Implementation of Medicaid Managed Long-Term Services and Supports for Adults With Intellectual and/or Developmental Disabilities in Kansas
04 Apr 2017-Intellectual and Developmental Disabilities (The American Association on Intellectual and Developmental Disabilities)-Vol. 55, Iss: 2, pp 84-96
TL;DR: This study describes MLTSS implementation in Kansas for adults with IDD and identifies key aspects of the Centers for Medicare and Medicaid Services' newMLTSS regulations in the design and implementation of MLTSs programs.
Abstract: Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs.
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TL;DR: Social determinants are critical to promote the quality of life and health equity of people with IDD and for every one unit increase in the number of social determinant outcomes present, there was a 7.97% decrease in emergency department visits.
13 citations
TL;DR: The IDD Medicare FFS group had high prevalence rates for chronic physical and mental health conditions, overuse of emergency departments, and high rate of 30-day readmission, highlighting the need for evidence-based health care coordination, improved and increased public health interventions, and continued surveillance.
Abstract: Gaps in knowledge and systematic tracking of the prevalence of intellectual and developmental disabilities (IDD) and characteristics that may affect the health of this disability group limits our ability to address the health disparities they experience in comparison to people without disability. The purpose of this study is to begin to fill one relevant critical gap in knowledge: understanding the demographics and health outcomes of adults with IDD who receive services under Medicare Fee-for-Service (FFS), many of who are also eligible for Medicaid. Using 2016 Medicare administrative claims, we examined the prevalence and characteristics of five diagnosis groups of IDD, in those under 65 and those 65 and over, as well as their health outcomes. We found that the IDD Medicare FFS group had high prevalence rates for chronic physical and mental health conditions, overuse of emergency departments, and high rate of 30-day readmission. These findings highlight the need for evidence-based health care coordination, improved and increased public health interventions, and continued surveillance.
13 citations
TL;DR: It is revealed that when PWD are able to choose their services, the impact can be widespread and organizations are not only facilitating self-determination, but, ultimately, improving PWD's QOL.
12 citations
TL;DR: The impact of self-management of health can be wide-ranging, regardless of impairment severity, and represents a paradigm shift for people with IDD because it transforms people from passive recipients to active directors of their health.
Abstract: Background Self-management of health includes people with intellectual and developmental disabilities (IDD) playing a key role in health management in collaborating with healthcare professionals. Methods This study analysed data from Personal Outcome Measures® surveys (n = 1,341) to explore self-management of health. We had the following research questions: Who is most likely to be supported to self-manage their health? How does being supported to self-manage impact different areas of health? and How does being supported to self-manage impact other health-related organizational supports? Results Findings revealed the impact of self-management of health can be wide-ranging, regardless of impairment severity. When supported to self-manage their health, healthcare professionals were more likely to address healthcare issues, and interventions were more likely to be effective. Conclusions Self-management represents a paradigm shift for people with IDD because it transforms people from passive recipients to active directors of their health.
6 citations
Cites background from "Implementation of Medicaid Managed ..."
...There has been a movement across the world, and more recently in the United States, to shift to supported decision making, a least‐restrictive guardianship model which avoids automatically giving guardians broad sweeping pow‐ ers by creating assisted opportunities for people with disabilities to exercise legal capacity (Salzman, 2011)....
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...Currently, in the United States, disability service organizations tend to do things for people when it comes to health care, instead of helping the person to do them, because of agency liability—they over support because of risk....
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...As of July 2014, 55 mil‐ lion people in the United States were enrolled in Managed (Centers for Medicare & Medicaid, n.d.)....
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...Self‐management of services, also referred to as participant or consumer direction, has grown exponentially for people with IDD in the United States because of its ability to result in fewer unmet needs, increased physical and emotional well‐being for people with IDD, and increased control (Heller, Arnold, McBride, & Factor, 2012; Swaine, Parish, Igdalsky, & Powell, 2016; Timberlake, Leutz, Warfield, & Chiri, 2014)....
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...In 1981, the United States authorized the Medicaid Home and Community Based Services (HCBS) waiver programme as an alter‐ native to institutionalized funding....
