and Human Services' (HHS) Assistant Secretary for Planning and Evaluation (ASPE), a National 
Technical Assistance conference on the subject of nursing home transition. HCFA will award grants to 
four to six State Medicaid agencies under the program initiative, and one or two collaborative technical 
assistance grants. ASPE and HCFA's Office of Strategic Planning will conduct an evaluation of grantees' 
program grants to assess effective practices and associated costs.  
HCFA's intent with this grant project is to foster the development and sharing of innovative and 
effective methods to eliminate the barriers that prevent beneficiaries from living independently in a 
community-based setting.  
II. Background and Goals  
Both President Clinton and U.S. Department of Health and Human Services' Secretary Shalala have 
expressed their commitment to expanding access to home and community based services for people 
with disabilities of all ages. The Olmstead decision--affirming the right of individuals with 
disabilities to receive services in the most integrated setting appropriate to their needs--further  underscores the need for HHS to work with States in identifying and implementing cost effective 
approaches for achieving these goals.  
Although many States have moved aggressively to expand access to home and community-based 
waiver services (HCBWS) and Program of All-Inclusive Care for the Elderly (PACE) as 
alternatives to nursing home care, the emphasis has been on deterring nursing home admissions. 
Far fewer States have focused on transitioning nursing home residents back into the community. 
There is evidence, however, that the situation is changing. In Federal Fiscal Year (FFY)1998, 
HCFA awarded grant monies to four States through the "Date Certain" grants initiative. These 
grants supported programs that either diverted beneficiaries from unnecessary nursing home 
placement and/or when appropriate, moved beneficiaries currently residing in nursing homes back 
into the community. In FFY 1999, HCFA's grants program focused only on transition programs.  
Nursing Home Transition FFY 2000 program grant builds upon the FFY 1999 Nursing Home 
Transition initiative because it focuses on transition rather than diversion. A new facet of the FFY 
2000 grant project is a technical assistance grant for States, which will be described below. 
Overall, the FFY 2000 provides an additional $2,000,000 to States to assist in developing  
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programs that:  
    identify and educate nursing home residents and their families about the alternatives 
available to them should the resident wish to return to the community;  
    overcome the resistance and the barriers which may impede a resident's decision to exercise 
his or her choice for home and community-based services;  
  enhance and enlist the experience of people with disabilities (via ILCs and similar networks) in 
identifying and transitioning individuals with disabilities from nursing homes into their communities;  
  develop the necessary community infrastructure and support to permit former nursing home 
residents to live safely and with dignity in their community; and  
  foster collaboration among Public Housing Authorities, the State Medicaid Agency, ILCs, Area 
Agencies on Aging, other State Medicaid Agencies, and others in order to identify and implement 
strategies for obtaining accessible, affordable housing for those leaving nursing homes.  
 
