Appendix III (continued)

Environmental Scan of Measures for Medicaid Title XIX Home and Community-Based Services Measure Scan as of July 5, 2007

Specific Research Inquiries

Tool or Measure Set: Quality of Life-AD
Data Source: Consumer interview
Respondent: Consumer and caregiver
Mode of Data Collection: In-person, structure interview; respondents follow along on their own copy of the tool; caregivers complete independently, with interviewer assistance if necessary.
Total Items/indicators: 13 items
HCBS MS Domains: Quality of Life
Populations: Individuals with mild to moderate Alzheimer's disease
Developer: Rebecca Logsdon, Laura Gibbons, Susan McCurry, and Linda Terri developed the tool for a specific research inquiry. Results published in 2000.
Use history: Unknown
States Currently Using: Unknown
Psychometric Testing: Information on the psychometric properties of this tool (reliability and validity) has been established and published.
Summary: The tool assesses patients' and caregivers' appraisal of the patient's physical condition, mood, interpersonal relationships, ability to participate in meaningful activities, financial situation, and an overall assessment of self as a whole and life quality as a whole. Response options limited to a 4-choice multiple choice format that is consistent across all questions, ranging from 1 (poor) to 4 (excellent). Total scores can range from 13 to 52.

Tool or Measure Set: Quality of Life Assessment Schedule
Data Source: Consumer interview
Respondent: Consumer. Proxy version also developed
Mode of Data Collection: In-person interview; interviewers create individualized scale based on a narrative and record and verify ratings.
Total Items/indicators: Five domains: physical, psychological, social/family, daily activities, and cognitive. Interviewers extract 2 concepts for each domain from a respondent's narrative.
HCBS MS Domains: Quality of Life
Populations: Individuals with Alzheimer's disease
Developer: Caroline Selai, Michael Trimble, Martin Rossor, and Richard Harvey developed the tool for a specific research inquiry. Results published in 2000.
Use history: Unknown
States Currently Using: Unknown
Psychometric Testing: Information on the psychometric properties of this tool (reliability and validity) has been established and published.
Summary: Tool is a subject-driven assessment, personally tailored to each individual respondent. Respondent rates each of the ten constructs on a 0-5 scale, where 0 is "no problem" and 5 is "could not be worse" for a possible maximum score of 50.

Tool or Measure Set: Dementia Quality of Life Scale
Data Source: Consumer interview
Respondent: Consumer
Mode of Data Collection: Structure, in-person interview
Total Items/indicators: 29 items in five subscales
HCBS MS Domains: Quality of Life
Populations: Individuals with mild-to-moderate dementia
Developer: Meryl Brod, Anita Stewart and Laura Sands developed the tool for a specific research inquiry. Results published in 2000.
Use history: Unknown
States Currently Using: Unknown
Psychometric Testing: Information on the psychometric properties of this tool (reliability and validity) has been established and published.
Summary: Tool assesses five scales: Aesthetics, Positive Affect, Negative Affect, Self-esteem, and Feelings of Belonging. Sample items include "Recently, how often have you enjoyed listening to music?" (Aesthetics) and "Recently, how often have you felt depressed?" (Negative Affect).

Return to Appendix III Contents

 

Other

Tool or Measure Set: Quality of Life Questionnaire
Data Source: Consumer interview
Respondent: Consumer or proxy; consumers can self-rate or offer verbal answers for interviewer to rate
Mode of Data Collection: Face-to-face interview
Total Items/indicators: 4 scales comprising 40 items
HCBS MS Domains: Quality of Life
Populations: Adults with intellectual disabilities with adequate expressive and receptive language
Developer: Robert Schalock, Ph.D. and Ken Keith, Ph.D.
Use history: One paper found that this was the most widely used QOL tool for people with intellectual disabilities.
States Currently Using: Nebraska, others?
Psychometric Testing: Information on the psychometric properties of this tool (reliability and validity) has been established and published in the peer review literature.
Summary: The tool allows the respondent or a rater to assign numerical points to items in each of four focus areas: satisfaction, competence/productivity, empowerment/independence, and social belonging/community integration. The points assigned to individual items are summed to create scale scores.

