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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.

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.

HCBS Measures

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 following measures: Identifying Personal Priorities for FASI Needs (CMIT Measure ID #969) in 2021 and Alignment of Person-Centered Service Plan with FASI Needs (CMIT Measure ID #970) in 2023.
  • Long-Term Services and Supports (LTSS) quality measures. The CMS LTSS nationally standardized quality measures are designed for states with delivery systems with managed long-term services and supports (MLTSS), and fee-for service (FFS) . The LTSS measures are aligned pairs, with unique technical specifications focused on MLTSS and FFS delivery systems. The LTSS quality measures evaluate LTSS assessment and person-centered planning processes, LTSS falls risk, and LTSS rebalancing and utilization (CMIT Measure ID #20, 414, 960-963, 968, and 1255). States with hybrid LTSS programs, delivered via FFS and MLTSS, should refer to both the FFS LTSS and MLTSS measures’ specifications to evaluate performance for their state’s LTSS programs.
  • The LTSS measures and other HCBS quality measures are included in CMS’s  HCBS Quality Measure Set, released in July 2022. The HCBS Quality Measure Set promotes 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

Previous Demonstrations

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 Measures Informational Bulletins and Briefs

2024 Home and Community-Based Services (HCBS) Quality Measure Set (QMS):  This CMCS informational bulletin updates the Home and Community-Based Services (HCBS) Quality Measure Set (QMS) for 2024.  CMS strongly encourages states to use the measures and plans to incorporate use of the HCBS QMS into the reporting requirements for specific Medicaid program authorities that include HCBS.

Home and Community-Based Services (HCBS) Quality Measure Set (QMS) Reporting Requirements for Money Follows the Person (MFP) Demonstration Grant Recipients: This informational bulletin describes the HCBS QMS reporting requirements for MFP grant recipients subject to the updated MFP Demonstration Program Terms and Conditions (PTCs) and addresses requirements and expectations in the following areas: populations groups, reporting timeframe, required measures, stratification and sampling.

This issue brief series summarizes major developments in HCBS quality measures, covering three critical processes and outcomes of high- quality care: