The use of technology in home and community-based services (HCBS) could help states address workforce shortages, increase service efficiency, and provide access to care in rural and underserved areas, while simultaneously supporting patients' autonomy, inclusion, and quality of life. As state adoption of technology-based HCBS increases and technology innovations continue to grow exponentially, state Medicaid agencies must develop payment strategies that reflect these services’ unique costs and structure. Unlike traditional HCBS that rely primarily on direct care staff, technology-based HCBS have greater variety in types of costs, including expenses related to the assessment of technology needs for individuals, technology infrastructure, devices, training, ongoing monitoring, and maintenance.
State Medicaid agencies should consider modeling Medicaid payment models to reflect this variability in costs, in addition to state-specific delivery requirements and overall state HCBS policy goals. The broadly accepted payment rate component build-up approach used by many states for HCBS can be leveraged for technology-based HCBS, as long as careful identification of the unique costs of these services is considered under each rate component. This white paper reviews the range of technology-based HCBS and benefits of adoption, the evolution of funding, and considerations for state policymakers when developing Medicaid payment strategies.
We cover the following discussion points.
- Key considerations for new technology-based HCBS: Ensuring that payment rates are supportive of providing access to efficient and high-quality services consistent with person-centered care, individual choice, independence, and community integration
- Benefits: Three key reasons to invest in technology at the state agency and individual levels
- Definition: The use of a wide range of service delivery modalities, devices, and technologies
- Medicaid authorization and delivery: What states must do as part of delivering technology-based HCBS
- Expansion and related funding: Factors such as the Public Health Emergency, the American Rescue Plan Act, and the Rural Health Transformation (RHT) program
- Developing reimbursement methodologies for technology-based services: No one-size-fits-all approach to developing a payment rate