Project Information

Bid Title

CSRA AAA FY2027 RFP 3 For Aging Services (non-nutrtion)

Issuing Agency

Central Savannah River Area Regional Commission

Location

Georgia

Published Date

Apr 2, 2026

Closing Date

May 4, 2026

Government Level

State & Local

Status

Closed

Original Source

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Bid Inquiries

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Bid Documents

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Project Description

CSRA AAA FY2027 RFP 3 For Aging Services (non-nutrtion)

RFP Due Date: May 4, 2026 by 3:00 PM Deadline for Questions: April 23, 2026 by 5:00 PM

The CSRA Regional Commission (CSRA RC), as the state-designated Area Agency on Aging for this region, is seeking proposals for non-nutrition-related Area Agency on Aging programs, to include

• health promotion and disease prevention

• individual counseling

• kinship care

• powerful tools for caregivers

• senior center activities (recreation)

Responders must apply by the due date in the manner described. The RFP can be accessed on or after April 2, 2026, at the CSRA RC’s website at https://csrarc.ga.gov/current-bid-opportunities

CSRA RC will receive responses until 3:00 PM on May 4, 2026. No responses will be accepted after this time.

Questions about the RFP must be directed in writing no later than 5:00 pm on April 23, 2026 to: rfps@csrarc.ga.gov Answers will be in writing and provided to persons who request to be included. To request a copy of answers, please send your agency name, contact email to rfps@csrarc.ga.gov by the due date for questions.

In making its award determination, the CSRA RC will take into account a variety of factors, including but not limited to the following: cost of the proposal, potential ability of the applicant to successfully perform under the contract’s terms and conditions, analysis of the applicable Unit Cost Methodology or other cost analysis, relevant past project experience and qualifications, organizational capacity to perform the required services, budget and financial capacity of the applicant, quality and thoroughness of responses to the scope of work and quality assurance sections in the proposal. Each of these factors will be considered to ensure that the selected proposal(s) are best suited to meet the needs of the project and comply with the expectations set forth in the RFP.

CSRA RC reserves the right, in its sole discretion, to: 1) cancel the RFP at any time, 2) amend the RFP before the due date, 3) alter the timetables for procurement; 4) request additional information from any Responder, 5) interview any Responder before issuing a grant award, 6) reject any or all Responses, and/or 7) waive any technicalities or formalities.

Any contracts and any subsequent periodic payments during the grant period is contingent upon receipt of local, state and federal funds.

CSRA AAA FY2027 RFP 3 Sample Document (use this to prepare information for the online portal)

FY2027 Uniform Cost Methodology Spreadsheet

FY2027 Aging Taxonomy of Services

Online Portal Application (only applications submitted through the portal will be considered)

Attachment Preview

Program:

(Program must match

what is in DDS)

AAA LINE ITEMS

Service Name:

(Service must match

what is in DDS)

AAA Administration

Unit of Measure:

N/A

Individual or

Group:

N/A

Appendix F - Taxonomy of Services - SFY 2027

Method of

Reimbursement:

Designated DAS Staff:

(Title, Section i.e.:

Regional Coordinator,

Business Ops)

Definition:

Line Item

Activities associated with overall area agency operations. Includes, but is not limited to analyzing data, planning, procurement, contracting, contract management, quality

N/A

assurance, compliance monitoring, financial management, technology management, personnel management, training, technical assistance, professional development, contractor

relations, program operations/management, resource identification, and development.

AAA LINE ITEMS

Advocacy

AAA LINE ITEMS

AAA LINE ITEMS

Coordination

Outreach

AAA LINE ITEMS

Program Development

N/A

N/A

1 Contact

N/A

N/A

N/A

Group

N/A

Line Item

Line Item

Line Item

Line Item

N/A

Activities related to monitoring, evaluating, and commenting on all policies, programs, hearings, levies, and community actions which affect older persons; conducting public

hearings on the needs of older people; coordinating planning with other agencies and organizations to promote new or expanded benefits and opportunities for older persons.

N/A

Engaging in cooperative arrangements with other service planners and providers to facilitate access to and use of all existing services and developing home and community-based

services to meet the needs of older persons effectively and efficiently.

N/A

Intervention with individuals 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.