Funds made available under this grant program can be used for a broad range of purposes 
identified by either program officials or nursing home residents and their families to permit a 
successful transition back into the community. For example, grant funds may be used to 
cover "transitional costs" which are traditionally not covered under the HCBWS program or 
are not included in the State Plan. Such transitional costs include temporary rent payments, 
furniture and clothing, special equipment or direct cash payments to the disabled individual 
and/or his or her families to ensure that necessary services are available. States may enter 
into collaborative or contractual agreements with ILCs and others to provide these types of 
transitional services. Funds may be used for planning and system change activities designed 
to enhance a State's capacity to prevent or remedy unnecessary institutionalization. States are 
urged to seek the active participation and input of elderly people, individuals with 
disabilities, and other key stakeholders in such efforts. States also are strongly encouraged to 
develop mechanisms that will make it easier for able beneficiaries to select and supervise  their community-based attendant services.  
III. The Initiative  
Below we describe (a) the program grant and (b) the technical assistance grant. A State may apply for 
just one or for both.  
The Program Grant  
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The purpose of the Nursing Home Transition 2000 Initiative is to provide States with administrative and/ 
or services resources to enhance opportunities for nursing home residents to move into the community. 
Grant awards of up to $455,000 will be available to States selected to participate in the program grant. 
Grant funds can be used for administrative tasks, such as program development or consulting, or for 
reimbursement of direct services not otherwise reimbursed by Medicaid under the State Plan. Because the 
type and extent of barriers to community placement varies among the States, grant funds are intended to 
provide for as much flexibility as possible. States may propose whatever combination of direct service 
and administrative funds is necessary to meet their needs.  
There is no limitation on the age of a beneficiary who may be served. There is no restriction on the 
medical condition of the beneficiary as long as effective measures for enhancing and ensuring his/her 
health and welfare in the community can be put in place. There is no restriction on the number of persons 
that can be served provided that, if a waiver of federal statutory requirements is needed, then all 
applicable cost-effectiveness, cost-neutrality, or budget neutrality tests are met. The following areas have 
been identified as particularly critical in the successful transition of nursing home residents to home and 
community-based settings. Successful applicants are expected in their proposal to address many or 
all of these areas.  
Identification of Nursing Home Residents Who are Potential Candidates for Transition Back Into the 
Community  
Advances in health care technology and innovative funding arrangements have increased the 
potential for elderly and disabled individuals to live in community settings. A major 
challenge facing States in developing successful nursing home transition programs is 
designing and implementing feasible and effective processes for identifying beneficiaries in 
nursing homes who are eligible for community living. The use of statewide data sources 
such as MDS or other assessments to help States in identifying potential candidates is 
encouraged. Nursing home ombudsmen, ILCs, area agencies on aging, protection and 
advocacy organizations and other local groups and programs have experience and expertise 
States should strongly consider utilizing.  
Communications  
An important element of a nursing home transition program is educating nursing home  residents about their options. It is essential to provide information to nursing home 
residents, their families, and/or legal guardians. States may want to explore options for 
working with nursing homes on outreach efforts. In addition, States should consider the 
importance of educating families and surrogates about the safeguards that can be employed 
to ensure the health and safety of the beneficiary living in the community and about 
community placement options. Of central importance is the role played by the State in 
developing and promoting the program, working with nursing homes to agree on project 
goals, developing mechanisms for gaining access to nursing homes, talking to potential 
candidates about their options, and ensuring informed choice.  
Development of Community-Based Services/Supports for the Institutionalized Individual  
Two of the primary goals of this grant initiative are to establish viable community support 
systems and a comprehensive set of choices for beneficiaries currently residing in nursing 
facilities which will enable them to live safely, maintain and improve their health status, and 
participate in community life to the fullest extent possible. States need to consider the range of 
services and supports that will enable people with all levels of disability, including significant 
disability, to meet the above goals and identify and eliminate barriers which may impede 
success. Appropriate housing options is of particular importance.  
Barriers to effective transition may sometimes be found in regulations, policies, or in the 
organization of the provider network. For example: there may be no provision for nighttime 
services; assistive technology may be difficult to obtain; or there may be no training available 
in how to use it. Alternatively, there may be gaps in the supply of quality providers ( i.e. 
attendants or transportation services) or a lack of opportunities for people with disabilities to 
direct their own services. As part of the solicitation, States are encouraged to explore ways of 
developing consumer controlled and other community-based providers, fostering voluntary 
supports, and creating housing opportunities for those nursing home residents who will 
