Are you ready for the increased costs of a financial compliance audit?

John Heveron gave you some tips a few weeks ago on preparing for your financial audit. Just a reminder — if you spent $750,000 or more in federal funds last fiscal year, or will this fiscal year, you are required to have this more extensive audit. Any year that you spend $750,000 in federal funds, this audit is required. For many centers, the CARES Act funding pushed them over that threshold.

Auditor and executive review financial information on a computer screen.
Auditor and executive review financial information on a computer screen.

But an astute CIL director asked me , “How can I afford those audit costs next year when CARES Act funds are gone?”

This is a good question. We cannot typically carry over funds to the next year with either Part C or CARES Act. What can we do to cover the audit expenses when we are back to our basic pre-COVID budgets? The “single audit” costs are required specifically because the CARES Act funds temporarily increased your income over this two-year period. So can the CARES Act pay their share of those costs? It doesn’t make sense for Part C to pay for costs generated by the CARES Act funds, does it? In fact I might argue that you CANNOT use a funding source to pay an expense incurred by a different project or cost objective.

You are allowed to pay for actual expenses of your federal grants after their closing date IF those costs were encumbered during the grant year (Prior to September 30, 2021 in this case.) Encumbered funds are monies that are intentionally set aside to pay for future obligated or planned expenses. Although encumbered funds are not released until the payment for the future expenses is due, the funds cannot be used for anything other than their specified purposes.

It seems allowable, to us, to develop a contract now for your single audit, to sign it prior to the end of the fiscal year. This would then encumber those dollars so that they cannot be used for any other purpose. You should be able to draw them down prior to December 31 and utilize them to pay the CARES Act portion of the audit expenses.

Remember that you still have to properly allocate all your shared expenses, including this audit, so your other grants will pay a share as well. If you have not had single audit/compliance audits in the past, you should meet with your auditor or another auditor qualified to do this and ask them to explain the process, including what they would expect from you, and tell you what their fee would be.

Let’s talk about the new funding focused on vaccination

You have until April 23, 2021 to submit a letter to ACL to indicate if you want the funds, or if you choose to decline them.

There is a new funding source available to Part C centers, as described in the Federal Register. This is a much smaller, much more narrow and focused opportunity than CARES Act. ACL/Office of Independent Living Programs announced this and is preparing an FAQ which we will disseminate as soon as it is available. The same regulations of the allowable activities under this CDC funding apply. The expenditures of the funds must be related to vaccines specifically, including:

  • Education about the importance of receiving a vaccine
  • Identifying people unable to independently travel to a vaccination site
  • Helping with scheduling a vaccine appointment
  • Arranging or providing accessible transportation
  • Providing companion/personal support
  • Reminding people of the second vaccination appointment if needed
  • Providing technical assistance to local health departments or other entities on vaccine accessibility

You probably noticed that all of these are also allowable under the CARES Act and in fact all of these have been repeatedly messaged by OILP as things CILs could be doing with CARES Act funds. This new money is not a supplement to the CARES Act but can provide supplemental funding for vaccine related costs.

All the same Federal rules around allowability are exactly the same as any other funding source. There, like for all Federal funding, will be reporting requirements (TBD), and grantees should expect to be able to track activities and expenses accordingly.

It appears total of $5 million in funds will be distributed equally between the centers that wish to access the funds. Please get your letter in to ACL/OILP asap so that funds can be calculated and distributed.

What about the COVID-19 Vaccine funds will assist Part B centers?

As with the CARES Act funds, the new Vaccine Access funding from the CDC will be given to centers that are direct grantees (Centers for Independent Living funding through Part C of Title VII of the Rehabilitation Act) from ACL. They will not be available to sub-grantees receiving funds through the SPIL in your state (Independent Living Services funded through Part B of Title VII of the Rehabilitation Act).

But the good news is all centers can work with other entities in your service area who ARE receiving these funds. Check out this federal register post for how the ADRCs are to work with others. CILs/ILCs are listed right there in the grant application.