N/A

Those activities directly related to either the establishment of a new service, or the improvement, expansion, or integration of an existing service. Activities must be intended to

achieve a specific service goal or objective; must occur during a specifically defined period of time, rather than being cyclical or ongoing in nature.

Dementia Care

AAA LINE ITEMS

Specialist Position

N/A

N/A

(DCS)

ADRC

ADRC Information and

Assistance

1 contact

Individual or

Group

ADULT GUARDIANSHIP

PROGRAM

Guardianship

N/A

Individual

DISASTER SERVICES

Congregate Meals

DISASTER SERVICES Home Delivered Meals

EAP - ADULT

PROTECTIVE SERVICES

APS Case

Management

EAP - ADULT

PROTECTIVE SERVICES

APS Intake

EAP - ADULT

PROTECTIVE SERVICES

APS Investigation

EAP - FSIU

FSIU Case

Consultation, Technical

Assistance

EAP - FSIU

FSIU Information and

Outreach

EAP - TERF

TERF Case

Consultation

EAP - TERF

TERF Case

Management

1 Meal

1 Meal

1 contact

1 contact

1 contact

1 Person

1 Session

N/A

N/A

Individual

Individual

Individual

Individual

Individual

N/A

N/A

Individual

Individual

Line Item

Line Item

N/A

Unit Cost

Unit Cost

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Dementia Team Lead,

Access to Services

The mission of the Dementia Care Specialist (DCS) Program is to support people living with dementia (PLWD) and their care partners so they can enjoy the highest quality of life.

The DCS will accomplish this by creating community partnerships through outreach, education, and building awareness for families and care partners. To increase dementia

awareness, build a dementia capable community, support care partners and PLWD, the DCS will focus on three domains: education and awareness, community outreach and

partnerships, and supporting care partners and PLWD.

Reference Manual 5200, Chapter 7000, Sections 7100, 7101, 7102, 7103 , and 7104 for all requirements and responsibilities of the Dementia Care Specialist position.

ADRC Team, Access to

Services

A service that: (A) provides individuals with information on services available within the communities; (B) links individuals to the services and opportunities that are available within

the communities; (C) to the maximum extent practicable, establishes adequate follow-up procedures. Internet web site "hits" are to be counted only if the information is requested

and supplied. The ultimate goal of the ADRCs is to serve all individuals with long-term care needs regardless of their age or disability by providing easier access to public and

private resources.

Note: The service of ADRC Information and Assistance includes the service of Community Options Counseling

(monitored by Transitions and Options Counseling Team Lead.)

Guardianship case management services are provided to adult persons under guardianship, also referred to as “wards,” whom a probate court has determined lack sufficient

capacity to make or communicate decisions concerning health or safety. When no other guardian is appropriate or available, a probate court may appoint the Department of

N/A

Human Services as guardian. The Division of Aging Services’ Adult Guardianship Program carries out guardianship duties when DHS has been appointed to serve as guardian.

Case managers acting as guardians make and express decisions for persons under guardianship that the person would have made if the person had the capacity to do so. This

substituted decision-making process is informed by the preferences and needs of the person under guardianship. Case managers respect the privacy and dignity of the person

under guardianship and choose options for the person that are the least-restrictive, allowing for the greatest exercise of self-determination, self-reliance, and individual rights.

Nutrition & Evidence Based

Programs Manager, Livable

Communities

Nutrition & Evidence Based

Programs Manager, Livable

Communities

Adult Protective Services

(APS)

A meal provided to a qualified individual in a congregate or group setting. The meal as offered meets all of the requirements of the Older Americans Act and State/Local laws.

Used only for services provided during disaster relief.

A meal provided to a qualified individual in his/her place of residence. The meal is served in a program administered by SUAs and/or AAAs and meets all of the requirements of

the Older Americans Act and State/Local laws. May include assistive technology required for dining. Used only for services provided during disaster relief.

A service provided as a result of the justification that a disabled adult and/or elder person is at risk for further abuse, neglect or exploitation (is in need of protective services) and

that the adult has consented to on-going APS case management services. Case management services include, but are not limited to, assessment, case plan development,

identification and coordination of essential services, follow up and reassessment.

Adult Protective Services A service to receive reports of alleged abuse, neglect, exploitation and/or self neglect of disabled adults (18-64) or elder persons (65+). Reports may be accepted for investigation,

(APS)

provide intervention (limited telephone case management) or for information and referral.

