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Highlights

Pursuant to a congressional request, GAO reviewed home visiting, focusing on: (1) the nature and scope of home-visiting programs in the United States and Europe; (2) its effectiveness; (3) strategies critical to the design of programs that use home visiting; and (4) federal options in using home visiting.

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Recommendations

Matter for Congressional Consideration

Matter Status Comments
Congress has expressed its interest in home visiting as a strategy for bolstering at-risk families. In view of the demonstrated benefits and cost savings associated with home visiting, Congress should consider establishing a new optional Medicaid benefit: as prescribed by a physician or other Medicaid-qualified provider, prenatal and postpartum home-visiting services for high-risk women, and home-visiting services for high-risk infants at least up to age 1. Making home visiting an explicitly covered Medicaid service to improve birth outcomes will encourage states to provide ongoing funding for prenatal and postpartum home visiting.
Closed - Implemented
H.R. 290, H.R. 1391, and S. 902 were introduced with a provision to make home visiting an optional covered Medicaid service for high-risk women and infants. Congress enacted a home-visiting program in P.L. 102-321. The Committee cited the GAO report and recommended using the report's program design elements as criteria to choose grantees. No further action has been taken regarding provisions to make home visiting an allowable Medicaid service and no future action, according to HHS officials and other experts, is expected. The reason cited is anticipated changes to Medicaid as a result of health care reform.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Education The Secretaries of Health and Human Services and Education should require federally funded programs that use home visiting to incorporate clear objectives, which are used to manage program progress and to evaluate program outcomes.
Closed - Implemented
Education agreed and has incorporated language on objectives in requests for proposals.
Department of Health and Human Services The Secretaries of Health and Human Services and Education should require federally funded programs that use home visiting to incorporate clear objectives, which are used to manage program progress and to evaluate program outcomes.
Closed - Implemented
HHS has required a "clear statement of the problem" and "measurable goals and objectives" in home-visiting projects funded through the new Maternal and Child Health (MCH) Block grant set-aside.
Department of Education The Secretaries of Health and Human Services and Education should require federally funded programs that use home visiting to incorporate structured services by trained and supervised home visitors whose skills match the services they deliver.
Closed - Implemented
Education agreed and is using similar requirements.
Department of Health and Human Services The Secretaries of Health and Human Services and Education should require federally funded programs that use home visiting to incorporate structured services by trained and supervised home visitors whose skills match the services they deliver.
Closed - Implemented
HHS has required planned services delivered by qualified personnel supervised by appropriate health personnel in new home-visiting projects authorized under the MCH block grant set-aside.
Department of Education The Secretaries of Health and Human Services and Education should require federally funded programs that use home visiting to incorporate close linkages to other service organizations to facilitate access to needed services.
Closed - Implemented
OSEP recommended establishing close linkages to project directors at their annual meeting, but has not required it for previous requests for proposals from home-visiting projects.
Department of Health and Human Services The Secretaries of Health and Human Services and Education should require federally funded programs that use home visiting to incorporate close linkages to other service organizations to facilitate access to needed services.
Closed - Implemented
HHS has required case management and linkage into the existing service delivery system for new home-visiting projects funded under the MCH block grant set-aside.
Department of Education The Secretaries of Health and Human Services and Education should require federally funded programs that use home visiting to incorporate commitments for further funding beyond any federal demonstration period to sustain benefits beyond short-term initiatives.
Closed - Implemented
Education agrees and uses this approach in its outreach program.
Department of Health and Human Services The Secretaries of Health and Human Services and Education should require federally funded programs that use home visiting to incorporate commitments for further funding beyond any federal demonstration period to sustain benefits beyond short-term initiatives.
Closed - Implemented
As it has previously, HHS has encouraged MCH projects to plan how to continue funding if and when federal funding is discontinued.
Department of Health and Human Services The Secretary of Health and Human Services should incorporate those program design components when implementing provisions of the Omnibus Budget Reconciliation Act of 1989 pertaining to new home-visiting demonstration projects.
Closed - Implemented
HHS language in the draft case for proposals indicates compliance with the recommendation.
Department of Education The Secretaries of Health and Human Services and Education should make existing materials on home visiting more widely available through established clearinghouses, conferences, and communications with states and grantees.
Closed - Implemented
Education provided information on home visiting for dissemination through the National Information Center on Handicapped Children and Youth and at regional resource centers.
Department of Health and Human Services The Secretaries of Health and Human Services and Education should make existing materials on home visiting more widely available through established clearinghouses, conferences, and communications with states and grantees.
Closed - Implemented
HHS requested its technical providers to disseminate materials on home visiting to state agencies and other interested parties.
Department of Education The Secretaries of Health and Human Services and Education should provide technical or other assistance to programs to more systematically evaluate the costs, benefits, and future cost savings associated with home-visiting services.
Closed - Implemented
OSEP disseminated a report on comparative costs and benefits of home- and center-based services for handicapped children. OSEP also provided technical support to the project.
Department of Health and Human Services The Secretaries of Health and Human Services and Education should provide technical or other assistance to programs to more systematically evaluate the costs, benefits, and future cost savings associated with home-visiting services.
Closed - Implemented
HHS is encouraging and funding cost-effectiveness evaluations of home visiting and will continue to disseminate the results through existing clearinghouses and technical assistance projects.
Department of Education The Secretaries of Health and Human Services and Education should give priority to collaborative, interagency demonstration projects designed to: (1) meet the multiple needs of target populations; (2) incorporate home visiting permanently into local maternal and child health and welfare service systems; and (3) replicate models that have demonstrated their efficacy.
Closed - Implemented
Education reviewed its support of projects and continues to support home-visiting projects so that the special home-visiting initiative is contemplated.
Department of Health and Human Services The Secretaries of Health and Human Services and Education should give priority to collaborative, interagency demonstration projects designed to: (1) meet the multiple needs of target populations; (2) incorporate home visiting permanently into local maternal and child health and welfare service systems; and (3) replicate models that have demonstrated their efficacy.
Closed - Implemented
HHS agreed to give priority to collaborative, interagency demonstration projects.
Department of Education The Secretaries of Health and Human Services and Education should charge the Federal Interagency Coordinating Council with the federal leadership role in coordinating and assisting home-visiting initiatives through such activities as: (1) providing technical assistance in developing program services and program evaluations; and (2) supporting the development of a core curriculum for home-visitor training.
Closed - Implemented
FICC did not agree this was an appropriate role for it and declined the role.
Department of Health and Human Services The Secretaries of Health and Human Services and Education should charge the Federal Interagency Coordinating Council with the federal leadership role in coordinating and assisting home-visiting initiatives through such activities as: (1) providing technical assistance in developing program services and program evaluations; and (2) supporting the development of a core curriculum for home-visitor training.
Closed - Implemented
FICC did not agree that this was an appropriate role for it and declined it.

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