Journal articles: 'Waiver services'

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Friedman, Carli, Mary C. Rizzolo, and Abigail Schindler. "Dental Services: A Nationwide Study of Medicaid Home and Community-Based Services (HCBS) Waiver Service Allocation." Inclusion 2, no. 1 (March 1, 2014): 17–36. http://dx.doi.org/10.1352/2326-6988-2.1.17.

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AbstractDespite literature that highlights the dental needs of people with intellectual and developmental disabilities (IDD), very few of these people receive adequate dental care. To determine whether Medicaid home and community-based services (HCBS) waivers address the dental-services gaps left by Medicaid state plans, this study examined the dental services proposed for fiscal year (FY) 2011 in 95 Medicaid HCBS waiver applications relating to individuals with IDD. Less than 20% of the waivers examined offered any type of dental service. This study also examined 88 FY 2010 HBCS waiver applications to determine changes from 2010 to 2011. Although increases were found from FY 2010 to FY 2011 in both spending for dental services and number of proposed participants, our results indicate that only a fraction of states are using HCBS waivers to address gaps in dental coverage for adults with IDD.

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Graaf, Genevieve, and Lonnie Snowden. "Medicaid Waiver Adoption for Youth With Complex Behavioral Health Care Needs: An Analysis of State Decision-Making." Journal of Disability Policy Studies 31, no. 2 (January 10, 2020): 87–98. http://dx.doi.org/10.1177/1044207319897058.

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Many states have enacted Home- and Community-Based Services (HCBS) Medicaid waivers, which waive or expand Medicaid means tests to increase access to community-based public mental health services for youth with Serious Emotional Disturbance (SED). This study sought to understand key factors in State Mental Health Authorities and Medicaid Agency decision-making in adopting Medicaid waivers for youth with SED. Using purposive sampling to collect data through semi-structured interviews with officials from 37 state mental health systems, interviews focused on fiscal, historical, and political reasons for states’ adoption or rejection of Medicaid waivers to serve youth with SED. Results suggest that decisions around waiver adoption relate to the size and flexibility of state budgets, the sufficiency of existing public HCBS funding and services, political prioritization of children and families, states’ desire to move away from a reliance on residential care, and ideology related to the role of the state in providing for the welfare of children and families. Advocacy efforts promoting state waiver adoption can address apprehensions about budget constraints and providing financial assistance to non-poor families by emphasizing potential cost savings from residential diversion and ethical imperatives to keep children in their homes and communities.

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Kuehn, Mary Beth, Devyn Hotho, and Maggie Prunty. "Parental Consent for Adolescent Research." Creative Nursing 22, no. 1 (2016): 51–55. http://dx.doi.org/10.1891/1078-4535.22.1.51.

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The purpose of this article is to increase understanding about how to obtain institutional review board approval to waive parental consent for adolescent research that involves minimal risk to subjects and/or that cannot be carried out practicably without the waiver. Because of IRB guidelines, the researchers were unable to use passive parental consent for a study of adolescent nonmedical prescription drug use (NMPDU). Without knowledge of waiver 45 C.F.R. §46.116 of the U.S. Department of Health and Human Services Code of Federal Regulations regarding the protection of human research subjects, the study design required active parental consent for survey administration. This requirement limited study participation and increased costs. Using the waiver, the study design could have waived parental consent with adolescent assent. By increasing awareness of the 45 C.F.R. §46.116 waiver and its subparts, the researchers hope to inform future researchers about reducing barriers to future adolescent research. Lessons learned include how using the waiver may decrease research costs, reduce participant selection bias, increase participant response rate, and expand data available to contribute to critical, emerging adolescent health issues such as NMPDU.

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Friedman, Carli. "Self-Advocacy Services for People With Intellectual and Developmental Disabilities: A National Analysis." Intellectual and Developmental Disabilities 55, no. 6 (December 1, 2017): 370–76. http://dx.doi.org/10.1352/1934-9556-55.6.370.

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Abstract Self-advocacy plays an important role in facilitating the empowerment of people with intellectual and developmental disabilities (IDD), and helps people with IDD develop the skills necessary for the participant direction of services. The purpose of this study was to examine Medicaid Home and Community Based Services (HCBS) 1915(c) waivers across the nation to determine how states were utilizing self-advocacy services for people with IDD. Findings revealed approximately half of waivers provided self-advocacy services; however, less than .01% of waiver spending was projected for stand-alone self-advocacy services. States need to expand the provision of self-advocacy services for people with IDD in order to strengthen their ability to direct their waiver services and exercise their rights.

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Singer, Phillip M. "States of Reform." State and Local Government Review 48, no. 4 (December 2016): 246–58. http://dx.doi.org/10.1177/0160323x17699526.

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A growing percentage of state budgets has been focused on caring for individuals who receive long-term services and supports (LTSS). States have an important tool to reduce the costs of caring for individuals with LTSS, Medicaid Section 1915(c) waivers. Using logistic regression, whether and when a state decides to apply for a waiver during the years 1993–2014 is tested. Wealthier, larger states are more likely to apply for waivers, while previous waiver applications are related to fewer applications. The role of political polarization within the legislature has mixed results on whether a state decides to apply for a waiver.

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Miller, Nancy A., M. Beth Merryman, Karen Goldrich Eskow, and Gregory S. Chasson. "State Design and Use of Medicaid 1915(c) Waivers and Related Benefits to Provide Services to Children and Youth With Autism Spectrum Disorder." American Journal on Intellectual and Developmental Disabilities 121, no. 4 (July 1, 2016): 295–311. http://dx.doi.org/10.1352/1944-7558-121.4.295.

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Abstract Medicaid is the most significant source of funding for medical services for individuals with autism spectrum disorder (ASD). We surveyed state Medicaid directors or their designees regarding their use of autism specific 1915(c) waivers and other Medicaid benefits to provide services to children and youth with ASD, with a response rate of 84%. Ten states used autism-specific waivers to provide services. These waivers varied in the number of children served, eligibility criteria and services provided, among other characteristics. Issues related to the number of children to serve and the specific services to provide were perceived to be the most difficult waiver design issues, while provider geographic distribution, capacity and expertise were perceived to be the most difficult implementation concerns. States used a variety of additional Medicaid state plan services (e.g., the optional rehabilitation benefit) and 1915(c) waivers (e.g., a more general waiver serving individuals with intellectual and developmental disabilities) to provide services to children and youth with ASD. Thus, continuing to examine the adequacy and effectiveness of state use of a range of Medicaid benefits, including autism-specific 1915(c) waivers is critical. Expanding the evidence base for intervention effectiveness is important as well.

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Friedman, Carli. "A National Analysis of Medicaid Home and Community Based Services Waivers for People With Intellectual and Developmental Disabilities: FY 2015." Intellectual and Developmental Disabilities 55, no. 5 (October 1, 2017): 281–302. http://dx.doi.org/10.1352/1934-9556-55.5.281.

