Home and Community Care Block Grant
In 1991, The Home and Community Care Block Grant (HCCBG), was ratified by the North Carolina General Assembly. The intent was to improve the planning, management, and coordination of in-home and community based services to older adults in North Carolina. Prior to this time, there were various sources of funding for older adult services, each with their own separate and sometimes divergent requirements. The HCCBG combines several sources of funding into one block grant with one set of requirements.
The HCCBG consists of the following funding sources:
• Title III-B Supportive Services
• Title III-C-1 Congregate Meals
• Title III-C-2 Home Delivered Meals
• Title III-D Frail Elderly Services
• Social Services Block Grant Funds for Older Adult Services
• Appropriations for Older Adult Services
Each County is responsible for:
• annual designation of an agency or office within the county to have lead responsibility for planning and coordination of the County Funding Plan which identifies the agency(s) to provide HCCBG services, the type service(s) to be provided, and the amount of dollars that will fund each service.
• appointment of a committee to serve as a Home and Community Care Block Grant Advisory Committee
• ensuring that the County Funding Plan is developed with public input through a planned use hearing and ensuring that all budget instructions for HCCBG funding are met within the plan
• approval of the County Funding Plan
• approval of a grant agreement with Kerr-Tar AAA for HCCBG funding
At the county level, the County Commissioners designate the lead agency and appoint the Advisory Committee. The Advisory Committee (with Kerr-Tar AAA representation) handles the public hearing, ensures that all budget requirements will be met within the plan, and makes recommendations to the County Commissioners about services to be offered, agencies to provide service, and dollars to be allocated. The County Commissioners are free to make whatever choices they want, however. The county then signs a grant agreement with Kerr-Tar AAA for HCCBG funding. At that point, the county contracts with each chosen agency for the services identified.
The Area Agency has these responsibilities:
• to be a member of each County Block Grant Advisory Committee
• to ensure that the funding plans meet all requirements and that development of the funding plans is appropriate
• to partner with each county using a grant agreement for HCCBG funding
• to serve the county by administering the grants and providing oversight, quality assurance, performance assurance, and technical assistance
The local aging services providers have this involvement:
• providers must convince the county Advisory Committee that they are the preferred agency to offer specific services
• in some cases providers must offer a bid proposal for service delivery
• the providers contract with the county, not the AAA
• providers are held accountable to both the county and the AAA for performance and quality of service
Home and Community Care Block Grant Advisory Committees
Each County HCCBG Advisory Committee is appointed by local County Commissioners per requirements. The Committee must represent a broad range of aging interests in order to effectively build local consensus on the County Funding Plan. The County Funding Plan identifies what HCCBG services will be funded in the county, the agency(s) that will provide the service(s), and how many of the total HCCBG dollars will be allocated to each service. Kerr-Tar AAA must be represented on each County Advisory Committee but participates as a non-voting member. It is expected that other members represent older adults, aging service providers, and local elected officials and civic leaders. The Division of Aging strongly recommends that older adults comprise at least one third of the Committee membership. The Committee determines the recommendations for services, funding, and providers that will be presented to the County Commissioners for approval. For more information on who is represented on the committees in each county, contact Jillian Hardin, the Director of Kerr-Tar Area Agency on Aging.
The County Grant Agreements for Service Delivery With Kerr-Tar AAA
Each county executes a grant agreement with Kerr-Tar Area Agency on Aging each fiscal year (July 1 – June 30) for implementation and administration of the County Funding Plan and allocation of the Home and Community Care Block Grant (HCCBG) funds. The county, in turn, executes a contract with each recipient of HCCBG funds.
If agreed to by the HCCBG Advisory Committee, a fund recipient may then subcontract part or all of the work for a service. Responsibility for performance continues to be with the original fund recipient or agency subcontracting for the work.
Aging Services Provider Agreements With the County
As part of the contract with the county, a local aging services provider agency agrees to abide by all applicable federal, state, and local rules and regulations related to the provision of that service. Each service has a set of service standards, set by the state, that must be followed in order to receive the funds. Kerr-Tar Area Agency on Aging ensures the quality of the service and the compliance with all rules and regulations through a performance review process.
