Medicaid home and community-based services (HCBS) provide individuals who need help with everyday activities the opportunity to receive services (such as personal care, homemaker, and adult day health services) in their own homes or the community as opposed to institutional settings. In 2022, the Centers for Medicare & Medicaid Services (CMS) issued State Medicaid Director Letter (SMD) #22-003 to release the first official version of the HCBS Quality Measure Set for voluntary use. The HCBS Quality Measure Set is a set of nationally standardized quality measures for Medicaid covered 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, and drive improvement in quality of care and outcomes for people receiving HCBS.
In April 2024, CMS released a Center for Medicaid and CHIP Services (CMCS) informational bulletin updating the HCBS Quality Measure Set for 2024. CMS also released a CMCS informational bulletin describing HCBS Quality Measure Set reporting requirements for Money Follows the Person grant recipients. On May 10, 2024, CMS published the Ensuring Access to Medicaid Services final rule (Access rule). Among other things, the Access rule requires states to report every other year on a set of nationally standardized HCBS quality measures, referred to as the HCBS Quality Measure Set, and describes the process for updating and maintaining the HCBS Quality Measure Set.
Implementing an effective quality measures reporting program includes periodically reassessing the measures since many factors (such as changes in regulatory guidelines and experiences with reporting and performance rates) may warrant modifying the measure set. Mathematica is supporting CMS by establishing and convening an HCBS Quality Measure Set Review Workgroup.
The Workgroup will review and identify gap areas in the current HCBS Quality Measure Set and recommend changes for improvement. The Workgroup will be comprised of subject matter experts with knowledge of the opportunities and challenges for collecting, reporting, and using the quality measures to improve the quality of care in Medicaid HCBS programs.
The final report of the 2028 HCBS Quality Measure Set Review is now available. This report summarizes the Workgroup process, discussion, recommendations, and public comments. The report is available for download at the link below.
Download Final ReportThis information is about the Home and Community-Based Services (HCBS) Quality Measure Set Review.
Go to Child and Adult Core Sets Annual Review Go to Health Home Core Sets Annual ReviewThis meeting will be an opportunity to ask questions about the HCBS Quality Measure Set Call for Measures. The meeting will provide a demonstration of the measure submission process. A recording and meeting transcript will be available on our website after the event.
This meeting will be an opportunity to ask questions about the HCBS Quality Measure Set Call for Measures. The meeting will provide a demonstration of the measure submission process. A recording and meeting transcript will be available on our website after the event.
This is the first meeting of the Workgroup to introduce the 2028 HCBS Quality Measure Set Review process. This meeting will introduce the Workgroup members and provide an overview of the 2028 HCBS Quality Measure Set Review process. This meeting is open to Workgroup members and the public.
This meeting will summarize the measures suggested for addition to or removal from the 2028 HCBS Quality Measure Set, provide an overview of materials available to Workgroup members for reviewing the measures, and describe the format of the Meeting to Review Measures for the 2028 HCBS Quality Measure Set. This meeting is open to Workgroup members and the public.
In this multi-day meeting, the Workgroup will make recommendations for strengthening the 2028 HCBS Quality Measure Set. Workgroup members will discuss and vote on the measures suggested for addition to or removal from the Quality Measure Set and identify gap areas in the Quality Measure Set. There will be opportunities for public comment throughout the meeting. This meeting is open to Workgroup members and the public.
For more information on the HCBS Quality Measure Set, visit
https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement-initiatives/measuring-and-improving-quality-home-and-community-based-services/index.html
For more information or to receive future mailings, contact the
Mathematica HCBS Quality Measure Review Team
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