ADvancing States and the ARPA HCBS TA Collective Announce Release of Report from the HCBS Sustainability Summit

ADvancing States Publications

ADvancing States regularly releases new publications on topics across the aging and disability spectrum. We highlight all of these publications, along with webinar materials and HCBS Conference presentations, on our publications and webinars page. See below for an overview of some of our recent additions:  

De-Mystifying Data: How Medicare Data Can Support Medicaid Agencies

This issue brief from the MLTSS Institute focuses on aspects of delivering effective care to individuals eligible for both Medicare and Medicaid (dually eligible individuals).The brief provides a primer on the ways that Medicare data can help states better deliver care to dually eligible individuals; it also details information about data sources and other resources available to help obtain and analyze Medicare data.

Addressing Social Isolation for Older Adults During the COVID-19 Crisis 

Thank you to all of the states, organizations, and individuals who have responded with activities and ideas on how to address social isolation for older adults during the COVID-19 crisis. This document combines responses received thus far. Please continue to submit state, CBO, and facility activities to ADvancing States so that we may update this document accordingly. 

Process and Application Changes to Benefit Enrollment Systems During COVID-19: Findings from State Aging and Disability Agencies

This issue brief explores adjustments that states have made to processing eligibility and enrollment for benefits access, including changes to application and supporting document requirements. Examples of opportunities and adjustments that states have made to ensure older adults and persons with disabilities have access to critical benefit programs during the pandemic are highlighted. 

Home Modification and Repairs for Older Adults: Challenges and Opportunities for State Units on Aging 

This report details the findings from a survey of the 56 state and territorial agencies on aging and disabilities regarding home modifications. The extent to which State Units on Aging contribute to maximizing access to home modification and repair has not been well understood. This report seeks to expand understanding of the role of these state agencies in coordinating access to and providing policy oversight and financing of home modification and repairs.

Aging and Disabilities Information Technology Systems: What You Need to Know

This issue brief is the first publication from the Aging and Disabilities Technology Workgroup. The paper seeks to define key IT terms for agency staff and explain how they relate to the technology that is currently used in aging and disabilities services as well as emerging opportunities in the field.

 

Click here to see all of our publications and webinars

 

HCBS New and Notable

Rhode Island No Wrong Door Promising Practice Profile

This promising practice profile describes the Rhode Island No Wrong Door system including key partners, the state’s long-term services and supports interagency reform initiative, and the state’s approach to person-centered options counseling. The profile includes links to important resources such as the state’s Person-Centered Options Counseling Operational Manual and the No Wrong Door System Strategic Plan. 

COVID-19 Medicare Regulation Tracking Tool

This issue brief analyzes COVID-19 related legislative, regulatory, and subregulatory changes to Medicare from January 1, 2020 to July 24, 2020. The brief groups these regulatory changes into nine themes and examines questions regarding the policy changes moving forward. The brief is accompanied by a policy tracker that categorizes all 212 changes based on factors including types of providers and plans affected, effective date, and expected duration.

Selection Processes for Social Security Administration Representative Payees of Adults

This independent study describes SSA's current processes for selection of representative payees for adults. As part of the study, Pamela Teaster and Laura Sands (Virginia Tech Center on Gerontology), and Erica Wood (formerly American Bar Association Commission on Law and Aging) conducted in-depth interviews and surveyed field office managers. The authors identify a number of recommendations to improve the efficiency and effectiveness of Social Security's payee appointment and selection.

COVID-19 & Adults with Disabilities: Health and Health Care Access Online Survey Summary Report

The American Association on Health & Disability previously conducted a survey to assess the coronavirus pandemic's impact on access to healthcare on adults with a range of disabilities. AAHD has now published a report summarizing the findings from this survey. The initial report presents findings from all responses, while future reports will analyze results by specific type of disability.

Compendium of Medicaid HCBS Waiver Waiting List Administration

This compendium includes select information on waiver capacity and waiting list management. The compendium highlights over 200 approved Section 1915(c) and Section 1115 waivers across all 50 states and DC. As an accompaniment to this compendium, MACPAC has also released an issue brief. This issue brief includes a description of the waiver analysis conducted in the compendium. It also features information from stakeholder interviews.

HHS Could Enhance Support for Grandparents and Other Relative Caregivers

This report analyzes the challenges grandparents and older relatives face as primary caregivers. The report outlines the numbers of grandparent and older relative caregivers, and the reasons for this care. It also examines how HHS supports state efforts to use federal programs and initiatives to assist these caregivers. GAO concludes the report by making recommendations for how HHS could improve the sharing of information and best practices about older caregivers with states.