Adult Protective Services

(APS)

Forensic Special Initiatives

Unit (FSIU)

For reports that meet criteria, investigation is a service to determine if alleged abuse, neglect, exploitation and/or self neglect has occurred, report (except self-neglect)

substantiated cases to law enforcement and to prevent further maltreatment of the adult at risk.

Case reviews/consultations for DAS, first responders and mandated reporters regarding issues related to Abuse, Neglect and Exploitation. Forensics is point of contact for

agencies engaged in criminal & death investigations to determine if victim and/or decedent is or was receiving services through Adult Protective Services. Persons will refer to the

individuals contacting FSIU for assistance, not the number of people involved in the case.

Forensic Special Initiatives Provision of services to include information and outreach to mandated reporters and first responders to increase awareness of and response to abuse, neglect & exploitation of

Unit (FSIU)

older adults and adults with disabilities.

Temporary Emergency

Respite Funds

(TERF) Unit

Temporary Emergency

Respite Funds

(TERF) Unit

Case consultation for DAS, first responders, and mandated reports regarding issues related to Abuse, Neglect, and Exploitation. TERF is the point of contact for Law enforcement,

Healthcare Facility Regulation Department, Adult Protective Services, Public Guardianship Office, Georgia Department of Public Health, Georgia Emergency Management and

Homeland Security Agency. These agencies are responsible for making referrals so that TERF can identify safe and appropriate placement options

A service provided as a result of a justification that a disabled adult and/ or elder person who is at risk of further abuse, neglect, and exploitation (lack of support or services), and

that the adult has consented to ongoing TERF case management services. Ongoing services include, but are not limited to, permanent housing assistance, verification of benefits,

assessment, case-plan development, identification and coordination of essential services, follow-up, and reassessment. Also, reconnection services with estranged family

members (visits, placement, etc.)

Program:

(Program must match

what is in DDS)

Service Name:

(Service must match

what is in DDS)

Unit of Measure:

EAP - TERF

TERF Placement

N/A

ELDERLY LEGAL

ASSISTANCE PROGRAM

(ELAP)

HCBS - CAREGIVER

SERVICES

Elderly Legal

Assistance

Caregiver - Group

HCBS - CAREGIVER

SERVICES

Community and Public

Education

HCBS - CAREGIVER

SERVICES

HCBS - CAREGIVER

SERVICES

Counseling - Group

Counseling - Individual

1 Hour

1 Case

1 Session

1 Session

1 Session

1 Session

1 Hour

HCBS - CAREGIVER

SERVICES

Health

Promotion/Disease

Prevention

1 Session

HCBS - CAREGIVER

SERVICES

Home Delivered Meals

HCBS - CAREGIVER

SERVICES

Material Aid - Home

Modifications/Home

Repair

HCBS - CAREGIVER

SERVICES

Material Aid - Other -

Group

HCBS - CAREGIVER

SERVICES

Material Aid - Other -

Individual

HCBS - CAREGIVER

SERVICES

Material Aid - Other -

Individual - Voucher

1 Meal

Unit

Per Item

Per Item

Per item

Individual or

Group:

Individual

Staff Activity

Logs

Group

Group

Group

Individual

Group

Individual

Individual

Group

Individual

Individual

Method of

Reimbursement:

N/A

Line Item

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Designated DAS Staff:

(Title, Section i.e.:

Regional Coordinator,

Business Ops)

Temporary Emergency

Respite Funds

(TERF) Unit

Definition:

A service provided to ensure the safety and well-being of a disabled adult and/ or elder person who is at risk of further abuse, neglect, and exploitation (lack of support or services).

Work with the referring point of contact to coordinate placement and any other necessary services. Based upon the client's needs or abilities, TERF will find an appropriate home

for the client. These homes can be, but are not limited to, a licensed personal care home, independent, assisted living, or placement with a loved one.

State Legal Services

Developer, VAAAS

Free legal representation, advice, and counseling for persons 60 and older

Caregiver Services

Specialist, Livable

Communities

Caregiver Services

Specialist, Livable

Communities

Individual clients documented. A support group is a gathering of people who share a common health concern or interest. Support groups can be led by a lay person, a health care

professional, or both, and are typically held on a regularly scheduled basis. Members share their common experiences and concerns to develop a mutual support system.

