Value-Based Payments: Intellectual and Developmental Disabilities Quality Indicators Associated With Billing Expenditures.

Although managed care is expanding into the intellectual and developmental disabilities (IDD) service system, there is little agreement about measurable and meaningful outcomes for people with IDD, including for use in value-based payments (VBP). In this study, we examined potential VBP metrics for people with IDD-relationships between quality and costs. We analyzed Basic Assurances data and long-term services and supports billing data from 68 human service organizations that supported 6,608 people with IDD. Our final hierarchical regression model predicted 66.40% of the variance of annual long-term services and supports (LTSS) billing per person. Our findings suggest quality assurance indicators can account for a significant portion of cost variance-quality metrics represent a potential for cost savings and efficient service delivery.

Self-management of health by people with intellectual and developmental disabilities.

BACKGROUND: Self-management of health includes people with intellectual and developmental disabilities (IDD) playing a key role in health management in collaborating with healthcare professionals. METHODS: This study analysed data from Personal Outcome Measures® surveys (n = 1,341) to explore self-management of health. We had the following research questions: Who is most likely to be supported to self-manage their health? How does being supported to self-manage impact different areas of health? and How does being supported to self-manage impact other health-related organizational supports? RESULTS: Findings revealed the impact of self-management of health can be wide-ranging, regardless of impairment severity. When supported to self-manage their health, healthcare professionals were more likely to address healthcare issues, and interventions were more likely to be effective. CONCLUSIONS: Self-management represents a paradigm shift for people with IDD because it transforms people from passive recipients to active directors of their health.

Correlates of Voting Participation of People with Intellectual and Developmental Disabilities.

People with intellectual and developmental disabilities (IDD) vote less frequently than nondisabled people and people with other disabilities. This study explores what factors facilitate and hinder people with IDD's voting participation. To do so, 1,341 people with IDD were surveyed using the Personal Outcome Measures®. Binary logistic regressions revealed significant relationships between voting participation, and support needs, residence types, guardianship statuses, and organizational supports. Along with the right supports, attention to barriers that might exist can ensure people with IDD are able to make use of their civil rights and participate in this crucial form of civic engagement.

Un/Paid Labor: Medicaid Home and Community Based Services Waivers That Pay Family as Personal Care Providers.

The United States long-term services and supports system is built on largely unpaid (informal) labor. There are a number of benefits to allowing family caregivers to serve as paid personal care providers including better health and satisfaction outcomes, expanded workforces, and cost effectiveness. The purpose of this study was to examine how Medicaid HCBS Section 1915(c) waivers for people with intellectual and developmental disabilities allocate personal care services to pay family caregivers. Our analysis revealed about two thirds of waivers in fiscal year (FY) 2014 allowed for family caregivers to potentially be paid for personal care services. This amounted to up to $2.71 billion of projected spending, which is slightly more than half of all personal care service expenditures in FY 2014.

Mental/Behavioral Health Services: Medicaid Home and Community-Based Services 1915(c) Waiver Allocation for People With Intellectual and Developmental Disabilities.

Research has indicated that people who have intellectual and developmental disabilities (IDD) appear to be more vulnerable to having a co-existing psychiatric diagnosis. This study examined Medicaid 1915(c) Home and Community-Based Services (HCBS) waiver applications for people with IDD to determine the mental/behavioral health services proposed. We found that a large variance exists across states in projected spending for services, spending per participant, annual hours of service per participant, and hourly reimbursement rates. Moreover, compared to overall funding we found a general lack of state commitment to mental/behavioral services. States must shore up the capacity of their HCBS 1915

Home and Community Based Services (HCBS) waivers: a nationwide study of the states.

In fiscal year (FY) 2009, the Medicaid program funded over 75% of all publicly funded long-term supports and services (LTSS) for individuals with intellectual and developmental disabilities (IDD) in the United States ( Braddock et al., 2011 ). The majority of spending was attributed to the Home and Community Based Services (HCBS) Waiver program. In FY 2009, federal-state spending for the HCBS Waiver program reached over $25.1 billion and constituted almost half of total funding across the nation that year ( Braddock et al., 2011 ). Considerable effort has been spent investigating Medicaid program expenditures, however, due in part to the unique and state-specific nature of HCBS programs, national-level analysis on the types of services offered to individuals with IDD has not been available. A full understanding of the supports available through the Medicaid program is critical as the United States considers strategies for economic recovery among competing state and federal budget priorities. This article presents the results of an analysis of 88 Medicaid HCBS Section 1915(c) waiver applications for individuals with intellectual and developmental disabilities in 41 states and the District of Columbia. It analyzes IDD data and trends close to the real time intent of states and empowers advocates in presenting timely solutions to real-time issues.

State of the States in developmental disabilities: 2004.

Public spending for MR/DD services grew rapidly during FYs 2000-2002. This rapid growth was followed by reductions in spending for MR/DD services as the nation's economy declined during 2002-2004. However, convergent factors stimulating future expansion of funding and services for persons with MR/DD include rapidly expanding cohorts of aging caregivers in the states, increasing longevity of persons with MR/DD, and extensive litigation in the states promoting access to services.