These summaries were finalized between April and November of 2005 (see the front pages of Appendix A, Appendix B, and Appendix C for specific months of completion). They answered our many questions with diligence and care, and we are especially grateful for their willingness to review early drafts of the summaries of our discussions. Many thanks also are owed to the state officials with whom we talked. Bob Whitaker read an early draft and made numerous suggestions that improved the report considerably. Sharon Clark managed the production of early drafts and the final report with her usual efficiency and good humor. Lindsay Harris, a former analyst on our staff, helped enormously in the early stages of the project, participated in many of the discussions with state officials, and drafted several of the summaries found in the appendices. We thank her very much for her considerable help and leadership. We are grateful to everyone who participated in these panels, and absolve them all from any inaccuracies or misinterpretations that remain in the report.Ĭille Kennedy, our project officer in the Office of the Assistant Secretary for Planning and Evaluation, provided the initial impetus for this project as well as continued encouragement, support, and good ideas. This group read an early draft of the report and provided many helpful comments and suggestions. The second panel, convened in March 2006, included Gary Blau, Sybil Goldman, Ron Hendler, Chris Koyanagi, Ken Martinez, Martha Moorehouse, Judith Teich, Constance Thomas, and James Wotring. These individuals helped develop an appropriate focus for the project in its early stages. The first, convened in May 2004, included Robert Friedman, Gary Harbison, Russell Frank, Darcy Gruttadaro, Bruce Kamradt, Carol Lichtenwalter, Lucy Keating, Sybil Goldman, Karen Spoelman, Randy Myers, and Andrea Fiero. We asked two panels of experts to assist in the development of the project and final report. SYNTHESIS AND IMPLICATIONS REFERENCES GLOSSARY NOTES APPENDICES APPENDIX A: States with Comprehensive Statewide Reforms APPENDIX B: States with Home and Community-Based Service Waivers APPENDIX C: States with a CMS Grant for a Feasibility Study and Development Project for Community-Based Treatment Alternatives for Children with SED APPENDIX D: Values and Principles Supporting the Systems of Care Approach APPENDIX E: Cost of Services Provided Through HCBS Waivers LIST OF TABLES TABLE ES.1: Advantages and Disadvantages of Four Financing Mechanisms for Supporting Intensive Home and Community Services for Youth with SED TABLE II.1: Estimates of Expenditures for Home and Community Services and Hospital Level Care for Youth with SED TABLE II.2: Mechanisms for Financing Intensive Home and Community Services for Youth with SED TABLE II.3: Use of Selected Mechanisms for Financing Intensive Home and Community Services TABLE IV.1: Advantages and Disadvantages of Four Financing Mechanisms for Supporting Intensive Home and Community Services for Youth with SED TABLE IV.2: Intensive Home and Community Services Provided Through HCBS Waivers in Five States ACKNOWLEDGMENTS Case-Rates Used by Designated Care Management Entities for High-Risk Populations D. STRENGTHS AND WEAKNESSES OF SELECTED FINANCING MECHANISMS A. STATE APPROACHES TO FINANCING HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SED AND THEIR FAMILIES A. The Role of Residential Treatment Facilities III. Financial Incentives for State Agencies E. Sources of Federal Funding for Child Mental Health Services C. Number of Youth with SED in Residential Care and Costs Associated with Their Care B. MECHANISMS FOR FINANCING SERVICES FOR YOUTH WITH SED AND THEIR FAMILIES: CRITICAL BACKGROUND ISSUES A. TABLE OF CONTENTS ACKNOWLEDGMENTS EXECUTIVE SUMMARY I. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. Her e-mail address is: opinions and views expressed in this report are those of the authors. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. For additional information about the study, you may visit the DALTCP home page at or contact the ASPE Project Officer, Cille Kennedy, at HHS/ASPE/DALTCP, Room 424E, H.H. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and Mathematica Policy Research, Inc. This report was prepared under contract #HHS-100-03-0024 between the U.S. Ireys, Sheila Pires and Meridith Lee Mathematica Policy Research, Inc. Department of Health and Human Services Public Financing of Home and Community Services for Children and Youth with Serious Emotional Disturbances: Selected State Strategies Henry T.
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