Instruction provided to caregivers or the general public regarding available support services for caregivers or practical information on the methods and techniques of caregiving.

Examples include but are not limited to health fairs, presentation, and caregiver conferences.

Caregiver Services

Specialist, Livable

Communities

Caregiver Services

Specialist, Livable

Communities

Caregiver Services

Specialist, Livable

Communities

Counseling to caregivers to assist them in making decisions and solving problems relating to their caregiver roles. This includes counseling to support groups and caregiver

training of families.

Counseling to caregivers to assist them in making decisions and solving problems relating to their caregiver roles. This includes counseling to individuals and caregiver training of

individuals and families.

The provision of activities promoting wellness, nutrition, and physical activity, disease prevention and risk management, healthy lifestyle and safety in a group setting.

Activities may include:

Disease Management

Medications Management

Physical Activity

Health Promotion

Health Indicators, Outcomes, Evaluation

Health Literacy

Preventative Action

Self-Care/Self-Management

Nutrition & Evidence Based

Programs Manager, Livable

Communities

A meal provided to a qualified individual in his/her place of residence. The meal is served in a program administered by SUAs and/or AAAs and meets all of the requirements of

the Older Americans Act and State/Local laws. May include assistive technology required for dining.

Caregiver Services

Specialist, Livable

Communities

Caregiver Services

Specialist, Livable

Communities

Caregiver Services

Specialist, Livable

Communities

Caregiver Services

Specialist, Livable

Communities

Provision of housing improvement services designed to promote the safety and well-being of adults in their residences, to improve internal and external accessibility, to reduce the

risk of injury, and to facilitate in general the ability of older individuals to remain at home. For Kinship Care, could include, but not limited to, safety electrical plugs, child safety

gates, window and drawer safety latches.

A provision of materials to caregivers for purchase of such materials. Materials may include: housing/shelter, transportation, utilities, food/meals, groceries, clothing, child safety

items, incontinence supplies, cleaning supplies, school supplies, etc.

For purchase of materials and/or supplies that support a person's ability to continue living in the community as independently as possible. Materials may include: housing/shelter,

transportation, utilities, food/meals, groceries, clothing, child safety items, incontinence supplies, cleaning supplies, school supplies, etc.

A voucher to be spent by caregivers for purchase of such materials. Materials may include: housing/shelter, transportation, utilities, food/meals, groceries, clothing, child safety

items, incontinence supplies, cleaning supplies, school supplies, etc.

HCBS - CAREGIVER

SERVICES

Outreach

1 Contact

Individual

Line Item

Caregiver Services

Specialist, Livable

Communities

Intervention with individuals 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.

HCBS - CAREGIVER

SERVICES

Powerful Tools for

Caregivers

1 Workshop

Group

Unit Cost

HCBS - CAREGIVER

SERVICES

RCI

Caring for You, Caring

for Me

1 Workshop

Group

Unit Cost

Caregiver Services

Specialist, Livable

Communities

Caregiver Services

Specialist, Livable

Communities

Powerful Tools for Caregivers is an evidence based six week education program designed to provide family caregivers with tools necessary to increase their self care and

confidence. The program improves self-care behaviors, management of emotions, self-efficacy, and use of community resources.

One workshop equals six weeks with one session/class per week.

Completers are participants who attend 4 of 6 sessions/classes.

One completer is required for reimbursement for the workshop.

A 10-hour evidence-informed caregiver program, conducted in five two-hour modules, that addresses the needs of family and professional caregivers. Caregivers learn: ways of

coping with caregiving; resources available and how to access them; ways to share common concerns and issues.

One workshop equals five 2-hour sessions/classes.

A completer is one participant who attends 4 of the 5 sessions/classes.

One completer is required for reimbursement for the workshop.

Program:

(Program must match

what is in DDS)

Service Name:

(Service must match

what is in DDS)

Unit of Measure:

Individual or

Group:

Method of

Reimbursement:

HCBS - CAREGIVER

SERVICES

RCI Dealing with

Dementia

1 Workshop

Group

Unit Cost

Designated DAS Staff:

(Title, Section i.e.:

Regional Coordinator,

Business Ops)

Caregiver Services

Specialist, Livable

Communities

Definition:

A four-hour workshop, paired with the comprehensive Dealing with Dementia Guide, a detailed workbook designed to help caregivers. The goal of the workshop is to increase

dementia knowledge and improve the caregiver’s confidence in their ability to provide care.