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Abstract Medicaid Home and Community Based Services (HCBS) 1915(c) waivers are the largest source of funding for the long term services and supports of people with intellectual and developmental disabilities (IDD). National-level analyses of HCBS IDD waivers are crucial because of the large variance across states, the recent CMS rule and regulation changes (CMS 2249-F/2296-F), and the ever changing economic and political landscape. Therefore, the aim of this study was to examine state waiver priorities for people with IDD. In FY 2015, 111 waivers projected spending $25.6 billion for approximately 630,000 people with IDD. The services with the most funding were residential habilitation, supports to live in one's own home, and day habilitation. However, our analysis revealed large discrepancies across states and services.

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Cidav, Zuleyha, Steven C. Marcus, and David S. Mandell. "Home- and Community-Based Waivers for Children With Autism: Effects on Service Use and Costs." Intellectual and Developmental Disabilities 52, no. 4 (August 1, 2014): 239–48. http://dx.doi.org/10.1352/1934-9556-52.4.239.

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Abstract We examined (a) the associations between Medicaid home and community-based waiver participation and service use and expenditures among children with ASD; and (b) how states' waiver spending moderates these effects. We used 2005 Medicaid claims to identify a sample of children with autism spectrum disorder (ASD). We selected two comparison groups who had no waiver participation: (a) children who were eligible for Medicaid through disability (disability group), and (b) children who had at least one inpatient/long-term care (IP/LT) episode (IP/LT group). Waiver participants were less likely to use IP/LT services and had lower associated expenditures than the disability group. As states' waiver spending increased, waiver participants became increasingly less likely to use IP/LT services. Waiver participants had more outpatient visits and associated expenditures; this difference increased as state waiver spending increased. Compared with the IP/LT group, waiver participants had lower IP/LT expenditures, more outpatient visits, and associated expenditures. Higher state waiver generosity increased this effect on outpatient visits and expenditures.

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Glucksmann, Eloïse. "Commisimpex v. Republic of Congo." American Journal of International Law 111, no. 2 (April 2017): 453–60. http://dx.doi.org/10.1017/ajil.2017.30.

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The law in France regarding waivers of foreign state (or sovereign) immunity from execution of judicial judgments (based largely on consideration of international law principles) has recently undergone significant developments. Previously, French case law had required a foreign state's waiver of immunity from execution to be both express and specific to consider valid the attachment of foreign state property allocated to public services (including bank accounts used for the functioning of both diplomatic missions and delegations to international organizations). In 2015, the French Court of Cassation relaxed the criteria it had previously required for giving effect to waivers of sovereign immunity in such situations, thus facilitating the ability of judgment creditors to attach foreign state property in France. Its decision in the Commisimpex v. Republic of Congo case appeared to put an end to that requirement by abandoning the criterion of a “specific” waiver on the ground that “customary international law does not require a waiver of immunity from execution other than express.” In December 2016, however, the French government enacted new legislation reinstating the need for a specific waiver of immunity for the attachment of the property as well as bank accounts of foreign embassies and diplomatic missions and additionally requiring a court order authorizing the attachment or seizure. As a result, France has now embraced a distinctly more protective approach to the immunity of foreign state assets from attachment and execution of judicial judgments.

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Friedman, Carli, Joe Caldwell, Angela Rapp Kennedy, and Mary C. Rizzolo. "Aging in Place: A National Analysis of Home- and Community-Based Medicaid Services for Older Adults." Journal of Disability Policy Studies 29, no. 4 (July 25, 2018): 245–56. http://dx.doi.org/10.1177/1044207318788889.

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The number of Americans needing long-term services and supports (LTSS) is projected to more than double in the coming decades largely due to an aging baby boomer population, meaning paying for LTSS will become an even greater challenge for American families and the country. Despite the benefits of aging in place, there remains a long-standing institutional bias within the Medicaid program, where services in nursing facilities are mandatory while home- and community-based services (HCBS) are mostly optional for states to cover. This study examined HCBS 1915(c) waivers ( n = 61 waivers) for older adults to categorize and compare service priorities. Findings revealed waivers for older adults were primarily focused on supporting individuals in their own homes to age in place. However, findings also revealed HCBS waivers are an underutilized mechanism for funding the LTSS of older adults. As states continue to deal with an increasing population of aging adults, with and without disabilities, the HCBS waiver option will continue to be an important component of a state’s service system.

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Kinney, Eleanor D., Jay A. Freedman, and Cynthia A. Loveland Cook. "Quality Improvement in Community-Based, Long-Term Care: Theory and Reality." American Journal of Law & Medicine 20, no. 1-2 (1994): 59–77. http://dx.doi.org/10.1017/s0098858800006432.

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Community-based, long-term care has become an increasingly popular and needed service for the aged and disabled populations in recent years. These services witnessed a major expansion in 1981 when Congress created the Home and Community-Based Waiver authority for the Medicaid program. Currently, all states offer some complement of community-based, long-term care services to their elderly and disabled populations and nearly all states have Medicaid Home and Community-Based Services waivers which extend these services to their Medicaid eligible clients.An ever increasing proportion of the population is in need of community-based, long-term care services. Between nine and eleven million Americans of all ages are chronically disabled and require some help with tasks of daily living. In 1990, thirty percent of the elderly with at least one impaired activity of daily living used a community-based, long-term care service. Not surprisingly, expenditures for community-based, long-term care have increased.

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Knopf, Alison. "Illinois Medicaid waiver to add case management, services." Alcoholism & Drug Abuse Weekly 28, no. 41 (October 21, 2016): 6–7. http://dx.doi.org/10.1002/adaw.30748.

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Abbott, Katherine, Jennifer Heston-Mullins, Athena Koumoutzis, Dayna Bennett, Karen Williams, and Robert Applebaum. "THE BLACK BOX OF CARE MANAGEMENT IN MANAGED LONG-TERM SERVICES AND SUPPORTS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 187–88. http://dx.doi.org/10.1093/geroni/igac059.749.

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Abstract Within Ohio’s MyCare demonstration, two distinct care management models were selected by the participating MyCare Ohio health plans (MCOPs): fully-delegated waiver care management and waiver service coordination. The purpose of this presentation is to describe the components of care management operating in MyCare Ohio. Qualitative interviews with n=91 Area Agency on Aging (AAA) and n=131 MCOP care management personnel were audio-recorded, transcribed, and checked for accuracy prior to thematic coding in Dedoose. Results indicate that comprehensive care management is the core element of MyCare Ohio. Fully-delegated care management models were viewed by participants as beneficial to reducing confusion for members however ‘scope creep’ challenged the already strained AAAs. Effective teamwork was identified for waiver service coordination models but the division of labor and communication needed between the AAA and MCOP care management personnel created tensions. The discussion will focus on practice recommendations for training, caseloads, and support staff.

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Steltenpohl, Emily A., Brandon K. Barry, Kim C. Coley, Melissa S. McGivney, Julie L. Olenak, and Lucas A. Berenbrok. "Point-of-Care Testing in Community Pharmacies: Keys to Success From Pennsylvania Pharmacists." Journal of Pharmacy Practice 31, no. 6 (October 15, 2017): 629–35. http://dx.doi.org/10.1177/0897190017735243.

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Background Clinical Laboratory Improvement Amendments (CLIA)-waived tests allow for quick, accurate, and noninvasive laboratory testing. Community pharmacists utilize CLIA-waived tests to provide clinical services such as point-of-care (POC) testing to help manage chronic disease and acute illness. Objective To identify key themes in the successful delivery of POC testing services by community pharmacists in Pennsylvania. Results An initial search identified 51 Pennsylvania pharmacies with a CLIA waiver. Of these, five independent pharmacies met inclusion criteria, three of which completed interviews. The remaining 38 chain pharmacies were represented by three interviews. In total, five key themes were identified as essential to POC testing services: (1) utilize state resources and professional connections to navigate federal and state regulations, (2) establish relationships with physician partners (3) offer tests that are meaningful to patients and their physicians, (4) evaluate financial impact, workflow adaptations, and marketing approaches when implementing POC testing services, and (5) focus on individualized attention and convenience of community pharmacy-based POC testing to improve patient satisfaction. Conclusion Successful POC testing services in community pharmacy practice rely on utilizing resources, partnering with known physicians, selecting meaningful tests for patients, and analyzing finances, workflow, and marketing to provide individualized attention and convenient care.

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Sheehy, Ann M., Charles FS Locke, Farah A. Kaiksow, W. Ryan Powell, Andrea Gilmore Bykovskyi, and Amy JH Kind. "Improving Healthcare Value: COVID-19 Emergency Regulatory Relief and Implications for Post-Acute Skilled Nursing Facility Care." Journal of Hospital Medicine 15, no. 8 (July 22, 2020): 495–97. http://dx.doi.org/10.12788/jhm.3482.

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Rarely, if ever, does a national healthcare system experience such rapid and marked change as that seen with the COVID-19 pandemic. In March 2020, the president of the United States declared a national health emergency, enabling the Department of Health & Human Services authority to grant temporary regulatory waivers to facilitate efficient care delivery in a variety of healthcare settings. The statutory requirement that Medicare beneficiaries stay three consecutive inpatient midnights to qualify for post-acute skilled nursing facility coverage is one such waiver. This so-called Three Midnight Rule, dating back to the 1960s as part of the Social Security Act, is being scrutinized more than half a century later given the rise in observation hospital stays. Despite the tragic emergency circumstances prompting waivers, the Centers for Medicare & Medicaid Services and Congress now have a unique opportunity to evaluate potential improvements revealed by COVID-19 regulatory relief and should consider permanent reform of the Three Midnight Rule. Journal of Hospital Medicine 2020;15:XXX-XXX. © 2020 Society of Hospital Medicine

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Heller, Tamar. "Unmet Needs of Families of Adults With Intellectual and Development Disabilities on Waiting Lists." Innovation in Aging 4, Supplement_1 (December 1, 2020): 690. http://dx.doi.org/10.1093/geroni/igaa057.2413.

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Abstract Most adults with intellectual and developmental disabilities live at home with their aging parents. Given the large waiting lists for residential and home-based services, families face many unmet service and support needs. The author will present results of a study that examined the impact of a Medicaid waiver program that provided either home-based or residential placements to 444 families of adults with IDD who were living at home at baseline through surveys at baseline and two years later. Families who did not receive the waiver services still had high unmet needs for person-centered planning training, networking with other families, respite, advocacy services, assistive technology, and home modifications at follow up. Regardless of services received, class members from minority backgrounds had more unmet needs than white class members, indicating the need for more targeted efforts to reach minority families.

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Franzosa, Emily, Ksenia Gorbenko, Abigail Baim-Lance, Gabrielle Schiller, Heather Wurtz, Sybil Masse, Katherine Ornstein, and Bruce Leff. "PROVIDING INPATIENT CARE BEYOND HOSPITAL WALLS: GEOGRAPHIC FACTORS IN ACUTE HOSPITAL CARE AT HOME WAIVER PROGRAMS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 22–23. http://dx.doi.org/10.1093/geroni/igac059.084.

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Abstract The Centers for Medicare and Medicaid Services’ (CMS) Acute Hospital Care at Home waiver offers hospital-level reimbursement to provide acute hospital-level care in patients’ homes for the first time. While this initiative may make acute care at home more financially viable for health systems, it also requires aligning Hospital at Home (HaH) operations with inpatient, rather than outpatient, regulatory requirements. We aimed to understand how participating HaH programs adapted to these requirements. We conducted semi-structured interviews with multiple leaders from 14 HaH waiver programs (n=18 clinical/medical, operational and program directors) varying in size, urbanicity, structure, and region, examining data through thematic analysis. Both urban and rural participants described geographic effects of waiver requirements. For instance, to ensure response to patient emergencies within 30 minutes, programs contracted with paramedic services to expand service areas, added program locations or moved primary locations to other system hubs. Programs maximized staff capacity across service areas by “leasing” staff from other home-based programs, focusing on urban hubs with more staff, balancing in-person visits with remote monitoring, and providing “hybrid” in-person/video appointments. However, travel time, length of acute care visits, staffing shortages, the need for new skills (e.g., acute care nurses, dietitians) and limited state scope of practice regulations, particularly for paramedics, limited the area and populations served. Adapting to waiver requirements required significant efforts to address staffing, logistical and regulatory challenges. Future waiver improvements should explicitly consider the unique resources needed to expand hospital-level care in geographically diverse ambulatory environments.

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Rizzolo, Mary C., Carli Friedman, Amie Lulinski-Norris, and David Braddock. "Home and Community Based Services (HCBS) Waivers: A Nationwide Study of the States." Intellectual and Developmental Disabilities 51, no. 1 (February 1, 2013): 1–21. http://dx.doi.org/10.1352/1934-9556-51.01.001.

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Abstract In fiscal year (FY) 2009, the Medicaid program funded over 75% of all publicly funded long-term supports and services (LTSS) for individuals with intellectual and developmental disabilities (IDD) in the United States (Braddock et al., 2011). The majority of spending was attributed to the Home and Community Based Services (HCBS) Waiver program. In FY 2009, federal–state spending for the HCBS Waiver program reached over $25.1 billion and constituted almost half of total funding across the nation that year (Braddock et al., 2011). Considerable effort has been spent investigating Medicaid program expenditures, however, due in part to the unique and state-specific nature of HCBS programs, national-level analysis on the types of services offered to individuals with IDD has not been available. A full understanding of the supports available through the Medicaid program is critical as the United States considers strategies for economic recovery among competing state and federal budget priorities. This article presents the results of an analysis of 88 Medicaid HCBS Section 1915(c) waiver applications for individuals with intellectual and developmental disabilities in 41 states and the District of Columbia. It analyzes IDD data and trends close to the real time intent of states and empowers advocates in presenting timely solutions to real-time issues.