Return to Appendix III Contents

 

V. Tools and Measures Developed or Endorsed by Associations and Accrediting Bodies

Associations

Tool or Measure Set: ANCOR Performance Excellence Markers
Data Source: Multiple-data to be collected and compiled by agencies providing services, includes Personal Outcome Measures developed by the Council on Quality and Leadership
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: Full framework includes 86 markers of excellence for a "quality agency"; 6 measures currently under evaluation for use by all member organization
HCBS MS Domains: Person Centeredness/Autonomy; Qualified Providers, Health and Welfare, Coordination of Long-Term Care and Other Services
Populations: Individuals with intellectual disabilities
Developer: American Network of Community Options and Resources (ANCOR) in collaboration with its member organization.
Use history: Development process begun in 2005, Phase 2 measures published in May 2007 report
States Currently Using: Measures are designed for use by provider agencies and could be reported to State HCBS programs that contract with these providers.
Psychometric Testing: ANCOR members are currently working with Deyta, a company with extensive experience in performance management systems, to establish criteria for each measurement. Plans are to eventually submit these measures to the National Quality Forum for review.
Summary: In March 2005 46 representatives from ANCOR's membership participated in a Quality Café to identify indicators of quality process and outcomes for HCBS services. The following key focus areas for quality measurement were identified and used to organized the recommended performance excellence markers: Management/Leadership; Strategic Planning; Customer and Market Focus; Measurement, Analysis, and Knowledge Management; Human Resources Focus; Process Management; Business Results; Personal Outcome Measures. The six measures under current evaluation are: customer satisfaction and choice; mortality Rate (proposed variables to be measured include tracking individuals who have a diagnosis of Downs Syndrome; whether the individual ever resided within an institution and where the person was receiving services prior to their death); preventative health care; substantiated instances of abuse and/or neglect; Medication Errors; Direct Service Provider Retention Rates; Direct Service Provider Turnover Rates; Direct Service Provider Vacancy Rates.

Tool or Measure Set: Quality Improvement Organizations (QIO) Scope of Work (SOW) Measures
Data Source: Multiple
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 43 indicators
HCBS MS Domains: Safety, Effectiveness, Timeliness, Efficiency, Access, Coordination of Long-Term Care and Other Services, and Administrative Oversight
Populations: Adults and children with disabilities
Developer: Quality Improvement Organization Program
Use history: The QIO Program is currently operating within its 8th Round SOW contract cycle (August 2005—July 2008). The 9th version of the QIO Scope of Work Measures will become effective in August 2008.
States Currently Using: Under the direction of CMS, the Quality Improvement Organization (QIO) Program consists of a national network of 53 QIOs, responsible for each U. S. State, territory, and the District of Columbia.
Psychometric Testing: Unknown
Summary: Quality Improvement Organizations (QIO) Program, under the auspices of the Medicare program, operates performance-based contracts to collect data on clinical measures across the provider, State, and national level. Measures are provided for four separate settings of support: nursing homes, home health, hospital, and physician services. Both clinical and nonclinical topics for measurement are provided for all four areas. Examples of home health clinical topics include bathing, transferring, mobility, medication and pain management, and discharge. Examples of home health nonclinical topics include immunization assessment, telehealth utilization, and organizational culture and assessment.

Tool or Measure Set: Alliance of Information and Referral Systems (AIRS) Standards for Professional Information and Referral
Data Source: Multiple sources
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 19 standards
HCBS MS Domains: Effectiveness, Person Centeredness/Autonomy, Timeliness, Efficiency, Access, Qualified Providers, Coordination of Long-Term Care and Other Services, and Administrative Oversight
Populations: Individuals with disabilities seeking information about services
Developer: Alliance of Information and Referral Systems
Use history: 4th edition, revised October of 2002. National standards first developed in 1973 by the United Way of America.
States Currently Using: Unknown
Psychometric Testing: Standards not necessarily defined as measures.
Summary: Standards define what is determined to be effective practices within information and referral programs. Standards are utilized for AIRS program accreditation, certification of specialists, and operating 2-1-1 systems. Standards range from required components for accreditation to supplemental suggestions for program enhancement. Standards can be utilized across populations, services, for-profit and nonprofit settings, as well as government settings. Focus areas include service delivery (4 standards), resource databases (5 standards), reports and measures (2 standards), cooperative relationships (4 standards).

