Quality of home- and community-based services

Long-Term Services and Supports

People who receive home- and community-based services (HCBS) typically have chronic conditions and their functional ability is likely to decline over time due to the nature of their disability or age. Thus, quality measures focusing on improvements in health status and function are not alone sufficient to monitor these HCBS over the long term. More appropriate HCBS quality measures include improvement in quality of life, community integration, and avoidance or delay of institutionalization. Measures must also address the needs of different populations; for example, certain outcomes, such as satisfaction with employment supports, may be more relevant to younger individuals with intellectual or developmental disabilities (ID/DD) than to older adults.

Most current measures used to assess the quality of HCBS focus on compliance with waiver reporting requirements such as confirming that provider qualifications or personal goals were included in service plans (SHADAC 2016). There are relatively few measures for service delivery and effectiveness, community inclusion, and caregiver support (NQF 2016).

Efforts are underway to develop and test HCBS quality measures that can provide information to aid policymakers in long-term services and supports (LTSS) program oversight. These efforts place emphasis on beneficiary experiences and outcomes.

  • The Experience of Care (EoC) Survey of beneficiaries with all types of disabilities, developed and tested by CMS, has been incorporated into the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program as the CAHPS Home and Community-Based Services Survey. The National Quality Forum has also endorsed 19 quality measures derived from the survey (CMS 2017).
  • The National Core Indicators for Intellectual and Developmental Disabilities and National Core Indicators for Aging and Disabilities beneficiary surveys can be used in both FFS and managed care programs. Both surveys focus on beneficiaries’ reports of their quality of life and outcomes (Bradley et al. 2017).
  • CMS has contracted with Mathematica Policy Research and the National Committee for Quality Assurance to develop and test standardized managed LTSS (MLTSS) quality measures. CMS has begun making technical specifications available to states, beginning with four comprehensive assessment and care planning measures. These technical specifications will allow states to implement these measures if they desire to do so (CMS 2018).

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