Counties contract with local agencies to ensure service delivery. Local agencies may find that they do not have the staffing capacity and/or the expertise to provide a service directly. However, the local County Commissioners feel that the contracted agency is the best local provider to oversee the service delivery and/or is the best agency to provide a focal point for aging service delivery in the county. In such cases, the agency may choose to subcontract the service. Usually, the agency retains administrative responsibility for the service. Examples of subcontracted services might be the catering portion of the meals program, the provision of in-home aides, or perhaps institutional respite services.
In order to receive federal funding, a subcontract must be handled in accordance with the Federal Register 45 CFR Part 92.36. This means that, as is the case with Area Agencies on Aging, no subcontract may be awarded to a for-profit service provider without the benefit of a competitive process in accordance with the above and county policy.
Direct quality assurance and performance review of the subcontractor is the responsibility of the agency contracting for service unless other arrangements have been made. Subcontract reviews will be conducted yearly. However, Kerr-Tar AAA will review the performance review results and methodology, and will ensure follow-up on any compliance issues.
Kerr-Tar AAA has more specific information available on procurement of services and recommendations for appropriate and legally sufficient procurement. Each local provider must ensure that all federal, state, and county requirements are fulfilled during a subcontract award process. Kerr-Tar AAA is available to assist local providers with this effort.
Most of the funding for local services is received through the Home and Community Care Block Grant (HCCBG). It is allocated on a state fiscal year basis that runs from July 1 to June 30 each year. In order to achieve equity, HCCBG funds are distributed through an intrastate funding formula.
The intrastate funding formula adds these indicators:
• (50%) of the number of 60+ population in the county
• (30%) of the number of 60+ population living in poverty
• (10%) of the number of 60+ population who are minority
• (10%) of the number of 60+ population living in rural areas
This county total is applied to the total dollars available to the region. The regional total is determined by applying the seven county totals to the total dollars available to the state.
Funding sources subject to allocation through the formula are:
• Older American Act Health Promotion and Disease Prevention
• on the basis of the medically underserved counties
• determined by the N.C. Office of Rural health
There are some funds allocated through the Area Agencies on Aging that are not subject to the intrastate funding formula.
• State in-home and Adult Day Care funding transferred from the Division of Social Services on 7/1/92 (a fixed amount to the HCCBG)
• State AAA support (fixed at $45,424)
• Caregiver support (based on updated 70+ population estimates; funds added to the HCCBG)
• State Senior Center Outreach/Development
• Ombudsman program
• Family Caregiver Support
The Ombudsman program has its own formula which adds the following indicators:
• 70% of the number of nursing home and assisted living facility beds
• 20% of the number of Community Advisory Committees in Region K
• 10% of the square miles in Region K
• State funding allocated for FY 93/94
• any new Title VII funding from FY 94/95 forward
Excluded from the ombudsman formula are:
• Title VII funding for FY 93/94 ($77,484 )
• Title III-B
What is match? Match is the amount of state dollars and local county dollars that must be set aside in order to “draw down” federal dollars. For example, using the chart below for the Ombudsman Program, the federal government will pay 85% of the allocated amount if the state pays 5% of the total and local government contributes 10%.
Planning & Administration 75% 4.11% 20.89%
Ombudsman Program 85% 5% 10%
Elder Abuse 85% 5% 10%
AAA Support (State only) 100%
State Aging Services Funding 90% 10%
Disease Prevention/Health Promotion 85% 5% 10%
National Caregiver Support Program 60% 25% 15%
Administrative and Service Performance Reviews
Each agency recipient of Older Americans Act (OAA) funds is to be held accountable for complying with the policies and procedures specified by the state agency assigned the responsibility for administering the OAA dollars. In North Carolina, the Division of Aging and Adult Services (DAAS) is that state agency.
In 1992, the Home and Community Care Block Grant (HCCBG) merged Older Americans Act federal funds with other state funds under a common set of policies and procedures. It is the responsibility of the Area Agencies on Aging (per DAAS and the county grant agreements with AAAs) to ensure that the policies and procedures are followed. One of the ways this is accomplished is through the Administrative and Service Performance Reviews.
DAAS developed a service standard for every allowable service. These standards specify the minimum level of expected performance in order to be able to receive funding to offer the service. For each service standard, there is also a corresponding performance review tool. The AAAs use these tools to help identify compliance areas and to be able to see where technical assistance is needed.
DAAS developed procedures for the AAAs to follow regarding the frequency of the reviews, the depth of the reviews, and when a review is required outside of the normal performance review plan. Time limits are also identified.