For you to receive some of these funds you will need to be named by your ADRC in their proposal — so there is no time to lose. You must AT LEAST have a phone conversation with them and ask to be included. Hopefully you can think first of the minimum amount of funding you need to reach all your consumers with vaccine assistance and request that amount. These funds can be used in a number of ways, including:

  • Education about the importance of receiving a vaccine
  • Identifying people unable to independently travel to a vaccination site
  • Helping with scheduling a vaccine appointment
  • Arranging or providing accessible transportation
  • Providing companion/personal support
  • Reminding people of the second vaccination appointment if needed
  • Providing technical assistance to local health departments and other entities on vaccine accessibility

Other local partners (linked to the Federal Register announcement when available) receiving these funds include:

So, Part B centers, Work with these partners and bring some of the necessary resources to your community to save the lives of those vulnerable people with disabilities to get immunized against COVID-19. And do it now — this funding is intended to be a quick response so the funds will be allocated shortly.

Three tools to conquer COVID

Payroll protection plan Part 3 is a two-month extension of Part 2, signed by the President today. If you didn’t apply for PPP in the original opportunity, you can check this article to see more details.

New funding from CDC, through ACL, will issue $5 million to the Part C Centers for Independent Living so you can provide assistance with scheduling vaccine appointments, transportation to vaccine sites, direct support services needed to attend vaccine appoints, connection to in-home vaccination options, and education about the importance of receiving the vaccine to older adults and people with disabilities. ACL will release along with guidance in the near future.

And really good news for Part B Independent Living Services programs – someone in your community is funded to do this vaccine work, and you can partner with them to make sure your communities benefit. The partners include:

  • State Units on Aging and Area Agencies on Aging ($50 million)
  • Aging and Disability Resource Centers (S26 million)
  • University Centers of Excellence in Developmental Disabilities ($4 million)
  • Protection and Advocacy systems  ($4 million)
  • State Councils on Developmental Disabilities ($4 million)

SILCs, if you addressed advocacy in emergencies in your SPIL, or have a goal for statewide collaboration, you may be a key partner with your centers that only get Part B in making sure another provider in your state serves those areas and people that would otherwise not have funding.

Stay tuned for more news as it breaks.

ACL Releases Updated Version of the CARES Act Funding FAQ

Three colorful conversation bubbles stating Frequently, Asked, Questions

The Centers that are direct grantees through ACL received CARES Act funding about a year ago that has assisted them in meeting the COVID-19 related needs of their communities. ACL has just released its most resent set of Frequently Asked Questions related to the proper use of those funds. You can find that new FAQ at https://acl.gov/COVID-19 It is the first item listed under What’s New (February 23 – March 17)

The content includes the prior FAQ and nine additional questions along with a number of links to helpful information, growing the document from six pages to nine. I have found it helpful to read and re-read this guidance to make sure CARES Act decisions are made in line with these items. At the end of the day your CIL is responsible for the proper use of all its funds, including this additional money to assist individuals with significant disabilities to be safe and healthy during these times. Here is the summary from ACL:

As we continue to discuss CARES Act funding, ACL is pleased to announce that an updated version of the CARES Act FAQ is available and is attached for your reference. It can also be found at https://acl.gov/COVID-19 under the heading of Guidance for ACL Programs and sub-heading of Independent Living programs.

Within this document, you will find several areas which have been addressed.

  • Questions 22-23 comment on the utilization of multiple funding sources and record requirements.
  • Questions 24-25 go into detail on equipment/capital improvements and audit costs.
  • Questions 26-29 describe recommendations post CARES Act, including strategies and examples of funding usage.
  • Page 9 provides valuable resources and links for additional information on use of CARES act funds.

As always, please reach out to me with any questions.

Sean Barrett, Team Lead | Office of Independent Living Programs,Administration for Community Living  U.S. Department of Health and Human Services

330 C Street, SW. Washington DC 20201 | 202.795.7397 | www.acl.gov

IL-NET National Training and Technical Assistance Center for Independent Living

ILRU’s IL-NET National Training and Technical Assistance Center for Independent Living provides timely and responsive technical assistance (TA) to centers for independent living (CILs) statewide independent living councils (SILCs), and (related to Independent Living Programs) designated state entities (DSEs).

  • For general questions about finding resources or trainings or being added to our email lists to receive updates on upcoming training activities, please contact ILRU at ilru@ilru.org or at 713-520-0232.
  • For more specific questions related to the needs of your organization or improving operational excellence, attend Technical Assistance Office Hours with Paula McElwee — Third Thursday of each month from noon to 2:00 p.m. Eastern. For more immediate assistance, contact the IL-NET Associate Director of Technical Assistance, Paula McElwee, at paulamcelwee.ilru@gmail.com or 559-250-3082 (Pacific time).

