Disease Prevention and Health Promotion Services (OAA Title IIID)
Authorizing Legislation: Section 361 of the Older Americans Act (OAA) of 1965, as amended.
AoA uses a graduated or tiered set of criteria for defining evidence-based interventions implemented through the OAA. The criteria below should be used as a checklist, moving from the minimal criteria and working upward. In order to meet the highest-level criteria, each of the eight bullets must be met. Health promotion programs can fall within any of the three tiers. The goal is for all Title IIID activities to move toward the highest-level criteria. Communities should check with their State Unit on Aging for State-specific requirements.
The Title IIID Highest-Tier Criteria Evidence-Based Disease Prevention and Health Promotion Programs Cost Chart is not an exhaustive list of interventions, and inclusion on this webpage does not constitute an endorsement. Program submission was a voluntary, self-nominating process in which intervention developers elected to participate. Programs do not need to be listed on this webpage to be an appropriate use of OAA Title IIID funds. However, interventions must be evidence-based, as outlined in the following criteria.
- Proven effective with older adult population, using Experimental or Quasi-Experimental Design;* and
- Fully translated in one or more community site(s); and
- Includes developed dissemination products that are available to the public.
Title IIID Highest-Tier Criteria Evidence-Based Disease Prevention and Health Promotion Programs Cost Chart
- Published in a peer-review journal; and
- Proven effective with older adult population, using some form of a control condition (e.g. pre-post study, case control design, etc.); and
- Some basis in translation for implementation by community level organization.
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- Demonstrated through evaluation to be effective for improving the health and wellbeing or reducing disease, disability and/or injury among older adults; and
- Ready for translation, implementation and/or broad dissemination by community-based organizations using appropriately credentialed practitioners.
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The Purpose of the Program
Title IIID of the OAA was established in 1987. It provides grants to States and Territories based on their share of the population aged 60 and over for education and implementation activities that support healthy lifestyles and promote healthy behaviors. Evidence-based health promotion programs reduce the need for more costly medical interventions. Priority is given to serving elders living in medically underserved areas of the State or who are of greatest economic need.
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Funding and Innovation
Title IIID programs help stimulate innovation by providing seed money to test new evidence-based Disease Prevention and Health Promotion (DPHP) activities. DPHP programs help to attract young older adults through innovative fitness programs, health technology, and healthy aging programs. The Aging Services Network leverages many other funding streams and in-kind contributions for DPHP programs, including both public and private sources. Additionally, other key federal funding sources include programs funded by the Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention and the U.S. Department of Agriculture.
Funding for DPHP programs during the past seven years is as follows:
Partnerships extend the reach of DPHP programs, and can include: community health centers, mental health centers, state and local government agencies, centers for independent living, public health departments, state and local non-profit organizations, hospitals, universities and community colleges, and faith-based organizations. Senior centers and congregate meal sites are key partners for implementation and consumer feedback for DPHP programs. Prior to 2012, Evidence-based disease and disability prevention programs (EBDDP) were not required. However, in many parts of the country, especially those that exemplify best practices, communities have been using OAA Title IIID funds for EBDDP for several years.
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Guidance for the FY 2012 Title IIID Notice of Awards Requirements/Frequently Asked Questions
Select a question to view its answer or Expand All.
- Does the Older Americans Act (OAA) define evidence-based?
While the aging network has been moving towards evidence-based disease prevention and health promotion programs for the past several years, the FY-2012 Congressional appropriations now require that OAA Title IIID funding be used only for programs and activities which have been demonstrated to be evidence-based. The full final appropriations language is copied below with the key provision bolded.
