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Promoting Community Integration through Long-Term Services and Supports: Quality Measures

Beneficiaries using long-term services and supports account for about one third of all Medicaid expenditures. States are looking for ways to better measure the quality of care and health outcomes for beneficiaries in long-term services and supports (LTSS).[1] As part of the Medicaid Innovation Accelerator Program, the Centers for Medicare & Medicaid Services (CMS) contracted with Mathematica Policy Research and its partners, Brandeis University and the National Committee for Quality Assurance, to develop a measure for the CMS Medicaid Innovation Accelerator Program (IAP): Admission to an institution from the community among Medicaid fee-for-service (FFS) home and community-based service (HCBS) users.

Admission to an institution from the community among Medicaid fee-for-service (FFS) home and community-based service (HCBS) users (PDF, 246.7 KB): This measure looks at the rate of institutional admissions (nursing facility or intermediate care facility for individuals with intellectual disabilities [ICF/IID]) per 100,000 months of HCBS use among Medicaid FFS beneficiaries age 18 and older in the measurement year. Three rates will be reported:

  • One for short stays (1 – 20 days)
  • One for medium stays, (21 – 100 days)
  • One for long stays (101 days or more)

Measure Dissemination Webinars

CMS introduced the several new LTSS Medicaid quality measures, including one measure developed for IAP: Admission to an Institution from the Community (Fee-for-Service version)

[1] Eiken S, Sredl K, Burwell B, and Saucier P. Medicaid Expenditures for Long-Term Services and Supports (LTSS) in FY 2013: Home and Community-Based Services were a Majority of LTSS Spending Truven Health Analytics, June 30, 2015.