Tool or Measure Set: Proposed Consensus of Performance Indicators for Behavioral Health
Data Source: Multiple recommended: self-reported data, clinical records, and automated data systems
Total Items/indicators: 35 indicators
HCBS MS Domains: Access, Unmet Need, Person Centeredness/Autonomy, Health and Welfare, Safety, Coordination of Long-Term Care and Other Services
Populations: Adults with mental illness. Select indicators apply to children with mental illness.
Developer: American College of Mental Health Administrators, in consultation with the Commission on Accreditation of Rehabilitation Facilities (CARF), NCQA, JCAHO, The Council on Quality and Leadership, and the Council for Accreditation for Children and Family Services
Use history: Proposed measure set published in 2001.
States Currently Using: Extent of current use unknown
Psychometric Testing: The workgroup sought feedback from consumers on the proposed measure set to establish relevance and importance (content validity.) Selected measures come from established measure sets whose reliability and validity have been established elsewhere.
Summary: Based on four years of work, the partners listed above identified 35 indicator definitions for recipients of behavioral health services, grouped into three major focus areas: access, process, and outcomes. Select indicators are designated as appropriate for quality comparison purposes. Information is available in a final report that addresses the issue of potential data collection tools and sources, although it does not endorse specific measures.

Tool or Measure Set: Home-Based Primary Care Quality Indicator Set (HPCQI)
Data Source: Administrative
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 200 indicators for 23 geriatric conditions
HCBS MS Domains: Health and Welfare; Coordination of Long-Term Care and Other Services
Populations: Elders with physical and cognitive disabilities
Developer: Mount Sinai Visiting Doctors Program, Mount Sinai Medical Center, New York, NY-panel members represent a number of academic institutions. Study endorsed by the American Academy of Home Care Physicians.
Use history: Measure set first published in 2007; measures available online
States Currently Using: Unknown
Psychometric Testing: Unknown; measures in original measure set may have been tested previously
Summary: This project built upon the Assessing Care for Vulnerable Elders (ACOVE) initiative, which developed several quality indicator sets for ambulatory geriatric and nursing home patients. The HPCQI team used a multi-step process to adapt and expand these existing measure sets for home-based primary care, by modifying language, dropping institutional measures and creating new, home care-specific measures. These measures are all process measures defining quality home care.

Tool or Measure Set: General Symptom Distress Scale
Data Source: Consumer Interview
Respondent: Consumer
Mode of Data Collection: Face-to-face structured interview
Total Items/indicators: 11 possible scores
HCBS MS Domains: Health and Welfare; Unmet Need
Populations: Home care clients
Developer: Home Care Association of Washington
Use history: Results of field test published in 1987
States Currently Using: Unknown
Psychometric Testing: Tools field tested in five home care agencies in Washington State. Interrater reliability assessed, and face, content, and construct validity established. Internal consistency low, as predicted, given the independence of symptoms assessed.
Summary: This scale is a broad measure of patients' distress caused by 11 general symptoms that home care personnel consider important to manage for all clients, regardless of their diagnoses. Patients indicate which of the 11 symptoms they have expressed during the past month, and then queried about the treatment and severity of each. Scores are calculated for each symptom. Scores can be used to flag clients at risk and to respond appropriately.

Tool or Measure Set: Performance Measures for Managed Behavioral Healthcare Programs (PERMS 2.0)
Data Source: Administrative data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 23 measures
HCBS MS Domains: Access, Effectiveness, Timeliness, Efficiency
Populations: Individuals receiving mental health services
Developer: American Managed Behavioral Healthcare Association
Use history: The original measure set, PERMS 1. 0, was first published in 1995
States Currently Using: Unknown
Psychometric Testing: Not specified
Summary: Measure set includes 23 industry-standardized measures designed specifically for substance abuse and mental health treatment. Focus areas are access, consumer satisfaction, and quality. Quality measures include systems effectiveness for substance abuse treatment and continuity of care for patients in treatment and detoxification.

