The 2014 U.S. Centers for Medicare and Medicaid Services "Settings Rule," which took effect in 2023, restricts Home and Community Based Services funding for adults with intellectual disabilities to small integrated settings and person-centered supports. The Settings Rule responds to the fact that community services, mandated by the…

Purpose: The purpose of this study is to investigate the incidence of all-cause mortality, institutionalization, and condition improvement among participants of a state home- and community-based services program (HCBS). Methods: We evaluated the follow-up data of 11,444 individuals with disabilities aged 45-59 years at application who received…

Eleven states offer 1915(c) Home and Community Based Services (HCBS) Medicaid waivers to organize and fund programs that provide in-home and community support services to address the unique needs of children and youth with complex mental health concerns and their families. However, as the COVID-19 pandemic-imposed restrictions on community…

Recognizing the crisis the COVID-19 pandemic represents to the Home- and Community-Based Services (HCBS) service system and the health, safety, and quality of life of people with intellectual and developmental disabilities (IDD), states temporarily amended their HCBS programs to strengthen service delivery. States are able to temporarily amend…

This study's aim was to examine the impact of pandemic emergency Home- and Community-Based Services (HCBS) payments on the continuity and security of people with intellectual and developmental disabilities (IDD). Using a multilevel logistic regression, we analyzed secondary Personal Outcome Measures interviews from 738 people with IDD (March 2020…

Using the 2008-2013 Medicaid Analytic eXtract files, this retrospective cohort study was to evaluate the effect of Medicaid home and community-based services (HCBS) waiver programs on emergency department (ED) utilizations among youth with autism spectrum disorder (ASD). Our study showed that the annual ED utilization rates were 13.5% and 18.8%…

Despite physically relocating "into" the community, many people with intellectual and developmental disabilities (IDD) fail to be meaningfully included "in" the community. The Home and Community Based Services (HCBS) Settings Rule was introduced to expand community integration, person-centered services, and choice. The aim of…

Self-directed home and community based services (HCBS) waiver services and supports for people with intellectual and developmental disabilities (IDD) have become a viable and widely used method of service provision in the United States. Grounded in theories of self-determination, previous literature on self-direction has suggested high…

The Home and Community Based Services (HCBS) settings rule (CMS 2249-F/2296-F) strictly enforces meaningful community-based settings for those receiving Medicaid HCBS funding. Stakeholders have the opportunity to impact states' setting rule plans and hold states accountable to ensure rules are truly community based. Yet, the complex rule can be…

Speech language and hearing (SLH) services can improve people with intellectual and developmental disabilities' (IDD) health, autonomy, and community participation. The aim of this study was to explore how SLH services are offered to people with IDD across the nation, particularly in fiscal year 2015 Medicaid Home and Community Based Services…

This manual was designed primarily for use by people with disabilities. The hope is that it is also useful for families, as well as service coordinators and providers who directly assist families and individuals with disabilities. The focus of this manual is to provide easy-to-read information about available resources, and to provide immediate…

Describes Block Nurse Program, in which existing resources and agencies are used to help keep elderly persons in their own homes with case management by public health nurses in community. Discusses external evaluation of program which documented that the neighborhood long-term care delivery model kept older adults in their homes at low cost and…

This study aimed to examine the implementation, adequacy, and outcomes of discharge planning. The authors carried out a prospective study of 1,426 adult patients discharged from 11 acute care hospitals in Israel. Social workers provided detailed discharge plans on each patient. Telephone interviews were conducted two weeks post-discharge. Findings…

Eligibility assessment systems for community long-term care vary widely across programs funded by states and Medicaid and in proposals to expand federal funding. Improved equity and efficiency will require better specification of eligibility criteria, timing and setting of assessments, language of assessment items, training of assessors,…

Examined public and private costs for nursing home applicants participating in Virginia Nursing Home Pre-Admission Screening Program. Found that applicants diverted to community care were less dependent and had greater informal supports than those admitted, and that public and private payments for community care were lower than for nursing home…