For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 (“OAA”), section 398 and title XXIX of the PHS Act, section 119 of the Medicare Improvements for Patients and Providers Act of 2008, $1,473,703,000: Provided, that amounts appropriated under this heading may be used for grants to States under section 361 of the OAA only for disease prevention and health promotion programs and activities which have been demonstrated through rigorous evaluation to be evidence-based and effective: Provided further, That none of the funds provided shall be used to carry out sections 1701 and 1703 of the PHS Act (with respect to chronic disease self-management activity grants), except that such funds may be used for necessary expenses associated with administering any such grants awarded prior to the date of the enactment of this Act: Provided further, That the total amount available for fiscal year 2012 under this and any other Act to carry out activities related to Aging and Disability Resource Centers under subsections (a)(20)(B)(iii) and (b)(8) of section 202 of the OAA shall not exceed the amount obligated for such purposes for fiscal year 2010 from funds available under Public Law 111–117: Provided further, That notwithstanding any other provision of this Act, funds made available under this heading to carry out section 311 of the OAA may be transferred to the Secretary of Agriculture in accordance with such section.
- Will SUAs/AAAs have to go back and alter contracts that have already been set?
The new requirements outlined in the FY-2012 awards (NOAs) apply only to those funds. Contracts made with previous award funds, e.g., FY-2011 funds, do not have to be altered. That said, multi-year contracts which began prior to FY-2012 may have to be altered depending on whether such contracts include activities that meet at least the minimal criteria for evidence-based Title IIID programs.
- Do exercise programs meet the criteria for evidence-based programs?
- How can Older Americans Act Title IIID grantees afford to implement evidence-based programs given limited funding?
One source of funding may not be sufficient to meet all the disease prevention and health promotion needs of clients. Partnership and collaboration can extend the reach of health promotion programs. Many States, Tribes, AAAs, and PSAs use Title IIID funding to leverage other funds. It is common practice to braid or blend funding streams to fund different components of the same activity in order to make a complete program. Depending on the health promotion program, funding sources may include: public health departments, hospitals, foundation giving, universities, Cooperative Extension System Offices (USDA), professional organizations (such as pharmacy, dental and dietetic associations), United Way, voluntary donations, private donors, Medicare, Medicaid, outpatient clinics, non-profit organizations, federally-funded health centers, city parks and recreation departments, sliding scale co-pay, and others.
States, Tribes, AAAs, and PSAs leverage many other funding sources and in-kind contributions for Title IIID programs including both public and private entities. Other key federal funding sources are the Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, and the US Department of Agriculture. In addition to partnerships outside the Aging Services Network, some AAAs have pooled their Title IIID funding and implemented regional and/or statewide evidence-based programs.
- Can a portion of the Title III D award be used for State administration?
State Administration is based on the full Title III allocation and can be charged to any of the parts of Title III. As provided in OAA, Sec. 308(b), each state may determine the amount of Title III funds, including Title IIID, it will use for State plan administration activities up to 5% of its Title III allocation or $500,000, whichever amount is greater.
- Why are evidence-based initiatives in preventative health (Title IIID) important?
OAA Title IIID is intended to initiate programs designed to help older adults prevent and/or manage chronic diseases and promote healthier lifestyles. Healthy aging reduces healthcare costs and increases quality of life for older adults.
Evidence-based programs are shown to be effective at helping participants adopt healthy behaviors, improve their health status, and reduce their use of hospital services and emergency room visits. Older Americans are disproportionately affected by chronic disease. Evidence-based programs can mitigate the negative impact of chronic diseases and related injuries, such as falls.
Evidence-based programs empower older adults to take control of their health by maintaining a healthy lifestyle through increased self-efficacy and self-management. Evidence-based initiatives provide the greatest impact given available funding. Before the OAA Title IIID evidence-based requirement was implemented in 2012, States, Tribes, AAAs, and PSAs had already begun to shift their Title IIID funding towards evidence-based approaches to achieve better results for their limited funding.
- Are there new reporting requirements for Older Americans Act Title IIID to reflect the evidence-based requirement?
No. The reporting requirements for Title IIID have not changed. The State Program Report (SPR) does not require any client level reporting for Title IIID, but a State Unit on Aging may include them in their “total persons served” count. To view the AoA Program Results and Evaluation resources, visit: http://www.aoa.gov/AoARoot/Program_Results/index.aspx
- Are OAA Title IIID funds able to be used to support the Chronic Disease Self Management Program (CDSMP)?
