Appendix III (continued)

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

Nevada

Tool or Measure Set: Client Satisfaction Interview Questions for the Nevada PAS Programs
Data Source: Consumer Survey
Respondent: Consumer
Mode of Data Collection: Self-report
Total Items/indicators: 55 close-ended items
HCBS MS Domains: Unmet Need, Person Centeredness/Autonomy, Safety
Populations: Adults with physical or intellectual disabilities, including those with acquired brain injuries, receiving personal assistance services
Developer: Not specified
Use history: Date created listed as 2003
States Currently Using: Nevada State staff could not confirm if this tool was still in use.
Psychometric Testing: Not specified
Summary: Collection of demographic and satisfaction/experience items, not organized by domain, primarily related to treatment by and interactions with personal assistance staff. Examples include "On a day-to-day basis, do care tasks go often uncompleted?" and "Is the homemaker, attendant or companion's appearance neat and clean?"

Tool or Measure Set: Nevada Division of Aging Services Case File Review Form
Data Source: Data collected by staff reviewers
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 34 items
HCBS MS Domains: Unmet Need, Person Centeredness/Autonomy, Safety
Populations: Older adults
Developer: Nevada Division of Aging Services
Use history: Used with three waivers: Community Home-Based Initiative Program (CHIP) Waiver, Waiver for the Elderly in Adult Residential Care (WEARC), Assisted Living (AL) Waiver. The division reviews 100% of all intake/initial packets prior to being sent to Medicaid for approval, and reviews 20% of all ongoing cases.
States Currently Using: Nevada
Psychometric Testing: Not specified
Summary: Areas tracked are: Choice, Level of Care, Individualized Goals, Plan of Care objectives, and Plan of Care duration/frequency. The Division has a supervisory review tool and database that captures this information. Primary focus of tool appears to assessing compliance in paperwork with State requirements.

Return to Appendix III Contents

 

New Hampshire

Tool or Measure Set: New Hampshire Consumer-Directed Personal Care Satisfaction Survey
Data Source: Consumer Surveys
Respondent: Consumer
Mode of Data Collection: Mail Survey
Total Items/indicators: 32 close-ended items and 10 open-ended questions
HCBS MS Domains: Safety, Effectiveness, Person Centeredness/Autonomy, Timeliness, Efficiency, Access, Qualified Providers, Health and Welfare, Administrative Oversight, Unmet Need, and Quality of Life
Populations: Elders with physical disabilities and adults with physical disabilities and/or chronic conditions
Developer: Granite State Independent Living
Use history: Version dated April 13, 2005. Survey administered for services provided under New Hampshire's Home and Community-Based Care—Elderly and Chronically Ill Waiver.
States Currently Using: New Hampshire
Psychometric Testing: Not specified
Summary: Survey is conducted to evaluate the Granite State Independent Living Personal Care Services program, a program that provides consumer-directed personal care services as part of New Hampshire's Community-Based Care—Elderly and Chronically Ill Waiver. Tool addresses timeliness of enrollment, satisfaction with orientation, access to information, safeguards, satisfaction with skills training, consumer choice and control, and community integration as a result of provided support.

Tool or Measure Set: New Hampshire ServiceLink Resource Center Consumer Satisfaction Survey
Data Source: Consumer Survey
Respondent: Consumer
Mode of Data Collection: Mail Survey
Total Items/indicators: 22 close-ended items and 6 open-ended questions
HCBS MS Domains: Effectiveness, Timeliness, Efficiency, and Access
Populations: Elders with physical or cognitive disabilities, adults with acquired brain injuries, and adults with physical disabilities and/or chronic conditions
Developer: University of New Hampshire
Use history: Version dated November 17, 2004
States Currently Using: New Hampshire-unclear if still in use
Psychometric Testing: Not specified
Summary: SurveyLink Resource Center Consumer Satisfaction Survey was developed to assess individual experiences with ServiceLink, an aging and disability resource network consisting of ten entities throughout the State. Individual experiences related to timeliness of response and effectiveness of referrals is assessed.

