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.
Examples of HCBS quality measures that states may report on a voluntary basis are listed below:
- The HCBS Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey measures the experience of care for beneficiaries with disabilities or chronic illness who use HCBS. The HCBS CAHPS is intended to provide standard measures for HCBS programs that are applicable to populations they serve. 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). The National Core Indicators for Aging and Disabilities is included in the Medicaid Adult Core Set (CMS 2021).
- CMS has developed a set of standardized managed LTSS (MLTSS) quality measures for use by states and managed care organizations and prepaid inpatient health plans. The measures address comprehensive assessment and care planning processes, LTSS use, and rebalancing (CMS 2019).