participate in the nursing home transition program.  
Coordinating Efforts with Nursing Facilities  
States may also need to consider exploring a nursing facility's role in facilitating an 
individual's transition into the community. For example, a State could explore alternative 
ways in which nursing facilities can utilize their facility to support community-based 
programs.  
Develop Innovative Funding Arrangements  
Another barrier to the use of home and community-based services is the fragmentation of 
home and community-based funds among several different State agencies. Thus, even when 
home and community-based services are less expensive than nursing home care, it is often 
difficult for an individual to access community-based services or to transition to community-
based services because of a lack of coordinated funding. States are encouraged to explore and 
develop flexible funding arrangements that would allow a shift from institutional care to home 
and community-based services, thereby enabling adequate funding to follow the beneficiary.   Monitoring and Safeguarding Individuals Transitioning into the Community  
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Once an individual is settled in the community, States need to consider how to ensure that the 
beneficiary's needs continue to be met, that problems are resolved, and that there exists a way for the 
beneficiary to request and receive either additional or a different mix of services and supports as his or 
her circumstances change. States should consider the variety of safeguards that need to be in place, 
particularly in the first year of the person's return to the community, to ensure that his or her progress is 
monitored and appropriate intervention is available as is warranted by the person's individual 
circumstances.  
We encourage States to provide orientation, training, and supports to beneficiaries who have transitioned 
into their homes and communities in ways in which they as individuals can help to ensure and enhance 
their own basic safety and well-being. The State also may wish to call upon advocacy and beneficiary 
groups to help monitor or develop the mechanisms to monitor the quality of the State's program. The 
groups could also provide feedback to the State on issues that need to be addressed and on how to 
improve the program.  
Partnerships with Beneficiaries, Families, Advocacy Groups, Consumer Directed Agencies and other 
Providers  
The success of the nursing home transition program will be enhanced significantly by the development 
of partnerships. Partnerships can be with the beneficiary, the beneficiary's family and significant others, 
consumer directed agencies, advocacy groups, ILCs, Public Housing Authorities, other State and local 
agencies, and the State legislature. These partners can join with the State Medicaid agency to help 
develop the State's demonstration program, identify needed infrastructure, and design the care system. 
Advocacy groups, consumer directed agencies, and beneficiaries can be used to educate case managers 
about beneficiaries' needs.  
HCFA is particularly interested in State strategies for obtaining necessary accessible, affordable housing. 
Applicants should include in the proposals evidence of intent to work closely with Public Housing 
Authorities and/or housing finance agencies (such as a Memorandum of Understanding). States are 
encouraged to address the use of partnerships in their proposals.  
The State Technical Assistance Grant  
HCFA's Nursing Home Transition Initiative is now in its second year. We would like to 
engage all States and key local agencies in an active dialogue about nursing home transition. 
The State technical assistance grant is one way to assist States and local agencies with 
varying degrees of experience with nursing home transition to come together to exchange 
ideas.  
The technical assistance grant is a new facet of the HCFA's Nursing Home Transition 
Grants and will set aside funds for a State that collaborate together with one or more local  ILCs and HCFA to accomplish two objectives. First, the grantee will assist in sponsoring 
the National Technical Assistance conference on nursing home transition. Second, it will 
contract with one or more ILCs in the State to provide direct technical assistance to other 
ILCs (in and outside the host State) in working effectively with States to enable successful 
transition of people with disabilities from nursing facilities to community residences. 
States applying for this grant are urged to involve State ILC Councils in helping to 
coordinate such technical assistance efforts. We expect the conference portion of the 
technical assistance grant to range in cost from $75,000 to $90,000 (including speaker 
expenses, subsidy of attendee expenses, registration, logistics, planning, etc.), and the 
contract(s) with ILC(s) for technical assistance to range from $50,000 to $105,000. Please 
refer to Appendix Three for Review Criteria for the technical assistance grant. At State 
option, the contracts for the conference and for ILC technical assistance and information 
dissemination may be combined.  
IV. General Provisions  
for the Program and State Technical Assistance Grants  
Although applicants have considerable flexibility in developing demonstration projects 
under this solicitation, the project must comply with the following:  
Duration of Proposed Program  
States applying for a grant should delineate a proposed timeline for the grant program, 
assuming an October 1, 2000 receipt of funding. States are encouraged to allow sufficient 
time for start-up in their timelines. The timelines for a program grant should include an 
implementation date for the provision of transition services and a conclusion date for the 
transition program. This time period should ideally be no more than eighteen months from 
the date of award. For a State technical assistance grant, the time period should be no more 
than 9 months from the funding availability date.  
Benefit Package Considerations and Waiver Authority  
