National Measures of Quality in HCBS

Opportunity

Home- and community-based services (HCBS) help many people with disabilities live independently in their homes and other integrated community settings. Working with partners at National Association of State Directors of Developmental Disabilities Services (NASDDDS) and National Association of States United for Aging and Disability (NASUAD) and funded by the Administration for Community Living, we developed a standardized set of measures to examine the quality of these services nationwide, across payers and delivery systems—with a particular focus on person-centered approaches.

Approach

Knowing what to measure

Unlike other aspects of the health care and social services system, HCBS lacks any standardized set of quality measures at the federal level. For most Medicaid HCBS programs, states are required to assess quality and implement quality improvement efforts, but without agreed-upon measures and definitions there are gaps and variation.

The National Core Indicators – Intellectual and Developmental Disabilities and the National Core Indicators – Aging and Disabilities are widely used survey instruments, administered at the state level on a voluntary basis, with a long history of informing the field on state HCBS quality system performance. The Administration for Community Living worked with HSRI and its National Core Indicators partners to develop a set of measures to support a national HCBS quality measurement infrastructure.

Partnering to drive improvement

This work built on work conducted by a multi-constituent committee convened by the National Quality Forum. The committee included representatives from social services and other community support services, as well as providers, payers, caregivers, advocates, and HCBS consumers. This work received a groundswell of interest and public comment.

Technical assistance to states

As part of the contract with ACL, we and our National Core Indicators partners, NASDDDS and NASUAD, are provding technical assistance to states to expand their use of NCI and NCI-AD in supporting quality enhancement. This involves:

• Training for state staff
• The development of data briefs and ‘data nuggets’
• Guidance on sampling procedures
• Guidance on survey impemetation and interpreting results
• Examining results in the context system improvement goals and priorities
• Expanding state participation in NCI and NCI-AD

Impact

Using National Core Indicators consumer survey tools as the basis (both NCI and NCI-Aging and Disabilities), developed a standardized set of measures that will undergird a comprehensive HCBS quality system—one that will support the effective use of tools to develop and monitor the quality of long-term supports and services. These included measures related to person-centered planning and supports.