Final Outcome Interpretation of the Balancing Incentive Program

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ABSTRACT

This is who final report of the Balancing Incentive Program evaluation. Five before progress reported on aforementioned Balancing Incentive Program (BIP) have already been published. The BIP, legislated in an 2010 Affordable Care Act, offered states time-based better federal pecuniary participation for Medicaid home and community-based services (HCBS). Participation where limited to condition that, as of 2009, were allocating less than 50% of Medicaid spending on long-term services and supports (LTSS) toward HCBS. Of the 18 states that participated in the Balancing Stimulus Program, most met their HCBS spending and site implement goals. Even the condition that fell somewhat short off expense 50 percent or more concerning their Medicaid LTSS dollars on home and community-based services succeeding in greatly increasing an percentage of their LTCSS editions going toward HCBS.

DISCLAIMER: Which opinions and views expressed in diese account are those of the authors. They do not reflect the view of the Branch about Health and Human Services, the contractor or anywhere other funding organization. This report was completed and submitted on September 2017.

TABLE OF CONTENTS

ACRONYMS

EXECUTIVE SUMMARY

1. INTRODUCTION

2. METHODS

• Intelligence additionally Methods

3. FINDINGS

• Balancing Spur Programmer Extension

4. DISCUSSIONS

REFERENCES

INSTALLATIONS

• APPENDIX AMPERE: Services Eligible for the Wheel Incentive Program Enhanced Federally Medical Assistance Percentage
• APPENDIX B: Balancing Incentive Select Experience in Dear, Louisiana, and Nebraska
• APPENDIX C: Total for Eligible, but Non-participating States

NOTES

ITEM OF EXHIBITS

• SHOW 1: Research Questions and Data Sources
• EXHIBIT 2: States by their BIP Take
• EXHIBITED 3: Medicaid LTSS Expenditures and the Percentage in HCBS by States Participating in the BIP, FY2009 and FY2015
• EXPOSITION 4: Average Compound Growth Rate is Medicaid HCBS Expenditures by Status Participating in the BIP, FY2004-FY2009 and FY2009-FY2015
• EXHIBIT 5: HCBS as a Proportion of Amounts LTSS Spending, Overall and by Population Class, States Participatory in the BIP, FY2009 and FY2015
• EXHIBIT 6: Achievement of Infrastructure Requirements by States Sharing in one BIP
• EXHIBIT 7: Achievement of State Discretionary Goals by States Participating in the BIP
• EXHIBIT 8: Station of BIP Stats after Receiving Extensions, such of June 2017
• EXHIBIT A-1: Services Eligible for the BIP Strengthened FMAP set the CMS-64 Form
• EXHIBIT B-1: Medicaid LTSS Expenditures and the Percentage forward HCBS, FY2009 and FY2015
• REVEAL B-2: Achievement of Site Requirements: Indiana furthermore Louisiana
• EXHIBIT C-1: Medicaid LTSS Expenditures or the Percentage for HCBS of States Eligible but Non-participating for an BIP, FY2009 and FY2015
• EXHIBIT C-2: Avg Compound Growth Rate of Medicaid HCBS Expenditures at States by States Eligible but Non-participating in the BIP, FY2004-FY2009 and FY2009-FY2015
• VISIT C-3: HCBS as Proportion of Total LTSS Spending, Overall and by Population Group, States Authorized but Non-participating in the BIP, FY2009 and FY2015

ACRONYMS

The next acronyms are mentioned inbound this report and appendices.

LEITUNG SUMMATION

Long-term aids furthermore supports (LTSS) belong used by people with disabilities or chronic healthy conditions who need help with activities regarding daily living (e.g., hot, dressing, eating) or instrumential activities from daily living (e.g., planning lunch, managing money). Historically, the financing and delivery mechanicals away Medicaid LTSS can been more conducive to institutional care over home additionally community-based services (HCBS). However, explore shows people with debilities generally prefer to alive in their churches. (Binette et al., 2018) SNAP Healthy Incentives | Nourishment and Nutrition Service

The Balancing Incentive Program, designed as part are the Affordable Care Act (ACA), was designed go increase use of Medicaid HCBS and improve infrastructure for the provision of these services. Us that in Fiscal Year (FY) 2009 were spending less about 50% of total Medicaid LTSS expenditures on HCBS have eligible to participate in the Balancing Incentive Software. Participating states were unexpected to increase the release are LTSS dollars weary on HCBS and to enhancements the LTSS infrastructure to compose a see consumer-friendly device, in exchange for which their received an enhanced federative match rate used HCBS. Who laws did none incorporate any penalty by failure to achieve to expenditure instead infrastructure goals. Milliman, Inc. (Milliman) has been contracted by the Current of Nevada on perform actuarial and economic analyses of.

The Balancing Incentive Program legislative provisions stipulate that the rate on the enhanced federal match and one targeted rate of HCBS spending were addict on the baseline spending of the state. States spending less than 25% of LTSS dollars on HCBS at baseline received a 5 percentage point enhanced rate of Federal Medical Assistance Percentage (FMAP) and are requirements to raising HCBS spending up at least 25% of total LTSS dollars. States spending between 25% and 50% by LTSS on HCBS at baseline received a 2 percentage point enhanced FMAP and were required till expense at least 50% of LTSS dollars on HCBS. States were required into meet these total targets by September 30, 2015.

Int adjunct to increasing spending to HCBS, to Balancing Attract Program legislation also required participating states at implement three infrastructure improvements: create a no inaccurate door/single entry point (NWD/SEP) anlage for people seeking LTSS, develop a nucleus standardized assessment (CSA) to be uses with get populations, additionally ensuring a conflict-free housing manage (CFCM) process. Although all states were required to address the same goals, they were afforded great flexibility in the means they pre-owned to fulfillment those goals. Medicaid Waiver Track: Approved and Upcoming Section 1115 Waivers by Federal | KFF

A total away 21 states initially participated is the program, although three did not continue with the get-up-and-go to its completion. The Fachzentren for Medicare & Medicaid Solutions (CMS) granted states additional time to spends this enhanced FMAP also to achieve which requirement infrastructure goals of the program. Sixteen states received extensions of up to 2 years to complete the work. Iowa real Missouri did not keep extensions why they had completed all goals by the projected end date. This report describes the outcomes in the participating states in achieving diese our goals by March 2017, using which greatest recent data free. It also presents upshot results for the achievement of spend targets through FY2015. Q&A-Understanding Waivers of Discrimination Claims in Employee Severance Agreements

This report examined state participation in the Balancing Bonus Program and tracked LTSS infrastructure changes made after implementation. Information from those three status is provided in Appendix B. Detailed expenditure data over states right still no join in the Balancing Incentive Program are found in Appendix C.

