LTSS Limelight: Home and Community-Based Services Gain State Traction
November 4, 2021 · Paige Cooke
The LTSS landscape continues to buzz with innovation and promise thanks to the funding provided through ARPA for Medicaid HCBS. For this quarter’s Limelight Series, we wanted to highlight essential solutions the National Association of Medicaid Directors (NAMD) presented in its Medicaid Forward LTSS Report, with an eye on what states are including in their state narratives.
NAMD has been hard at work engaging states on which solutions show promise in enhancing, expanding or strengthening home and community-based services for LTSS populations. NAMD’s recommended state and federal actions in the Report have been widely adopted across state narratives. Several of the CMS-approved state narratives provide insight into the HCBS program innovations that are gaining traction in adoption and implementation.
Over the summer, NAMD convened an Executive Work Group of Medicaid LTSS Directors and thought leaders, such as AARP, CityBlock Health, and IDD Human Services Resources Institute, to inform their Report. The Report follows the CMS structural changes encouraged for states to use in their state narratives. The solutions presented are organized into four distinct categories for both state and federal action:
- Build & Strengthen the LTSS Workforce
- Assist & Strengthen Individuals’ Natural Supports
- Promote Adoption of Telehealth & Assistive Technology
- Advance Person-Centered Outcomes & Quality through Innovative Payment Approaches
NCQA has highlighted a subset of the solutions in the table below and included some color commentary of our own to keep it interesting… We encourage you to visit the complete report for a comprehensive review.
|Solution Categories||Recommended State-Specific Actions|
|Build & Strengthen LTSS Workforce|
|Assist & Strengthen Individual’s Natural Supports|
|Promote Adoption of Telehealth & Assistive Technology|
|Advance Person-Centered Outcomes & Quality through Innovative Payment Approaches|
Let’s Focus in On IDD
There is a particular area of focus that we felt deserves its own spotlight in this blog.
As outlined by CMS the recently developed HCBS Spending Plans and Narratives webpage, and emphasized in the NAMD Report, use of the HCBS funds to support Intellectual and Developmental Disabilities (I/DD) population is essential. Recommended solutions highlighted in the LTSS Report underline the need for states to implement new housing and behavioral health supports for both adult and child I/DD populations.
Several state narratives (NY, CT, TN, MN) highlighted the expansion or development of mobile crisis units for adults and children with I/DD, to ensure the right professionals respond to acute situations in the community. These and other states also focused on the adoption of programs that strengthen workforce opportunities for persons with disabilities as well.
How Can NCQA Help the IDD Population
NCQA is proud to have several Community-Based Organizations across the country supporting IDD populations and advancing their service coordination efforts with an increased focus on continuous quality improvement through the Accreditation of Case Management for LTSS standards (CM-LTSS). A few to highlight are Alleghenies United Cerebral Palsy, MORC, Inc., and UDS in Pennsylvania; Bluebonnet Trails Community Services and the Texana Center in Texas, and LifeTime Resources Inc. in Indiana.
As NCQA works to advance LTSS requirements for future updates, IDD populations, SMI, SUD, and child and adolescent populations are at the top of the agenda. We are closely tracking how states are working to advance HCBS programs for these important populations receiving LTSS. For example, Arizona highlighted its efforts (and required funding) to enhance data collection and build a more efficient case management system for provider monitoring and oversight by integrating with the state HIE. These innovations help create a stronger data infrastructure that supports better care management and outcomes which can then be evaluated through digital quality measurement. As NCQA continues efforts to support quality’s evolving digital landscape, insights like these help inform the journey.
What’s Next/Our Mission
It is clear a lot remains to be done. However, with new funding and concerted focus, states are laying the groundwork to improve their delivery, quality and accountability for HCBS. We are encouraged by the recommended solutions presented and those gaining traction in state narratives thanks to the guidance from CMS and other vital national stakeholders like the NAMD.
NCQA remains focused on our goals to improve the quality of the delivery system, including supporting state priorities to improve and strengthen HCBS. We continuously engage stakeholders to enhance our programs. As states begin to advance the solutions brought forward, we encourage them to reach out to us at email@example.com to learn more about NCQA’s tools that are available to help execute and sustain these great advancements in HCBS well into the future.