For Centers for Independent Living (CILs):

  • ILRU offers peer group technical assistance discussions at 3pm Eastern for:
    • Executive Directors – Second Monday of each month
    • Assistant Directors, Program Managers, or Middle Managers – Second Tuesday of each month
    • CIL Financial Managers – scheduled quarterly
  • For one-on-one technical assistance, contact the IL-NET Associate Director, Technical Assistance, Paula McElwee, at paulamcelwee.ilru@gmail.com or 559-250-3082 (Pacific time).

For Statewide Independent Living Councils (SILCs):

  • ILRU offers peer group technical assistance discussions at 3pm Eastern for:
    • SILC staff and members (called SILCSpeak) – First Thursday of each month
    • Designated State Entities (DSEs) – scheduled quarterly
  • For one-on-one technical assistance, contact the IL-NET Technical Assistance Coordinator, Paula McElwee, at paulamcelwee.ilru@gmail.com or 559-250-3082 (Pacific time).

Peer-to-Peer Mentoring

  • Peer mentoring is a specific form of individualized training assistance that matches CIL or SILC peers with peers from other CILs or SILCs to offer focused assistance with management and program issues. Peer mentoring offers an opportunity for CIL or SILC staff to strengthen operations or programs by learning from experienced colleagues. Please fill out this short survey if you are interested in learning more about:
    • Becoming a mentor and working with an organization to grow their programs or learn how to better run their organization.
    • Receiving a mentor to assist with growing a program or improving operations.

Technical assistance provided by the Southwest ADA Center:

CARES Act and Transition from Congregate Living

If I had a say, I would say to CILs, “Use CARES Act for transition!” Never have residents of congregate living been more at risk! Cases and deaths in group living settings account for from one third to one half the COVID-19 deaths. One way to protect our people from COVID-19 is to get them out of there!

While this is getting a little better as vaccines are given, many people with disabilities remain at risk. Especially if they have a home in the community to go back to (removing the very difficult barrier of finding affordable housing), you may be able to use CARES Act funds to help them get home where they will be safer and healthier than in their current setting. You can apply CARES Act funds to the needs they have for home modifications or other expenses around moving home.

The barrier that many CILs are running into is one of access — the CIL access to talk with residents as they assist them. Good news — from the ACL Blog, regarding ACL Advocacy: Visitation in Congregate Settings

From the ACL Blog

ACL Advocacy: Visitation in Congregate Settings

February 24, 2021

by Vicki Gottlich, Director, ACL’s Center for Policy and Evaluation

Throughout the COVID-19 pandemic, ACL has worked with the HHS Office for Civil Rights, the Centers for Medicare & Medicaid Services and other partners to protect the rights of people with disabilities and older adults. One issue on which we have been heavily engaged is visitation for people who live in a range of congregate settings, and we wanted to make sure our networks were aware of the latest guidance on this crucial topic. 

On Feb. 10, CMS issued guidance on visitation in Intermediate Care Facilities (ICF) for Individuals with Intellectual Disabilities and psychiatric residential treatment facilities (PRTF). This complements CMS’ guidance for visitation in nursing homes, which was issued in September.

The new guidance includes a number of provisions that are important for ACL’s partners in the aging and disability networks to be aware of. For example, although it allows facilities to restrict visitation in order to prevent the spread of COVID-19, it makes clear that visitation may not be restricted without a reasonable clinical or safety cause.  It further says that even if a facility is otherwise limiting in-person visitation, it should allow visits – with appropriate safety measures — by the following:  

  • Protection and Advocacy systems
  • People who provide in-person supports necessary for equal access to care and communication under disability rights laws
  • Long-Term Care Ombudsmen (for ICFs licensed as nursing facilities and certified under section 1919 of the Social Security Act)
  • Outside healthcare and service providers, including providers assisting with transition from a facility to the community
  • People providing support in a compassionate care situation.  The guidance further clarifies that compassionate care situations are not limited to end-of-life. The guidance offers several examples in which visitation by family and caregivers could be considered compassionate care and makes clear that the list should not be considered all-inclusive.  

The guidance also includes descriptions of key federal disability rights laws and P&A programs and provides best practices for allowing visitation safely. This new guidance augments the guidance CMS issued in December on infection control for ICFs, psychiatric hospitals, and PRTFs (which included strategies for transition to the community, where appropriate). 

As always, the HHS Office for Civil Rights stands ready to assist if in-person supports or visitation are being denied in violation of federal disability rights laws.  Complaints can be filed through OCR’s portal. If you have questions or need help filing a complaint, you can email OCR at OCRMail@hhs.gov or call toll-free at: 1-800-368-1019, TDD: 1-800-537-7697. OCR also provides materials in alternative formats (such as Braille and large print), auxiliary aids and services (such as a relay service), and language assistance.

ACL will continue to advocate for the needs of people with disabilities and older adults, and we’ll continue to share information from federal partners and our grantees, as well as resources we think may be useful to the aging and disability networks, and the people we all serve. Watch ACL.gov/COVID-19 for the latest information and be sure to sign up for ACL Updates.


Related links:

Can we require staff to get tested for COVID-19? Take the COVID-19 vaccine?

As is so often the case, the answer is, “It depends.” Here are some of the issues to consider.

A needle is stuck into a vial of COVID-19 Vaccine

Williams Mullen of jdsupra.com stated:

Quote: While the EEOC and the CDC have not specifically stated that employers may mandate vaccination, there are indicators that such a mandate would be legally permissible. Most importantly, the EEOC has confirmed that COVID-19 meets the “direct threat” definition under the ADA in many cases. Therefore, if the employer can show that, based on the unique circumstances of the work environment, a failure to be vaccinated would pose a “direct threat” to the health or safety of other co-workers or third parties with whom they interact, there would appear to be support for upholding mandatory vaccination programs. The EEOC has now confirmed, in its guidance specific to COVID-19 vaccination, that the ADA allows an employer to have a qualification standard that includes “a requirement that an individual shall not pose a direct threat to the health or safety of individuals in the workplace,” such as a vaccination requirement. However, if this requirement screens out or tends to screen out an individual with a disability, the employer must show that an unvaccinated employee would pose a direct threat due to a “significant risk of substantial harm to the health or safety of the individual or others that cannot be eliminated or reduced by reasonable accommodation.”

Here are a few quotes from the EEOC:

Quote: Because the CDC and state/local health authorities have acknowledged community spread of COVID-19 and issued attendant precautions as of March 2020, employers may measure employees’ body temperature. As with all medical information, the fact that an employee had a fever or other symptoms would be subject to ADA confidentiality requirements.

Quote: A.6. May an employer administer a COVID-19 test (a test to detect the presence of the COVID-19 virus) when evaluating an employee’s initial or continued presence in the workplace? The ADA requires that any mandatory medical test of employees be “job related and consistent with business necessity.” Applying this standard to the current circumstances of the COVID-19 pandemic, employers may take screening steps to determine if employees entering the workplace have COVID-19 because an individual with the virus will pose a direct threat to the health of others. Therefore an employer may choose to administer COVID-19 testing to employees before initially permitting them to enter the workplace and/or periodically to determine if their presence in the workplace poses a direct threat to others. The ADA does not interfere with employers following recommendations by the CDC or other public health authorities regarding whether, when, and for whom testing or other screening is appropriate. Testing administered by employers consistent with current CDC guidance will meet the ADA’s “business necessity” standard.

Quote: The ADA, which protects applicants and employees from disability discrimination, is relevant to pandemic preparation in at least three major ways. First, the ADA regulates employers’ disability-related inquiries and medical examinations for all applicants and employees, including those who do not have ADA disabilities.(7) Second, the ADA prohibits covered employers from excluding individuals with disabilities from the workplace for health or safety reasons unless they pose a “direct threat” (i.e. a significant risk of substantial harm even with reasonable accommodation).(8) Third, the ADA requires reasonable accommodations for individuals with disabilities (absent undue hardship) during a pandemic.(9)

So this tells us — in order to require a vaccine you must determine not receiving it poses a direct threat to your other staff and consumers; AND you must provide reasonable accommodation to those who do not wish to take the vaccine due to their disability. Quote: A “direct threat” is “a significant risk of substantial harm to the health or safety of the individual or others that cannot be eliminated or reduced by reasonable accommodation.”(20) If an individual with a disability poses a direct threat despite reasonable accommodation, he or she is not protected by the nondiscrimination provisions of the ADA.