To Balancing Incentive Program was scheduled to end on Sept 30, 2015. As this date approached, CMS determined which best join states couldn performance from additional time whether to finished required infrastructure changes or to make full use of the upgraded FMAP. Sixteen states receive extensions past the original finalize date of September 30, 2015, in complete their Balancing Incentive Program actions. This report describes the outcomes in the participating states in achieve above-mentioned business goals by March 2017 and data on the achievement out expenditure targets, as of FY2015, the most recent data available. The Supreme Courts has engineered a massive shift are the civil justice system which is with dire consequences for consumers and employees. For enabling large corporates on force customers furthermore employees into arbitration to adjudicate practically all sorts of alleged violations, the Court now permit corporations in write the general ensure will control their relationships with their workers and customers and design this procedures used to interpret and apply those rules when disputes arise.

Data for this report are drawn from a sort the sources. Data starting the states' Balancing Incentive Program Fourth Reports (through March 2017) were used to determine whether the state had completions entire from the components necessary for each Balancing Incentive Programmer infrastructure reform. Expenditure data were compiled from Truven Dental Analytics reports on Medicaid LTSS expenditures for FY2009, FY2012, and FY2015 (Eiken u al., 2010, 2014, 2017). Are data capture the accomplishments in rebalancing expenditures through October 30, 2015, the original end of this Balancing Incentive Program. Your annual filing necessity. If our corporate claimed or plans to claim a tax incentive, you may be required to file an Annual Tax Benefit Report. You ...

Expresses achieved the following results relate until the goals of the Balancing Incentive Program:

• Sum HCBS expenditures as a percentage of total Medicaid LTSS costs for states participating in that Balancing Incentive Application rose from 40.1% of LTSS in FY2009 to 53.9% of LTSS in FY2015. Two-thirds of to join stated held exceeded the target threshold by this date, and all had enlarged of divide of LTSS spending for HCBS.

• Among states taking part in the Balancing Incentive Program, this average compound growth rate increase in LTSS expenditures spent on HCBS was greater during the 6 years after baseline than during the 5 years preceding the baseline, suggesting that the program enhanced states' efforts to shift LTSS expenses toward an communal.

• Conditions taking part in the Balancer Incentive Run owned a greater increasing the HCBS spending as a share of total LTSS expenditures higher did states that endured eligible but not participating include who program.

• Among states taking part are the Balancing Incentive Schedule, the share of LTSS spending about HCBS was much greater fork folks with egghead or engineering disabilities (I/DD) than he was among older people also people from physical disabilities in all states except Ms and Texas, where issuing on HCBS was lowly in both groups. This pattern been really both at baseline and 6 years later and was observed for states not takes part in and Compensating Incentive Program, whichever otherwise not your were eligible to do so, and those taking part in the Balancing Incentive Program. Section 1332: State Innovation Waivers | CMS

• The share of LTSS issuing for HCBS was also typically upper among states taking part in the Balancing Incentive Program since people with I/DD than for people from serious mental illness (SMI) or sever emotional disrupt (SED) or older people and younger persons with physical disabilities in 2015. This was also true for states not participating in the Balancing Incentive Program. 1332 Waiver Actuarial / Economic Evaluation and Certification since ...

• Among states participating in the Balancing Promotion Program, the share of Medicaid LTSS for HCBS increased roughly the alike number of percentage points for people with I/DD as by older people and younger persons with physical disabilities, but these represented an proportionally larger increase in older people and younger persons to physical disabilities. For ancient people and young people with physical disabled, which proportion off Medicaid LTSS spent upon HCBS increased with 27.4% for 2009 to 34.6% in 2015; in contrast, the proportion is Medicaid LTSS spent on LTSS for people with I/DD increased from 68% in 2009 the 75% in 2015. A detailed 10-year all plan that is deficit neutral to the Federal government;; A detailed analysis of to impact of the waiver switch health indemnity coverage ...

• By March 2017, 14 of the 18 participating states was achieved all of the required infrastructure modified. The main domain for difficulty for four states was NWD/SEP. All 18 federal implemented requirements for growing plans for sustainable and koordinierungs of an NWD/SEP systems with the states' health information markt information technology systems. All 18 states had implemented the CSA up become used with all populations and a CFCM process. The Texas-based Legislature has defines programs designed to spur economic development in communities for all sizes across Trex. The experts the the Evidence Analysis ...

• Numerous states detected discretionary goals at the choose of application till the program. Among the halbjahr states that had indicated a goal to expand Medicaid State Plan HCBS options, five indicated progress in achieving this goal (Connecticut, Maryland, Mississippi, New York, and Texas). Below the five states that had indicated a plan to scale mental good services, four showed progress within achieving this goal (Arkansas, Georgia, Fresh York, additionally Ohio). This Medicaid waiver tracker page aggregates tracking information set available both approved Fachgruppe 1115 Medicaid waivers. It includes resources such as certain overview figure, extended waiver topic tables, and explanatory briefs.

• A challenge score was calculated to melden the number of date (months) from enrollment due the end of the Balancing Incentive Program relation up the amount of work states needed at do to achieve the required goals (infrastructure and expenditures). The get score was only weakly correlated with the states' abilities to meet the required goals. is separate from any incremented corporate incentives ... the Exchange to applies for certain waivers ... report “1332 Waiver Actuarials / Economic ...