There are a variety of benefit combinations that a State can put together as part of its 
proposal under this grant initiative and which can utilize both State Plan services and/or any 
one of the waiver authorities found at sections 1915(b), 1915(c), 1915(d) or 1115 of the 
Social Security Act. A State, however, is not required to submit an application for any of 
these waiver programs as part of its grant proposal. Nevertheless, it may choose to do so in 
order to waive Federal statutory requirements that prevent a State from, among other things, 
developing innovative funding arrangements or eliminating barriers to the use of community-
based care. Waivers will be granted if they meet Federal requirements. Moreover, all 
applicable required demonstrations of cost-effectiveness, cost-neutrality, or budget neutrality 
remain in effect should any of the above noted waiver authorities be sought as part of this 
grant initiative.   Budget Neutrality  
Budget neutrality requirements differ depending on the Medicaid waiver authority necessary 
to conduct the demonstration. The budget neutrality standard for a Medicaid 1115 waiver is 
the most stringent required for any of the Medicaid waiver authorities. The Medicaid 1115 
waiver requires that federal Medicaid expenditures not be higher than they would have been 
in the absence of the waiver. HCFA and ASPE will provide assistance to State grantees to 
explain and assist with the budget neutrality requirements of the waiver most applicable to 
their demonstration.  
Independent Evaluation  
All grantees receiving awards under this grant program must agree to participate in an 
independent evaluation of their programs' effectiveness. Grantees agree to provide health 
status, expenditure, utilization, outcome and additional data as appropriate to support the 
evaluation. States may be required to submit case studies of persons participating in the 
transition project.  
Choice of Services  
The beneficiary (or legal guardian acting on the beneficiary's behalf) have the opportunity, 
information and tools to make an informed choice to either transition into the community or 
remain in the nursing home.  
Civil Rights  
All grantees receiving awards under this grant program must meet the requirements of Title 
VI of the Civil Rights Act of 1964; Section 504 of the Rehabilitation Act of 1973; the Age 
Discrimination Act of 1975; Hill-Burton Community Service nondiscrimination provisions; 
and Title II, Subtitle A, of the Americans with Disabilities Act of 1990. States are 
encouraged to contact the Office of Civil Rights, DHHS at (202) 619-0403 for technical 
assistance in developing a grant proposal that meets all the requirements of the civil rights 
and disability laws.  
V. Applying For A Grant  
Eligible Applicants  
Applicants eligible for grant funding must be State Medicaid agencies. State Medicaid 
agencies are encouraged to work with beneficiaries and their families, other State agencies,  
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community organizations, consumer-directed agencies, providers, and other entities in 
developing applications. States may apply for a program grant and a State technical 
assistance grant simultaneously.   Proposal Format  
Appendix One contains a format for submitting a program grant proposal. Appendix Two 
contains a Application Guidelines for a program grant. Appendix Three contains 
Application Guidelines for a State technical assistance grant. Although States are required 
to send an original and only 2 copies of each of the proposals, in order to facilitate timely 
distribution, review, and award of the grant, HCFA requests an original and 10 copies of 
each of the proposals.  
Deadline for Submission  
The closing date for proposals submitted under this solicitation is July 26, 2000. A proposal 
will be considered on time if it is postmarked on or before this date. The proposal must also 
be received in the HCFA grants office. Proposals must be mailed through the U.S. Postal 
Service or a commercial delivery service. A proposal postmarked after the closing date will 
be considered late. Late proposals will not be considered for an award.  
An original proposal should be sent with ten copies to:  
Attn: Ms. Marilyn Lewis-Taylor Health Care Financing Administration OICS, 
AGG, Grants Management Staff C2-21-15 7500 Security Boulevard Baltimore, 
Maryland 21244-1850 Phone : (410) 786-5701  
VI. Application Review  
A review will be conducted by panels of experts from the federal government. The panelists' 
recommendations will contain numerical ratings (based on the criteria specified in Appendix 
Two), the ranking of all applicants, and a written assessment for each proposal. The 
recommendations of the panel will be reviewed by HCFA and ASPE. HCFA reserves the 
right to conduct site visits to States receiving the highest ratings from the technical review 
panel.  
Final award decisions will be made by the HCFA Administrator after consideration of the 
comments and recommendations of the technical review panelists, comments and  
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recommendations of the site visit teams (if conducted), and availability of funds. 
Preferences for the program grant will be given to applicants who have not received a FFY 
1999 Nursing Home Transition or FFY 1998 Date Certain Grant. Preferences for the State 
technical assistance grant will be given to applicants who either have received a FFY 1999 
Nursing Home Transition or FFY 1998 Date Certain Grant in the past, or who are applying 
for a FFY 2000 Nursing Home Transition Grant. Additionally, for the program grants, 
HCFA reserves the option to stratify the ranked applications by broad geographic 
parameters for the purpose of achieving regional balance.   We expect to announce award decisions in September 2000. Grant awards will be made by 
September 30, 2000. Applicant States will receive written notification of the final award 
decision.  
VII. Additional Information  
For additional information regarding this solicitation, please contact:  
Thomas Shenk  
phone: (410) 786-3295  
E-mail: tshenk@hcfa.gov  
 
