Managed Long-Term Care Services: A Playbook Innovation or a Hail Mary?

The approach to providing long-term services and supports (LTSS) has changed dramatically over the last three decades in both the financing and delivery arenas. In the U.S., long-term strategies have varied by state in organizational structure, scope of delivery and administrative practices. In the past two decades an additional change has emerged with over half the states adopting some form of managed LTSS. This shift has deepened the divide in state approaches to LTSS system design and delivery. The shift to managed LTSS has been largely fueled by ideological expectations and concerns about growing Medicaid costs: Empirical research findings have played a minimal role. For example, the large CMS evaluation conducted in this area did not include Medicaid data or encounter data from the managed care plans as part of the study efforts. However, the managed LTSS experiment does create an opportunity to compare costs and outcomes of these different models of financing and delivery. This symposium will present preliminary evaluation findings from two states, Ohio and Pennsylvania, which are generating data to assess both the implementation and outcomes of these alternative LTSS models. To set the context an initial paper will discuss the expansion of managed LTSS programs across the nation and examine how these efforts compare to the development occurring in the European LTSS systems. The third presentation will discuss the results of the Community Catalyst dual eligibles’ managed care demonstration program monitoring project.

Advancing Access to Higher Education for Students with Intellectual Disability in the United States

Due to changes in legislation and policy in the United States, higher education has become more available to people with intellectual disability (ID). Currently, over 6000 students with ID are enrolled in 310 colleges and universities. In the past decade, the federal government has invested over 100 million dollars in a model demonstration program aimed at institutions of higher education to create, expand, or enhance high-quality, inclusive higher education experiences to support positive outcomes for individuals with ID. This article will describe the impetus and impact of this funding as well as related changes in policy and practice. With the emergence of these opportunities, a field of research has emerged, offering new knowledge about what higher education can offer to students with ID as well as the positive impact these students have on their peers, professors, and campus communities. We have also begun to see documentation of more long-term impacts of higher education on students’ employment, independent living outcomes, and life satisfaction. By describing these policy, practice, and research developments, this article will provide readers with a better understanding of the background, current status, and future needs of the field of inclusive higher education for people with ID in the United States and potential takeaways for similar stakeholders in other countries.

National Survey of Pediatric Sickle Cell Providers on Their Contraceptive Practices for Female Patients

Introduction: Pregnancies of women with sickle cell disease (SCD) have increased risk of morbidity and mortality, with potential additional complications due to uncertain teratogenicity of hydroxyurea and the newer medications. Unintended pregnancy is common among adolescents and young adults (AYA). We aimed to assess the beliefs, practices and barriers of U.S. pediatric hematology providers related to contraception for female AYA with SCD, as little is known about this topic. Methods: We developed a 25-question, web-based survey guided by the Health Belief Model to assess pediatric SCD providers' contraceptive perspectives and practices. Most questions were adapted from published surveys assessing provider views and practices on contraception for general AYA care or patients with other chronic health conditions. The survey was distributed from December 2020-April 2021 to licensed U.S. prescribers who provided care to female SCD AYAs ages 12-21 years within the prior two years. The anonymous survey was distributed by two methods: (1) a list of 526 pediatric SCD and/or general hematology providers from the HRSA SCD Treatment Demonstration Program Regional Collaborative, cross-referenced for reminder emails to 126 providers using a list from the HRSA Regional Genetics Collaborative (https://www.hrsa.gov); (2) directors from all 74 U.S. ACGME-accredited Pediatric Hematology-Oncology fellowship programs, asking then to forward the survey to their SCD providers. Surveys with >50% completion were analyzed using descriptive statistics and chi square analyses. Results: Of 177 respondents, 160 surveys met inclusion criteria and were analyzed: 73 (45.6%) contacted by emails and 87 (54.4%) contacted via the fellowship directors (Table 1). Respondents recruited via fellowship program directors were more frequently NP/PAs (total of 30 (18.7%)), of younger age (total 103 (64.4%) and had fewer years in practice compared to those contacted directly. The majority of providers reported counseling (76.9%) and/or referring patients for contraception (90.9%), but not prescribing (41.8%). Practices regarding contraception differed by provider characteristics (Table 2). Trainees vs. established providers less frequently reported counseling about contraception (54.1% vs. 84.6%, p<0.001). Overall however, younger vs. older providers (<45 years), did not differ in contraceptive counseling (75.7% vs. 80.7%, p=0.7). Motivators for providing counseling differed by certain demographics (data not shown): female providers more frequently counseled about contraception when patients disclosed being sexually active (87.0% vs 66.7%, p=0.046); NPs/PAs more frequently counseled if standards for counseling were in place (45.5% vs 22.0%, p=0.03); and providers with more years in practice when they had concerns about SCD patients' increased pregnancy risks (43.1% vs 23.9%, p=0.03). Provider practices did not differ by region or size of SCD practice. Providers who believed that hydroxyurea causes increased risk of pregnancy complications more frequently reported prescribing contraception (48.8% vs. 31.7%, p=0.04), but did not differ by counseling or referral practices. Concerns about teratogenic risk of hydroxyurea was not significantly associated with provider practices. The most frequently reported barriers for counseling (>30% respondents) were insufficiencies in time, patient/parent willingness, formal training, knowledge/ability and/or professional guidelines. Concerns about side effects was a barrier to prescribing (34.2%), while lack of access to providers with contraceptive expertise was the most common barrier to patient referral (34.9%). Multivariate analyses are ongoing. Conclusions: To our knowledge, this is the first national report of pediatric hematology providers' beliefs and practices regarding contraception for female AYA with SCD. While providers generally felt responsible for offering counseling and referral but not prescribing, practices varied based on certain provider characteristics, beliefs and perceived barriers. Clinical guidelines, improved provider education and training, and patient/parent decision Figure 1 Figure 1. Disclosures Smith-Whitley: Global Blood Therapeutics: Current Employment. Strouse: Takeda: Consultancy.