Research and policy development on long-term services & supports in the community
This report describes and examines themes discussed during a self-advocate summit on community living for people with intellectual and developmental disabilities, or I/DD. The Community Living Summit, a two-day moderated discussion, was hosted by the Autistic Self Advocacy Network (ASAN) and funded by the University of California, San Francisco's Community Living Policy Center.
The purpose of the summit was:
As a growing number of states adopt Managed Long-Term Services and Supports frameworks, it becomes imperative that ongoing efforts to promote HCBS over institutional services continue and are integrated into the incentives and requirements of managed care contracts. Managed care can help states accelerate the shift towards the community--or slow and reverse it, depending on the incentives put into requests for proposals and contract language.
The decentralized nature of Home and Community-Based Services, and the fact that many HCBS providers travel to an individual’s home rather than service recipients traveling to provider facilities, have presented real difficulties for policymakers and advocates seeking to determine the most appropriate means of measuring network adequacy for LTSS providers. This report outlines multiple options that are available to state policymakers seeking to evaluate network adequacy for HCBS providers under MLTSS programs.
In the absence of widespread training standards, many personal care aides (PCAs) enter the field without adequate preparation, which can lead to anxieties and injuries on the job, among other concerns. Despite their career aspirations, some of these workers end up leaving their jobs because they lack the skills and confidence to provide high-quality care. Recognizing a need to raise the bar on PCA training, six states -- Arizona, Maine, Massachusetts, New York, Virginia, and Washington -- have developed model curricula for statewide implementation.
In 2014 California implemented a demonstration project called Cal MediConnect, which used managed care organizations to integrate Medicare and Medicaid, including long-term services and supports for beneficiaries dually eligible for Medicare and Medicaid. Post-enrollment telephone surveys assessed how enrollees adjusted to Cal MediConnect over time. Results showed increased satisfaction with benefits, improved ratings of quality of care, fewer acute care visits, and increased personal care assistance hours over time.