Expanding Stakeholder Knowledge of the Home and Community Based Services (HCBS) Settings Rule

Inclusion ◽  
2017 ◽  
Vol 5 (3) ◽  
pp. 203-212 ◽  
Author(s):  
Carli Friedman
Keyword(s):  
Policy Process ◽  
Exploratory Study ◽  
People With Disabilities ◽  
Support Staff ◽  
Community Based ◽  
Outreach Programs ◽  
Education And Outreach ◽  
Community Based Services

Abstract The Home and Community Based Services (HCBS) settings rule (CMS 2249-F/2296-F) strictly enforces meaningful community-based settings for those receiving Medicaid HCBS funding. Stakeholders have the opportunity to impact states' setting rule plans and hold states accountable to ensure rules are truly community based. Yet, the complex rule can be inaccessible for the very people it will impact most. This exploratory study evaluates the HCBS Advocates Creating Transformation (ACT) program's ability to educate 86 stakeholders about the rule. Our findings suggest that the HCBS ACT program pilot was a useful intervention that can be replicated for education and outreach programs. Doing so can actively engage people with disabilities, their families, and their support staff in the policy process.

“I Honestly Would Not Have Known What to Do”: An Exploratory Study of Perspectives on Client Suicide Among Vocational Rehabilitation Support Staff

2017 ◽  
Vol 80 (3) ◽  
pp. 458-475 ◽  
Author(s):  
Emily M. Lund ◽  
Jared C. Schultz ◽  
Katie B. Thomas ◽  
Michael R. Nadorff ◽  
Christina M. Sias ◽  
...  
Keyword(s):  
Vocational Rehabilitation ◽  
Exploratory Study ◽  
People With Disabilities ◽  
Support Staff ◽  
Emotional Impact ◽  
Client Suicide ◽  
High Prevalence ◽  
Suicide Training ◽  
And Training ◽  
Do So

Despite the high prevalence of suicide both overall and among people with disabilities in particular, little research has explored suicide in the context of the vocational rehabilitation (VR) system or in counseling support staff in general. We analyzed the responses of 14 VR support staff who responded to an open-ended qualitative prompt regarding their experiences with suicide training and competency. Key themes included a perceived lack of and desire for more training regarding suicide, seeking and receiving suicide training outside of VR, and a perceived lack of resources for working with suicidal clients. Responses also underscored the heavy emotional impact of working with these clients, especially when one feels unprepared to do so. These results suggest that it is important to provide VR support staff with resources and training for addressing suicide in their client populations.

scholarly journals Policy Research Challenges in Comparing Care Models for Dual-Eligible Beneficiaries

2017 ◽  
Vol 18 (2) ◽  
pp. 72-83 ◽  
Author(s):  
Janet H. Van Cleave ◽  
Brian L. Egleston ◽  
Sarah Brosch ◽  
Elizabeth Wirth ◽  
Molly Lawson ◽  
...  
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Exploratory Study ◽  
Coordinated Care ◽  
Care Model ◽  
Community Based ◽  
Research Challenges ◽  
Care Models ◽  
Dual Eligible ◽  
Community Based Services

Providing affordable, high-quality care for the 10 million persons who are dual-eligible beneficiaries of Medicare and Medicaid is an ongoing health-care policy challenge in the United States. However, the workforce and the care provided to dual-eligible beneficiaries are understudied. The purpose of this article is to provide a narrative of the challenges and lessons learned from an exploratory study in the use of clinical and administrative data to compare the workforce of two care models that deliver home- and community-based services to dual-eligible beneficiaries. The research challenges that the study team encountered were as follows: (a) comparing different care models, (b) standardizing data across care models, and (c) comparing patterns of health-care utilization. The methods used to meet these challenges included expert opinion to classify data and summative content analysis to compare and count data. Using descriptive statistics, a summary comparison of the two care models suggested that the coordinated care model workforce provided significantly greater hours of care per recipient than the integrated care model workforce. This likely represented the coordinated care model's focus on providing in-home services for one recipient, whereas the integrated care model focused on providing services in a day center with group activities. The lesson learned from this exploratory study is the need for standardized quality measures across home- and community-based services agencies to determine the workforce that best meets the needs of dual-eligible beneficiaries.