- If an Area Agency on Aging feels it does not have the expertise to conduct Title IIID programs that meet the new evidence-based requirements, can the State Unit on Aging take their allocation and give it to another AAA who is able to meet the new requirements?
The AoA regional office is able to assist States and AAAs with implementing disease prevention health promotion programs that meet the new requirements. Many health promotion programs currently being implemented already meet the minimal evidence-based criteria, such as health screenings, oral health programs and vaccinations.
States are required to deliver Title IIID funding via the approved interstate funding formula (Note: Some states may have a separate section of the IFF for Title IIID funding that goes to “medically underserved areas” rather than to all AAAs.). In the event an Area Agency on Aging is unable to meet the new Title IIID requirements after receiving the funds via the IFF, States would have to follow their own written policy regarding programmatic compliance and reclamation of funds.
- Where in the OAA can I find a definition for evidence-based disease prevention and health promotion programs?
Older Americans Act, Sec. 102.(a)(14) defines the term disease prevention and health promotion services. As seen below in bolded green text, the term evidence-based health promotion was added to Sec. 102(a)(14)(D) of the OAA in the 2006 Amendments.
- The term “disease prevention and health promotion services” means—
- health risk assessments;
- routine health screening, which may include hypertension, glaucoma, cholesterol, cancer, vision, hearing, diabetes, bone density, and nutrition screening;
- nutritional counseling and educational services for individuals and their primary caregivers;
- evidence-based health promotion programs, including programs related to the prevention and mitigation of the effects of chronic disease (including osteoporosis, hypertension, obesity, diabetes, and cardiovascular disease), alcohol and substance abuse reduction, smoking cessation, weight loss and control, stress management, falls prevention, physical activity and improved nutrition;
- programs regarding physical fitness, group exercise, and music therapy, art therapy, and dance-movement therapy, including programs for multigenerational participation that are provided by—
- an institution of higher education;
- a local educational agency, as defined in section 14101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 8801); or
- a community-based organization;
- home injury control services, including screening of high-risk home environments and provision of educational programs on injury prevention (including fall and fracture prevention) in the home environment;
- screening for the prevention of depression, coordination of community mental health services, provision of educational activities, and referral to psychiatric and psychological services;
- educational programs on the availability, benefits, and appropriate use of preventive health services covered under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.);
- medication management screening and education to prevent incorrect medication and adverse drug reactions;
- information concerning diagnosis, prevention, treatment, and rehabilitation concerning age-related diseases and chronic disabling conditions, including osteoporosis, cardiovascular diseases, diabetes, and Alzheimer’s disease and related disorders with neurological and organic brain dysfunction;
- gerontological counseling; and
- counseling regarding social services and follow up health services based on any of the services described in subparagraphs (A) through (K). The term shall not include services for which payment may be made under titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq., 1396 et seq.).
- Would a health fair qualify under the new OAA Title IIID evidence-based requirement?
Some activities included at health fairs, such as health screenings, do qualify as evidence-based and are therefore an acceptable use of Title IIID funding. However, for health fair activities that do not meet at least the minimal criteria of evidence-based as outlined in the AoA multi-level definition for IIID, other sources of funding or in-kind contributions will have to be used. A few examples of health fair activities that do not meet at least the minimal criteria of evidence-based, include sports competitions, health information booths, and demonstrations.
- What funding can be used to support health fair activities that do not qualify under the new OAA Title IIID evidence-based requirement?
