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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.

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.

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:

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

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 Measure Issue Briefs

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