One completer is required for reimbursement for the workshop.

HCBS - CAREGIVER

SERVICES

RCI REACH

(Resources Enhancing

Alzheimer’s Caregiver

Health)

HCBS - CAREGIVER

SERVICES

Respite Care - In-Home

HCBS - CAREGIVER Respite Care - In-Home

SERVICES

- Voucher

15 min

1 Hour

Unit

Individual

Unit Cost

Individual

Individual

Unit Cost

Unit Cost

Caregiver Services

Specialist, Livable

Communities

Caregiver Services

Specialist, Livable

Communities

Caregiver Services

Specialist, Livable

Communities

RCI REACH serves family caregivers who assist a care partner with Alzheimer’s disease or another type of dementia. The program uses a “coaching” model rather than the usual

caseworker or classroom approach to supporting caregivers. During twelve visits to the family home over a period of six months, the coach and caregiver work together to identify

which issues are causing the most difficulty and then develop strategies to overcome the challenges. Caregivers also receive training in stress management and coping with

dementia behaviors.

Services that offer temporary, substitute supports or living arrangements for care recipients in order to provide a brief period of relief or rest for caregivers. Respite includes: In-

Home Respite (personal care, homemaker, and other in-home respite).

Vouchers issued for caregivers to pay for services that offer temporary, substitute supports or living arrangements for care recipients in order to provide a brief period of relief or

rest for caregivers. Respite includes: In-Home Respite (personal care, homemaker, and other in-home respite).

HCBS - CAREGIVER

SERVICES

Respite Care - Out-of-

Home

1 Hour

Individual

Unit Cost

Caregiver Services

Specialist, Livable

Communities

Services that offer temporary, substitute supports or living arrangements for care recipients in order to provide a brief period of relief or rest for caregivers. Respite includes: 1)

respite provided by attendance of the care recipient at a senior center, adult day program, or other nonresidential program, 2) institutional respite provided by placing the care

recipient in an institutional setting such as a nursing home for a short period of time as a respite service to the caregiver.

HCBS - CAREGIVER

SERVICES

Respite Care - Out-of-

Home - Voucher

Unit

HCBS - CAREGIVER

SERVICES

Support Group

HCBS - CAREGIVER

SERVICES

Support Groups -

Caregiver Group

HCBS - CAREGIVER

SERVICES

CareABC

HCBS - CASE

MANAGEMENT

HCBS - CASE

MANAGEMENT

HCBS - CASE

MANAGEMENT

Behavioral Health

Coaching - Congregate

Behavioral Health

Coaching - Non-

Congregate

BRI Care Consultation

Session

Session

Unit

1/4 hour

1/4 hour

1/4 hour

HCBS - CASE

MANAGEMENT

Case Management

HCBS - CASE

MANAGEMENT

HCBS - CASE

MANAGEMENT

Case Management

Brokering

Support Options

Coordination

1/4 hour

1/4 hour

1/4 hour

Individual

Group

Group

Individual

Individual

Individual

Individual

Individual

Individual

Individual

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Unit Cost

Caregiver Services

Specialist, Livable

Communities

Vouchers issued for caregivers to pay for services that offer temporary, substitute supports or living arrangements for care recipients in order to provide a brief period of relief or

rest for caregivers. Respite includes: 1) respite provided by attendance of the care recipient at a senior center, adult day program, or other nonresidential program, 2) institutional

respite provided by placing the care recipient in an institutional setting such as a nursing home for a short period of time as a respite service to the caregiver.

Caregiver Services

Specialist, Livable

Communities

Individual clients documented. A support group is a gathering of people who share a common health concern or interest. Support groups can be led by a lay person, a health care

professional, or both, and are typically held on a regularly scheduled basis. Members share their common experiences and concerns to develop a mutual support system.

Caregiver Services

Specialist, Livable

Communities

Individual clients documented. A support group is a gathering of people who share a common health concern or interest. Support groups can be led by a lay person, a health care

professional, or both, and are typically held on a regularly scheduled basis. Members share their common experiences and concerns to develop a mutual support system.