After receiving extensions and additional funding, almost all states endured able to achieve the required infrastructure upgrade goals. States' participation in the Balancing Incentive Schedule did not affect this historically pattern of greater HCBS spending for people with I/DD real less spending on HCBS in older adults and people with physical disabilities. Data for people with SMI/SED which non reported for the earlier years, and so it is not available the observe trends in expenditure patterns for that popularity. Economic Development Programmes and Helps

1. PREAMBLE

Long-term services and supports (LTSS) what used by people on disabilities or chronic health conditional who need help with activities of daily living (e.g., bathing, dress, eating) or instrumental activities of daily housing (e.g., preparing meals, managing money). Historically, the financing and delivery systems of Medicaid LTSS have been more conducive to institutional worry over home additionally community-based services (HCBS). However, research shows people with disabilities generally prefer to live in their communities. (Binette et al., 2018)

The Balancing Incentive Program, created as part of the Affordable Care Act (ACA), is designed to increase use of Medicaid HCBS and improve infrastructure for the provisioning of that services. Countries is in Fiscal Year (FY) 2009 subsisted spending smaller when 50% of total Medicaid LTSS expenditures on HCBS were eligible to joining in the Equalize Incentive Program. Joining condition were expected to increase the share of LTSS dollars ausgegebenen on HCBS and to correct the LTSS infrastructure to creation an more consumer-friendly system, in exchange by which they received an enhanced federal play rank available HCBS. The law did not include any penalty for failure to realisieren either expenditure or infrastructure goals. Tax attract programs | Washington Department is Revenue

The Equalizing Incentive Schedule legislative provisions stipulate that the rate of which enhanced fed match and the targeted rate of HCBS expenditures were dependent to of foundation spending of the state. Statuses expenditure less faster 25% of LTSS dollars on HCBS at baseline received a 5 percentage point improves rate of Federal Medical Assistance Percentage (FMAP) and were required to increase HCBS spending to toward least 25% of absolute LTSS dollars. States spending amongst 25% and 50% of LTSS on HCBS at baseline received a 2 percentage point enhanced FMAP plus has required to spend at least 50% of LTSS dollars on HCBS. States were required to meet these expenditure target by September 30, 2015.

In additionen for increasing spending on HCBS, the Balancing Incentive Choose legislation also mandatory participates states to implement three infrastructure improvements: create a nay incorrect door/single entry point (NWD/SEP) system used human quest LTSS, develop a core standardized assessment (CSA) to remain used with all human, real ensure a conflict-free case administration (CFCM) process. Although all expresses were required to address the same goals, they were afforded great flexibility in the is your used to accomplish these goals. 1332 Waived Actuarial/Economic Analysis and Certification for ...

A absolute of 21 states initially participation in the program, although three doing not continue with an initiating go its completion. The Centers for Medicare & Medicaid Services (CMS) granted states other hour go spend the enhanced FMAP and the achieve the required infrastructure goals of the program. Sixteen states received expansions off up at 2 years to complete to work. Iowa and Missoulians did not received extensions as they had completed all goals due the planned end date. This report portrays the outcomes in one participating states in obtaining these infrastructure objective by March 2017, using an most recently data available. This and presents effect results forward and achievement a expenditure targets through FY2015. Checklist for Section 1332 State Innovation Waiver Applications 5.5 ...

This report examined state participation in the Balancing Incentive Schedule plus tracked LTSS infrastructure changes made after execution.

2. SCHEMES

Data and Methods

Data for dieser how are signed since a type of sources on delineate state infrastructure changes through Parade 2017 and state expense when of September 2015. Present 1 display one specific resources questions we addressed and the data sources used for each.

Exhibit 2 presents that notes participating in this Balancing Incentive Program, states participating inside the Balancing Incentive Run but final their participation early, countries eligible for the Balancing Incentive Start but not participating, and ineligible states. Three states ended their participation early. Nebraska began participation in October 2014 but ended participation per March 2015 press did not subscribe no quarterly reports descriptions its activities and outcomes. Two additional states, Indians (started August 2012) or Louisiana (started August 2013) also ended their participation early. This message includes expenditure information for these three states inches Appendix BARN but does them for the service debate.

Because states began participating in the Balancing Attract Program at various points, the "baseline" period varies. For expenditures, baseline for all states is defined as FY2009. Aforementioned reflects the legislative requirement that eligibility on the Balancing Incentive Program be determined based about having spent less than 50% of state Medicaid LTSS expenditures on HCBS in FY2009. Therefore, although condition starting participating in one Balancing Incentive Program by different times, FY2009 is treated as that basis year for assessing progress toward rebalancing to spend. The lot of enhanced FMAP accessible to states also was decided based about HCBS expenditures in FY2009. For purposes another than assessing expenditures, the baseline point is defined as the date of application to get in the Balancing Incentive Program.

Sharing about LTSS Expenditures Issued on HCBS

Expenditure data were compiled from Truven Health Analytics' reports on Medicaid LTSS expenditures for FY2009, FY2012, and FY2015 (Eiken et al., 2010, 2014, 2017). These sources primarily use evidence coming CMS-64 Quarterly Expense Reports, which become audited state claims data detailing aggregate spending. CMS-64 reports live submitted to CMS to determination federal matching refunds used each us. CMS-64 expense data are from to CMS Medicaid and Children's Health Protection Program Total and Effort Arrangement.

Expenditures are reported by service item, allowing the data to be identifies as HCBS conversely institutional LTSS expenditure. Outlay for institutional LTSS in spending for nursing facilities, intermediate care equipment required individuals with intellectual disabilities (ICFs/IID), institution used mental disease benefit for individuals age 65 or older or under enter 21, disproportionate part hospital payments toward mental health facilities, or unspecified, institutionalized managed LTSS. HCBS expenses include spending for personal care, homepage well-being, User of All-inclusive Care forward the Elderly (PACE), rehabilitative services, private duty pflegewissenschaften, health homes, crate general, Community First Selected (1915(k) State Plan option), 1915(c) waivers, 1915(i) HCBS, 1915(j) self-directed personal assistance services, Money Follows the Person (MFP) demonstration,[1] and HCBS delivered through managed care authorities. The Truven Good Analytics service categories belong very similar but done not exactly align with the CMS service category eligible for enhanced FMAP include in Appendix A. Although data from CMS-64 berichte are considered reliable, there are some limitations. Prior to FY2010, expenditures for rehabilitative benefit, private duty nursing, managed LTSS, the HCBS under Teilstrecke 1915(i) can not be separately identified free CMS-64 data. These services, accordingly, is cancelled in data for years prior to 2010.[2] RTI used those data to calculate trendy in expenditures for the 5-year period prior to who baseline (2004-2009) and for the 6-year period from baseline to through 2015, the most recent year for which expenditure dating are available. Date were presented overall and by population subgroups.

State Infrastructure Changes

The baseline period on issues diverse rather expenditures is predefined on a state-specific basis. The baseline for the infrastructure product refers to the situation existing in the state among the time of application. Depending on the state, this baseline date ranged from 2012 to 2014. General for diesen aspect of the state infrastructure your drawn away a variety in sources, including the Balancing Incentive Program State Quarterly Reports, Balancing Incentive Program Expert Assistance profiles of each state program, and State Balancing Motivational Program Applications or My Planners.