Tool or Measure Set: New Hampshire Developmental Services Adult Outcomes
Survey: Consumer and Family Versions
Data Source: Consumer Survey
Respondent: Consumer and/or proxy (interviewer determines)
Mode of Data Collection: Face-to-face structured interview
Total Items/indicators: 88 close-ended items
HCBS MS Domains: Quality of Life, Person Centeredness/Autonomy, Unmet Need, Coordination of Long-Term Care and Other Services, Safety, Access
Populations: Adults with intellectual disabilities
Developer: New Hampshire Department of Health and Human Services, Bureau of Developmental Services
Use history: Original tool developed in the early 1990s; items and wording have evolved over the years, based on stakeholder input. Current version was last modified in 2004, and is intended for use in Fiscal Years 2004 through 2007. Each year Bureau staff members contact 10% of service recipients to arrange for an in-person interview using the survey. Survey results are used for individual remediation (individualized reports include action items for providers), and are also rolled up into regional and statewide reports for trending and QI purposes.
States Currently Using: New Hampshire
Psychometric Testing: Not specified. Periodically the survey is reviewed by the Quality Improvement Coordinators to determine if changes to the items are warranted.
Summary: Survey items are organized into 11 main focus areas: home; paid work; volunteer activities; community participation; transportation; finance/money; health; assistive technology; service coordination; rights; planning process. Response options follow same pattern: yes/sometimes/no/not applicable/not known. Interviewers can determine whether to administer the proxy version to a family member or guardian, if the consumer is not able to provide responses; in rare cases a staff member may serve as a proxy. Select items have been determined core relative to key outcomes of interest. The survey guide provides simplified language options that can be used if necessary.

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New Jersey

Tool or Measure Set: New Jersey Senior Initiatives Community Choice Counseling Program Evaluation Survey
Data Source: Consumer Survey
Respondent: Consumer or Proxy
Mode of Data Collection: Not specified
Total Items/indicators: Survey not available at time of review.
HCBS MS Domains: Safety, Effectiveness, Person Centeredness/Autonomy, Timeliness, Efficiency, Access, Coordination of Long-Term Care and Other Services, Health and Welfare, Unmet Need, and Quality of Life
Populations: Elders with physical and cognitive disabilities, adults with acquired brain injuries, and adults with physical disabilities and/or chronic conditions
Developer: Rutgers Center for State Health Policy on behalf of the New Jersey Department of Health and Senior Services
Use history: Surveys conducted from a pool of 1,975 individuals discharged from a nursing home between January and December of 2000. A total of 859 individuals and/or their proxies were interviewed, a response rate of 56 percent.
States Currently Using: Study completed
Psychometric Testing: Not specified
Summary: Interviews were conducted with former nursing home residents who were discharged with support form the Community Choice Counseling Program. Interviews took place within six to eight weeks of discharge. Focus areas included preventative health characteristics, physical ability, current living situation, unmet need related to informal and formal supports, safety, service deficiencies, satisfaction, and quality of life.

Tool or Measure Set: New Jersey Division of Aging and Community Support Client Survey
Data Source: Consumer survey
Respondent: Consumer or caregiver
Mode of Data Collection: Mail survey
Total Items/indicators: 13
HCBS MS Domains: Access, Timeliness, Unmet Need, Person Centeredness/Autonomy, Quality of Life
Populations: Elders and adults with physical disabilities
Developer: New Jersey Department of Health and Senior Services, Division of Aging and Community Support
Use history: Mailed to sample of aged/disabled (A/D) waiver participants annually, data entered into database by State staff
States Currently Using: New Jersey
Psychometric Testing: No
Summary: Survey consists of 13 statements about consumers' experience with the waiver; consumers respond using a five-point scale. Examples include "My personal goals are in my plan of care" and "I am getting the services I need."

Tool or Measure Set: New Jersey Department of Health and Senior Services Agency Survey
Data Source: Data are self-reported electronically by providers
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 49 items
HCBS MS Domains: Qualified Providers, Administrative Oversight, Health and Welfare, Person Centeredness/Autonomy
Populations: Elders and adults with physical disabilities
Developer: New Jersey Department of Health and Senior Services
Use history: Agencies serving clients in three of the State's waivers (two aged/disabled and one Assisted Living) submit these data on CD to the State for review
States Currently Using: New Jersey
Psychometric Testing: Not specified
Summary: Items are organized into eight sections and align primarily with the CMS assurances. Most items look at the presence or absence of policies as well as which staff are performing which functions. In addition, the tool collects limited information regarding numbers of critical incidents. These data are not necessarily aggregated across providers.

Tool or Measure Set: New Jersey Department of Health and Senior Services Case Manager Survey
Data Source: Data are self-reported electronically by case managers
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 28 items: some items only apply to case managers in specific waivers
HCBS MS Domains: Person Centeredness/Autonomy, Unmet Need, Qualified Providers
Populations: Elders and adults with physical disabilities
Developer: New Jersey Department of Health and Senior Services
Use history: Used with two aged/disabled waivers and one Assisted Living waiver. Selected case managers, including new case managers, receive the tool for completion each year. Case managers submit these data on CD to the State for review.
States Currently Using: New Jersey
Psychometric Testing: Not specified
Summary: Items generally relate to how case managers do their jobs, including how plans of care are developed and how consumers are assured choice, as well as how case managers perform their oversight roles. Additional items assess whether case mangers have the necessary resources to perform their jobs.