Caregiver Services

Specialist, Livable

Communities

LC Team Lead & Case

Management, Livable

Communities

LC Team Lead & Case

Management, Livable

Communities

Caregiver Services

Specialist, Livable

Communities

Through registered access to the website at careabc.com, CareABC provides on-demand media resources for family caregivers with the information and detailed steps to provide

comprehensive, appropriate in-home care. Through various course materials, CareABC provides practical guidance as well as information about caregiver rights, obligations, and

requirements.

The process of assessment, service coordination, education, and coaching to support persons living with mental health and/or substance abuse issues to live as safely and

independently as possible in a congregate setting.

The process of assessment, service coordination, education, and coaching to support persons living with mental health and/or substance abuse issues to live as safely and

independently as possible in a non-congregate setting

An evidence-based information and coaching service delivered by telephone which empowers people to understand options, manage care, and make decisions more effectively.

Participants must complete periodic contacts based on program guidelines

LC Team Lead & Case

Management, Livable

Communities

Short-term assistance on behalf of an older person or caregiver who is experiencing immediate risk to health and safety, is at high risk of institutional placement, or has complex

needs across multiple domains of care. Activities of case management include such practices as comprehensive assessment, often across multiple domains; and developing and

monitoring short-term care plans. Case Management can be provided to older adults, persons with disabilities, caregivers, or relative caregivers raising children.

LC Team Lead & Case

Management, Livable

Communities

LC Team Lead & Case

Management, Livable

Communities

The conflict-free assessment of a consumer (preferably face-to-face) to determine eligibility or appropriateness for services, the recommendation of service(s) and frequency, and

the periodic rescreening of that consumer to determine ongoing eligibility or appropriateness for services.

Providing skills training and support to consumers in meeting their responsibilities as participants in the consumer-directed model of services, including training, coaching, and

providing technical assistance to consumers to assist them in using their budgets correctly and avoiding overspending.

Program:

(Program must match

what is in DDS)

Service Name:

(Service must match

what is in DDS)

HCBS - EVIDENCE BASED

SERVICES

Bingocize®

Unit of Measure:

1 Workshop

Individual or

Group:

Group

Method of

Reimbursement:

Unit Cost

Designated DAS Staff:

(Title, Section i.e.:

Regional Coordinator,

Business Ops)

Definition:

Bingocize ® is an evidence-based health promotion program that strategically combines the game of bingo, health education, and/or exercise. Trained leaders may select between

separate 10-week workshops that focus on exercise-only, exercise and falls prevention, or exercise and nutrition. Each workshop includes a facilitator's script for each session,

participants' materials, and "take home" cards for participants to complete exercises and tasks at home to reinforce the weekly health education information. Participants play

Bingocize ® twice per week, with each 45-60-minute session consisting of exercises (range of motion, balance, muscle strengthening, and endurance exercises) and/or health

Nutrition & Evidence Based education questions. Workshops can be delivered using a traditional in-person bingo game, along with printed curriculum facilitator and participants' materials. However, facilitators

Programs Manager, Livable and participants are recommended to use a stand-alone online version, Bingocize ® Online, to play Bingocize ® in-person or remotely. This adds a fun, interactive technology

Communities

component to the original game.

One workshop equals 10-weeks with two 45 - 60 minute sessions/classes per week for a total of 20 sessions/classes.

A completer is one participant who attends 16 of the 20 sessions/classes.

One completer is required for reimbursement for the workshop.

HCBS - EVIDENCE BASED

SERVICES

CDSME - CDSMP

1 Workshop

Group

HCBS - EVIDENCE BASED

SERVICES

CDSME - Diabetes

1 Workshop

Group

HCBS - EVIDENCE BASED

SERVICES

CDSME - Tomando

1 Workshop

Group

Unit Cost

Unit Cost

Unit Cost

Chronic Disease Self-Management Education (CDSME)

Chronic Disease Self-Management Program (CDSMP)

Nutrition & Evidence Based

Programs Manager, Livable

Communities

A Stanford University (SMRC) evidence-based, train the trainer program held for two an a half hours, once a week, for six consecutive weeks. Workshops and Lay Leader

Trainings are facilitated by either non-health care professionals or health care professionals able to adhere to the fidelity of the program, and giving preference to individuals with

chronic conditions themselves. The objective is to empower workshop participants to problem solve, and set weekly goals to improve skills needed to manage symptoms

experienced by participants with chronic conditions as well as caregivers of persons with chronic conditions.