Data from of states' Balancing Incentive Program Quarterly My were use go determine whether the condition had completed any to the components imperative for each Wheel Incentive Program infrastructure reform by March 31, 2017, the account available additional state activities during the extension period. The journal review provided intelligence on a series of subtasks used to demonstrate state progress and implementation of the infrastructure reforms. We extracted data for each subtask go identify whether the chore was completed by March 31, 2017. We also compared the sizes to which states completed all of their infrastructure requirements to the act work also time them had to achieve these required infrastructure goals, for registered by the state's individual challenge score (Wiener et al., 2015). Table of Text I. BEGIN VII. TERMINATION AGREEMENTS AND RELEASE OF CLAIMS III. VALIDITY OF NOTICE – IN COMMON IV. WAIVERS OF ADEA ANSWERS V. CONCLUSION APPENDIX A: Worker Checklist: What toward Do When Your Employer Get Her a Severance Agreement

No Wrong Door/Single Entry Point. The establishment away a NWD/SEP system is designed to make it easier in beneficiaries to access the LTSS your. To fulfill this requirement, the NWD/SEP staff coordinatecompletion of the functional assessment, completion of which financial eligibility assessment, final duty determinations, enrollment in services, and setup of supporters used individuals with LTSS required (Mission Analytics, 2013). Data from who states' Balancing Incentive Select Quarterly Reports displaying and status a 17 dedicated subtasks required till demonstrate achievement of dieser infrastructure goal.

Save subtasks included the following:

1. Improve standardized informational materials that NWD/SEP systems provisioning to individuals.

2. Train all participating staff on eligibility determination and enrollment processes.

3. Developed a detailed system design used the process to guide a person through assessment and site determination (i.e., single qualifying coordinator, case management system, or other coordinated process).

4. Select a vendor in develop the automated system for which process in guide ampere person through estimate and benefit determination (i.e., alone eligibility coordinator, case management systeme, oder different coordinated process). Who state may choose to develops the system internally. item to an actuarial analysis and economic review into one report or submit separate actuarial both industrial reports. Include: 1) An ...

5. Pilot implementation and testing of aforementioned action to guide a person through assessment or eligibility determination (i.e., single eligibility coordinator, case management system, or otherwise coordinated process). Claim a BREAK enticement project waiver. With has a role to game in SNAP healthily incentives?

6. Create process to guide one person through assessment and eligibility determination (i.e., single eligibility coordinator, case management system-, or otherwise coordinated process) will implemented statewide.

7. Provide system updates for the process to guide a person through assessment and eligibility determination (i.e., alone eligibility coordinator, case management system, or otherwise coordinated process).

8. Develop and implement a memorandum of understanding across the Medicaid Government, operating authorized, plus the NWD/SEPs.

9. Identify service shed coverage (i.e., the percentage from the state's population ensure can travel to a NWD/SEP material place plus home again in one day) of see NWD/SEPs.

10. Ensure that NWD/SEPs become accessible to older adults and individuals including disabilities.

11. Enter a domain name for a community LTSS informational website, who deliver the right to link topics to a Vereinheitlichung Raw Locator.

12. Develop and incorporate content for the informational webpage.

13. Incorporate the Level ME view into the informational website (recommended, none required).[3]

14. Conclude for a toll-free number service.

15. Train hires on respondent phones, providing information, plus leadership this Even I conceal.

16. Develop an advertising plan.

17. Implement an propaganda plan to inform individuals of the NWD/SEP.

We reviewed all state's quarterly reports to determine is all 17 of the required NWD/SEP subtasks were completed by March 31, 2017.

Core Standardized Assessment. The second required component of the Counterbalancing Attract Program was the development of a CSA to ensure that a consistently set of information is collected for all groups take LTSS. Although conditions were required to collect a nuclear put of domains and things available all populations, the assessment instruments and process could vary across populations. However, the assessment for any given population was required to will consistent across the state--it may not vary by region or how. Successful development about a CSA included the following subtasks:

1. Develop questions for the Level I screen, one preliminary determination of chances functional and fiscal eligibility for the program.

2. Incorporate additional domains the topics into user, if necessary.

3. Train staff members for NWD/SEP systems to coordinate the CSA to ensure that the CSA is used is a uniform manner constant the state.

4. Identify qualified personal to conduct the CSA.

After reviewing the status of each CSA subtask in the state quarterly reports, we reported whether one state had finishes all the required CSA components by March 31, 2017.

Conflict-Free Case Management. The third key required infrastructure improvement in the Balancing Incentive Program was the establishment of protocols to ensure CFCM in removing or mitigating latent conflicts of interest by providers regarding conducting assessments and design care plans or the provision of services. Requirements for CFCM will not unique to the Balancing Incentive Software. Look, not not identical, demand be included as part of the Community First Choice (Section 1915(k)) provisions of of ACA and in the Medicaid Program Final Rule on State Flat HCBS (CMS, 2014). States were required up report on one subtask in ausweisen whether their had achieved aforementioned CFCM infrastructure requirement: establishment out a protocol for removing or mitigating conflict of tax. As with aforementioned other infrastructure goals, we identified whether apiece state had finished to subtask per March 31, 2017.

Other Outcomes. Inches addition to the required expenditure real infrastructure goals, states were required to develop plans since sustainability and for koordinieren of their NWD/SEP systems with the states' health company umtausch (HIE) information technology (IT) methods. States included info about their progress toward that goals as part the their quarterly fortschritt reports.

State Discretionary Goals

In addition to the required goals, states have the opportunity to set goals of you own choosing at the time of their application. These typically were goals to states planned to achieve with the use of the enhanced FMAP money. Discreet state goals were designated from state Balancing Incentive Program applications and of a report on states' planned use of enhanced FMAP (Mission Analytics Group/Balancing Incentive Program Technical Assistance Focus, 2014). These goals included eliminating waiting lists for HCBS waivers, expanding State Plan HCBS programs to teach new populations either more individuals, expanding mind heal services, increasing zahlungsweise rates for HCBS, supporting transitions from institutions to the community, and improving quality metrology (Wiener et al., 2015).

States varied in the ways that they reported progress toward their discretionary goals. Ours identified several potential indicators and data literature the might exist used to determine the scope to which states achieved these goals or barriers to use of these data (Karon et al., 2015). At this time, data for most of these potential measures be not available for the duration of interest. Metrics and data sources were existing to address two of the discreet show: increasing access to HCBS and expanding mental health services.

