Introduction and Scan Methodology
The goal of the Home and
Community-Based Services (HCBS) measure scan was to identify extant, tested,
and prevalent performance measures that could be used or modified to assess and
compare the quality of Medicaid (Title XIX) HCBS programs nationwide. The measure
scan is the first step in the much larger constellation of activities related
to assessing HCBS quality that were mandated in the Deficit Reduction Act (DRA)
of 2005. Section 6086(b) of the law directs the Agency for Healthcare Research
and Quality (AHRQ) to:
in consultation with relevant stakeholders, measures of program
performance, client functioning, and client satisfaction with respect to
HCBS services provided through State Medicaid programs.
the quality of HCBS services and their outcomes, along with the overall
system for providing such services through the Medicaid program.i
best practice information distilled from a comparative analysis of the
system features of each State.ii
To conduct a thorough
environmental scan of existing and potential measures, Thomson Healthcare,
under contract to AHRQ, used a variety of complementary sources and
methodologies. These included a review
of electronic and academic resources, consultation with knowledgeable experts
and key informants, a formal solicitation, and a review of tools in current
usage by State Medicaid HCBS programs.
Specifically, to identify measures we:iii
more than 50 relevant Web sites, including databases such as HCBS.org and
the National Quality Measures Clearinghouse.
A list of Web sites reviewed can be
found in Appendix I.
a literature review of peer-reviewed journals, using search engines such
as Medline, PsychINFO, Ageline, and the New York Academy of Medicine Grey
Literature Report. Appendix I also includes a complete list of the
journal articles reviewed for potential measures, as well as the search
engines and keywords used in the literature search.
a formal Call for Measures via the Federal
Register, seeking submissions from measure developers, as well as
information from States regarding existing tools currently in use,
including modification of published instruments.iv
each of the Medicaid 1915c HCBS waiver programs active in the CMS waiver
database as of October 2006. Successful contact was made with State staff
representing more than 200 waivers.
Most of these waiver programs used some type of performance measures
for compliance and quality oversight purposes and were able to supply
Thomson Healthcare with documentation.
a technical expert panel (TEP) representing different areas of expertise,
including: selected disability populations (aging, physical disabilities,
intellectual and developmental disabilities, mental health, and children
with special health care needs); measurement science; State and national
associations representing Medicaid HCBS programs; consumer advocates; and
service providers. This panel
provided input at various points during the scan and met collectively via
conference call on January 29, 2007, and February 1, 2008, as well as in person
on June 22, 2007. A complete list of members and their professional
affiliations is in Appendix II. A companion
group of Federal staff, known as the Federal Partners, also provided
regular input. The members of this group are also listed in Appendix II.
As a result of these activities, more than 200 instruments
to collect data supporting performance measures, measure sets, and measure
databases were identified with potential relevance to Medicaid HCBS
quality. Together, they comprise
thousands of individual measures. A
summary of each instrument, measure set, and measure database was included in
the Compendium of Measures and Tools Identified Through the Medicaid Home and
Community-Based Services Measure Scan, as of July 5, 2007 (hereinafter the compendium)
dated March 7, 2008. This entire
document is presented in Appendix III. A preliminary draft of this document was the
focus of the in-person meeting of the TEP on June 22, 2007.
The compendium only includes those measures that were in existence
as of July 5, 2007, the cutoff date for formal submissions in response to the Federal Register notice. After this date, additional measures were not
included in the scan. However, measures
identified or submitted after this date were recorded. A list of these measures and sources is in Appendix IV. A
final contextual note: the timing of this project overlapped with other quality
performance activities undertaken by CMS, the Federal oversight agency for
Medicaid HCBS programs. While the
mandates of AHRQ and CMS are different, efforts were made to coordinate the
complementary quality measurement activities.
Return to Contents
Proceed to Next Section