Curriculum includes: medications management, developing goals around establishing/enhancing exercise programs, healthier nutrition habits, and other personal weekly action

items, learning better communication techniques, managing of pain and fatigue, working with healthcare professionals and the healthcare system, and much more.

One workshop equals 6 weeks of 2.5 hour sessions/classes once per week.

A completer is one participant who attends 4 of the 6 sessions/classes.

One completer is required for reimbursement for the workshop.

Chronic Disease Self-Management Education (CDSME)

Nutrition & Evidence Based

Programs Manager, Livable

Communities

A Stanford University (SMRC) evidence-based, train the trainer program held for two and a half hours, once a week for six consecutive weeks. Workshops and Lay Leader

trainings are facilitated by two trained individuals, one or both of whom have diabetes. Participants have diabetes or are diagnosed as being pre-diabetic. Completers will attend

at least four of the six sessions.

One workshop equals to 6 weeks of 2.5 hour sessions/classes once per week.

A completer is one participant who attends 4 of the 6 sessions/classes.

One completer is required for reimbursement for the workshop.

Chronic Disease Self-Management Education (CDSME)

Nutrition & Evidence Based

Programs Manager, Livable

Communities

A Stanford University (SMRC) evidence-based, train the trainer program for Spanish-speaking individuals held for two an a half hours, once a week, for six consecutive weeks.

Workshops and Lay Leader Trainings are facilitated by either non-health care professionals or health care professionals able to adhere to the fidelity of the program, and giving

preference to individuals with chronic conditions themselves. The objective is to empower workshop participants to problem solve, and set weekly goals to improve skills needed

to manage symptoms experienced by participants with chronic conditions as well as caregivers of persons with chronic conditions.

Curriculum includes: medications management, developing goals around establishing/enhancing exercise programs, healthier nutrition habits, and other personal weekly action

items, learning better communication techniques, managing of pain and fatigue, working with healthcare professionals and the healthcare system, and much more.

One workshop equals to 6 weeks of 2.5 hour sessions/classes once per week.

A completer is one participant who attends 4 of the 6 sessions/classes.

One completer is required for reimbursement for the workshop.

HCBS - EVIDENCE BASED Falls Prevention -

SERVICES

Matter of Balance

1 Workshop

Group

Unit Cost

Nutrition & Evidence Based

Programs Manager, Livable

Communities

Developed by researchers in Maine, this is an 8 week evidence based program designed to address the fear individuals have of falling. It combines education about falls

prevention as well as an introduction to physical activities that can help improve balance and stability. A completer is a participant who attends at least five of the eight sessions.

One workshop equals to eight 2-hour sessions/classes, either once per week for eight weeks or twice a week for four weeks.

A completer is one participant who attends 5 of the 8 sessions/classes.

One completer is required for reimbursement for the workshop.

Program:

(Program must match

what is in DDS)

Service Name:

(Service must match

what is in DDS)

Unit of Measure:

HCBS - EVIDENCE BASED Tai Chi for Arthritis and

SERVICES

Falls Prevention

1 Workshop

Individual or

Group:

Group

Method of

Reimbursement:

Unit Cost

Designated DAS Staff:

(Title, Section i.e.:

Regional Coordinator,

Business Ops)

Nutrition & Evidence Based

Programs Manager, Livable

Communities

Definition:

Developed by Dr. Paul Lam with tai chi and medical colleagues, the program utilizes Sun style Tai Chi for its ability to improve relaxation, balance, and its ease of use for older

adults. The program incorporates classes along with home practice to help improve muscular strength, flexibility, balance, and stamina. The class format is in person or

remote/virtual. Note: It is permissible to use a combination of remote (i.e. videoconference) and in person implementation in the same session or during a class series. For

example: 10 participants join by Zoom and 10 participants attend in a senior center and receive instruction at the same time. Two instructors for class size of 12-20, which

incorporates zoom participants.

One workshop equals to 8 weeks, two 1-hour sessions/classes per week.

A completer is one participant who attends 11 out of 16 sessions.

One completer is required for reimbursement for the workshop.

OR

One workshop equals to 16 weeks, one 1-hour session/class per week.

A completer is one participant who attends 11 out of 16 sessions.

One completer is required for reimbursement for the workshop.