or  
Andrew Mack  
phone: (410) 786-3005  
E-mail: amack@hcfa.gov 
 
This program is not covered by Executive Order 12372, "Intergovernmental Review of Federal 
Programs." Authority for this grant program lies in Sections 1110 and 1115(a) of the Social Security Act.  
 
Appendix One Grant Application Guidelines  
The following guidelines are intended to assist States in preparing applications for grant funding under 
the Nursing Home Transition 2000 Initiative.  
 The narrative portion of each grant proposal should not exceed 35 double-spaced typewritten 
pages.  
  
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Additional documentation may be appended; however, material should be limited to 
 
information relevant to the specific scope and purpose of the grant. Please do not include 
critical details in an Appendix.  
Recommended Proposal Format  
A complete proposal consists of a narrative application plus the required material noted below. 
Application materials should be organized as follows:   (cid:31)  1.   Governor's Designation Letter  
(cid:31)  A letter from the Governor identifying the lead organization and affirming its responsibility for 
overseeing the planning and development of the State's proposed initiative. The letter should indicate that 
the lead organization has clear authority to oversee and coordinate the proposedactivities and is either a 
representative of, or has the responsibility of convening, a suitable interagency working group of all 
relevant State agencies and other key stakeholders.  
(cid:31)  2.   Cover Letter From Medicaid Director  
(cid:31)  A cover letter signed by an authorized individual on behalf of the lead organization. The letter 
should indicate the title of the project, the name of the lead organization and principal contact person, the 
amount of funding requested, the amount of State funds committed for the planning phase, and the names 
of all organizations collaborating in the effort.  
2  Project Abstract  
 
A project abstract limited to one page. The abstract should serve as a succinct 
description of the proposed project and should include:  
For both grants, the overall goals of the project. 
    
(cid:31)  For the program grant, a description of the proposed target population, covered benefits, and 
reimbursement methodology.  
(cid:31)  For both grants, an estimated synopsis of budget items and  
 
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associated costs.  
 Narrative Application  
The narrative application should provide a concise and complete description of the proposed project. The 
narrative or body of the application must not exceed 35 double-spaced pages plus the one page abstract 
noted above. Please do not rely on appendices to describe key details. This narrative should contain the 
information necessary for reviewers to fully understand the project being proposed and should be 
organized as follows:  
A.  
Provide a description of the State's current home and community-based care systems for Medicaid 
beneficiaries and the status of Medicaid pre-admission screening and nursing home reimbursement 
systems. Please include the following:  
(cid:31)  the number and types of Medicaid beneficiaries already enrolled in Medicaid home and community 
based services programs (waivers, PACE, and personal care), and plans for expansion and the status of 
pending waiver applications.  
(cid:31)  the availability of data (especially functional status) on nursing home residents and persons in 
home and community-based services programs.  
(cid:31)  an overall assessment of the strengths and weaknesses of the State's home and community based 
services infrastructure.   (cid:31)  an identification--based on the preceding assessment of strengths and weaknesses--of priority 
and/or incremental enhancements the State intends to make to its home and community-based services 
infrastructure.  
 
B. For the program grants, provide a description of the transition program that the State is planning to 
develop. While planning for many of the areas of the program may be incomplete, please include as  
much detail about the following proposed components as possible: 
 
Target Group  
Identify the target population for the nursing home transition program. The estimated number of persons 
to be moved from nursing homes to the community must be included and accompanied by an explanation 
of how this figure was reached. Applications not including a sound estimate of the number of persons 
to be offered the choice of community living under this announcement will be considered non-
responsive and will not be considered for funding. The discussion of the target population should 
include the following:  
potential data sources to be used to identify potential candidates for community transition; 
    
(cid:31)  geographic location of the target group;  
(cid:31)  estimated number of nursing homes from which program candidates will be drawn;  
(cid:31)  information and other supports to be made available to enable nursing home residents and their 
families or guardians, where appropriate, to make informed choices;  
(cid:31)  methods by which nursing home residents will be afforded accurate, objective, and easy-to-
understand information about their rights and the services and support available to them to live in the 
community or remain in an institutional setting; and  
(cid:31)  the extent to which ILCs and other consumer-directed agencies will be enlisted in helping to 
identify and provide peer counseling and other services and supports to potential candidates for 
community transition.  
 