Quote: May an employer covered by the ADA and Title VII of the Civil Rights Act of 1964 compel all of its employees to take the influenza vaccine regardless of their medical conditions or their religious beliefs during a pandemic?   No. An employee may be entitled to an exemption from a mandatory vaccination requirement based on an ADA disability that prevents him from taking the influenza vaccine. This would be a reasonable accommodation barring undue hardship (significant difficulty or expense). Similarly, under Title VII of the Civil Rights Act of 1964, once an employer receives notice that an employee’s sincerely held religious belief, practice, or observance prevents him from taking the influenza vaccine, the employer must provide a reasonable accommodation unless it would pose an undue hardship as defined by Title VII (“more than de minimis cost” to the operation of the employer’s business, which is a lower standard than under the ADA).(36) Generally, ADA-covered employers should consider simply encouraging employees to get the influenza vaccine rather than requiring them to take it.

What is Intensive Support?

What is Intensive Support and how does a CIL qualify?

The ILNet T/TA Center provides intensive support to individual Centers for Independent living when the CIL is referred from ACL or from the DSE based on compliance concerns. This is a specific area of technical assistance that requires full commitment from the leadership of the CIL to attain compliance and a higher level of quality performance.

ACL’s Office of Independent Living Programs (OILP) is committed to the COMP system (Compliance and Outcome Monitoring Protocol). The DSE (designated state entity) in each state may also conduct sub-recipient monitoring when a CIL receives state or Part B funds. Either of these processes may require corrective action on the part of the Center.  Either OILP or the DSE may refer the CIL to receive intensive support to correct the compliance issues.

It is possible for a CIL to cited by the DSE, but they DSE does not refer them for intensive support. In this case the CIL may request intensive support for completing the Corrections for those citations.

Criteria for Intensive Support services are as follows:

  • Referral from OILP Program Officer or DSE indicating areas of concern or lack of compliance. Services provided include:
    • Develop a Corrective Action Plan to address identified areas of non-compliance including outcomes and target dates
    • If the CIL denies the findings, assist in understanding what is required and how they can appeal.
    • Provide specific resources (typically training, peer support, or one-to-one TA) to assist the center in completing the Corrective Action Plan and returning to compliance.
  • Referral from OILP Program Officer or DSE of new executive directors. Services provided include:
    • Connecting the new executive director with peers in their state or region.
    • Connect the new individual with the national peer to peer support available in Conversations and Peer to Peer Calls and website resources.
    • Assist the individual in assessing their compliance with the COMP requirements.
    • Assist the new executive director in establishing a plan of action to identify weak areas for their CIL and to identify two or more desired outcomes to accomplish with T & TA.
    • Introduce the new director to the Peer Mentoring program if they express a desire for that support.

What is Intensive Support and how does a SILC apply?

 The SILC intensive support is defined as on-going requests for support that cannot be resolved in a call or two. While referrals may still come from the OIP Program Officer, self-referrals are also accepted.

 SILC T/TA support that takes place over more than sixty days and that has a plan of action will be considered intensive support.

Referrals can be made by the Program Officer at ACL, the DSE, the SILC chair or SILC staff. SILC intensive support will only be available to SILCs that are willing to set a plan with measurable outcomes. We will emphasize compliance with regulations in this process.

Process followed to apply for Intensive Support

  • Referrals or requests for intensive support will be in writing, by email to paulamcelwee.ilru@gmail.com , from the Program Officer or from the CIL, SILC, or DSE. Related compliance review or other concerns must be submitted with the request.
    • For new executive directors, the request may be more general until the CIL or SILC and the T/TA Associate Director, can assess the need and establish two or more measurable outcomes that will advance the operational excellence of the CIL or SILC.
  • Once the initial goals are set, the T and TA Associate Director will work with the Consultant Team to assign the CIL or SILC to the most appropriate consultant for the development of a more comprehensive plan with steps to accomplish as they complete the identified outcomes.
  • The Consultant Team will provide monthly reports to the T and TA Associate Director on the progress toward desired outcomes and the identification of additional areas of need that have come to light.
  • While T and TA is always available on demand, this intensive support is specifically outcome driven and will be considered complete when the desired outcomes are met.
  • Once the T and TA is complete, the CIL or SILC will be given an opportunity to evaluate the intensive support provided.
  • ACL will receive a summary report of the results of all intensive support activities.

