Telehealth Service Delivery in Medicaid Home- and Community-Based Services for People with Intellectual and Developmental Disabilities

Authors

  • Carli Friedman CQL | The Council on Quality and Leadership, Towson, MD, USA

DOI:

https://doi.org/10.5195/ijt.2022.6478

Keywords:

Long-Term Services and Supports (LTSS), Medicaid Home-and Community- Based Services (HCBS), People with intellectual and developmental disabilities; Telehealth

Abstract

Medicaid Home- and Community-Based Services (HCBS) 1915(c) waivers are the largest funding mechanism for Long-Term Supports and Services (LTSS) for people with intellectual and developmental disabilities (IDD) in the United States. This study’s aim was to examine telehealth service provision in Medicaid HCBS waivers for people with IDD. We analyzed fiscal year 2021 Medicaid HCBS waivers for people with IDD and emergency Appendix K authorizations (2020-2022) to examine permanent and temporary use of telehealth respectively. The overwhelming majority of waivers (98.1%) temporarily permitted the use of telehealth service delivery for people with IDD. However, only a fraction (27.6%) permanently included the use of telehealth for people with IDD. The most prevalent types of services that permitted telehealth service delivery were: employment, day, and prevocational services; clinical and therapeutic services; and in-home and residential supports. When developing and implementing telehealth, it is important to consider the needs of people with IDD.

  

References

Abrams, H. R., Loomer, L., Gandhi, A., & Grabowski, D. C. (2020). Characteristics of US nursing homes with COVID‐19 cases. Journal of the American Geriatrics Society, 68(8), 1653-1656. https://doi.org/10.1111/jgs.16661

Americans With Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 328, (1990).

ANCOR Foundation, & United Cerebral Palsy. (2021). The case for inclusion 2021: A special report on the sustainability of community disability services in America. https://caseforinclusion.org/application/files/2416/1376/5849/Case_for_Inclusion_2021_Special_Report.pdf

Anderson, M., & Perrin, A. (2017). Disabled Americans are less likely to use technology. https://www.pewresearch.org/fact-tank/2017/04/07/disabled-americans-are-less-likely-to-use-technology/

Avalere Health. (2020). Impact of COVID-19 on organizations serving individuals with intellectual and developmental disabilities. American Network of Community Options and Resources (ANCOR). https://www.ancor.org/sites/default/files/impact_of_covid-19_on_organizations_serving_individuals_with_idd.pdf

Braddock, D., Hemp, R., Tanis, E. S., Wu, J., & Haffer, L. (2017). The state of the states in intellectual and developmental disabilities: 2017 (11th ed.). The American Association on Intellectual and Developmental Disabilities.

Bradley, V. J. (2020). How COVID-19 may change the world of services to people with intellectual and developmental disabilities. Intellectual and Developmental Disabilities, 58(5), 355-360. https://doi.org/10.1352/1934-9556-58.5.355

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa

Brewer, J. L., Taber-Doughty, T., & Kubik, S. (2010). Safety assessment of a home-based telecare system for adults with developmental disabilities in Indiana: A multi-stakeholder perspective. Journal of telemedicine and telecare, 16(5), 265-269. https://doi.org/10.1258/jtt.2010.090902

Centers for Disease Control and Prevention. (2020). Using telehealth to expand access to essential health services during the COVID-19 pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html#print

Centers for Medicare and Medicaid Services. (2014). Medicaid Program; State Plan Home and Community-Based Services, 5-year period for waivers, provider payment reassignment, and Home and Community-Based Setting requirements for Community First Choice and Home and Community-Based Services (HCBS) waivers (CMS 2249-F/2296-F). Author.

Centers for Medicare and Medicaid Services. (2019). Application for a §1915(c) Home and Community-Based Waiver [Version 3.6]: Instructions, technical guide, and review criteria. https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/instructions_technicalguide_v3.6.pdf

Centers for Medicare and medicaid Services. (n.d.). 1915(c) Home and Community-Based Services waiver instructions and technical guidance: Appendix K: Emergency preparedness and response. https://www.medicaid.gov/state-resource-center/downloads/1915c-appendix-k-instructions.pdf

Clift, A. K., Coupland, C. A., Keogh, R. H., Hemingway, H., & Hippisley-Cox, J. (2021). COVID-19 mortality risk in Down syndrome: Results from a cohort study of 8 million adults. Annals of Internal Medicine, 174(4), 572-576. https://doi.org/10.7326/M20-4986

Dinesen, B., Nonnecke, B., Lindeman, D., Toft, E., Kidholm, K., Jethwani, K., Young, H. M., Spindler, H., Oestergaard, C. U., & Southard, J. A. (2016). Personalized telehealth in the future: A global research agenda. Journal of Medical Internet Research, 18(3), e5257. https://doi.org/10.2196/jmir.5257

Dobransky, K., & Hargittai, E. (2016). Unrealized potential: Exploring the digital disability divide. Poetics, 58, 18-28. https://doi.org/10.1016/j.poetic.2016.08.003

Embregts, P. J., van den Bogaard, K. J., Frielink, N., Voermans, M. A., Thalen, M., & Jahoda, A. (2022). A thematic analysis into the experiences of people with a mild intellectual disability during the COVID-19 lockdown period. International Journal of Developmental Disabilities, 15(2), 168-196. https://doi.org/10.1080/20473869.2020.1827214

Ervin, D. A., & Hobson-Garcia, D. (2020). Community supports and COVID-19: Self-determination in a pandemic. Intellectual and Developmental Disabilities, 58(6), 453-457. https://doi.org/10.1352/1934-9556-58.6.453

Friedman, C. (2020). There's no place like home: A national study of how people with intellectual and/or developmental disabilities and their families choose where to live. The Arc of the United States, & CQL | The Council on Quality and Leadership. https://futureplanning.thearc.org/assets/CFP_Housing_Survey_Technical_Report-80e6eb718c816d07a15a9972df06a6e73b1393d5b56ae145acc058fce243cd93.pdf

Friedman, C. (2022). Medicaid Home- and Community-Based Services for people with intellectual and developmental disabilities. Manuscript submitted for publication.