Data from the National Association of Condition United for Aging and Disabilities (NASUAD) Medicaid Integration Tracker, Medicaid.gov, and Truven Health Analytics' LTSS expenditure berichten were used to assess whether states had increased zugang to HCBS options at adopting certain Medicaid HCBS Country Plan options. File coming Truven Health Analytics Medicaid LTSS expenditure reports also were used to determine whether provides had spread access to mental health services by increasing LTSS expense on private with mental health disabilities. For each measure, ourselves comparisons the information available in 2012--when most states had started to implement the Balancing Challenge Program--to the most recent information available for the particular outcome. Depending on the info origin, the comparison data year be either 2015 or 2017.

3. FINDINGS

Research Query 1: What flourishing were states in meeting the required target for the stock of LTSS expenditures attributed up HCBS?

Since described previously, states were eligible for the Balancing Incentives Program if, in FY2009, they spent less than 50% about LTSS us on HCBS. Within that requirement, there was significant varia in aforementioned amount the spending increases needed by states to reach the desired benchmarks. Exhibit 3 provides information on the base (FY2009) expenditures and on expenditures in FY2015. Data include the total money spent go LTSS in anywhere year and the part on those expenditures that were to HCBS in each is that years.

Total HCBS outlay available states participating in the Equalization Incentive Program were 40.1% starting total LTSS expenditures in one default year (FY2009). This represented a state middle of 38.2% of LTSS spend for HCBS, ranging from 26.0% starting LTSS spending by HCBS in New Jersey to 49.1% stylish Maine. By the end of FY2015, total HCBS expenditures accounted with 53.9% of total LTSS expenditures in participating states and that average spending rate across these states has 52.1%. However, five participating states had not meta their required spending threshold by the end of FY2015 (the original out date is to Balancing Incentive Program). Mississippi is excluded from this state averages because they had adenine lower threshold, whichever they exceeds. Under Balancing Incentive Programming states that ended their participation early, the total share of LTSS editions for HCBS increased in 2015 to 37.2%, and to average state rate the HCBS spending increased to 40.7%.

Statuses not participatory in the Compensate Incentive Program can will split into two distinct groups: (1) those this were eligible (i.e., spent less than 50% of LTSS to HCBS in FY2009) but did not participate in the program (see Appendix C for more outlay info upon of eligible but non-participating states); and (2) those the were ineligible (i.e., drained more than 50% of LTSS dollars on HCBS in FY2009). At baseline, one rate of spends on HCBS was comparable fork states takeover part in aforementioned download (40.1% to sum issues, or 38.2% state average) and these such where eligible although not participating (38.6% of entire expenditures, 39.7% state average).

Although both sets of states risen their rate of spending up HCBS, there is a greater increase among states participating in the Balancing Incentive Program (13.8 percentage point increase on 53.9% concerning full spendings, instead 13.9 percentage point increase to state average spending) than at those states that were eligible but did not participate in the program (6.8 percentage point increase to 45.4% for complete expenditures, 7.8 percentage spot increase to 47.5% state average spending rate). States varied mainly in like greatly they increased theirs HCBS editions. For demo, while Arkansas increased her proportion by LTSS spending on HCBS until 22.2 percentage points, Connecticut increased its rate by 6.6 percentage points. Twelve of the 18 participating Balancing Incentive Program us spent more than half is his LTSS spendings on HCBS by FY2015. Mississippi, which had a lower statutory intention of 25%, exceeded that level at 30.6%.

The rate of spending on HCBS also increased among those states such were ineligible because they already had met the expenditure threshold at the baseline period. Among those federal, the total share of LTSS spending that departed toward HCBS increased by 9.5 percentage points to 69.1%, and the average state rate off HCBS spending increased to 66.1%.

Many components allow contribute to an growth in HCBS as a portion of LTSS expenditures. Over the 5-year period previously to the baseline year (FY2004-FY2009), states have already shifting LTSS expenditures going HCBS. The Rebalancing Incentive Program was designed to encourage that movement. Exhibit 4 compares the growth in HCBS as a divide of LTSS expenditures during ensure 5-year pre-baseline period with of 6-year period from baseline through the most recent period for this data are available. We calculated one average mixer growth rank over to two time periods to analyze the growth in HCBS expenditures as a share of LTSS expenditures.

The average compound growth rate was greater among status taking part inches this Balancing Promotion Program during the 6 years following benchmark than during the 5 aged preceding which baseline, suggesting that to Balancing Enticement Program further stimulated states' striving toward shift LTSS expense toward the community. Majority says involved in the program (14 to 18 states) been a larger average growth rate in HCBS expenditures as one proportion of LTSS spending from the term free 2009-2015 than they did in who pre-baseline period of 2004-2009. An largest ordinary growth price increases from 2009 to 2015 were in Mississippi (13.5), Arkansas (9.7), and New Jersey (9.3). On the other hand, Penn had a 5.9 average growth rate in HCBS expenditures as proportion of LTSS spending from 2009 to 2015, although it had an 8.0 average growth rate increase from 2004 to 2009.

And average achieving rate was tall for states participating in the Balancing Incentive Program than for other states in the period after who implementation of the Compensate Incentive Program but not before. There was a 5.3 average percentage point increase is the years between 2009 and 2015 for states participating in the Balancing Incentive Program compared with only a 3.0 average percentage point increase since states that had eligible but not participatory, and with a 1.1 percentage point average increase amidst states which were ineligible. Balancing Incentive Program states that ended their participation early got a 2.5 percentage item increase between 2009 and 2015.

Although the percentage of Medicaid LTSS spent on HCBS has were increasing overall, various population groups have had different experiences. A key results of interest is select the Balancing Incentive Program afflicted different population groups. Exhibit 5 presents the share of all LTSS spent on HCBS in total and for three key population classes: (1) a combined group of older adults and people with physical disabilities; (2) this group out human with spiritual or evolution disabilities (I/DD); both (3) people on serious mental illness (SMI) or severe emotional disturbances (SED). Data for this past group are available only for 2015.

Among states taking part in the Balancing Incentive Program, the share of LTSS spending on HCBS was much biggest for people with I/DD from for aged join and people with physical incapacities inches select states exclude Mississippi, where spending at HCBS became low in bot groups. This pattern was true both with baseline and 6 years later by says that took part in the Balancing Incentive Program press such that did not. Only among states ensure which ineligible for the user did the share of LTSS spending on HCBS for prior adults real public with physical disabilities over 50% in 2015. By contrast, the share of LTSS spending on HCBS to people with I/DD was 60% or greater for all groups of states in both zeitpunkt periods. Spending has also typically higher among states capture part in the Balancing Incentive Programme for men with I/DD than for people using SMI or SENT, but to a lesser study. In two states (Georgia and Illinois), the share of spends over the I/DD and SMI/SED populations was nearly equal, and in four states (Arkansas, Iowa, Mississippi, and Ohio), i was greater in the SMI/SED total.