Is it time to re-open the Center?

While COVID-19 precautions are somewhat varied based on where you are located, one thing many centers have in common is that their office is closed or partially closed while staff primarily work from home. We are shifting, though, as the vaccines are distributed and communities begin to open. I see a wide variety of current status including:

  • Office remains closed, with staff primarily working for home. Staff are equipped for remote record keeping and to hold life skills classes, peer support groups and one to one meetings with consumers by Zoom or other video platform. Consumers are equipped with a device and digital access to participate.
  • Office is partially open, with staff rotating attendance at the office so that there is less crowding. They are instructed in new cleaning techniques and policies. The office has been upgraded to reduce the chance of transmission, including hand sanitizer stations, UV wands for disinfecting phones and bags, plexiglass screens added in face-to-face locations like the reception area, policy and method for checking temperatures for any person entering the office. Office is equipped with masks for use any time there is a face to face conversation. Staff rotate use of rest rooms, break room, and any other common areas so that there is not staff to staff transmission, whenever possible doors open hands free so that handles are touch free, etc. Handwashing and constant cleaning of surfaces take place.
  • Special arrangements are made for individuals who are at higher risk to continue to work from home if they feel that is necessary for their safety. This can be extended to include people with family members at high risk.
  • Office is open to consumers by appointment. Appointment times are staggered to reduce the likelihood of transmission between consumers. Staff also still staggered.
  • Office is fully staffed, open to consumers by appointment.
  • Office is open to the public. Temps, masks and hand sanitizers required. Proper hand washing and regular cleaning are emphasized. Due to the heavier use of cleaning supplies, people with multiple chemical sensitivities are consulted about what works best for them. (Home visits, visits first thing Monday morning so Friday’s cleaning chemicals have dissipated, etc.)

As you can see, “reopening” can mean different things. Whatever your policies, you need to develop and implement strategies for basic hand hygiene, cleaning and disinfecting surfaces, social distancing, identification and isolation of sick employees, workplace controls and flexibility, and employee training. There is also a balance needed so that shifting from working at home to working in the office occurs in an organized purposeful way. In other words, you need a plan.

Your plan can include equipment, supplies and procedures including deep or more frequent cleaning that you can fund with your CARES Act funds. You can install some automatic door openers to reduce touching door surfaces and barriers at windows. You can enhance the ventilation in the building. You can purchase a temperature station (one CIL I know of even connected the temp station to the door opener, so the door won’t open to anyone with a fever. The receptionist can help the person with a fever through the barrier at the front desk, but they do not enter the building, reducing contamination.) Hint: Don’t keep an individual record of temperatures. If you keep them you create a medical record that has to be kept 30 years beyond the end of the individuals employment.

As soon as you are open again, you increase the possibility of staff or consumers bringing the infection into the work place. You need to have a procedure for what happens in that case. Even if you take all precautions and everyone — staff, volunteers and consumers — uses the provided soap, water and paper towns to wash frequently and properly (for at least 20 seconds) someone may test positive who was recently in your office. OSHA’s guidance on Returning to Work states, “Establish a protocol for managing people who become ill in the workplace, including details about how and where a sick person will be isolated (in the event they are unable to leave immediately) while awaiting transportation from the workplace, to their home or to a health care facility, and cleaning and disinfecting spaces the ill person has occupied to prevent exposure to other workers, customers, or visitors. Employers may need to collaborate wit health officials to facilitate contact tracing and notification related to COVID-19 cases or possible exposures.” The CDC has information regarding this at https://www.cdc.gov/coronavirus/2019-ncov/index.html Talk to your county health office or check the state or county web pages for guidance in how this is handled locally.

If staff have been exposed, they need to know how to isolate/quarantine and monitor their own health. You policies should address how long everyone stays at home, how the building is sanitized, and what is required to occur before people return to work.

For more information about COVID-19 as it relates to the ADA and other Equal Employment Opportunity Laws, see this reference: https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws

Based on OSHA’s publication: https://www.osha.gov/Publications/OSHA4045.pdf