Community Services and Supports to be Made Available  
Describe the continuum of services that are expected to be made available to individuals 
who transitition from nursing homes into their communities. The use of direct services grant 
funding and/or other innovative financing or housing programs should also be discussed. 
The application should outline the services that are currently available, the proposed 
additional services funded by Medicaid, and the proposed additional services to be funded 
by the direct services portion of the grant. Also included in this section are services from 
other agencies that are part of the continuum of services necessary to support disabled 
persons in the community. For example, States may want to consider advocacy services to 
ensure that the interests of the transition population are protected during and  
after a move into the community.  
Communication / Access Plan   Discuss the State's thinking with respect to how it will inform residents and their families and 
care givers about the program. The State should also describe how its staff will gain entrance to 
nursing homes to discuss the program with residents.  
Removal of Barriers  
Discuss the major barriers for nursing home residents to transitioning into and remaining in the 
community as well as a proposed plan for removing these barriers. Included in this section should 
be a discussion of the use of direct services funding plus services available through partnership 
with housing and/or other State and nonprofit agencies.  
Waivers  
The application should contain an initial assessment of any waiver amendment or new waivers that 
the State feels are necessary to implement the program. States may need to request Medicaid 
waivers to provide services not currently covered under the Medicaid program. To the extent that a 
State plans to amend an existing home and community-based services waiver to add new services 
or to request a new waiver to provide needed services and supports to beneficiaries served under 
the grant the State must describe its plans for doing so and meet all applicable cost-neutrality 
requirements.  
Partnerships  
Describe any partnership with other federal, State or local agencies whose services are part of the 
continuum of services and supports necessary to enable those leaving nursing homes to lead 
meaningful lives in their own communities. For example, the availability of accessible, affordable 
housing will be a major determinant of program success. States should consider how Medicaid 
agencies can work more closely with Public Housing Authorities to leverage housing options for 
nursing home residents.  
Ensuring and Enhancing the Basic Health, Well-being and Personal Security of Individuals 
Leaving Nursing Homes  
Describe plans for ensuring and enhancing the basic health, well-being, and personal security of 
individuals leaving nursing homes, during and after the transition process. Persons moving to 
the community may require both initial assistance in obtaining or reacquiring the skills 
necessary to function independently as well as ongoing assistance to maintain community 
residence. States should also describe how they will monitor the safety of persons moving back 
into the community. Discuss ways in which beneficiaries who have transitioned into their 
homes and communities will be equipped with the information, tools and supports necessary for 
them to help ensure and enhance their own basic safety and well-being.  
Applying Lessons Learned and Achieving Lasting Results  
Outline steps the State expects to take to ensure that the lessons learned as well as promising  practices which are identified through the grants will be applied in a manner that enhances the 
system's ongoing capacity to assist individuals with disabilities to avoid unnecessary 
institutionalization and to respond with timely alternatives.  
C.  
For both grants, describe milestones and work products to be accomplished during the grant period. 
The purpose of this section is to outline clearly what the State hopes to achieve during the grant 
period.  
(cid:31)  Examples of work products might include an analysis of current nursing home resident functional 
characteristics, systems designs, brochures/outreach materials, conference date, conference report, etc.  
(cid:31)  Timetable for accomplishing the above-mentioned tasks.  
 
Please include key dates relevant to the proposed project (e.g. State budget cycles and legislative 
sessions).  
D.  
F or both grants, describe the project organization and staffing, including:  
 Proposed management structure and how key project staff will relate to the proposed 
project director, the lead organization, and the interagency working group.  
  
Brief biographical sketches of the project director and key project personnel 
 
indicating their qualifications and prior personal and/or professional experience 
relating to living with a disability, disability services, and the project. Resumes for 
the key project personnel should be provided as an attachment.  
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E. Provide a set of endorsements of the support and commitments that have been pledged for the 
proposed project (e.g. cooperation from other State and local agencies, Public Housing Authorities, the 
executive branch, the legislative branch, insurers, business groups, etc.). Individual letters of support 
should be included as attachments.  
5.  
Program Budget  
The proposed budget for the program should distinguish the administrative portion of the grant from the 
direct services portion of the grant.    
Appendix Two 
Review Criteria for 
Program Grant  
1. Technical Approach  
( 40 points)  
The State must define how it will design and implement its project, addressing the following areas: 
 
 characteristics of and estimated number of the target population to be offered the opportunity to 
transition into the community, and the geographic location of nursing homes from which they will 
be drawn;  
  
(cid:31)  approach for identifying beneficiaries, gaining access to them and educating them about their 
choices;  
(cid:31)  partnerships with beneficiary and well qualified provider agencies, particularly those that are 
consumer-directed, at the local, State and federal level;  
(cid:31)  process for identifying and remedying barriers to community-based services;  
(cid:31)  benefits and services, including consumer-directed personal assistance; and  
(cid:31)  quality assurance/ monitoring strategies (particularly those that enable and enhance the abilities of 
beneficiaries to ensure their own basic safety and well-being).  
 
