Sending Office: Honorable Steve Stivers
Sent By:

Dear Colleague,


We are writing to encourage you to join this
letter (included below) to Administrator Seema Verma of the Centers for Medicare and Medicaid Services requesting additional guidance on the use of technology within Medicaid. 
While states currently have the authority to approve the use of technology in the Medicaid program, they have been slow to do so under the Home and Community Based Services (HCBS) waiver and Intermediate Care Facilities for Individuals with Intellectual Disabilities
(ICFs/IID) programs. 


Each year, turn-over rates of the Direct Support Professionals (DSPs) working with the I/DD community average at 50%, with some states exceeding 70%.  CMS
guidance actively encouraging the use of remote technology, such as motion detectors/sensors, promotes a less invasive and more cost-effective solution to this workforce crisis. 


In light of this, we ask you to join us in urging CMS to issue guidance on the use of the technologies already permitted within Medicaid.  In addition, we
encourage state Medicaid agencies to allow HCBS and ICFs/IID programs to promote cost-savings and patient-centered care through technology. 


If you have any questions or would like to sign-on, please contact Congressman Steve Stivers’ office through Drew Hatter at, or Congressman Paul Tonko’s office through Jeff Morgan at by
March 21, 2018. 





Steve Stivers                                                                                       Paul Tonko

Member of Congress                                                                           Member of Congress



Seema Verma, Administrator

Centers for Medicare & Medicaid Services

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Washington, DC 20201

Dear Administrator Verma:

We write to express our support for the greater incorporation of technology in the delivery of services for people with disabilities under the Home and Community Based Services (HCBS)
waiver and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) programs. We encourage the Centers for Medicare and Medicaid Services (CMS) to authorize the innovative use of technology in these important waiver services to:
improve service provision; more effectively utilize the skills of direct support professionals given the ongoing workforce crisis; and make more efficient use of Medicaid funding.

Over half of all Medicaid long term care spending is spent on home and community-based services, yet over half a million people with disabilities are on waiting lists for home and
community-based services under the 1915(c) waiver alone. We believe that by embracing technological advancements more people can be provided these services under a shared staff model. Examples include remote technology like passive and interactive video support,
and unique sensor technology. This would deliver more person-centered and independent services for these individuals while also saving and best utilizing Medicaid funding.

Providers of services for people with disabilities should be able to access federal funding to technological advancements just as other health care systems do, but the current system
does not allow for this to occur. For example, standards and requirements for these services should be revisited, including the standard that on-site direct support professional time is the only standard or measure of services that may be delivered, funded,
or determine a person’s need for support or supervision. We must ensure that regulatory and payment methodologies enable rather than deter service providers and families’ access to the most innovative emerging technologies to promote integration and efficiency. 
These individuals must have the flexibility to transition from on-site staff to technology-enabled remote supervision to increase their functional independence without jeopardizing loss of services or access to adequate resources.

Finally, we encourage CMS to support shared savings models that allow providers to leverage technology-initiated savings to bolster their workforce, to invest in technology for additional
waiver recipients and to serve more people. We believe this is a smart investment in quality services and an effective approach to address long and growing waiting lists for services.

We respectfully request that CMS review and enhance its ability to permit providers of HCBS and ICFs/IID program services to provide services using emerging technology. We also request
that CMS communicate to states providers’ ability to use emerging technology within their Medicaid partnerships with the federal government.

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