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Adigwe, Obi Peter, and Davidson Oturu. "The role of patent waivers and compulsory licensing in facilitating access to COVID-19 vaccines: Findings from a survey among healthcare practitioners in Nigeria." PLOS Global Public Health 2, no. 7 (July 7, 2022): e0000683. http://dx.doi.org/10.1371/journal.pgph.0000683.

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The roll out of COVID-19 vaccines has again revealed the gap between high income countries and developing nations in terms of access to healthcare commodities and services. With the slow vaccination roll out in many low income countries and the emergence of more contagious variants of COVID-19, many persons are at risk of contracting the disease in settings with low immunisation coverage. This study aimed at exploring the views of healthcare practitioners on the role of patent waivers and compulsory licensing in facilitating access to vaccines. A cross-sectional study was undertaken among practitioners in the health sector, which comprised private, public, and development agencies. A well structured and validated questionnaire was administered to the study participants using both physical and online methods of administration in Nigerian setting. A total of 526 respondents participated in the study, majority of them were males (54.4%). A third of the study participants (31.1%) had postgraduate degrees. A strong majority of the respondents (81.2%) agreed that the role of patent is to promote innovation, whilst 70.6% of them indicated that intellectual property waivers can improve access to COVID-19 vaccines. Slightly above half of the respondents (56.0%) indicated that patent waivers can reduce innovation in the pharmaceutical sector, they however indicated that such challenge can be mitigated by granting incentives to innovators whose intellectual property rights had been waived. This study has revealed that there is a need for intellectual property rights waiver and compulsory licensing of all novel COVID-19 commodities including vaccines, as this is an important strategy that can improve access to relevant products in developing countries.

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Andrusiv, Uliana, Volodymyr Kossak, Mariya Mykhayliv, Nataliіa Fedina, and Dmytro Zabzalіuk. "Grounds and consequences of waiver of the contract on the provision of tourist services." Revista Amazonia Investiga 10, no. 45 (October 29, 2021): 63–72. http://dx.doi.org/10.34069/ai/2021.45.09.6.

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The purpose of the article is to clarify the legal nature, grounds, realization mechanism and consequences of waiver of the contract on the provision of tourist services. The research was conducted using such methods of scientific knowledge as dialectical, comparative, formal-legal, logical-legal. Based on the analysis of doctrinal approaches and regulations, it is established that the refusal of the agreement on the provision of tourist services is a measure of operational influence and a means of protecting the civil interest. The grounds for unilateral waiver of the contract differentiated into unconditional and those that are a consequence of violation of its terms. At the same time, it is stated that this subjective right is exercised in out-of-court procedure by sending a written (electronic) notice to the counterparty. In the context of the COVID-19 pandemic, it is proposed to give tourists the opportunity to choose between postponing the trip to another term and exercising withdrawal from the agreement. Particular attention is paid to the general and special consequences of lawful refusal. Based on the study, the authors made generalizations and conclusions about the state and prospects of improving the mechanism for exercising the right to unilateral waiver of the contract on the provision of tourist services.

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Damte Tegegn, Biruk, and Keneni Gutema Negeri. "Assessment of utilization of health care services and the associated factors among adult fee-waiver beneficiaries in Hawassa, southern Ethiopia: A community based cross sectional study." Journal of Public Health Research 11, no. 4 (October 2022): 227990362211399. http://dx.doi.org/10.1177/22799036221139940.

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Background: Over the past decades, developing countries like Ethiopia have resorted to the implementation of user fees in public health care systems. Nonetheless, evidences suggest that user fees affect the poor negatively. Therefore, Ethiopian government introduced fee-waiver mechanism in 1998 aiming to mitigate the financial constraints faced by the poorest segment of the population in utilizing health care services. Yet, in the country, there is limited evidence on this subject. Objective: The overall objective of the study was to assess health care utilization and the associated factors among the fee-waiver beneficiaries in Hawassa City of Southern Ethiopia. Methodology: A quantitative, cross-sectional study design was employed using a sample of 636 fee-waiver beneficiaries. Data was collected using a structured interviewer-administered questionnaire and analyzed using binary logistic regression. An odds ratio with the corresponding CI was used to identify the associated factors, while P < 0.05 was used to declare significance. Results: The response rate to the survey is 581(91.4%). Of this, 377 (65%) utilized health services in the preceding 3 months of data collection. Availability of medical equipment [AOR = 1.501; 95% C.I. (1.066–2.114)], being >50 years of age [AOR = 2.271; 95% C.I. (1.304–3.953)], improved drug availability in the health care facilities [AOR = 1.682; 95% C.I. (1.118–2.530)] and beneficiaries’ perception of health worker’s handling practice [AOR = 3.759; 95% C.I. (1.425–9.912)] were among the significant factors associated with beneficiaries’ utilization of health care services at public health facilities. Conclusion and recommendation: The overall fee waiver beneficiaries’ health care utilizations rate is 64.9%. Optimizing availability of medical equipment, enhancing drug availability and strengthening good patient handling practices are recommended.

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Kaskie, Brian, Seamus Taylor, and Lili Xu. "The Intersection of Medicaid and Assisted Living for Residents with Dementia." Innovation in Aging 4, Supplement_1 (December 1, 2020): 716. http://dx.doi.org/10.1093/geroni/igaa057.2524.

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Abstract Medicaid has increasingly offered coverage to persons residing in assisted living (AL). However, the scope of coverage across states is unknown. We sourced 2019 state administrative regulations specific to Medicaid and AL and determined forty-five (45) states link Medicaid with AL. Twenty-seven (27) do so as part of their state plan, 32 use a §1915(c) waiver, and 11 use a §1115 waiver. Forty-four states limit Medicaid coverage to a specific population, 16 limit coverage to those with a diagnosed disability, and 1 state limits coverage to a specific geographic region. In addition, 33 states provide payment for room and board with 28 states upholding a payment cap. In regards to services, 13 states reimburse a limited range of services while 32 offer a more expansive range of services. As Medicaid programs have extended coverage to residents of AL, researchers must now consider the impact on AL access and residents’ outcomes. Part of a symposium sponsored by Assisted Living Interest Group.

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Eskow, Karen, Lisa Pineles, and Jean Ann Summers. "Exploring the Effect of Autism Waiver Services on Family Outcomes." Journal of Policy and Practice in Intellectual Disabilities 8, no. 1 (March 2011): 28–35. http://dx.doi.org/10.1111/j.1741-1130.2011.00284.x.

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BUNINA, Alina. "Problematic issues of replacement or waiver of the right to accept a defense lawyer's services who provides free secondary legal aid in criminal proceedings." Economics. Finances. Law, no. 7/1 (July 30, 2021): 9–14. http://dx.doi.org/10.37634/efp.2021.7(1).2.