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2. Level of Commitment to the Project (20 points)  
States must demonstrate their commitment to this initiative. A State is encouraged to provide 
any documentation which would evidence its commitment to providing community-based 
options to nursing home residents. Additional points will be awarded to applications from 
States that provide greater support for the proposed transition program. Such support can be 
demonstrated by the extent to which a State uses its own resources in combination with grant 
funds, and by the extent of agency coordination and cooperation in creating an array of 
services and supports that enable and enhance the abilities of individuals with significant 
disabilities to live fuller lives of their own choosing and direction in the community.  
3. Project Scope  
(18 points)   Applications will be judged based on the scope of the proposed program in relation to the size 
of the current nursing home census in the State. Additional points will be given to 
applications in which the proposed program has the realistic potential to provide transition 
options to a larger number of nursing home residents. Additional points will also be given to 
applications from States for which the proposed program represents an effective and practical 
vehicle for beginning to make major and lasting improvements to infrastructure for 
supporting disabled persons with home and community-based services. A State wishing to be 
considered for being awarded such additional points, therefore, should clearly indicate how 
grant monies will be used in a manner that boosters its ability to serve people in the most 
integrated settings, particularly after the grant funds have been spent.  
4. Staff  
(12 points)  
Identification of key program staff and evidence that key staff (including the project 
director) are qualified and possess the experience and skills to implement and conduct the 
program within the available time frames. Preference will be given to State applicants that 
utilize staff with extensive personal and/or professional experience with living with a 
disability, disability services, and the project.  
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5.  
Involvement of Individuals in Target Group(10 points)  
Commitment to meaningful involvement of elderly people and individuals with disabilities in 
the design and implementation of the initiative, consistent with the target group selected by 
the State. Provide evidence and examples of the ways in which the State will meaningfully 
utilize the experiences of individuals with disabilities, older persons and family members in 
all phases of the design and implementation of the initiative.  
 
Appendix Three 
Review Criteria 
for State Technical Assistance Grant 
  1. Planning Approach  
( 65 points)  
The State must describe its approach to include at least the following: 
 
Conference Design  
: By its design of the conference, to what extent does the State evidence knowledge of 
important policy and operational issues a state must consider in a successful nursing home 
transitions initiative? To what extent does the State have an effective design for planning, 
organizing, and sponsoring a major national technical assistance conference? Does the State 
include an effective plan to capture the contents and recommendations of the conference and 
ensure its wide dissemination to other States and ILCs?  
ILC Contracting and Collaboration  
: To what extent does the State have an effective plan for engaging with its ILCs, ensuring 
ILC staffing for a technical assistance function for both in-state and out-state technical 
assistance, and involving the expertise of people with disabilities and elderly people in the 
overall nursing home transitions initiative?  
Housing  
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: Does the State include a strategy for addressing the problems of housing in its technical assistance 
plan and have an approach which engages people with housing expertise and the Public Housing 
Authority?  
Deliverables  
: To what extent does the State identify useful deliverables from its technical assistance 
activities that would benefit other States, and ILCs in other States, in designing and 
implementing successful nursing home transition initiatives? Is the dissemination plan 
promising?  
2. Level of Commitment to Nursing Home Transitioning  
(20 points)  
States that are currently seeking to enhance programs for nursing home transition, either via  application for a 2000 grant or having been a recipient of a former Date Certain or 1999 Nursing 
Home Transition Grant, or via other State programs, exhibit a high level of commitment to nursing 
home transition. A State is encouraged to provide any documentation which would evidence its 
commitment to providing community-based options to nursing home residents.  
3. Staff/resources  
(15 points)  
Identification of key program staff and evidence that key staff are qualified and possess the 
experience and skills to implement and conduct the conference within the available time frames. 
Include a description of contractors that the State might utilize in order to host the conference, for 
example, conference planners, compliance with ADA requirements, researchers to write the 
conference report, etc.  
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