OAA Title IIIB funds can be used as well as Administration funds. Some communities have obtained donated services and/or found volunteers for activities such as informational booths, walk-a-thons and exercise demonstrations. By inviting local organizations to host a booth, give a presentation or offer a demonstration, they receive free marketing and in return provide a health fair activity free of charge. These activities could include: presentations on healthy diets and grocery shopping tips by a nutritionist paid for by a local grocery store; healthy cooking demo hosted by a local restaurant; benefits of stretching demo by a local gym instructor; presentation on building healthy relationships by a local therapist, psychiatrist, psychologist or psychotherapist; alternative medicines demo by a local acupuncturist, massage therapist or herbalist; bicycle and pedestrian safety demo by a local partner of the National Bicycle Safety Network; back health demo by a local chiropractor; CPR and First Aid demo by local EMTs; dental care presentation by a local dentist or dental hygienist; and skin cancer prevention demo hosted by a local dermatologist.
- In my state, we are in the process of establishing an evidence-based program that will ultimately be eligible for payment by Medicare/Medicaid. Is it permissible to use Title IIID funds to implement the program, while waiting for approval for Medicare/Medicaid reimbursement payment?
Yes. However, once payment may be made by Medicare or Medicaid, the program should no longer be funded with Title IIID dollars. The Older Americans Act (OAA) states that the Disease Prevention and Health Promotion Services Program (Title IIID) may not cover health programs covered by Medicare or Medicaid.
Section 102(a)(14)(L) of the OAA states:
- For the purposes of this Act—
- (14) The term “disease prevention and health promotion services” means—
- (L) counseling regarding social services and follow up health services based on any of the services described in subparagraphs (A) through (K). The term shall not include services for which payment may be made under titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq., 1396 et seq.).
- In order to meet the highest-level criteria in the AoA evidence-based definition does my health promotion program first have to meet the other two criteria?
Yes. In order to meet the highest-level criteria you must have already met the minimal and intermediate criteria. Think of the graduated set of criteria as a check list, as you check off each bullet your evidence-based health promotion program is moving further towards meeting the highest-level of evidence-based criteria posed by AoA.
- Can OAA Title IIID evidence-based funding be used for Care Transitions?
- For interventions that fall into the minimal and/or intermediate criteria what, if any, supporting documentation should SUAs or AAAs provide to substantiate that they are meeting the new OAA Title IIID requirements?
AoA does not require prior approval or documentation to be submitted regarding evidence-based health promotion programs. However, AAAs and SUAs may want to retain documentation of the evidence behind their chosen Title IIID health promotion program(s) for their own records. Depending on the program, this could be anything from a copy of an appropriately credentialed practitioner’s certification (e.g. nutritionist, pharmacist, dentist, CNA, LPN, etc.), to a peer-reviewed journal article, to dissemination products.
For a Title IIID evidence-based health promotion program meeting the minimal criteria such as blood pressure screenings at a health fair, documentation could include a copy of the CNA, LPN, RN or other performing practitioner’s license number along with information about the blood pressure screenings that were performed. In the event student volunteers are used, such as dental students, nutritionists or pharmacists, a letter or email from the faculty instructor could be retained as a record of the evidence-base of the health promotion program implemented with Title IIID funds.
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Disease Prevention and Health Promotion Webinar on the Evidence-Based Requirement
MOVING ON UP! OAA Title IIID Funds - Disease Prevention and Health Promotion Webinar on the Evidence-Based Requirement. (June 4th, 2014)
Evidence-Based Programs 101 Webinar
Presenters from the Program on Healthy Aging at the Texas A&M's School of Rural Public Health share what programs are available, why they’re important, how to find the right one for your organization, and how to measure success. This webinar is part of a series given by the Center for Healthy Aging and partners as part of the Recovery Act Chronic Disease Self Management Program grant. (July 24th, 2012)
AoA Health, Prevention and Wellness Programs
ACL Aging and Disability Evidence-Based Programs and Practices
ACL: Empowerment through Chronic Disease Self-Management Education Programs
CDC Community Health Resources Database
SAMHSA National Registry of Evidence-Based Programs and Practices
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* Experimental designs use random assignment and a control group. Quasi-experimental designs do not use random assignment. (Shadish, William R., Thomas D. Cook, and Donald T. Campbell. 2002. Experimental and Quasi-Experimental Designs for Generalized Causal Inference. Boston: Houghton Mifflin.)↩