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TL;DR: Analysis of quasi-experimental mixed-methods evaluation data suggests that both models hold promise as vehicles to reduce utilization and cost among adults who have lived long-term with disability by addressing their unique health care and social needs.
Abstract: A significant gap remains between existing evidence-based care coordination techniques for the general population and those that have been successfully translated for people with intellectual and d...
3 citations
References
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TL;DR: The authors operationalize saturation and make evidence-based recommendations regarding nonprobabilistic sample sizes for interviews and found that saturation occurred within the first twelve interviews, although basic elements for metathemes were present as early as six interviews.
Abstract: Guidelines for determining nonprobabilistic sample sizes are virtually nonexistent. Purposive samples are the most commonly used form of nonprobabilistic sampling, and their size typically relies on the concept of “saturation,” or the point at which no new information or themes are observed in the data. Although the idea of saturation is helpful at the conceptual level, it provides little practical guidance for estimating sample sizes, prior to data collection, necessary for conducting quality research. Using data from a study involving sixty in-depth interviews with women in two West African countries, the authors systematically document the degree of data saturation and variability over the course of thematic analysis. They operationalize saturation and make evidence-based recommendations regarding nonprobabilistic sample sizes for interviews. Based on the data set, they found that saturation occurred within the first twelve interviews, although basic elements for metathemes were present as early as six...
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TL;DR: Qualitative research produces large amounts of textual data in the form of transcripts and observational fieldnotes, and the systematic and rigorous preparation and analysis of these data is time consuming and labour intensive.
Abstract: This is the second in a series of three articles
Contrary to popular perception, qualitative research can produce vast amounts of data. These may include verbatim notes or transcribed recordings of interviews or focus groups, jotted notes and more detailed “fieldnotes” of observational research, a diary or chronological account, and the researcher's reflective notes made during the research. These data are not necessarily small scale: transcribing a typical single interview takes several hours and can generate 20–40 pages of single spaced text. Transcripts and notes are the raw data of the research. They provide a descriptive record of the research, but they cannot provide explanations. The researcher has to make sense of the data by sifting and interpreting them.
#### Summary points
Qualitative research produces large amounts of textual data in the form of transcripts and observational fieldnotes
The systematic and rigorous preparation and analysis of these data is time consuming and labour intensive
Data analysis often takes place alongside data collection to allow questions to be refined and new avenues of inquiry to develop
Textual data are typically explored inductively using content analysis to generate categories and explanations; software packages can help with analysis but should not be viewed as short cuts to rigorous and systematic analysis
High quality analysis of qualitative data depends on the skill, vision, and integrity of the researcher; it should not be left to the novice
In much qualitative research the analytical process begins during data collection as the data already gathered are analysed and shape the ongoing data collection. This sequential analysis1 or interim analysis2 has the advantage of allowing the researcher to go back and refine questions, develop hypotheses, and pursue emerging avenues of inquiry in further depth. Crucially, it also enables the researcher to look for deviant or negative cases; that is, …
7,637 citations
Journal Article•
TL;DR: Items such as physical exam findings, radiographic interpretations, or other diagnostic tests often rely on some degree of subjective interpretation by observers and studies that measure the agreement between two or more observers should include a statistic that takes into account the fact that observers will sometimes agree or disagree simply by chance.
Abstract: Items such as physical exam findings, radiographic interpretations, or other diagnostic tests often rely on some degree of subjective interpretation by observers. Studies that measure the agreement between two or more observers should include a statistic that takes into account the fact that observers will sometimes agree or disagree simply by chance. The kappa statistic (or kappa coefficient) is the most commonly used statistic for this purpose. A kappa of 1 indicates perfect agreement, whereas a kappa of 0 indicates agreement equivalent to chance. A limitation of kappa is that it is affected by the prevalence of the finding under observation. Methods to overcome this limitation have been described.
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TL;DR: Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.
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TL;DR: In this paper, the authors formulate and define standards for reporting qualitative research while preserving the requisite flexibility for the broad spectrum of qualitative research, and present a set of guidelines for reporting such research.
Abstract: PurposeStandards for reporting exist for many types of quantitative research, but currently none exist for the broad spectrum of qualitative research. The purpose of the present study was to formulate and define standards for reporting qualitative research while preserving the requisite flexibility
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