Review of the Home and Community-Based Services (HCBS) Quality Measure Set

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, drive improvement in quality of care and outcomes for people receiving HCBS, and support States’ efforts to promote equity in their HCBS programs.

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.