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Accrediting Bodies

Tool or Measure Set: Patient-Centered Quality Measures for the National Health Care Quality Report
Data Source: Not specified
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 10 measures
HCBS MS Domains: Access, Person Centeredness/Autonomy
Populations: All health care consumers
Developer: Christina Bethell, PhD, Foundation for Accountability (FAACT)
Use history: Paper published in May 2000
States Currently Using: Unknown
Psychometric Testing: Measures not fully developed, just articulated in narrative format. A review of psychometrically valid and reliable tools to measure concepts was provided in accompanying report.
Summary: This paper sought to identify categories and measurement categories of patient-centered care for consideration in the National Health Care Quality Report. Measures are organized in a matrix, along five quality domains (The Basics, Staying Healthy, Getting Better, Living with Illness, and Changing Needs) and within four categories (Patient-Centered Communication and Caring, Patient-Centered Education and Teamwork; Consumer Empowerment, and Patient-Centered Systems of Care). Report outlining concepts for measurement provides a rational for including measures of patient-centered care in the National Health Care Quality Report in addition to already existing categories of patient safety, effectiveness, promptness and efficiency. Patient-centered quality measures are intended to be used among various subgroups as well as across diverse ethnic, racial, socioeconomic, and demographic groups. The attachments to the report provide sample measures for each focus area as well as tools that can be utilized for the data collection. A list of relevant surveys is also provided as an attachment.

Tool or Measure Set: Healthcare Effectiveness Data and Information Set (HEDIS®) (previously known as the Health Plan Employer Data and Information Set)
Data Source: Health plan administrative data on utilization plus beneficiary-provided information from a customer satisfaction survey
Total Items/indicators: 74 measures; 61 have been deemed applicable to Medicaid recipients
HCBS MS Domains: Health and Welfare, Qualified Providers
Populations: Health plan enrollees, including Medicaid and Medicare recipients
Developer: National Committee for Quality Assurance (NCQA)
Use history: Used by more than 90% of health plans, 2007 measure set available online
States Currently Using: Used nationwide by health plans that serve the Medicaid population, including people with disabilities.
Psychometric Testing: NCQA follows a detailed, multistep process to develop and test new measures, including field testing and public comment.
Summary: The HEDIS measures have been designed for assessing and comparing the quality of care provided by managed care plans. Medicaid measures relate almost exclusive to acute care; some Medicare measures, such as medications management and fall risk preventions, may be adapted or relevant to an HCBS population. CAHPS® surveys for children and adults are included as measures of client experience.

Tool or Measure Set: The National Quality Forum Endorsed Definition and Framework for Measuring Care Coordination
Data Source: Administrative data, Providers, and Consumer Surveys
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 25 concepts/indicators
HCBS MS Domains: Safety, Effectiveness, Person Centeredness/Autonomy, Timeliness, Efficiency, Access, Coordination of Long-Term Care and Other Services, Health and Welfare, and Administrative Oversight
Populations: All health care recipients
Developer: National Quality Forum
Use history: Definition and framework endorsed in May of 2006 as part of the National Quality Forum Ambulatory Care project.
States Currently Using: Unknown
Psychometric Testing: Framework, not measures
Summary: The National Quality Forum identified the need for well developed care coordination measures. To drive this process, the National Quality Forum created a standardized definition of care coordination and developed a framework to facilitate the development of care coordination measures. Focus areas include the creation of a health care "home", proactive plan of care and follow up, communication, information systems, and transition. Four guiding principles also accompany the framework.

Tool or Measure Set: National Quality Forum-Endorsed National Voluntary Consensus Measures: 2000-2005
Data Source: Multiple sources, primarily administrative, utilization and medical record data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: Approximately 200 total
HCBS MS Domains: Unmet Need, Safety, Effectiveness, Health and Welfare
Populations: All health care recipients
Developer: Compendium compiled by the National Quality Forum; endorsed measures are drawn from a number of established datasets, such as OASIS, NCQA measures, and ORYX®.
Use history: The 2000-2005 compendium was published in 2006.
States Currently Using: Unknown
Psychometric Testing: Described individually for each measure
Summary: The National Quality Forum (NQF) is a public-private partnership created in 1999, whose mission is to improve the quality of health care; this guide provides information about all quality of care measures endorsed by the organization. Measures are endorsed through a consensus process; should federal regulations regarding health care metric be promulgated, regulators are obligated to use NQF-endorsed measures whenever feasible. Endorsed measures comprise the full range of medical services, and many are condition specific (e.g., heart disease or diabetes) and relate to acute care. Measures are organized by focus areas: those in the care management, environmental events, criminal events, chronic care, functional, and patient-centered outcomes domains could be relevant or adapted to HCBS.

