Remote monitoring (RM) services offered through Medicaid home and community-based service (HCBS) waivers allow some individuals with intellectual and developmental (IDD) to live the increasingly independent lives in their community of choice. For some individuals, RM services provide sufficient supports so that the individual does not need a direct support professional (DSP) in his or her home. This reduces the cost of the service. It may also promote autonomy among individuals with IDD, that would be an efficient and effective use of state and federal dollars.

In Ohio, RM services can be delivered through the following methods:

  • Live video feed
  • Live audio feed
  • Motion sensing system
  • Radio frequency identification
  • Web-based monitoring system
  • Another Similar device

To ensure health and safety, each system must include devices to engage in live two-way communication with the individual being monitored.

Methods

The Center for Epidemiological Research for Individuals with Intellectual and Developmental Disabilities (CERIIDD) analyzed RM services access, utilization rates, and cost for Ohioans with IDD receiving an HCBS waiver. 2012-2017 State Fiscal Year Medicaid claims data for this analysis was provided by the Ohio Department of Developmental Disabilities (DODD).

Results

In fiscal year 2017, in Ohio, 176 individuals were using their HCBS waiver dollars to access RM services, a 13 fold increase from 2012 when the services were launched (Figure 1). These 176 individuals reside in 44 of Ohio’s 88 counties. While interest and participation in RM services continued to grow each year, individuals who access RM services represent less than .5% of the population who received services through an HCBS waiver (n=38,487).

Individuals with IDD can also use their waiver funding to receive homemaker/personal care services (H/PC) or on-site/on-call (OSOC) services. In H/PC services, a DSP actively provides supports in an individual’s home or another community setting and can be provided if an individual is awake or asleep.¹ In OSOC services, a DSP is providing supports in an individual’s home while the individual is asleep at night and does not need supervision. Staff is present in the event an individual needs support during the night, but staff is not required to be awake while on call. RM services may offer cost savings compared to these other traditional supports.²

To compare cost across services, CERIIDD calculated the range of possible hourly rates for the three different services (Figure 2). In Ohio, the cost of service can be impacted by the geographic location of service delivery, if an individual has complex medical or behavioral needs, and the number of individuals a DSP is supporting at one time. To calculate the costs range in Figure 2, an individual is receiving one-on-one supports from a DSP. CERIIDD’s analysis shows RM services can cost between two and three times less than traditional H/PC services. Not included in this calculation is the annual $5,000 that an individual can access to purchase RM equipment.

 

Figure 3 displays the average hourly claims per site as reported by the DODD. DODD calculated fiscal year 2017’s  average cost for an hour of H/PC service as $19.61 and the average for an hour of RM services as $7.17. Unlike the calculations in Figure 2, average claims per hour per site includes both one-on-one services and shared services. However, combining shared services and one-on-one services still results in RM services costing more than two and a half times less than H/PC services. Not included in this calculation is the average monthly per site RM equipment cost of $133.31.

Discussion

 

RM services may be a viable alternative service delivery method. However, there is no accepted best practices for the use of RM broadly among the IDD population. It is recommended that RM services be analyzed to determine when RM would not meet the needs of an individual with IDD. For the individuals who RM services are appropriate, the service may facilitate a new level of independence, but this requires additional analysis. The utilization of RM services may result in an efficient allocation of Medicaid funds and may also allos providers to efficaciously utilize their direct support staff.

Citations

¹ Ohio Admin. Code 1501:2-9-35 ({6/26/2017})
² Ohio Admin. Code 1501:2-9-30 ({8/22/2017})

Data Brief: Remote Monitoring in Ohio (pdf)