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The paper raises the issue of waiver (replacement) of a state defense lawyer by a suspect (accused) who provides free legal aid in criminal proceedings. The author analyzes the provisions of the current legislation in Ukraine, which regulates the provision (replacement) of a lawyer, compares and analyzes the practice of courts in the application of the law, focuses on the issue of determining the criteria for the quality of services provided by a lawyer, studies the view on this problem through the decisions of the ECHR (European Court of Human Rights), and also suggests ways to solve this problem by amending the current legislation and presents a fundamentally new approach to the procedure of waiver (replacement) of a lawyer in criminal proceedings. In the paper, the author notes the problem in the legislative definition of the possibility of waiver (replacement) of the lawyer and, as a result, the uneven application of the law occurs in practice by the courts; it is proposed to amend the specific procedural rules that regulate these relations, namely, to detach the issue of waiver (replacement) of the lawyer into a separate process, the author justifies the need for such detachment and decision-making by the investigating judge. The author notes that the issue of refusal (replacement) of a lawyer during a pre-trial investigation with a legally defined adversarial proceeding is decided by the prosecution-the investigator (prosecutor), which is in itself wrong and can affect the choice of a lawyer, his tactics and methods of defense. The proposed changes, in the author's opinion, solve the problem of inconsistency in the application of the law in terms of waiver (replacement) of a defense lawyer by a suspect (accused), determine the unity of approach in solving these issues, preserving the defendant's right to choose freely a lawyer and protecting him from disclosing the chosen line of defense to the prosecution.

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Sheppard-Jones, Kathleen, Harold Lawrence Kleinert, Wendy Druckemiller, and Megan Kovacevich Ray. "Students With Intellectual Disability in Higher Education: Adult Service Provider Perspectives." Intellectual and Developmental Disabilities 53, no. 2 (April 1, 2015): 120–28. http://dx.doi.org/10.1352/1934-9556-53.2.120.

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Abstract Postsecondary education (PSE) is increasingly becoming an option for students with intellectual disability (ID; Grigal & Hart, 2012). Postsecondary education offers the promise of pursuing a valued social role (that of college student), enhanced social networks, and, most significantly, increased employment options. To date, research and practice in the area of transition to PSE for students with ID has focused primarily upon the sending (public school systems) and receiving (colleges or universities) agencies (Oertle & Bragg, 2014; Thoma et al., 2011). Yet adults with ID often require ongoing supports through state and federally funded developmental disability waivers, and agency providers of waiver services have, for the most part, not been part of this vital conversation. This study represents an exploratory study of directors of developmental disability provider agencies in one midwestern state to assess their knowledge of PSE for individuals with ID. A total of 87 directors responded; quantitative results are presented and, based on these findings, we provide implications for the future.

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Bucy, Taylor, John Mulcahy, Eric Jutkowitz, and Tetyana Shippee. "Scoping Review: Home and Community-Based Service Waiver Programs and Person-Reported Outcomes." Innovation in Aging 5, Supplement_1 (December 1, 2021): 842. http://dx.doi.org/10.1093/geroni/igab046.3082.

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Abstract State Medicaid programs are rebalancing their long-term care spending from nursing home to home and community-based services (HCBS). Emphasis on person-centered and person-directed care warrants investigation into models of HCBS delivery that promote quality of life. We performed a scoping review of the literature to catalogue the breadth of the studies describing HCBS waiver programs targeting adults (18+). We identified 757 articles, and after duplicate removal and reconciliation, we excluded articles on children or adolescents, non-peer reviewed reports, international studies, and articles that did not describe HCBS waiver programs. After abstract and title review, 292 articles met our inclusion criteria. Most included articles (22.3%) were single state descriptive evaluations or evaluations of service use patterns among participants. 17.8% of included articles examined multi-state or national variation in program trends, while 17.1% made national program conclusions without a major focus on interstate comparison. Less common were studies examining integrated care or dual-eligibles (7.5%), PACE (3.4%), medication management (3.1%), quality and satisfaction of both consumer and caretaker perspectives (3.8%) and consumer-only perspectives (5.1%). The remaining articles focused on HIV (4.1%), TBI (1.4%) or ID/DD (14.4%) waiver programs. The 8.9% of articles addressing quality and satisfaction consisted mostly of interviews, either with state Medicaid administrators or with care recipients and/or caregivers. Consumer reported satisfaction and unmet care needs were the primary outcomes examined. Given the heightened focus on long-term care as a result of the ongoing coronavirus pandemic, this review justifies further exploration into the delivery and outcomes of state-directed HCBS waiver programs.

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Solhkhah, Ramon, Cathryn L. Passman, Glenn Lavezzi, Rachel J. Zoffness, and Raul R. Silva. "Effectiveness of a children’s home and community-based services waiver program." Psychiatric Quarterly 78, no. 3 (June 12, 2007): 211–18. http://dx.doi.org/10.1007/s11126-007-9042-2.

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Vladeck, Bruce C. "Physician Involvement With Medicaid's Home- and Community-Based Services Waiver Program." JAMA: The Journal of the American Medical Association 272, no. 20 (November 23, 1994): 1569. http://dx.doi.org/10.1001/jama.1994.03520200023011.

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Degenholtz, Howard. "IMPLEMENTATION AND IMPACT OF MANAGED LONG-TERM SERVICES AND SUPPORTS IN PENNSYLVANIA." Innovation in Aging 6, Supplement_1 (November 1, 2022): 141. http://dx.doi.org/10.1093/geroni/igac059.561.

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Abstract In 2018, Pennsylvania began implementing a mandatory Medicaid managed care program called Community HealthChoices (CHC). CHC replaces the 1915(c) aging waiver and 4 other waiver programs that covered adults with disabilities and people with acquired brain injury. The new program covers people receiving long-term services and supports (LTSS) in both nursing homes and home and community-based settings as well as people dually eligible for both Medicaid and Medicare. The program is administered by 3 managed care organizations (MCOs) that are obligated to coordinate with Medicaid Behavioral Health, Medicare Advantage and D-SNP plans. The MCOs are incentivized to serve people with LTSS needs in community-based settings by increasing access to HCBS and supporting transitions from nursing homes back into the community. This symposium will present findings from a comprehensive, mixed-methods evaluation of the program. Drawing from our qualitative interviews with key stakeholders and examination of program materials, we will describe some of the challenges of the implementation process. Next, we will share findings from interviews with cohorts of participants conducted before and after implementation of the new program. Next, we will present findings from analysis of Medicaid claims data to examine changes in use of home and community-based services as well as overall rebalancing. Finally, we will present both qualitative and quantitative data on person-centered service planning- a critical requirement for HCBS programs.

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Ferber, Joel D. "Auto-Assignment and Enrollment in Medicaid Managed Care Programs." Journal of Law, Medicine & Ethics 24, no. 2 (1996): 99–107. http://dx.doi.org/10.1111/j.1748-720x.1996.tb01842.x.