Tool or Measure Set: Standards for the Development of Lifelong Supports and Community Resources for Persons with Autism Spectrum Disorder and their Families
Data Source: Administrative data, Providers, Consumer Survey
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 25 core standards with subelements
HCBS MS Domains: Effectiveness, Person Centeredness/Autonomy, Equity, Access, Qualified Providers, Administrative Oversight, and Quality of Life
Populations: Adults or children with mental retardation or developmental disabilities
Developer: Commission on Accreditation of Rehabilitation Facilities (CARF)
Use history: Current standards published in 2007
States Currently Using: Used to accredit providers nationwide
Psychometric Testing: Standards not necessarily defined as indicators
Summary: Standards are part of the 2007 Employment and Community Service Standards and include expectations specific to supporting an individual with autism spectrum disorder to transition from school, develop lifelong supports, seek employment, continue their education, live in the community, and perform life planning. The standards are intended to provide a blueprint for community providers, local communities, as well as State and Federal government for supporting individuals with autism. A list of potential desired outcomes is also provided. Additional standards available to organizations seeking accreditation.

Tool or Measure Set: Standards for Integrated Behavioral Health/Primary Care
Data Source: Administrative data, Providers, and Consumer Surveys
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 16 survey preparation questions
HCBS MS Domains: Effectiveness, Person Centeredness/Autonomy, Efficiency, Access, Qualified Providers, Coordination of Long-Term Care and Other Services, and Administrative Oversight
Populations: Elders with physical and cognitive disabilities, adults with mental retardation or developmental disabilities, adults with severe and persistent mental illness, adults with acquired brain injuries, and adults with physical disabilities and/or chronic conditions
Developer: Commission on Accreditation of Rehabilitation Facilities (CARF)
Use history: Current standards published in 2007
States Currently Using: Used to accredit providers nationwide
Psychometric Testing: Standards not necessarily defined as indicators
Summary: Standards are part of the 2007 Behavioral Health Standards Manual and are for organizations seeking accreditation for their integrated behavioral health/primary care program. Focus areas include providing a no wrong door approach, choice, and ability to assess and provide support for various medical and behavioral needs through an integrated approach. Additional standards available to organizations seeking licensing.

Tool or Measure Set: Standards for Dementia Care
Data Source: Administrative data, Providers, Consumer Surveys
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 23 survey preparation questions
HCBS MS Domains: Effectiveness, Person Centeredness/Autonomy, Efficiency, Access, Qualified Providers, Coordination of Long-Term Care and Other Services, and Administrative Oversight
Populations: Elders with cognitive disabilities
Developer: Commission on Accreditation of Rehabilitation Facilities (CARF)
Use history: Current standards published in 2006
States Currently Using: Used to accredit providers nationwide
Psychometric Testing: Standards not necessarily defined as indicators
Summary: Standards are part of the 2006 Aging Services Standards Manual. Organizations seeking accreditation as a Dementia Care Program are required to meet the dementia care standards in addition to standards for adult day services, aging services network, assisted living, or person-centered long term care nursing home communities. Focus areas include quality of life, quality of staff support, program performance, and family and network partnership.

Tool or Measure Set: Personal Outcome Measures®
Data Source: Consumer Interview
Respondent: Consumers and proxies ("those who know the person best")
Mode of Data Collection: Face-to-face interview
Total Items/indicators: 21 outcome indicators
HCBS MS Domains: Person Centeredness/Autonomy, Quality of Life, Health and Welfare, Safety
Populations: Individuals with intellectual and developmental disabilities
Developer: The Council on Quality and Leadership (CQL)
Use history: Development and testing, including field testing, occurred between 1991 and 1993; first measure set (30 indicators) published in 1993; second measure set (25 indicators) published in 2000; current measure set (21 indicators) published in 2005. This tool can be used as a stand alone, or as part of the Quality Measures 2005® accreditation process.
States Currently Using: Currently used by selected State programs for people with intellectual and developmental disabilities including Florida, South Carolina, North Dakota, South Dakota, North Carolina, Georgia, Louisiana, Nevada, Illinois, and New Mexico
Psychometric Testing: Field testing included interrater reliability and factor analysis, which revealed seven factors: identity, autonomy, affiliation, attainment, rights, health, and safeguards. Reliability and validity have been examined in peer-review articles.
Summary: There are four versions of the Personal Outcome Measures tools: Personal Outcome Measures®, Personal Outcome Measures for Children and Youth, Personal Outcome Measures for Families with Young Children, and Personal Outcome Measures in Consumer-Directed Behavioral Health.
Interviewers must be trained and certified by CQL to administer the tool. Based on indepth structured interviews with consumers, interviewers determine if each outcome has been realized. Examples of outcomes include "People are treated fairly" and "People realize personal goals."Items developed based on input from consumer focus groups and review by technical experts.
Eight items identified with social capital were extracted from the Personal Outcome Measures® database and analyzed for reliability and validity. A factor analysis of the eight Personal Outcomes resulted in the identification of two factors, identified and named Bonding and Bridging. These form the Social Capital Index®

Tool or Measure Set: Shared Values®
Data Source: Multiple sources including providers, direct support staff, consumers, and families
Respondent: Providers, staff, consumers and families, community members
Mode of Data Collection: Onsite visit by trained reviewers, includes consumer interviews, focus group meetings, targeted interviews, observations
Total Items/indicators: Ten factors and 32 indicators
HCBS MS Domains: Person Centeredness/Autonomy, Quality of Life, Health and Welfare, Safety
Populations: Adults and/or children with intellectual or development disabilities; physically or cognitively disabled elders; Adults and/or children with severe and persistent mental illness; Adults with acquired brain injuries; Adults with physical disabilities and/or chronic conditions
Developer: The Council on Quality and Leadership (CQL)
Use history: CQL has used and/or field tested this instrument in at least 40 of the 50 States, through direct work with State agencies, community based provider organizations and networks. This tool can be used as a stand alone, or as part of the Quality Measures 2005® accreditation process.
States Currently Using: Currently used by selected State programs for people with intellectual and developmental disabilities including Florida, South Carolina, North Dakota, South Dakota, North Carolina, Georgia, Louisiana, Nevada, Illinois, and New Mexico
Psychometric Testing: Reliability and validity have been examined in peer-review articles.
Summary: Shared Valuesidentifies the values that shape how individuals define, measure and elicit feedback about quality of life and quality of services. Domains include Dignity and Worth, Legal and Human Rights, Self-Determination and Choice, Community Settings, Social Capital, Community Partnerships, Shared Leadership, Continuous Learning, Open Communications, and Continuous Improvement.

Tool or Measure Set: Basic Assurances®
Data Source: Multiple sources including providers, direct support staff, consumers and families, administrative data
Respondent: Providers, staff, consumers and families
Mode of Data Collection: On site visit by trained reviewers, includes consumer interviews, focus group meetings, and review of data systems and analysis
Total Items/indicators: Ten factors and 46 indicators
HCBS MS Domains: Person Centeredness/Autonomy, Quality of Life, Health and Welfare, Safety
Populations: Adults and/or children with intellectual or development disabilities; physically or cognitively disabled elders; Adults and/or children with severe and persistent mental illness; Adults with acquired brain injuries; Adults with physical disabilities and/or chronic conditions
Developer: The Council on Quality and Leadership (CQL)
Use history: CQL has used and/or field tested this instrument in at least 40 of the 50 States, through direct work with State agencies, community based provider organizations and networks. This tool can be used as a stand alone, or as part of the Quality Measures 2005® accreditation process.
States Currently Using: Currently used by selected State programs for people with intellectual and developmental disabilities including Florida, South Carolina, North Dakota, South Dakota, North Carolina, Georgia, Louisiana, Nevada, Illinois, and New Mexico
Psychometric Testing: Reliability and validity have been examined in peer-review articles.
Summary: Designed to detail the essential, fundamental and nonnegotiable requirements for all service and support providers, by looking at the provision of safeguards from the person's perspective. While the Basic Assurances contain requirements for certain systems and policies and procedures, the effectiveness of the system or the policy is determined in practice, person by person. Focus areas included are Rights Protections and Promotion, Dignity and Respect, Natural Support Networks, Protection from Abuse, Neglect, Mistreatment and Exploitation, Best Possible Health, Safe Environments, Staff Resources and Supports, Positive Services and Supports, Continuity and Personal Security, and the Basic Assurances System.