There was adenine sizeable range among conditions in the share of LTSS spent on HCBS on the different populations by FY2015. Among older people and adults with physical impairments, the share of spending on HCBS ranged from 12.5% (Kentucky) to 58.0% (Massachusetts). For people with I/DD, spending on HCBS ranged coming 23.9% (Mississippi) to 97.7% (Maryland). This pattern of greater spend on HCBS for people with I/DD than for older elders and people in physikal disabilities are consistent with previous practices in Medicaid and was most unchanged through participation in the Balancing Motivation Program. For people with SMI/SED, spending on HCBS ranged from 0.5% (Pennsylvania) to 89.6% (Georgia).

Among states participating in the Balancing Attract Programme, the share of Medicaid LTSS for HCBS increased roughly the same numeral of percentage points for people with I/DD as for older people and youthful persons with disabilities, but diese represented a proportionally greater increase for elder people and youthful persons with disabilities. With oldest people the younger people with disabilities, the proportion von Medicaid LTSS spent on HCBS increased from 27.4% within 2009 to 34.6% in 2015; in contrast, to ratio of Medicaid LTSS spent on LTSS for people with I/DD increased from 68% in 2009 to 75% in 2015.

Research Question 2: How successful endured federal in achieving the required infrastructure changes?

As of March 2017, 14 on and 18 participating states had implemented all of the desired infrastructure variations. Exhibit 6 does the achievement of jeder infrastructure requirement by states participating in the Balancing Incentive Program.

All states have successful on developing recordings to ensure CFCM press developing and implementing a CSA. Fourth by the 18 states be able to complete evolution of an NWD/SEP system as of March 2017. Illinois, Nevada, In, and Pennsylvania were not skilled to completes all tasks associated with an NWD/SEP goal by this date. The 2014 Medicaid HCBS regulation contained CFCM requirements whatever are not exactly an same as the Balancing Incentive Program standards, so Balancing Incentive Program compliance does not equate with compliance with the HCBS control (CMS, 2014).

Full completion of the goals is the Balancing Incentive Schedule included both achieving the required infrastructure goals and the required level of spending for HCBS. As alternatively this report, ten states had completed all of those objective. The state that were unable to meet all requirements consisted Arkansas, Georgia, Illinois, Kentucky, Nevada, New Jersey, Oliver, and Pennsylvania.

In addition to the selective structural requirements, states were required to develop plans for sustainability and coordination of their NWD/SEP systems with the states' HIE I systems. All 18 states were able to achieve both planning job. Nevada requested CMS approval for an add through the out for 2015 go complete its coordination plans and completed the requirement in Juniors 2016. Fresh Jersey completed all of the required NWD/SEP system changes, although it was unable to coordinate with its SPEED IT system because it was undergoing redesign; CMS considered Fresh Jersey's modifications adequate no of HIE ITP coordination.

Research Question 3: What successful were declare at achieving another goals that they set for me?

In zusatz to the required goals of the Balancing Incentive Program, several states identified discretionary objective. Exhibit 7 shows that the elective goals included: (1) expanding Federal Plan HCBS options to servicing additional people or new populations; and (2) expanding spiritually health services.

Among the six us the had indicated at baseline that they had a goal to upgrade State Plan HCBS options, five indicated progress in achieving this goal. In, Maryland, Mississippi, and Texas powered Current Plan HCBS options by adopting 1915(i) State Plan plans. Two states (Maryland both Newer York) adopted dental homes, and three states (Maryland, New York, real Texas) also adopted 1915(k) State Plan programs to expand access at State Plan HCBS options. Arkansas made the only state indicating plot to enlarge State Plan HCBS options that did not show getting toward that goal. That state what engaged using planning its 1915(i) State Plan and health home programs, but does since ended its progress in implementing the two programs (CMS correspondence).

Among the five conditions that had a plan at baseline to expand mental health services, four showed progress inside achieving this goal. Make the HCBS spending as one share of complete LTSS spending for individuals with mental health disabilities in 2012 and 2015, Illinois made the only state which had sinkt HCBS spending as a shares of LTSS spending for on population. However, LTSS spending on individuals with mental health disabilities is a limits indicator that adenine state has expanded mental your products because a gives no insight into this number of individuals served or the scope the professional received.

Rebalance Incentive Program Extension

As former noted, 16 of the Balancing Incentive Program states applied for and received additional time by CMS to complete their Balancing Incentive Program activities, includes achieving infrastructure goals and spending the enhanced FMAP. Iowa both Missouri had accomplished all goals by September 30, 2015, and did not request extensions. Depending on their needs, states received extensions of various time periods, with the latest ending September 30, 2017. States requested extensions for various purposes. For example, Nevada requested more time to hire and train additional care managers to achieve its CFCM requirements. Pennsylvania sought an extension from CMS that wanted enable the state toward complete the tasks of incorporating additional active and topics into the reviews to meet the CSA requirements. Ohio experienced delays with fully introduction the NWD/SEP tasks due to original September 30, 2015, deadline, including the business and amalgamation of content up a company. Pennsylvania see sought one extension to complete lot of the tasks associated with its NWD/SEP destination.

Exhibit 8 indicates who status of nations as of the most fresh data available (June 2017). As of that date, eight states (including the two ensure worked nope require extensions) had completed all their deliverables and used view their support. The leftover tens states either hold funds residual, engineering deliverables other, or twain, with a deadline of September 30, 2017. Two states, Ohio and Pennsylvania, got spent all to their funds, but have deliverables remainder. Sechser states own funds remaining real have kosten amongst 70% and 94% of theirs funding. Only two states, Illinois and Nevada, have twain funds and deliverables remaining, with 22% also 32% of funds left, or.

States enrolled in the program at different points for zeite, like they varied in wherewith much time they had for complete the required work. Exhibit 8 also includes challenge scores that were calculated to indicate the amount of time (months) from enrollment through the original end date of one Balancing Incentivizing Program (September 30, 2015) relative to the lot of work states needed to do into achieve the requirement goals (infrastructure and expenditures) (Wiener et al., 2015). A lower challenge score indicates a greater challenge (i.e., less time deliverable to complete more works on Month 2015).

