HCBS Quality Measure Set
In September 2020, CMS released a request for information (RFI) seeking public input on a draft set of recommended measures for Medicaid-funded HCBS. This RFI requested feedback on the potential benefits of and challenges that could result from a nationally available set of recommended quality measures for voluntary use by states, managed care organizations, and other entities engaged in the administration and delivery of HCBS. CMS also requested stakeholder comment on the purpose and organization of the recommended measure set, the criteria used to select measures, and a preliminary draft set of measures for assessing the quality and outcomes of Medicaid-funded HCBS.
On July 21st, 2022, CMS issued a State Medicaid Director Letter to release the first official version of the HCBS Quality Measure Set. The HCBS Quality Measure Set is a set of nationally standardized quality measures for Medicaid-funded HCBS. It is intended to promote more common and consistent use within and across states of nationally standardized quality measures in HCBS programs, create opportunities for CMS and states to have comparative quality data on HCBS programs, drive improvement in quality of care and outcomes for people receiving HCBS, and support states’ efforts to promote equity in their HCBS programs.
CMS developed a technical assistance resource for states containing supplemental information about the quality measures in the HCBS Quality Measure Set. The Measure Summaries includes technical specifications, links to testing reports, and information about the measures’ alignment with the CMS Meaningful Measures Initiative, CMS Measures Management System Blueprint measure criteria, 1915(c) waiver assurances and subassurances, and health equity variables.
CMS is available to provide technical assistance to states on the implementation of the measure set. Questions or requests for technical assistance related to the measure set can be directed to HCBSmeasures@lewin.com.
CMS Quality Design and Review Processes for 1915(c) Waivers
In response to recommendations from the General Accounting Office in 2004, CMS initiated a structured and transparent quality oversight process with states related to section 1915(c) waiver programs. At that time CMS established an evidentiary approach to quality reviews of HCBS waiver programs using a continuous quality improvement process applied to the waiver assurances. CMS clarified the role of the Single State Agency as having first line responsibility for quality reviews and established a waiver cycle timeline in which the reviews were regularly conducted.
In 2007, CMS released a second revised iteration of the quality review process. CMS standardized three key steps in the review cycle, clarified the site visit policy, and included a worksheet and checklist to improve consistency of reports across regional offices. Concurrently, CMS released version 3.5 of the section 1915(c) application, which further clarified the design of the state quality improvement strategies with a focus on performance measures, sampling, and the continuous quality improvement process (discovery, remediation, and system improvement). CMS also established a tracking system for the timeliness of internal processes associated with the quality review, in an effort to facilitate effective waiver renewals.
In 2014, CMS released new modifications to the quality review process and version 3.6 of the section 1915(c) application. CMS, with significant involvement by stakeholders, refined the reporting expectations of states. CMS utilizes the updated quality review process to conduct oversight of states’ 1915(c) waiver and 1915(i) State Plan programs. Building off of these foundational activities, CMS aims to streamline processes related to HCBS quality measurement and reporting and to improve the quality of services and outcomes for people who receive HCBS.