All States/Territories

In 1996, Vermont began to shift resources from nursing facilities to home and community-based services. To implement the legislation, several programs, new services, and policy changes were created that offered individuals more choices for long-term services. This report describes how Vermont changed its long-term care system to reduce institutional reliance by supporting people with physical disabilities and older people in the most appropriate and least restrictive environment possible.

This document describes Utah’s efforts to educate nursing home residents about community-based long-term care options. Group and individual educational sessions and assessments are conducted through organizations knowledgeable about community services. The document provides further information on the implementation of this program.

This was a teleconference held on March 17, 2004. The purpose of the teleconference was to have CMS Medicaid and Medicare staff discuss Dual Eligibility in both programs, particularly as it relates to children transitioning to eligibility as adults. Programs which paid for Medicare premiums, coinsurance and deductibles were also discussed.

In most cases, systems in use are paper-based and time intensive, which can lead to a high risk of fraud and abuse. The AuthentiCare Solution is an automated point-of-service verification system developed by GovConnect. The solution is designed to provide accurate, real-time access to information and to document that services have been provided. The solution uses a simple, secure, integrated phone and Internet environment.

The National Clearinghouse on the Direct Care Workforce publishes a free e-mail newsletter called Quality Jobs/Quality Care. Published twice a month, the newsletter covers issues concerning direct-care workers in long-term care and provides reliable, up-to-date information related to the direct-care workforce nationwide. To subscribe, visit the Clearinghouse website at www.directcareclearinghouse.org and look for Free E-mail Alerts.

This report documents the State of Massachusetts’ community governing boards. These boards were established to manage service delivery as a part of a self-determination initiative for people with developmental disabilities. The governing boards – elected by people with disabilities and their families – reflect Boston’s ethnic neighborhoods and serve people with similar ethnic and cultural backgrounds.

On May 28, 2004, Glenn Stanton Acting Director of CMS’ Disabled Elderly Health Programs Group transmitted modifications and additions to the Interim Procedural Guidance for oversight of Medicaid waivers to all CMS Regional Administrators. The Guidance documents include the memo from Mr. Stanton, a diagram detailing the HCBS Waiver Quality Life Cycle and several attachments. The Guidance was updated in Feb. 2007, the link to that letter is also attached.

The Administration on Aging (AoA) and the National Governors Association (NGA) will sponsor a policy academy as part of Idaho Governor Dirk Kempthorne's Long-Term Care Initiative. Activities include creating strategies to improve the availability of community-based long-term care services. In addition to the meeting, technical assistance and a grant will assist academy states or territories in implementing strategies to balance long-term care systems throughout the course of one year.

Millions of Americans with disabilities or long-term illnesses need assistance with daily activities. Family members and friends fill much of that need, but paid workers are a critical source of care and services. The need for assistance is increasing yet the number of people available is growing slowly. CMS funded this paper to summarize literature and research on the home care, home health, and personal assistance services workforce, highlighting issues raised and lessons learned.

This memorandum and the accompanying tables present data on Medicaid 1915(c) Home and Community-Based Services (HCBS) waiver expenditures from Federal Fiscal Years 1998 through 2003.