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The Road to Remote Supports A Practical Guide (INTERNAL DRAFT v1 09292026)
Table of Contents Purpose 3. Introducing Remote Supports Services 4. Spreading the Word 7. Education and Training 10. Implementation of Remote Support Services 12. Success Stories 14.
Purpose This guide is intended for state Medicaid and home and community-based services (HCBS) program staff evaluating or launching a remote supports (RS) initiative. It outlines the foundational elements that should be in place before a program launches, and the practices that most reliably determine whether a new initiative succeeds or stalls. It draws on patterns observed across multiple state rollouts of RS services.
Introducing Remote Supports Services Remote Supports (RS) is the delivery of real-time support from a trained professional located somewhere else. Support is provided through agreed- upon devices—phones, tablets, sensors, and other assistive technology— but the heart of the service is still human connection. Before building a RS initiative, states should confirm three foundational elements are in place. Each is a prerequisite; without it, a program is significantly more likely to stall regardless of how well the rollout itself is managed. Regulatory Foundation for the Service A Budget Built into Standard Delivery Executive Level Commitment Establish clear rules and regulations governing remote support before program launch and tie the service explicitly to a waiver. Remote supports should not be treated as a standalone, add on budget line. Support for the initiative has to come from the executive level of the state agency, not only from enthusiastic staff lower in the organization. Let’s explore these elements in more depth.
A Regulatory Foundation for the Service Establish clear rules and regulations governing remote support before program launch and tie the service explicitly to a waiver. Providers, case managers, and families all need a defined regulatory basis to operate from. Ambiguity here creates hesitation at every level of the system. CMS has recognized remote / telehealth delivery of waiver services as a service-delivery modality. CMS provides guidance on technology in HCBS waivers through the Waiver Technical Guide found on their waiver portal. Several states have updated their rules and regulations. Create a Clear Definition of Remote Supports Remote supports (RS) is a technology-based service that allows trained, remote supports professionals (RSPs) to deliver live support to an individual at a remote location. Maryland Iowa Oversight and monitoring in the participant's home through an off-site electronic support system to reduce or replace staffing while ensuring health, safety and welfare. Supported Community Living provided by a trained remote support professional who is in a remote location and engaged with the person through enabling technology using live two-way communication.
A Budget Built into Standard Delivery Remote support should not be treated as a standalone, add on budget line. It is a service and should be funded the same way any other service delivery is funded, tied to the individual's general service budget rather than carved out as something extra. Remote support is an alternate means of delivering service, not a supplement to it, and the budget structure should reflect that. Create billing codes specific to remote support and fund them at a level sufficient to make the service genuinely useful, not merely available on paper. Determine if the service will be included in all waivers. Consider supports for older adults in addition to individuals with intellectual and developmental disabilities. Executive Level Commitment Support for the initiative has to come from the executive level of the state agency, not only from enthusiastic staff lower in the organization. Without a strong, visible commitment from the top, culture change of this kind is not achievable. States should identify a sponsor at the executive level who is actively pushing for the initiative to succeed, so that case managers, providers, and regional offices can see that leadership itself is invested in the outcome. Adopt your own Technology First Initiative. Create an inclusive cross program technology workgroup. Engage stakeholders in discussions about technology and remote support services.
Spreading the Word Once the foundational elements above are in place, the following practices consistently distinguish initiatives that gain traction from those that stall after launch. I. Rely on Provider Expertise Rather than Building it Internally State agencies and case managers play a critical role in supporting remote services, while specialized partners can provide the technology and operational expertise needed to implement them effectively. Organizations should lean on remote support provider companies to help fill technical and operational knowledge gaps, identify champions across departments and regions who are genuinely enthusiastic about the technology and can encourage adoption organically, and empower people with lived experience to share their own stories about how remote support has impacted their lives. These stories can be amplified through video testimonials, success stories, and speaking engagements, as real-life examples are often more persuasive than secondhand accounts from staff. In addition, supporting the creation of demo homes can provide stakeholders with a tangible way to experience and better understand the benefits of remote support firsthand.
II. A. Communicate Clearly the Benefits of Remote Supports There are three primary benefits that appeal to stakeholders: III. A. Communicate Clearly the Benefits of Remote Supports New service offerings are difficult to get off the ground all at once. States should: Target a pilot size of roughly 50 to 100 individuals. Larger pilots generally produce more reliable results. Consider funding the pilot with grants or other resources outside of fee for service. Start with a pilot cohort rather than a full statewide rollout. Funding the Pilot Funding the pilot with grants or other resources outside of fee for service enables the initiative to prove itself before it has to compete for standard budget dollars.
