Best Practice, Expected Practice, and the Challenge of Scale by Michael W. Smull, Mary Lou Bourne, and Helen Sanderson. Most state developmental disabilities (DD) systems have attempted to nurture the development and application of innovative practices through pilot projects and demonstrations that have defined desired best practice outcomes. While progress has been made, the challenge to move typical practice toward best practice, to “take best practice to scale” remains. To do this, state leaders need to operationally define “expected practice” and create positive pressure for change through a set of actions that move typical practice toward best practice. This paper explores our understanding of the meaning of best practice, reviews the lessons learned from thought leaders who have taken change to scale and offers a new way of thinking about expected practice.

Advancing Integrated Employment Outcomes through Home and Community-Based Waiver Services: Briefing Document on Section 1915(c) Medicaid Waiver Service Definitions.The State Employment Leadership (SELN) recommends changes for core service definitions to Center for Medicare and Medicaid Services (CMS). The recommendations are made to bring clarity to employment outcomes in delivery of services and supports under Medicaid Waiver Programs. The recommendations will be taken into consideration by CMS during the review and revision process for Version 3.6 of the Medicaid Application for a §1915(c) Home and Community-Based Waiver [Version 3.5] Instructions, Technical Guide and Review Criteria, which will occur in the next 12 to 18 months.