The State of Transportation for People With Intellectual and Developmental Disabilities in Medicaid Home and Community-Based Services 1915(c) Waivers

2016 ◽  
Vol 27 (3) ◽  
pp. 168-177 ◽  
Author(s):  
Carli Friedman ◽  
Mary C. Rizzolo
Keyword(s):  
Developmental Disabilities ◽  
Public Transportation ◽  
Independent Living ◽  
People With Disabilities ◽  
Transportation Systems ◽  
Intellectual And Developmental Disabilities ◽  
Community Based ◽  
Transportation Services ◽  
Services And Supports ◽  
Community Based Services

Transportation is the most frequently reported problem for people with disabilities. While some people with disabilities have difficulty with limited or no public transportation systems, others have trouble with inaccessible infrastructures and systems. In addition, people with intellectual and developmental disabilities (IDD) often have trouble with many of the skills that navigating transportation requires. Although accessible transportation is crucial for independent living, Medicaid only requires states cover nonemergency medical transportation and does not require transportation related to other aspects necessary for community living such as accessing work, errands, or recreational activities. The purpose of this article is to examine Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers, the largest provider of long-term services and supports for people with IDD, to see how transportation is provided for people with IDD. Our examination of 99 waivers for FY 2013 revealed 58 waivers provided transportation-specific services and 71 waivers provided transportation within another service. The majority of waivers provided transportation for people with IDD through these two means; however, this transportation was often limited to very specific purposes. From our findings, it appears transportation services for people with IDD in waivers need to be expanded to support community access and integration.

The Impact of Home and Community Based Settings (HCBS) Final Settings Rule Outcomes on Health and Safety

2020 ◽  
Vol 58 (6) ◽  
pp. 486-498
Author(s):  
Carli Friedman
Keyword(s):  
Exploratory Study ◽  
Community Integration ◽  
Health And Safety ◽  
Intellectual And Developmental Disabilities ◽  
Emergency Room Visits ◽  
Community Based ◽  
Abuse And Neglect ◽  
Potential Impact ◽  
The Impact ◽  
Community Based Services

Abstract Despite physically relocating into the community, many people with intellectual and developmental disabilities (IDD) fail to be meaningfully included in the community. The Home and Community Based Services (HCBS) Settings Rule was introduced to expand community integration, person-centered services, and choice. The aim of this exploratory study is to examine the potential impact of HCBS Settings Rule implementation, specifically by examining how the presence of HCBS Settings Rule outcomes impact three areas of health and safety. We analyzed secondary Personal Outcome Measures data relating to the HCBS Settings Rule, and emergency room visits, abuse and neglect, and injuries data from 251 people with IDD. Findings indicate a clear need to improve HCBS Settings Rule related areas of people's lives.

Stakeholders’ Home and Community Based Services Settings Rule Knowledge

2017 ◽  
Vol 43 (1) ◽  
pp. 54-61
Author(s):  
Carli Friedman
Keyword(s):  
Community Integration ◽  
People With Disabilities ◽  
Medicaid Program ◽  
Community Based ◽  
Transition Plans ◽  
Rule Knowledge ◽  
Key Stakeholders ◽  
Services And Supports ◽  
Community Based Services

Medicaid Home and Community Based Services (HCBS) waiver programs provide the majority of long-term services and supports for people with intellectual and developmental disabilities (IDD). Relatively new (2014) HCBS rules (CMS 2249-F/2296-F) governing these programs require meaningful community integration of people with disabilities who receive services under this Medicaid program. States are required to develop and submit transition plans, which document how their programs will meet the so-called settings rules. Public comment periods provide advocates the opportunity to impact states’ rules by ensuring that plans are truly community based. Yet the lengthy and technical description of the rules may be inaccessible for people with disabilities and their allies. Because knowledge of the HCBS settings rules can be crucial for people with IDD to enable them to access their rights, the aim of this study was to explore HCBS settings rules knowledge of people with IDD and key stakeholders. Our findings confirmed that there is a need to make the HCBS settings rules more accessible to those most affected by the changes—people with IDD and family members of people with IDD. Doing so is a necessary first step to promote advocacy regarding its implementation.

Sign in / Sign up

Export Citation Format

Share Document