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In the face of escalating Medicaid costs and anticipated reductions in federal Medicaid spending, states are increasingly converting from fee-for-service (FFS) to managed health care systems. The interrelated issues of enrollment and auto-assignment are fundamental to the overall success or failure of Medicaid managed care programs. The purpose of this article is to suggest how policy makers, consumer advocates, and providers should address these issues. My major premise is that implementation of managed care will proceed more smoothly if states adopt enrollment strategies that promote voluntary selection of health plans by Medicaid consumers, minimize the likelihood of auto-assignment, and mitigate the negative consequences of mandatory assignment of consumers to managed care organizations (MCOs).States seeking to implement Medicaid managed care must apply for a waiver from the secretary of the Department of Health and Human Services (DHHS). Two different types of waivers are available to implement Medicaid managed care.

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Sands, L. P., Z. Jin, R. Pruchno, K. A. Roberto, and Y. Hong. "DECLINE IN MEDICAID WAIVER SERVICES AFTER HURRICANE SANDY INCREASES RISK-ADJUSTED HOSPITALIZATION." Innovation in Aging 1, suppl_1 (June 30, 2017): 1226–27. http://dx.doi.org/10.1093/geroni/igx004.4455.

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Knopf, Alison. "W.Va. Medicaid 1115 waiver would pay for more beds, methadone, peer services." Alcoholism & Drug Abuse Weekly 29, no. 40 (October 16, 2017): 1–3. http://dx.doi.org/10.1002/adaw.31735.

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Blackburn, Justin, Sharon Baggett, Ellen Burton, and Yonda Snyder. "CHARACTERIZING HOME AND COMMUNITY-BASED SERVICE ENROLLEES IN MINNESOTA’S MEDICAID WAIVER PROGRAM." Innovation in Aging 6, Supplement_1 (November 1, 2022): 26–27. http://dx.doi.org/10.1093/geroni/igac059.097.

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Abstract Medicaid waivers allow states’ provision of home and community-based services (HCBS), leading to variations in design and delivery. States monitor expenditures, but cannot easily anticipate growth. Understanding the needs of this population can aid in early identification and improve service delivery. We conducted a Partitioning Around Medioids cluster analysis of first-time enrollees in Minnesota’s Elderly Waiver HCBS program during 2019 to identify trajectories of entry and characterize activities of daily living (ADL) and instrumental activities of daily living (IADL) needs at enrollment. Administrative data collected via long term care consultation assessments provided enrollment, ADL/IADL needs, living arrangements, and other clinically relevant information that was linked to other sources including Minnesota health care program enrollment and utilization, Minimum Data Set skilled nursing facility (SNF) assessments, and calls to the Senior LinkAge Line (SLL)—a free long-term care counseling service. Of 5,284 first-time enrollees, most had prior engagement with state programs—nearly two-thirds had called the SLL, 36% had a SNF stay, and 56% had prior Medicaid enrollment. We identified six clusters representing three levels of living arrangements and two levels of need: 1) lived alone, low needs (32%), 2) lived with others, moderate needs (20%), 3) congregate living, moderate needs (14%), 4) congregate living, high needs (14%), 5) lived with others, high needs (11%), and 6) lived alone, high needs (9%). Lacking caregivers and prior Medicaid were possible exacerbating reasons for HCBS enrollment. The magnitude of the differences between clusters highlights the constellation of factors leading to enrollment in HCBS.

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Braddock, David, Richard Hemp, Susan Parish, and Mary C. Rizzolo. "Growth in State Commitments for Community Services: Significance of the Medicaid Home and Community-Based Services Waiver." Mental Retardation 38, no. 2 (April 2000): 186–89. http://dx.doi.org/10.1352/0047-6765(2000)038<0186:giscfc>2.0.co;2.

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Ylvisaker, Mark, Timothy Feeney, and Melissa Capo. "Long-Term Community Supports for Individuals With Co-Occurring Disabilities After Traumatic Brain Injury: Cost Effectiveness and Project-Based Intervention." Brain Impairment 8, no. 3 (December 1, 2007): 276–92. http://dx.doi.org/10.1375/brim.8.3.276.

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AbstractOutcome studies have established that successful community living is compromised in the population of individuals with traumatic brain injury and chronic behavioural difficulties along with a co-occurring diagnosis of substance abuse and/or mental health disorder. Two studies are presented. The first was aimed at describing long-term outcome of a sample of individuals (N = 51) served by the New York State Department of Health TBI Medicaid Waiver Program. Each of the participants was diagnosed with TBI plus either substance abuse or a mental health disorder, or both. Because of significant behavioural challenges, all of the participants were in a restrictive living setting the year before enrolment in the waiver program (e.g., nursing or correctional facility). Data on community living arrangement, self-reported community integration experiences, and costs are presented. Results indicate that most of the participants (41 of the 46 who were alive and living in state) continued to live in the community 8 to 9 years after commencement of community support services. The participants' community integration responses were generally positive and cost data demonstrate substantial savings to the state for this cohort. Comparing prewaiver costs in residential settings with most recent (2005) costs for community supports, there was an average daily cost savings of US$137 per person for the 1996 cohort and US$144 per person for the 1997 cohort. The second study explored the use of project-oriented interventions and supports in an agency that provides community support services to this dual diagnosis population. Project-oriented services are described as meeting many needs common to this dual-diagnosis population. Clinical staff (N = 11) and a sample of waiver participants (N = 7) were surveyed. Results suggest that the use of personally meaningful projects can become a clinical habit for staff and that projects are generally judged by participants to be a meaningful use of time, and significant in giving them an opportunity to play an expert role and to help others.

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Da Costa, Damian, and Howard Degenholtz. "Residence in HUD Housing Associated With Greater Benefit From HCBS Services for Medicaid Enrollees in Pennsylvania." Innovation in Aging 5, Supplement_1 (December 1, 2021): 475. http://dx.doi.org/10.1093/geroni/igab046.1839.

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Abstract State Medicaid programs seek to shift the delivery of long-term care services away from institutional settings and toward community-based settings by expanding access to home-and-community-based services (HCBS). HCBS are hypothesized to prevent or delay the need for protracted nursing home stays. This study explores the question of which types of community residence maximize this protective effect of HCBS. We used a probabilistic matching technique to identify whether waiver-eligible Medicaid enrollees were likely to reside in project-based HUD housing in 2013. We applied multinomial logistic regression to observe the risk of long-stay nursing home admission (>100 days) relative to persistent community residence in the subsequent four years. Our model controlled for age, race, gender, urban status, and receipt of home-and-community based services. Our predictor of interest was the interaction between receipt of home and community based services (HCBS) and residence in HUD housing. The eligible baseline population included 152,632 community-residing Pennsylvania Medicaid enrollees in 2013. The analytic sample excluded individuals who died during 2013 or who were no longer waiver-eligible after 2013. Residence in HUD project-based housing while receiving HCBS is independently associated with a 27% percent reduction in risk of long-stay nursing home admission (p = .01) when controlling for individual-level demographics. No significant association was observed between the predictor of interest and risk of death during the follow-up period, suggesting that this finding is not likely confounded by individual health status. Further research should test whether this association is causal and specify possible mechanisms.