IV. Build Incentives for Providers Remote supports initiatives have stalled in states where the provider has been unintentionally disincentivized to support an individual transitioning from a legacy service to remote supports. Remote supports provides a significant positive economic impact, and the funding model should be designed so providers benefit rather than lose out. Options include: Backup support arrangements that keep providers engaged and compensated. Value based payment models, as used in Missouri, that share savings rather than remove funding.
Education and Training Here are some useful tips for organizing education and training on remote supports. I. Let Providers Participate in Training Allowing remote supports providers to help train case managers and state representatives produces a far more thorough and practical training than state staff alone can deliver. To keep the process fair and transparent, states should: Structure training as an open bid contract, or Invite all qualified national and local providers to present their approach. II. Collaborate with Other State Developmental Disability Agencies Training can also be developed by collaborating with other State Developmental Disability Service Agencies who have existing training plans. Click the icons below to see examples. Oklahoma Colorado Pennsylvania
III. Learner Groups to Target When planning training experiences, consider providers, managed care organization, families, individuals, and case managers. Providers Managed Care Organizations Families Individuals Case Managers Case managers should learn to make enabling technology a starting point in service planning, not an afterthought. They should understand common remote-supports technologies, including their capabilities and limitations. Emphasize to case managers that when recommending remote supports to individuals, their guiding question should be: What's the least intrusive way technology could address this need? At the conclusion of each training, give learners a chance to apply the new knowledge, skill, or ability in a realistic scenario. Lastly, encourage case managers to commit to some action. This could look like: Starting a conversation with an individual about remote supports. Considering technology as a support earlier in the planning process. Considering how technology can support an individual’s goals and lifestyle. Presenting remote supports as an option to supplement in-person services.
Implementing RS Services Here are some useful tips for implementing remote supports services. Keep the Process Simple for Case Managers Keeping processes simple for case managers is essential because they already manage complex responsibilities and competing demands. A complicated process can become a barrier that prevents case managers from considering or recommending a new service. Consideration of technology and remote supports can be included as a standard part of every service planning meeting by asking these five questions: 1. What does the individual want to be able to do? 2. What support do they actually need to accomplish it? 3. Could technology help them do more independently? 4. Could some of the human support be provided remotely? 5. What is the least intrusive combination of technology and human support that will keep the person safe and successful?
Create easy and efficient processes: Request Assessment Connect to Service Options Approval Start of Service If adding remote supports becomes a burden for case managers, they will not use it, and the program will not achieve buy in. To minimize friction, states should: Avoid requiring case managers to collect multiple competing quotes. Avoid requiring multiple separate assessment forms. Limit the case manager's role to knowing the individual and communicating what services are needed, then let the RS provider complete the assessment together with the care team.
Success Stories Jeff’s Story Jeff from Virginia has Down Syndrome and Diabetes. His parents, who are aging, were concerned about his future and wanted to ensure he adhered to his medication routine. They feared that as they could provide less direct support, no one would be available to remind him to take his medications and manage his diabetes, as well as other tasks to keep him healthy and safe. RS provided the perfect solution. With this service, Jeff receives reminders and prompts to take his medications, clean his home, make healthy food and drink choices, and engage in meaningful social interactions. He values his independence and didn't want in-home support, so Remote Supports offered a way to get the assistance he needed without having people in his space. As a result, Jeff has been successfully taking his medications on schedule, leading to balanced blood sugar levels. This gives his parents and support coordinator peace of mind, knowing he can continue living independently and stay safe and healthy. Jeff now enjoys his independence while maintaining a healthy lifestyle and engaging socially.
George’s Journey to Stability George attends a day program, but when he returns home to live by himself, he often feels depressed and anxious. This anxiety and depression caused him to act out and break things in his home. George wanted to continue living independently, so Remote Supports was suggested to provide on- demand support. With Remote Supports, George can reach out whenever he feels lonely, afraid, or anxious. Having someone to talk to helps him manage hisd feelings and maintain a positive outlook. Since starting Remote Supports, George no longer acts out. He is able to go to bed at a normal time, sleep well, and wake up ready to attend his day program. Thanks to Remote Supports, George has successfully managed his depression and anxiety, leading to a more stable and independent life