HCBS - EVIDENCE BASED

SERVICES

Geri-Fit Program

1 Workshop

Group

HCBS - EVIDENCE BASED Health Coaches for

SERVICES

Hypertension Control

1 Workshop

Group

HCBS - EVIDENCE BASED

SERVICES

Hospital Transition -

Care Transitions

Intervention

1 Person

Individual

HCBS - EVIDENCE BASED

SERVICES

CDSME - CPSMP

1 Workshop

Group

Unit Cost

Unit Cost

Line Item

Unit Cost

Geri-Fit® is a 45-minute evidence-based health promotion program and chronic disease self-management support program. Designed exclusively for older adults, Geri-Fit helps

rebuild strength that's been lost through the aging process. The progressive resistance strength training program uses bodybuilding techniques to increase strength. The program

also incorporates range of motion exercises, stability and balance training, cardiovascular activity for heart health, and gait exercises to help improve walking. Geri-Fit helps ensure

a higher level of function and improvement in activities of daily living as well as management of chronic diseases such as diabetes, heart disease, pain management, depression

and more. There's no dancing, aerobics, or choreography to learn and participants never have to get on the floor. Most of the exercises are performed seated in chairs with a set of

light dumbbell weights, however, participants have the option to do the exercises standing if they prefer. Each person is encouraged to work out at their own pace and fitness level.

Nutrition & Evidence Based

Programs Manager, Livable

Communities

One workshop equals four weeks with two session/classes per week.

A completer is one participant who attends 5 of 8 sessions/classes.

One completer is required for reimbursement for the workshop.

OR

One workshop equals twelve weeks with two sessions/classes per week.

A completer is one participant who attends 16 of the 24 sessions/classes.

One completer is required for reimbursement for the workshop.

Health Coaches for Hypertension Control consists of eight sessions delivered by Health Coaches using a scripted manual and visual aids. The 90-minute sessions include

experiential learning strategies appropriate for those with health literacy challenges. Specific session topics include: Basics of Hypertension Control; Nutrition with emphasis on

Dietary Approaches to Stop Hypertension (DASH); Physical Activity with emphasis on creating a personal physical activity plan; Tobacco Cessation; Stress Management;

Medication Management; one session about developing short-term action plans and another on creating a long-term action plan. The Nutrition and Physical Activity sessions also

include content on weight control.

Nutrition & Evidence Based

Programs Manager, Livable

Communities

One workshop equals eight 90-minute sessions/classes.

A completer is one participant who attends 5 of the 8 sessions/classes.

One completer is required for reimbursement for the workshop.

OR

A workshop equals two 90-minute sessions/classes per week for four weeks.

A completer is one participant who attends 5 of the 8 sessions/classes.

One completer is required for reimbursement for the workshop.

Nutrition & Evidence Based Care Transitions Intervention® is also known as CTI® and the Skill Transfer Model®. During a 30-day program, patients with complex care needs and/or family caregivers receive

Programs Manager, Livable specific tools while they work with a Transitions Coach®. Clients learn self-management skills that will ensure their needs are met during the transition from hospital to home. This

Communities

is an evidence-based intervention comprised of a home visit and three phone calls.

Chronic Disease Self-Management Education (CDSME)

Chronic Pain Self-Management Program (CPSMP)

Nutrition & Evidence Based

Programs Manager, Livable

Communities

The Chronic Pain Self-Management Program (online, synchronous) is an interactive group workshop delivered via Zoom or similar virtual platform for those living with chronic pain

such as arthritis, backpain, neck pain, headache, or pelvic pain. Participants learn the skills to manage their pain on day-to-day basis: exercise, healthy eating, cognitive pain

management, as well as how to deal with such concerns as fatigue, sleep problems, difficult emotions, weight loss, communicating with family, friends, and coworkers. Core self-

management skills taught include action planning, problem solving and decision making.

This service description specifies the target audience as “Adults, 18 years and older, living with chronic pain”. For all services funded with Title IIID, the client must be 60 years of

age or older.

One workshop equals 6 weekly, 2.5-hour sessions/classes.

A completer is one participant who attends 4 of the 6 sessions/classes.

One completer is required for reimbursement for the workshop

Commodity Codes

• NAICS 541330Engineering Services
• NAICS 541611Administrative Management and General Management Consulting Services
• NAICS 541690Other Scientific and Technical Consulting Services

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