Home and Community-Based Services (HCBS) Quality
The Centers for Medicare & Medicaid Services (CMS) works with states to assure and improve quality across the Medicaid authorities that support long-term services and supports (LTSS). Current approaches to improving quality have expanded to include managed care, section 1115 demonstrations, state plan services, and the HCBS Quality Measure Set. Through HCBS quality initiatives, CMS seeks to maximize the quality of life, functional independence, health, and well-being of HCBS participants.
The Centers for Medicaid and CHIP Services (CMCS) also uses contractors to oversee select efforts to develop and maintain Medicaid HCBS quality measures and to support state technical assistance on topics such as encouraging community integration and the holistic well-being of HCBS participants. Understanding the quality of HCBS has become increasingly important as demand for HCBS grows.
CMS’s focus on HCBS quality spans many years, with recent focus on developing new HCBS quality measures to further performance evaluation and measurement, supporting evidence-based promising practices, and promoting person and person-centered outcome measurement.
CMS has supported development of several HCBS quality measures. The HCBS Quality Measures webpage provides current information on HCBS and LTSS measures, including:
- Consumer Assessment of Healthcare Providers and Systems Home and Community-Based Services (HCBS CAHPS®) Survey quality measures. The HCBS CAHPS Survey, developed by CMS, includes 19 quality measures. A Consensus-Based Entity endorsed the HCBS CAHPS Survey quality measures in 2016 (CMS Measure Inventory Tool [CMIT] Measure ID #95).
- Functional Assessment Standardized Items (FASI) performance measures. CMS tested the use of two FASI performance measures under the Testing Experience and Functional Tools Demonstration. A Consensus-Based Entity endorsed Performance Measure-1: Identifying Personal Priorities for FASI Needs (CMIT Measure ID #969) in 2021 and Performance Measure-2: Alignment of Person-Centered Service Plan with FASI Needs (CMIT Measure ID #970) in 2023.
- LTSS quality measures. CMS has eight MLTSS quality measures for states to consider when using a managed care delivery system for providing LTSS (CMIT Measure ID #20, 414, 960-963, 968, and 1255).
These and other HCBS quality measures were included in CMS’s HCBS Quality Measure Set, released in July 2022. The HCBS Quality Measure Set is intended to promote more common and consistent use within and across states of nationally standardized quality measures in HCBS programs. The Measuring and Improving Quality in HCBS webpage provides information and resources related to the HCBS Quality Measure Set.
New HCBS Measures
New CMS HCBS quality measures are also in development, including multiple HCBS and LTSS measures. Additional information about new measure development and announcements about public comment opportunities are available on the HCBS New Measure Development webpage.
Testing Experience and Functional Tools Demonstration: Designed to test quality measurement tools and demonstrate health information technology in Medicaid HCBS, the Testing Experience and Functional Tools Demonstration concluded in 2018. All Testing Experience and Functional Tools Demonstration materials may be found on the TEFT webpage.
HCBS Quality Measure Issue Briefs
This issue brief series summarizes major developments in HCBS quality measures, covering three critical processes and outcomes of high- quality care: