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ADvancing States and the ARPA HCBS TA Collective Announce Release of Report Summarizing State Experiences with ARPA HCBS Initiatives

FOR IMMEDIATE RELEASE
April 23, 2024
CONTACT: Camille Dobson
202-898-2578

ARLINGTON, VA — ADvancing States and our partners in the American Rescue Plan Act (ARPA) home and community-based services (HCBS) Technical Assistance Collective (TA Collective) are proud to release a report sharing findings about states’ experience in implementing their ARPA HCBS initiatives. While the ARPA infusion of federal dollars into HCBS provided an historic opportunity to try bold, new approaches to supporting people in their homes and communities, states were challenged to make systemic improvements given the time-limited nature of the federal funds.

To gather insights into states’ experiences in implementing their ARPA HCBS spending plans, the TA Collective fielded a national survey in early 2024 that aimed to identify successful strategies used by states implementing their ARPA HCBS spending plans, as well as any barriers hindering their success. Based on responses to that survey, this report highlights the challenges and barriers states faced in thoughtfully executing their initiatives in the midst of a public health emergency. The thirty-three states that responded to the survey shared the top barriers to implementing their projects as planned. These barriers include:

  • Delays in obtaining approval from CMS for both their spending plans and the necessary federal authorities to implement those plans;
  • Lack of staff capacity to design and implement complex initiatives;
  • The time it takes to complete state procurement processes to implement projects; and
  • The need to secure legislative approval and/or budget authority before beginning work.

The report also suggests ways to make any future time-limited investments in the HCBS system more effective, including giving states more time to implement, easing the CMS approval process and providing resources to both states and CMS. Moreover, any future investments should be accompanied by a federal evaluation to glean insights into successful interventions that could be replicated across the country.

While this report highlights challenges and lessons learned, it should be noted that, against all odds, states created transformational change with their ARPA spending plan initiatives. Our hope is that this report — and the recommendations contained therein — serves as a roadmap for any future federal investment in the HCBS system.

This report is also informed by the TA Collective’s work supporting states with their ARPA initiative planning, implementation, and evaluation activities and by observations and analysis of state and federal ARPA HCBS activities. It builds upon the TA Collective’s past work including, Efforts to Evaluate the Impact of ARPA HCBS Investments, an issue brief examining state evaluation approaches, and a summary of the work of the HCBS Sustainability Summit, which provided valuable context on sustaining the HCBS commitment fostered by ARPA investments. Both reports can be found here.

We are grateful to The John A. Hartford Foundation, the Care for all with Respect and Equity (CARE) Fund, The SCAN Foundation, and the Milbank Memorial Fund for their support in making the work of the TA Collective possible.

Visit here to read the new report.

Photo by Michael Schofield on Unsplash

The While House issued a press release announcing that the Access Final Rule will be released later today. These regulations include:

  • The Nursing Home Minimum Staffing Rule, which will require all nursing homes that receive federal funding through Medicare and Medicaid to have 3.48 hours per resident per day of total staffing, including a defined number from both registered nurses (0.55 hours per resident per day) and nurse aides (2.45 per resident per day);
  • Introducing the requirements of the rule in phases to make sure nursing homes have the time they need to hire staff, with longer timeframes for rural communities;
  • Ensuring adequate compensation for home care workers for HCBS operations of in-home care (both Personal Assistance Services and Community Habilitation) by “requiring that at least 80 percent of Medicaid payments for home care services go to workers’ wages. This policy would also allow states to take into account the unique experiences that small home care providers and providers in rural areas face while ensuring their employees receive their fair share of Medicaid payments and continued training as well as the delivery of quality care;”
  • The state requirement to be more transparent in how much they pay for home care services and how they set those rates, increasing the accountability for home care providers; and
  • The creation of a state home care rate-setting advisory group made up of beneficiaries, home care workers, and other key stakeholders to advise and consult on provider payment rates and direct compensation for direct care workers.

We will continue to monitor the details of these regulations and Pennsylvania’s plans to comply. If you have any questions, please contact Fady Sahhar.

The Office of Long-Term Living (OLTL) has announced that they will be presenting a six-session webinar series that will focus on housing issues. The live, interactive webinars will be conducted from 12:00 pm – 1:30 pm in April and May and will focus on the following topics:

2024 OLTL Spring Housing Series Curriculum

  • April 2: Understanding Housing Nuances in Pennsylvania
  • April 9: Recommended Relationships to Have in the Housing Sector
  • April 16: Fair Housing and Landlord/Tenant Issues with the Housing Equality Center of PA
  • April 23: OFF
  • April 30: Types of Housing Funding Sources
  • May 7: Keeping Participants Housed with Landlord Engagement Techniques AND Housing Information Resources to be Aware of
  • May 14: Assistive Technology and Housing with the PA Assistive Technology Foundation (PATF)

Target Audience

The webinar series targets Service Coordinators, Managed Care Organizations (MCO), and Service Coordination Entity support staff who assist program participants in securing and maintaining affordable, accessible housing through Home and Community-Based Services (HCBS). The target audience for these webinars includes individuals and organizations who provide long-term services and supports (LTSS) for older Pennsylvanians and people with physical disabilities.

Important Information

The information covered in this webinar series will be similar to the information covered in the 2023 OLTL spring and fall housing webinars (except for an added session on assistive technology). Since the information is similar, if you attended the 2023 housing webinars, you do not need to attend this series unless you wish to refresh your knowledge on the topic, participate in a session that you missed, or participate in the new assistive technology session.

This webinar series builds on information already provided in the Online Housing Training Modules and the Self-Determination Housing of Pennsylvania (SDHP)/Inglis’ Prepared Renter Program (PREP) curriculum.