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Nord, Derek, Teresa Grossi, and John Andresen. "Employment Equity for People With IDD Across the Lifespan: The Effects of State Funding." Intellectual and Developmental Disabilities 58, no. 4 (August 1, 2020): 288–300. http://dx.doi.org/10.1352/1934-9556-58.4.288.

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Abstract In the last decade, major strides have been made to elevate the importance of employment for people with intellectual and developmental disabilities (IDD). Despite progress, improvement in employment outcomes remain modest. Using extant data, a sample of 9,871 adults with IDD accessing Medicaid Home and Community-Based Services waiver services across 33 states were studied using hierarchical modeling to understand the effects of age on employment as well as assess how state fiscal effort toward integrated employment services affects employment equity across the lifespan. Key findings showed young and older adults experienced the lowest employment outcomes. The effects of age, however, were moderated in states with higher fiscal effort to integrated employment services. Implications for research, policy, and practice are discussed.

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Kellett, Kathy, Martha Porter, Dorothy Wakefield, and Julie Robison. "Connecticut’s Veterans-Directed Care Program Outcomes Compared to HCBS Waiver Participants: HCBS CAHPS Results." Innovation in Aging 5, Supplement_1 (December 1, 2021): 360. http://dx.doi.org/10.1093/geroni/igab046.1396.

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Abstract Connecticut (CT) Veterans Directed Home and Community Based Services Program (VDC) is an innovative Veterans Administration (VA) services option providing veterans at risk of institutionalization with person-centered consumer-directed long-term services and supports at home. Funded by an Administration for Community Living grant, the CT Department of Aging and Disability Services partnered with the VA, the five CT Area Agencies on Aging, and UConn Health Center on Aging (UConn). UConn researchers conducted the Consumer Assessment of Healthcare Providers and Systems in Home and Community Based Services (HCBS CAHPS) survey with VDC participants (n=36) from October 2019 through March 2020. The standardized, validated HCBS CAHPS survey, which Connecticut administers to individuals in most CT Medicaid HCBS programs, is a universal, cross-disability tool to assess/improve the quality of HCBS programs. Analyses compared VDC participants’ program experiences to survey results from individuals in the Connecticut Home Care Program (CHCP) (for older adults) (n=629), Personal Care Assistance (PCA) (n=282), and Acquired Brain Injury (ABI) (n=327) waiver programs. Notably, more VDC participants (91%) knew who their support broker was, compared to CHCP, ABI, and PCA (82%, 79%, and 72%, respectively) who knew their case manager; 91% of VDC participants gave their support broker the highest rating, compared to 66% to 74% of participants in other programs who rated their case manager. This study provides strong evidence that the CT VDC program is positively impacting veterans and that the AAAs and support brokers are effectively helping them receive the HCBS they need in a consumer-directed way.

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Beaulieu, Joyce E. "Results of the Assessment of Kentucky's Medicaid Home- and Community- Based Services Waiver." Home Health Care Services Quarterly 12, no. 3 (December 23, 1991): 33–57. http://dx.doi.org/10.1300/j027v12n03_04.

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Williams, Marian E., Barbara Y. Wheeler, Lisa Linder, and Robert A. Jacobs. "Evolving Definitions of Autism and Impact on Eligibility for Developmental Disability Services: California Case Example." Intellectual and Developmental Disabilities 55, no. 3 (June 1, 2017): 192–209. http://dx.doi.org/10.1352/1934-9556-55.3.192.

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Abstract When establishing eligibility for developmental disability (DD) services, definitions of specific diagnostic conditions, such as autism, impact policy. Under the Medicaid home and community-based waiver program, states have discretion in determining specific program or service eligibility criteria, the nature of supports to be provided, and the number of individuals to be served. Individuals with DD, their families, and advocates have pushed to expand eligibility and improve the quality of services and supports received. This article uses a California legal case to explore the impact on individuals seeking eligibility for DD services when states rely on evolving diagnostic criteria for autism spectrum disorder. Recommendations are made for a more equitable and consistent approach to disability eligibility determination.

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Hirsh, Bruce R. "The WTO Bananas Decision: Cutting Through the Thicket." Leiden Journal of International Law 11, no. 2 (June 1998): 201–27. http://dx.doi.org/10.1017/s0922156598000168.

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The Bananas decision demonstrated that WTO dispute settlement panels and the Appellate Body are capable of effectively and clearly analyzing whether extremely complex measures are consistent with WTO rules. The trade-liberalizing decision established the General Agreement on Trade in Services (GATS) as a meaningful constraint on discriminatory measures with an impact on both goods and services and clarified the nature of the GATS Most-Favoured Nation (MFN) obligation. The decision also severely constrained the ability of the EU to justify non-tariff discriminatory measures such as the quota allocation system at issue in Bananas based on the Lomé waiver.

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Lai, Benjamin, Ivana Croghan, and Jon O. Ebbert. "Buprenorphine Waiver Attitudes Among Primary Care Providers." Journal of Primary Care & Community Health 13 (January 2022): 215013192211122. http://dx.doi.org/10.1177/21501319221112272.

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Background: Despite efforts to improve access to Medications for Opioid Use Disorder (MOUD), such as buprenorphine, the number of opioid overdoses in the United States continues to rise. In April 2021, the Department of Health and Human Services removed the mandatory training requirement to obtain a buprenorphine waiver; the goal was to encourage more providers to prescribe buprenorphine, thus improving access. Little is known about the attitudes on buprenorphine prescribing after this policy change. Objective: The primary objective was to assess attitudes among primary care providers toward the removal of the buprenorphine waiver training requirement. A secondary objective was to identify other barriers to prescribing buprenorphine. Methods: We conducted a survey between September 15 and October 13, 2021 to assess the overall beliefs on the effectiveness of MOUD and attitudes toward the removal of the waiver training, current knowledge of buprenorphine, current practice styles related to screening for and treating OUD, and attitudes toward prescribing buprenorphine in the future. This survey was sent to 890 Mayo Clinic primary care providers in 5 US states. Results: One hundred twenty-three respondents (13.8%) completed the survey; 35.8% respondents agreed that the removal of the waiver training was a positive step. These respondents expressed a greater familiarity with the different formulations, pharmacology, and titration of buprenorphine. This group was also more likely to prescribe (or continue to prescribe) buprenorphine in the future. Approximately one-third (34.4%) of respondents reported perceived institutional support in prescribing buprenorphine. This group expressed greater confidence in diagnosing OUD, had greater familiarity with the different formulations, pharmacology, and titration of buprenorphine, and was more likely to prescribe (or continue to prescribe) buprenorphine in the future. Respondents who have been in practice for 11 to 20 years since completion of training were most likely to refer all OUD patients to specialists. Conclusions: Results of our survey suggests that simply removing the mandatory waiver training requirement is insufficient in positively changing attitudes toward buprenorphine prescribing. A key barrier is the perceived lack of institutional support. Future studies investigating effective ways to provide such support may help improve providers’ willingness to prescribe buprenorphine.

