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

April 23, 2024
CONTACT: Camille Dobson

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.

The Pennsylvania Partnerships for Children has published its 2023 State of Child Welfare Report, providing an analysis of child safety, placement, and permanency based on 2022 data. This 14th annual report focuses on Pennsylvania’s county-administered, state-supervised child welfare system, highlighting findings such as increases in child abuse reports in 2022. The report includes policy recommendations to address system challenges and improve outcomes for children and families. The full report, state-level data tables, and county tables can be accessed on the PA Partnerships for Children website.

RCPA would like to thank PA Partnerships for their partnership and shared advocacy on behalf of children and families in Pennsylvania.

Image by Tom und Nicki Löschner from Pixabay

The Pennsylvania Compulsive and Problem Gambling Annual Report for 2022/23 outlines the impact of programs funded by the Compulsive and Problem Gambling Treatment Fund. According to the report, around $8.3 million was transferred to support crisis counseling, awareness programs, and treatment services. The funds were distributed among Single County Authorities to conduct needs assessments and prevention programs. Additionally, the gambling treatment providers received direct support from the funds. Outpatient treatment providers spent $469,145 in 2022/23, focusing on monitoring demographics such as age, race, ethnicity, income, and preferred gambling methods. The Pennsylvania Gambling Helpline received 2,834 calls, indicating an increase from the previous year, with financial hardship being a common issue.

For a comprehensive overview, including detailed statistics on treatment admissions, demographics, and gambling methods, refer to the full report.

The Centers for Medicare and Medicaid Services (CMS) recently released two reports focused on Long-Term Services and Supports (LTSS). The reports are the Medicaid Long-Term Services and Supports Annual Expenditures Report, Federal Fiscal Year 2020, and the Medicaid Section 1915 (c) Waiver Programs Annual Expenditures and Beneficiaries Report.

These reports provide information on the LTSS rebalancing trends and patterns in expenditures for different home and community-based services (HCBS) and institutional care, both nationally and across states.

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The Centers for Medicare and Medicaid Services (CMS) has released the updated inpatient rehabilitation facility (IRF) provider preview reports. These ‎reports contain provider performance scores for quality measures and contain IRF-Patient Assessment Instrument (PAI) data submitted ‎by IRFs from Quarter 4 2021 through Quarter 3 2022, as well as Centers for Disease Control and Prevention (CDC) Clostridium Difficile (CDI) and Catheter-‎Associated Urinary Tract Infections (CAUTI) measures from Quarter 4 2021 through Quarter 1 2022 and Quarter 4 2021 ‎through Quarter 1 2022 of the Healthcare Personnel (HCP) Influenza measure. The HCP COVID-19 Vaccination ‎Coverage measure data for Quarter 3 2022 is also included. ‎

Providers have until April 14, 2023, to review their performance data. Providers can request CMS ‎review their data during the preview period if they believe the scores are inaccurate. The final reports ‎will be published on Care Compare and Provider Data Catalog (PDC) during the June 2023 refresh of ‎the website. For additional information, visit the CMS IRF QRP Public Reporting website.

ODP Announcement 23-029 releases the Fiscal Year (FY) 2021/22 Annual Data Report. The Office of Developmental Programs (ODP) created this statistical report so that all stakeholders can review the number of individuals ODP serves, settings where they live, what services are provided to them, and the costs of those services. While these facts and figures are important, they provide a limited view of the service system. They allow us to assess growth in the programs provided, types of services that are prioritized, and how we are investing in people.

In addition to this report, ODP publishes an annual report on strategies and performance measures developed by the Information Sharing and Advisory Committee (ISAC), as well as various other reports that target specific topical areas or strategies (e.g., waiting list, employment, etc.).  All of these are used to comprehensively assess the system.

Access the FY 2021/22 Annual Data Report here. Please send any questions you have electronically.