Tool or Measure Set: Community Life®
Data Source: Multiple sources including providers, direct support staff, consumers, families, and community members
Respondent: Providers, staff, consumers and families, community members
Mode of Data Collection: On site visit by trained reviewers, includes consumer interviews, focus group meetings, community tour/assessment
Total Items/indicators: Three factors and 8 indicators
HCBS MS Domains: Person Centeredness/Autonomy, Quality of Life, Health and Welfare, Safety
Populations: Adults and/or children with intellectual or development disabilities; physically or cognitively disabled elders; Adults and/or children with severe and persistent mental illness; Adults with acquired brain injuries; Adults with physical disabilities and/or chronic conditions
Developer: The Council on Quality and Leadership (CQL)
Use history: CQL has used and/or field tested this instrument in at least 40 of the 50 States, through direct work with State agencies, community based provider organizations and networks. This tool can be used as a stand alone, or as part of the Quality Measures 2005® accreditation process.
States Currently Using: Currently used by selected State programs for people with intellectual and developmental disabilities including Florida, South Carolina, North Dakota, South Dakota, North Carolina, Georgia, Louisiana, Nevada, Illinois, and New Mexico
Psychometric Testing: Reliability and validity have been examined in peer-review articles.
Summary: Measures place emphasis on relationships between and among people-people with disabilities, families, supporters and community members. The measures also increase the examination of the relationship between organizations and the community. Focus areas include Data, Information and Analysis, Organizational Role, and Community Life Initiatives®.

Tool or Measure Set: Responsive Services®
Data Source: Multiple sources including providers, direct support staff, consumers, families, management practices and planning
Respondent: Providers, staff, consumers and families
Mode of Data Collection: Onsite visit by trained reviewers, includes consumer interviews, focus group meetings
Total Items/indicators: Four factors and 21 indicators
HCBS MS Domains: Person Centeredness/Autonomy, Quality of Life, Health and Welfare, Safety
Populations: Adults and/or children with intellectual or development disabilities; physically or cognitively disabled elders; Adults and/or children with severe and persistent mental illness; Adults with acquired brain injuries; Adults with physical disabilities and/or chronic conditions
Developer: The Council on Quality and Leadership (CQL)
Use history: CQL has used and/or field tested this instrument in at least 40 of the 50 States, through direct work with State agencies, community based provider organizations and networks. This tool can be used as a stand alone, or as part of the Quality Measures 2005® accreditation process.
States Currently Using: Currently used by selected State programs for people with intellectual and developmental disabilities including Florida, South Carolina, North Dakota, South Dakota, North Carolina, Georgia, Louisiana, Nevada, Illinois, and New Mexico
Psychometric Testing: Reliability and validity have been examined in peer-review articles.
Summary: Responsive Services® integrates the quality indicators from Shared Values, Basic Assurances, Personal Outcome Measures, and Community Life. Responsive Services is intended to redefine the relationships among people, community and organizations. The four domains are Person Focus, Community Focus, Strategic Focus, and Accountability Focus.

Tool or Measure Set: Importance/Satisfaction (IS) Map®
Data Source: Consumer Survey
Respondent: Consumers and proxies ("those who know the person best")
Mode of Data Collection: Face-to-face interview
Total Items/indicators: Seven factors and 31 indicators
HCBS MS Domains: Person Centeredness/Autonomy, Quality of Life, Health and Welfare, Safety
Populations: Adults and/or children with intellectual or development disabilities; physically or cognitively disabled elders; Adults and/or children with severe and persistent mental illness; Adults with acquired brain injuries; Adults with physical disabilities and/or chronic conditions
Developer: The Council on Quality and Leadership (CQL)
Use history: CQL has used and/or field tested this instrument in several States, through direct work with State agencies, community based provider organizations and networks.
States Currently Using:
Psychometric Testing: Reliability and validity have been examined in peer-review articles.
Summary: The Importance/Satisfaction (IS) Map is designed for organizations to assess consumer satisfaction. Organizations use the IS Map to interview people about the importance of services and supports and the degree to which their priority goals are being met. Domains include Work, Living, Community, Relationships, Health, Safety, and Organization.

Page last reviewed June 2010
Internet Citation: Appendix III (continued): Environmental Scan of Measures for Medicaid Title XIX Home and Community-Based Services Measure Scan as of July 5, 2007. June 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/hcbs/hcbsreport/hcbsapiiic.html