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Promote Community Living for Older Adults and People with Disabilities

HHS is committed to improving access to appropriate health and behavioral health care and social services to help older adults and people with disabilities to stay healthy and independent in their own homes and communities.  HHS is working with states to ensure that when long-term services and supports are needed, people have access to options, including self-directed models of home- and community-based services and recovery support services, which give the individual more control over who provides these services and how the services are delivered.

Promote and Support Community Long-Term Services and Supports

With the help of new opportunities made possible by the Affordable Care Act, HHS is testing new models of care designed to improve access to critical health, behavioral health, and long-term services and supports, and enhance the efficiency of Medicare and Medicaid. Several of the new models aim to improve health care delivery for people with complex care needs by integrating care across multiple settings including physician offices, hospitals, behavioral health settings, and community providers, among many others. Other initiatives are designed to keep people healthy by improving management of chronic conditions, promoting the use of evidence-based models such as telemedicine for rural populations, improving care transitions, and preventing unnecessary hospitalizations. HHS is committed to integrating payment, delivery, and community-based referrals for evidence-based health programs into the health care system.  Several initiatives, including the Money Follows the Person Demonstration, Balancing Incentive Program, Community First Choice Option, and the Financial Alignment Demonstrations will support community living by helping states expand the availability of home- and community-based services, including work supports, for people on Medicaid. HHS also is working to support state efforts to build “No Wrong Door/Aging and Disability Resource Center” systems to make it easier for consumers and their families to access the long-term services and supports that are available in their communities. In addition, through the network of community-based providers funded under the Older Americans Act, HHS is providing people who are not eligible for Medicaid with key support services in the community, such as transportation, peer support services, home-delivered meals, and respite care, which may help delay or avoid spend down to Medicaid or unnecessary institutionalization.  Education and training will be provided to the health care workforce to give them the necessary knowledge and skills to help older adults and individuals with disabilities stay in their homes and communities.

Develop Standardized Quality Community Living Measures

HHS is working to identify, develop, and implement standardized measures to track the quality of long-term services and supports.  These include measures of consumers’ experience with the services they receive, as well as measures of the effectiveness of home- and community-based programs, including their impact on the health status, behavioral health status, and quality of life of consumers and their family caregivers.  Measures also will help track diversion from, and delay of entry into, institutional settings through use of effective home- and community-based services and supports.  Measures will be appropriately defined and tailored for the unique circumstances of each of the aging and disability subpopulations. HHS also is developing standards for incorporating meaningful person-centered practices into long-term services and supports, regardless of where the service is provided. Person-centered practices should result in higher quality services and supports that meet one’s unique needs and preferences, and also may reduce the need for longer duration of stay or higher intensity services.

Promote State Actions to Comply with the Olmstead Decision and Develop Integrated Settings, Services, and Supports

HHS will continue to coordinate its enforcement efforts and provide support to the U.S. Department of Justice to ensure compliance with the Supreme Court's Olmstead decision to eliminate unnecessary segregation of persons with disabilities, such as serious mental illness and physical, intellectual, and developmental disabilities, and to ensure that persons with disabilities receive services in the most integrated setting appropriate to their needs. HHS is working with the U.S. Department of Housing and Urban Development to ensure access to accessible and affordable housing for individuals that are at risk of institutionalization and to share effective practices to help states learn from one another.