The content in each webinar builds on prior content. Participants will get the most out of the series by taking all of the webinars.

To participate in the webinars, registration is available here.

Last week, ANCOR and United Cerebral Palsy (UCP) unveiled the latest Case for Inclusion report: Transforming Temporary Progress into Long-Term SustainabilityThe report is a vital resource assessing the effectiveness of state Medicaid programs in serving individuals with intellectual and developmental disabilities (I/DD) and their families. Since 2019, ANCOR has partnered with UCP to publish this comprehensive report, combining transactional data with transformational stories to inspire positive change.

The Case for Inclusion 2024 provides a deep dive into community inclusion across three data snapshots, featuring nearly 80 measures spanning six crucial issue areas: Addressing a Workforce in Crisis; Promoting Independence; Reaching Those in Need; Serving at a Reasonable Cost; Keeping Families Together; and Tracking Health, Safety, & Quality of Life.

Key findings from the report shed light on critical issues, including notable increases in hourly wages for direct support professionals (DSP), rising vacancy rates with full-time vacancy rates increasing to 16.5% and part-time vacancy rates increasing to 20.3%, and persistent challenges in addressing waiting lists for home- and community-based services (HCBS), with 497,354 people on state waiting lists for HCBS across the country.

The report also emphasizes that 17 states and the District of Columbia have closed their state-run institutions. Furthermore, it highlights the participation of 38 states in the federal Money Follows the Person program and the approval of 18 demonstration waivers nationally addressing social determinants of health with 17 more pending.

House Resolution 212 (2021), which was adopted June 29, 2022, created a legislative task force on services provided to individuals with intellectual disability, developmental disability, and autism. It directed the Joint State Government Commission to conduct a study on the impact of the Commonwealth’s current needs and system capacity for providing opportunities for individuals with intellectual disability, developmental disability, and autism.

The Commission was further directed to establish an advisory committee to assist in its study. The advisory committee included representatives from the Commonwealth agencies, who were charged with the responsibility of overseeing these services, namely the Department of Human Services (DHS) Office of Developmental Programs (ODP) and the Department of Labor and Industry (DLI) Office of Vocational Rehabilitation (OVR). Other representatives included individuals and family members of individuals who are receiving home and community-based services or who are on waiting lists for services. Service providers, advocates, self-advocates, a physician, and a representative of the Pennsylvania Association of County Administrators of Mental Health and Developmental Services, as well as other interested persons, were also on the advisory committee. Richard Edley, President and CEO of RCPA, and several RCPA members served on this committee.

The committee has completed their work, resulting in their finalized report and one-page summary.

Thursday, March 21, 2024
12:00 pm – 5:00 pm ET
Register for the Meeting

The President’s Committee for People with Intellectual Disabilities (PCPID) will host a virtual meeting for its members to address issues surrounding home and community-based services (HCBS) to be examined in the Committee’s Report to the President. All the PCPID meetings, in any format, are open to the public. This virtual meeting will be conducted in a discussion format with committee members addressing the issues and recommendations identified by PCPID work groups proposing to be incorporated in the PCPID Report to the President. View more details published in the Federal Register notice.

For further information, please email ACL.

This meeting will include CART and American Sign Language (ASL) services. If there are additional reasonable accommodation requests, please contact J. Welborn and Sensis Agency by Thursday, March 7.

Stakeholder input is very important to the PCPID. Comments and suggestions, especially from people with intellectual disabilities, are welcomed. If there are comments related to HCBS or other areas that you would like to inform the PCPID, please share them through the PCPID comment form. Comments received by March 12 will be shared with the PCPID at the March 21 meeting.

About the President’s Committee for People with Intellectual Disabilities
Initially established in 1966 by President Lyndon B. Johnson, the PCPID advises the president and the secretary of health and human services on a broad range of topics that impact people with intellectual disabilities, as well as the professional fields that support people with intellectual disabilities and their families. Its goal is to improve the quality of life experienced by people with intellectual disabilities by upholding their full citizenship rights, independence, self-determination, and lifelong participation in their communities.

RCPA is happy to share highlights of Governor Shapiro’s proposed budget that recognizes the needs of the ID/A community in a way that Pennsylvanians have not seen for many years.

Governor Shapiro is prioritizing investments in home and community-based service providers so that they can pay competitive rates to attract and retain staff who provide these life-changing services to Pennsylvanians. The governor is proposing an increase in reimbursement rates by 12%, which will invest a total of over $480 million. This will be divided by state ($217 million) and federal ($266 million) funding for programs that support ID/A.

This budget will invest $34.2 million in the Community Waiver and $1.85 million in the Community Base Program, which will allow the Department of Human Services (DHS) to expand the number of individuals participating in home and community-based services programs.

The 2024/25 executive budget invests $213 million toward the Community Waiver Program, $2.1 million in the Autism Intervention Program, and $1.1 million in the Community Base program. It also leverages $266 million in total federal funding to increase resources for providers of home and community-based services.

In addition, this budget invests $934,000 to add American Sign Language and English interpreter services to programs serving those who require these services in order to experience equality in communication.

In response to this announcement, Richard Edley, PhD, President and CEO of RCPA, stated, “Governor Shapiro is really living up to his mandate to ‘get stuff done!’ The disability community has waited decades for a governor that would make systemic fixes a key budget issue, and the day has finally come. This may not solve all the issues that nearly destroyed this critical system of care and support, but it’s a start, which is more than we’ve had in quite some time.”

Read the summary of Governor Shapiro’s proposed budget plan for ID/A services. RCPA will be sharing more analysis of the budget when additional information is released.