Becoming a Medicare Fee-For-Service Provider: What CBOs Need to Know

This guide highlights the benefits and opportunities available for CBOs interested in providing services under Medicare FFS. It describes important considerations including billing and filing processes, culture change, and regulatory compliance. The guide also reviews how to enroll as a Medicare provider and outlines which services CBOs can offer.

 

Initatives

Direct Care Workforce State Resources

Visit our new page, which is home to resources intended for state staff working on direct care workforce issues. Resources include initiatives led by ADvancing States as well as information from various partners.

 

Click here to visit the page.

Get in-depth information about how ADvancing States works directly with states to design and implement cost-effective strategies to build and sustain long-term services and supports systems.

 
News date

ARLINGTON, VA - ADvancing States and our partners in the American Rescue Plan Act (ARPA) home and community-based services (HCBS) Technical Assistance Collective (TA Collective) are proud to release a report from the HCBS Sustainability Summit. The TA Collective brought together 18 HCBS thought leaders — comprised of state officials, home and community-based services (HCBS) advocacy leaders, people with lived experience and their caregivers — for a day-long meeting in October 2023 to discuss the challenges facing the HCBS system and approaches to building on the successes of the ARPA HCBS initiatives. We are grateful to The John A. Hartford Foundation, the Care for all with Respect and Equity (CARE) Fund, The SCAN Foundation, and the Milbank Memorial Fund for their support in making the Summit possible.

The ARPA infusion of dollars into HCBS provided an historic opportunity to try bold, new approaches to supporting people in their homes and communities. While work has been done nationally to highlight ideas and methods for improving HCBS and establishing more flexible policy, the current structure of Medicaid, and HCBS in particular, often serves as a barrier to modernization. The institutional bias within Medicaid poses an ongoing challenge to the true realization of HCBS as a viable option for all.

Summit attendees offered an abundance of thoughtful considerations for improving, expanding, and enhancing HCBS, focused on the broader systems changes necessary for advancing HCBS guided by these principles:

  • Our nation’s LTSS system must prioritize the preference of most people in the U.S. to live in HCBS settings.
  • People with lived experience must have a voice in efforts around HCBS.
  • HCBS must be the first option offered to individuals, and the system must have capacity to serve all individuals who choose it.
  • Operating HCBS must be made simpler and more understandable for all partners in the system.
  • HCBS must be available to all, regardless of how they communicate, their backgrounds, and their cultures.
  • Congress, CMS and states must create a space for new ideas and sharing across the country.

The HCBS system is facing more challenges than ever before. Our hope is that this report — and the strategies contained therein — serves as a roadmap for future direction and investments in our HCBS system.

Read the report here.

About the ARPA HCBS Technical Assistance Collective 

The ARPA HCBS Technical Assistance Collective brings together four organizations with deep expertise in HCBS systems: ADvancing States, Halperin Health Policy Solutions, the National Association of State Directors of Developmental Disability Services (NASDDDS), Riverstone Health Advisors, as well as Brian Burwell. The TA Collective’s mission is to support states as they strive to maximize the impact of the unprecedented HCBS funding available under the American Plan Rescue Act. The TA Collective has been working with states on their ARPA HCBS initiatives since October 2021 and has delivered project management support, direct technical assistance, and shared learning opportunities to states. 

ADvancing States (www.advancingstates.org) represents the nation’s 56 state and territorial agencies on aging and disabilities and long-term services and supports directors. ADvancing States supports visionary leadership, the advancement of systems innovation and the articulation of national policies that support long-term services and supports for older adults and people with disabilities and their caregivers. 

Halperin Health Policy Solutions (www.halperinhealthpolicysolutions.com) is an independent consulting firm that provides state and federal government agencies, non-profits, and provider organizations with direct assistance related to healthcare and long-term services and supports (LTSS) access and coverage issues for lower-income older adults and persons with disabilities.  

NASDDDS (www.nasddds.org) assists member state agencies in building person-centered and culturally and linguistically appropriate systems of services and supports for people with intellectual and developmental disabilities and their families. 

Riverstone Health Advisors (www.riverstonehealthadvisors.com) consults to state and federal agencies, health plans, vendors, and providers as they strive for success in government healthcare programs, including Medicaid home and community based services (HCBS) and other Medicaid long-term services and supports (LTSS) programs, Medicaid managed care, and Veterans’ healthcare, among other programs. 

Brian Burwell is an independent contractor and nationally recognized expert on HCBS policies and programs.  He served as a Commissioner on the Medicaid and CHIP Payment and Access Commission for six years.  His career has been focused on Medicaid policy for older persons and persons with significant disabilities.