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Kushner, Jonah, and K. John McConnell. "Addressing Social Determinants of Health through Medicaid: Lessons from Oregon." Journal of Health Politics, Policy and Law 44, no. 6 (August 8, 2019): 919–35. http://dx.doi.org/10.1215/03616878-7785823.

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Abstract States and policy makers have expressed a strong interest in using Medicaid to address social determinants of health (SDOH). While this approach holds promise for improving outcomes and reducing costs, using Medicaid to pay for services outside the medical system creates challenges. This article examines efforts to address SDOH in Oregon, which, as part of its 2012 Medicaid waiver, incorporated health-related services that lacked billing or encounter codes and were not included in Oregon's Medicaid state plan as a strategy to improve outcomes and control costs. We examine the varieties of health-related services that were used and describe the specific challenges in deploying and paying for these services. We conclude with lessons from Oregon that can help states and the federal government as they work to address SDOH.

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Heller, Tamar, Catherine K. Arnold, Lieke van Heumen, Elizabeth L. McBride, and Alan Factor. "Self-directed Support: Impact of Hiring Practices on Adults with Intellectual and Developmental Disabilities and Families." American Journal on Intellectual and Developmental Disabilities 117, no. 6 (November 1, 2012): 464–77. http://dx.doi.org/10.1352/1944-7558-117.6.464.

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Abstract The study examined the differential experiences and outcomes for people with intellectual and developmental disabilities and their families receiving self-directed services based on the type of personal support worker hired (parents, siblings, other relatives, friends, and agency staff). The sample consisted of 372 participants in a self-directed waiver program who used personal assistance services. Results indicated that the caregiver's satisfaction with the personal support worker, self-efficacy in managing personal support workers, and mental health varied significantly based on type of personal support worker hired. Also, the physical health and daily choice making of the adults with disabilities differed significantly by type of personal support worker hired.

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Sanchez, Matheson, and Shytierra Gaston. "Out with “Fine Time,” in with Financial Waivers: Recent Developments in Massachusetts Probation Fines and Fees Policies." Social Sciences 10, no. 10 (October 14, 2021): 391. http://dx.doi.org/10.3390/socsci10100391.

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The criminal justice system routinely imposes financial sanctions on probation clients. These fines, fees, and restitution debts often amount to more than what many clients can reasonably afford to pay. Until recently, Massachusetts courts have incarcerated clients solely for their inability to pay these debts in a practice known as “fine time”. In 2018, the state passed a landmark criminal justice reform bill that restricted the types of cases in which fine time can be ordered. Clients that can establish that payment would lead to financial hardship can now petition the court for a financial waiver accompanied by community service. The current study seeks to explore the implications of the recent reform efforts on probation services by analyzing surveys gathered from a sample of 121 Massachusetts probation officers in 2020. Descriptive findings of officers’ attitudes toward fines and fees, responses to nonpayment by clients, and the use of financial waivers are presented. Officers’ perceptions and practices align with the recent reform efforts, suggesting support among probation personnel for policies that limit punitive responses to nonpayment of legal debts by their supervisees. Possible directions for future research and policy development are discussed.

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Alkema, Gretchen E., Kathleen H. Wilber, Dennee Frey, Susan M. Enguidanos, and W. June Simmons. "Characteristics Associated with Four Potential Medication Problems Among Older Adults in Medicaid Waiver Services." Consultant Pharmacist 23, no. 5 (May 1, 2008): 396–403. http://dx.doi.org/10.4140/tcp.n.2008.396.

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Adams, E. Kathleen, Genevieve M. Kenney, and Katya Galactionova. "Preventive and Reproductive Health Services for Women: The Role of California's Family Planning Waiver." American Journal of Health Promotion 27, no. 3_suppl (January 2013): eS1-eS10. http://dx.doi.org/10.4278/ajhp.120113-quan-28.

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Davila, Victoria S., Lauren Pietzak, Danielle Rossi, Karen Phipps, and Margaret Danilovich. "PHYSICAL ACTIVITY PREFERENCES OF OLDER ADULT MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER CLIENTS." Innovation in Aging 3, Supplement_1 (November 2019): S500. http://dx.doi.org/10.1093/geroni/igz038.1851.

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Abstract Despite the known effectiveness, physical activity (PA) is not currently offered to older adult clients receiving Medicaid Home and Community Based Services (HCBS). To optimize PA implementation within Medicaid HCBS, understanding client preferences for PA programming is needed. Thus, the objective of this exploratory qualitative study was to identify the PA preferences of HCBS clients including mode, duration, implementation strategy, and frequency, as well as barriers and motivators to PA. We recruited participants from the Illinois’ Department on Aging Community Care Program. We conducted semi-structured interviews in participants’ homes which were audio recorded, transcribed, and analyzed using Dedoose (version 7.0.23). We derived semi-structured interview questions from the Health Belief, Social Cognitive, and Health Action Process Approach framework. We used a structured coding approach using conventional content analysis to derive codes from the text, then applied these codes to each interview and examined the frequency to determine themes. The most frequently referenced theme was barriers to PA, primarily co-morbidities. The primary motivator was social support by a peer or instructor. The preferred PA program components were walking 2-3 days per week with duration varying from 20 minutes to 2 hours. Clients also preferred individualized PA instruction versus a passive strategy such as pamphlets or videotapes. Our findings show that individual-level factors most significantly influence PA participation and should be addressed among Medicaid HCBS clients. We recommend Medicaid HCBS consider a personalized approach of PA implementation with their clients.

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Xu, Huiping, Michael Weiner, Sudeshna Paul, Joseph Thomas, Bruce Craig, Marc Rosenman, Caroline Carney Doebbeling, and Laura P. Sands. "Volume of Home- and Community-Based Medicaid Waiver Services and Risk of Hospital Admissions." Journal of the American Geriatrics Society 58, no. 1 (December 9, 2009): 109–15. http://dx.doi.org/10.1111/j.1532-5415.2009.02614.x.

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Alkema, Gretchen E., Kathleen H. Wilber, W. June Simmons, Susan M. Enguidanos, and Dennee Frey. "Prevalence of Potential Medication Problems Among Dually Eligible Older Adults in Medicaid Waiver Services." Annals of Pharmacotherapy 41, no. 12 (December 2007): 1971–78. http://dx.doi.org/10.1345/aph.1k270.

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Journal articles on the topic 'Waiver services'

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