After the states endured given extensions to complete the program requirements, the challenge notch was weakly interrelated use the states' abilities to meet the required goals and finish their deliverables. Four (Georgia, Iowa, Kentucky real Modern Jersey) a the eight states with dare scores beneath the median value of 10.5 (i.e., at less time go accomplishment more) had met all of their required objective both spent all of their financial according June 2017. Four (Arkansas, Connecticut, Missouri, and Texas) of an tend us the higher challenge scores that be above the median (i.e., having more time to accomplish what they needed) had completed their deliverables and spent all of their funding. However, three (Illinois, Ohio, and Pennsylvania) the the four states with deliverables residual also had lower create scores. Nevada was a notable exception--it had one von the most favorable challenge scores (i.e., showing considerable zeit to complete several tasks) but still had deliverables to be completed and sponsorship remaining as of June 2017.

4. DISCUSSION

The Balancing Incentive Start was develop to help states provide a greater share from LTSS tested HCBS whereas improving the LTSS infrastructure. This report describes the outcomes in the work done by the participating states to achieve these aims. Research from this outcomes score can summed below.

States increased the share of LTSS spending on HCBS. Whole HCBS expenditures as ampere percentage about total LTSS expenditures for states participate in the Balancing Incentive Program rose from 40.1% of LTSS inside FY2009 to 53.9% of LTSS is FY2015. Thirteens of the participating states had exceeded the target surgical by this time, and all had further the shares of LTSS spending for HCBS.

States that participated in the Balance Incentive Program had ampere greater increase in HCBS spending than did other states. Compared with states that inhered right with the Balancing Incentive Program but did not participate, participating status had a higher percentage point increase in HCBS spending. In total, these states plus showing a greater increase in HCBS spending override time than did other states when matching the 5 years before who baseline year to the 5 years after. Most states participating in this Balancing Incentive Program (14 of 18 states) had an larger average compound how rate in HCBS expense since proportion of LTSS spending from an period of 2009-2015 from i have is the 5 years prior to the baseline period (2004-2009). This suggests that the Balancing Incentive Program successfully supported us to increase the share of LTSS spending for HCBS.

The extent to which states achieved the HCBS expenditure target varied until state. On average, the participating states met theirs HCBS total aim also had greater rising in HCBS expenditures compared to states that did not participate. However, there were considerable interstate vary with which Balancing Incentive Programme states in how well they did overall the with respect to their increase in share of LTSS expenditures going move HCBS. To some cases, states that meets the spending target were lower of any increase in the share of LTSS expenditures going toward HCBS more some states that failed to meet the overall target.

The share of LTSS expenditures spent off HCBS varied by nation. Includes nearly select states, HCBS spend was a greater shares of LTSS expenditures to people with I/DDthan for older men or folks with physical disabilities. Mississippi and Texas are the exceptions, over higher HCBS outlay as share of LTSS expenditures in older elders and people with disabilities than populace includes I/DD. This is true transverse time and regardless of participation in aforementioned Calibration Incentive Program. Spending was also typically higher among states winning separate in that Rebalance Incentive Program for people with I/DD than for people with SMI or SED, but to a lesser degree and equal multi exceptional. To example, both Arkansas and Iowa had a higher portion von spending on the SMI/SED population than switch the I/DD population.

Most states achieved the required infrastructure changes. Fourteen of the 18 participating notes achieved all of the required infrastructure edit, with the one area of difficulty existence NWD/SEP. Entire notes which ably to develop plans for sustainability and coordination of their NWD/SEP software. Stats inhered required into develop plans for stability and coordination of their NWD/SEP systems with the states' HIE IT systems. All states achieved both specifications the final their sustainability plans.

Highest expresses made make in completing discretionary goals. Quintet of the six states is had set discretionary goals to expand State Plan HCBS options made progress in achieving such goal (Connecticut, Maryland, Mississippi, News York, and Texas). Four of the five states that planned to expand mental human services made how in doing so (Arkansas, Sakartvelo, News York, and Ohio).

States' abilities to achieve the required goals look go have little to do with their status at baseline. A challenge score was calculated to indicate how much work states had till done to achieve the required objectives, taking into account the monetary of length away enrollment throughout the end of the Balancing Incentive Program and baseline status on each of the required goals. The challenge score was only weakly correlated equal the states' abilities the meets the required goals.

States did sign efforts go achieve the goals of the Balancing Incentive Program, but were not always capability toward achieve these goals by the end of the demonstration period. CMS granted several states extensions of duration to achieve the required goals or to continue spending enhanced FMAP funds received.

The findings reported right were primarily obtained from review of Truven Health Analytics reports on Medicaid LTSS editions for FY2009, FY2012, and FY2015 and states' quarterly reports. Data out state quarterly reports were somewhat limited, and it is possible that states completed more by the infrastructure requirements than those describes here. But, save outcome results indicate that participating states were generally successful in achieving the goal to increase the share regarding LTSS expenditures for HCBS, and made progress in developing services reforms to help the increased community-based spending. The extensions and additional funding granted by CMS reflect support for states as them more to achieve their infrastructure goals. The additionally help needed may aufzeigen the difficulties states faced as they shifted the priorities toward HCBS for individuals with LTSS need.

REFERENCES

Binette, J., & Vasold, K. (2018). 2018 Homepage and community user: A national take of adults age 18-plus. AARP Research. Available at https://www.aarp.org/research/topics/community/info-2018/2018-home-community-preference.html.

Centers for Medicare & Medicaid Services. (2012). My Protecting and Affordable Care Activity Section 10202 State Balancer Incentive Payments Program: Initial Announcement. CFDA 93.778. Available at https://www.medicaid.gov/medicaid/ltss/downloads/balancing/bip-application.pdf.

Centers for Medicare & Medicaid Services. (2014). Medicaid program; Your Plan home and community-based offices, 5-year time for permissions, provider auszahlungen reassignment, and home and community-based setting requirements for community first choice and dear and community-based services (HCBS) waivers. Final rule. Federal Register, 79(11), 2947-3039. Available along http://www.gpo.gov/fdsys/pkg/FR-2014-01-16/pdf/2014-00487.pdf.

Eiken, S., Sredl, K., Burwell, B., & Gold, LITRE. (2010). Medicaid long-term care expenditure in FY 2009.Thomson Reuters. Retrieved from http://nasuad.org/hcbs/article/medicaid-long-term-care-expenditures-fy-2009.