Friedman, C., & VanPuymbrouck, L. (2021). Telehealth use by persons with disabilities during the COVID-19 pandemic. International Journal of Telerehabilitation, 13(2). https://doi.org/10.5195/ijt.2021.6402

Galewitz, P. (2020). Telemedicine surges, fueled by coronavirus fears and shift in payment rules. Kaiser Health News. https://khn.org/news/telemedicine-surges-fueled-by-coronavirus-fears-and-shift-in-payment-rules/

Gleason, J., Ross, W., Fossi, A., Blonsky, H., Tobias, J., & Stephens, M. (2021). The devastating impact of COVID-19 on individuals with intellectual disabilities in the United States. NEJM Catalyst Innovations in Care Delivery, 2(2). https://doi.org/10.1056/CAT.21.0051

Kompaniyets, L., Pennington, A. F., Goodman, A. B., Rosenblum, H. G., Belay, B., Ko, J. Y., Chevinsky, J. R., Schieber, L. Z., Summers, A. D., & Lavery, A. M. (2021). Underlying medical conditions and severe illness among 540,667 adults hospitalized with COVID-19, March 2020–March 2021. Preventing Chronic Disease, 18. https://doi.org/10.5888/pcd18.210123

Krysta, K., Romańczyk, M., Diefenbacher, A., & Krzystanek, M. (2021). Telemedicine treatment and care for patients with intellectual disability. International Journal of Environmental Research and Public Health, 18(4), 1746. https://doi.org/10.3390/ijerph18041746

Landes, S. D., Turk, M. A., Formica, M. K., McDonald, K. E., & Stevens, J. D. (2020). COVID-19 outcomes among people with intellectual and developmental disability living in residential group homes in New York State. Disability and Health Journal, 13(4), 100969. https://doi.org/10.1016/j.dhjo.2020.100969

Lussier-Desrochers, D., Normand, C. L., Romero-Torres, A., Lachapelle, Y., Godin-Tremblay, V., Dupont, M.-È., Roux, J., Pépin-Beauchesne, L., & Bilodeau, P. (2017). Bridging the digital divide for people with intellectual disability. Cyberpsychology: Journal of Psychosocial Research on Cyberspace, 11(1). https://doi.org/10.5817/CP2017-1-1

Luterman, S. (2020). The neglect of disability care. The American Prospect. https://prospect.org/familycare/the-neglect-of-disability-care/

Nygren, M. A., & Lulinski, A. (2020). State of the science on COVID-19 and people with IDD. American Association on Intellectual and Developmental Disabilities. https://www.aaidd.org/docs/default-source/publication/state-of-the-science-on-covid-19-and-people-with-idd---dec-2020.pdf?sfvrsn=25893421_0

Olmstead v. LC, 527 US 581 (Supreme Court 1999).

Perry, J., Beyer, S., & Holm, S. (2009). Assistive technology, telecare and people with intellectual disabilities: ethical considerations. Journal of Medical Ethics, 35(2), 81-86. https://doi.org/10.1136/jme.2008.024588

Pettinicchio, D., Maroto, M., Chai, L., & Lukk, M. (2021). Findings from an online survey on the mental health effects of COVID-19 on Canadians with disabilities and chronic health conditions. Disability and Health Journal, 14(3), 101085. https://doi.org/10.1016/j.dhjo.2021.101085

Scheffers, F., van Vugt, E., & Moonen, X. (2021). Assessing the quality of support and discovering sources of resilience during COVID-19 measures in people with intellectual disabilities by professional carers. Research in Developmental Disabilities, 111, 103889. https://doi.org/10.1016/j.ridd.2021.103889

Valdez, R. S., Rogers, C. C., Claypool, H., Trieshmann, L., Frye, O., Wellbeloved-Stone, C., & Kushalnagar, P. (2021). Ensuring full participation of people with disabilities in an era of telehealth. Journal of the American Medical Informatics Association, 28(2), 389-392. https://doi.org/10.1093/jamia/ocaa297

Williamson, E. J., Walker, A. J., Bhaskaran, K., Bacon, S., Bates, C., Morton, C. E., Curtis, H. J., Mehrkar, A., Evans, D., & Inglesby, P. (2020). Factors associated with COVID-19-related death using OpenSAFELY. Nature, 584(7821), 430-436. https://doi.org/10.1038/s41586-020-2521-4

Young, D., & Edwards, E. (2020). Telehealth and disability: Challenges and opportunities for care. National Health Law Program. https://healthlaw.org/telehealth-and-disability-challenges-and-opportunities-for-care/

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Published

2022-05-25

How to Cite

Friedman, C. (2022). Telehealth Service Delivery in Medicaid Home- and Community-Based Services for People with Intellectual and Developmental Disabilities. International Journal of Telerehabilitation, 14(1). https://doi.org/10.5195/ijt.2022.6478

Issue

Vol. 14 No. 1 (2022)

Section

Medicaid HCBS Waivers

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