Workforce Challenges & DDS Waiver Services Analysis
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Illustrative Areas for Potential Further Study
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This study focused on existing pathways for people with intellectual disabilities, developmental disabilities, and autism, gaps, and recommendations on how to fill those
gaps. There are correlating issues that are beyond the scope of this study that may be helpful to understand further. Some examples are listed below.
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Rates: This study did not address current rate adequacy and equity across programs. We did recommend cost reporting as part of implementation, so that
rates for new services would be developed in a way that is data-driven and based upon actual provider experiences.
Regulatory Oversight: State systems have a responsibility to oversee their provider network and assure quality, incident reporting, mortality review, and
prevention of fraud, waste and abuse. How states implement this varies and there is a balance needed to assure health and safety without being unduly
burdensome. This study did not review North Dakota's regulatory structure,
Private Insurance: In 2018 the North Dakota Department of Insurance issued a bulletin requiring insurance companies to cover autism treatments with
limits that are no more restrictive than the limits placed upon benefits for medical and surgical treatments by 2019. It may be helpful to research how private
insurance companies are implementing this requirement.
Workforce: Nationally, and here in North Dakota, there is a workforce crisis impacting the field and especially the availability of Direct Support Professionals.
Understanding and planning for expansion will require consideration of how to leverage the current workforce, effectively incentivize people to join this
workforce, and how to retain existing workers. (Please see Appendix Section on Workforce Challenges for more information.)
Tribal Engagement: A&M reached out to tribal leaders, but only connected with 2 Native American stakeholders. They spoke about lack of access to
providers, difficulty with schools, and the need for culturally competent services. A&M recommends continuing these conversations and looking at ways to
leverage the Indian Health Center 100% Medicaid match.
Educational System Capacity: We heard that school systems have varying capacity to support children with the greatest needs, and also that in some
instances, children are pulled from class time to do non-educational oriented clinical interventions like ABA.
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