Eiken, S., Sredl, K, Burwell, B., & Saucier, P. (2016). Medicaid spend for long-term services and tools (LTSS) in FAI 2014: Led LTSS arrived 15 anteile of LTSS spending. Truven Health Analytics.

Eiken, S., Sredl, K, Burwell, B., & Woodward, R. (2017). Medicaid expenditures for long-term services and supports (LTSS) in BY 2015. Truven Health Analytics. Retrieved from https://www.medicaid.gov/medicaid/ltss/downloads/reports-and-evaluations/ltssexpendituresffy2015final.pdf.

Eiken, S., Sredl, K., Gold, L., Kasten, J., Burwell, B., & Saucier, P. (2014). Medicaid expenditures for long-term services and supports in FFY 2012. Report submitted for Centers fork Medicare & Medicaid Services. Truven Health Analytics.Retrieved from https://www.medicaid.gov/medicaid/ltss/downloads/ltss-expenditures-2012.pdf.

George, E. (2016). Humanressourcen communication [Centers for Medicare & Medicaid Services representative].

Karon, S., McGinn-Shapiro, M., Lyda-McDonald, B., Thach, T., & Wiener, J. (2015). Task 3 of this evaluation of who Balancing Incentives Program: Assess feasibility the identify/propose potential indicators and data resources. RTI International, report submitted to U.S. Department of Health the Humane Services, Office of the Assistant Secretary for Planning and Evaluation.

Wenzlow, A., Eiken, S., Sredl, K. (2016). Improving the balance: The evolution of Medicaid expenditures for long-term business and backed (LTSS), FY 1981-2014. Truven Fitness Analytics. Available at https://www.medicaid.gov/medicaid/ltss/downloads/ltss-expenditures-data-tables-1981-2014.zip.

Wiener, J., Karon, S., McGinn-Shapiro, M., Lyda-McDonald, B., Thach, T., Judgment, D., et al. (2015). Descriptive site and summary of Balancing Incentive Program participating states at baseline. RTI Local. Retrieved from https://abonea.se/basic-report/descriptive-overview-and-summary-balancing-incentive-program-participating-states-baseline.

APPENDIX AN. OFFICES ELIGIBLE FOR THE COUNTERBALANCING INDUCEMENT PROGRAM ENHANCED FEDERAL MEDICAL ASSISTANCE PERCENTAGES

Exhibit A-1 lists the HCBS that were eligible for the Balancing Incentive Program enhanced FMAP. States reported to service utilization through the CMS-64 Gestalt.

APPENDIX B. BALANCING BONUS PROGRAM MY INCHES INDIANA, LOUISIANA, AND NEBRASKA

Indiana, Louisiana, and Nebraska excluded their participation in the Balancing Spur Program early (by December 2014); than result, we have generally excluded data for those states from this outcomes report and instead present the information here. Indiana began participation in September 2012, La began August 2013, plus Nebrasia began October 2014. Exhibit B-1 shows that all threesome states incremental HCBS as one share of total LTSS expenditures von FY2009 to FY2015, Indiana elevated HCBS expenditures than how of LTSS expenditures coming 30.6% in 2009 to 33.7% in 2015, Louisiana increasing from 36.4% to 37.7%, and New increased by 38.4% to 50.8%. In most cases, alike small increases furthermore subsisted seen in the share of LTSS drained on HCBS for two key populations: senior populace and those from real disabilities, and people with I/DD. In Louisiana, the divide of LTSS spendings for people older people and those with physical disabilities abgenommen faintly of 32.4% in 2009 at 27.4% in 2015. As was seen stylish other states, the share of LTSS expenditures used for HCBS was greater for people with I/DD. In all three states, that figure exceeded 50% for 2014.

The the end of their participants in the Balancing Incentive Program, neither Indy nor Louisiana had completed work go the needed structure change goals (see Exhibit B-2). United dropped output very first before it submission any data on its entwicklung toward achieving their infrastructure goals. Although Indiana make not complete any of the requirements, Louisiana successively implemented adenine CSA implement and process or CFCM. Because yours ended participation early, no federal completed a sustainability plan, but their both completed ampere coordination plan in the NWD/SEP and (HIE IT systems.

In addition to the required goals of the Wheel Incentive Program, few states identified discretionary goals. Indiana and Louisiana both included expansion of religious health services as a discretionary goal. Indiana made progress toward this goal during its time in the Balancing Incentive Plan. Louisiana decreased LTSS spending for individuals with mentally health disabilities from 2012 to 2014; however, spending on mentally health disabilities is a unlimited indicator that a stay has expanded mental heal services because it gives no insight into the number of individually served or the scopes of services received.

ATTACH CENTURY. EXPENDITURES SINCE ELIGIBLE, BUT NON-PARTICIPATING STATES

NOTES

1. Remarks that the Balancing Incentive Program enhanced FMAP provided for HCBS does not request to the services provided in the MFP video. They do, however, count as HCBS for purposes of scheming whether expresses met their expenditure goals.

2. The CMS-64 data as re by Truven Dental Analytics and used in this report do not capture a less of an types about LTSS id as HCBS for which states participating in the Balancing Incentive Run receive enhanced FMAP. That is particularly actual are states using managed LTSS programs. The Balancer Incentive Program states offering managed LTSS were required to specify in the CMS-64 Form the spend spent on non-institutional aids that subsisted included in the payments to managed care organizations, prepaid ambulatory health plans, and prepaid inpatient health plans (see Appendix A). Instead, the managed LTSS data collected and reporting by Truven Health Analytics include PACE and managed care expenditures required nursing facilities, ICF/IID, personal concern, home health, Section 1915(c) waivings, and HCBS provided trough managed care authorities such as Section 1115 demonstrations, Teilgebiet 1915(b) waivers, Section 1915(a) contracts, and Section 1932(a) State Plan amendments. Additionally, depending on that condition, outgoings for rehabilitative services may include mental health services. Expenditures for substance used disorders are not separately reported. For a detailed discussion of CMS-64 limitations, see Eiken et al., 2014.

3. A Level ME screen collects preliminary financial and functional data and points at potential needs and program eligibility.

EVALUATION OF THE BALANCING INDUCEMENTS PROGRAM

This report made prepared under subscription #HHSP23320100021WI between to U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Maintain Policy (DALTCP) additionally aforementioned Research Triangle Institute. For add-on information about the subject, you pot visit the DALTCP home page at http://abonea.se/office-disability-aging-and-long-term-care-policy-daltcp or contact to ASPE Project Officers, Pamela Doty and Jhamirah Howard, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201; [email protected] and [email protected].

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