Tool or Measure Set: New Jersey Department of Health and Senior Services File Review Tool
Data Source: Administrative data generated from file reviews
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 63 items: some specific to only one waiver
HCBS MS Domains: Timeliness, Unmet Need, Qualified Providers, Administrative Oversight, Person Centeredness/Autonomy
Populations: Elders and adults with physical disabilities
Developer: New Jersey Department of Health and Senior Services
Use history: Used with two aged/disabled waivers and one Assisted Living waiver. Data gathered electronically during reviews of selected client files.
States Currently Using: New Jersey
Psychometric Testing: Not specified
Summary: Oversight tool documenting adequacy and compliance in completion of client files. Items range from frequency of case manager monitoring and presence of required documentation to timeliness of care plan development and evidence of consumer choice.

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New York

Tool or Measure Set: Parent Satisfaction Survey for New York's Care at Home Waivers
Data Source: Consumer Survey
Respondent: Parents of service recipients
Mode of Data Collection: Mail survey
Total Items/indicators: 36 items, including 5 demographic items
HCBS MS Domains: Access, Quality of Life
Populations: Children with intellectual disabilities
Developer: New York Department of Health
Use history: Survey used for this first time in January 2007; copies were sent to families of 1,300 waiver participants in the State's four Care at Home waivers for children with intellectual disabilities. Approximately 28% of surveys were returned.
States Currently Using: New York
Psychometric Testing: No
Summary: Survey was developed internally by Department of Health staff, based on staff interests regarding program quality. The tool was not tested prior to mailing; staff members plan to use the results internally for quality improvement purposes. Most items are standard satisfaction items, such as "Are you satisfied with the nursing coverage your child receives?" Several open-ended items query the results of contacting agencies or requesting additional services.

Tool or Measure Set: New York Managed Long-Term Care (MLTC) Semi-Annual Assessment of Members (SAAM)
Data Source: Plans conducted the assessments every six months and submit data electronically using software developed by the State.
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 43 items
HCBS MS Domains: Unmet Need
Populations: Adults with physical disabilities
Developer: New York State Department of Health, with assistance from Peter Shaughnessey at the University of Colorado and the New York Peer Review Organization.
Use history: Current tool was released in 2005, and is used for enrollment and reassessment. State provides data to plans, based on their assessments, comparing them to all other plans.
States Currently Using: New York
Psychometric Testing: Reliability and validity of the Outcome and Assessment Information Set (OASIS) measure set has been established.
Summary: Adapted from OASIS, this is primarily an assessment tool that quantifies the consumer's status with respect to activities of daily living (ADLs) and instrumental activities of daily living (IADLs), as well as neuro/emotional/behavioral status. Several clinical items also examine areas such as sensory, integumentary and elimination status. Assessments are made based on functional ability at that time, not relative to time of admission or prior assessment. Data reported to plans are not risk adjusted; program staff are exploring mechanisms to do this, as well as standardized reports or indicators that could be generated from the data. The State is just beginning to use this tool for quality assurance purposes.

Tool or Measure Set: State of New York Department of Health Plan for Protective Oversight
Data Source: Administrative and provider data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 15 closed-ended items, 5 open-ended items, and basic demographic questions
HCBS MS Domains: Safety, Health and Welfare
Populations: Adults with acquired brain injuries
Developer: New York Department of Health
Use history: Developed to monitor safety for individuals with traumatic brain injury. Document is reviewed and updated every six months.
States Currently Using: New York
Psychometric Testing: No
Summary: This tool is utilized to identify individuals' risk factors, potential services to mitigate risk, and to document individuals responsible for addressing identified risk. Focus areas include money management, medication management, kitchen safety, and back up support services.

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North Carolina

Tool or Measure Set: Incident Data for North Carolina's 1915b/c Waiver: Consumers with Substance Abuse and Mental Health Issues and/or Developmental Disabilities
Data Source: Provider data on abuse, neglect, and exploitation
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 17
HCBS MS Domains: Safety, Health and Welfare, Quality of Life
Populations: Adults and children who are dually diagnosed with mental health and substance abuse disorders, or who have developmental disabilities
Developer: Piedmont Behavioral Healthcare
Use history: The North Carolina Department of Health and Human Services, Division of Medical Assistance requests its managed care organizations to collect this information on a routine basis.
States Currently Using: North Carolina
Psychometric Testing: Not specified
Summary: Items collected include: types of consumer deaths, use of restrictive interventions, consumer injuries, allegations of abuse, allegations of neglect, medication errors, consumer behaviors, and other incidents.

Tool or Measure Set: Piedmont Behavioral Healthcare Consumer Satisfaction Survey for North Carolina
Data Source: Consumer survey
Respondent: Consumer, parent, guardian, family member, other
Mode of Data Collection: Mail survey
Total Items/indicators: 24 items
HCBS MS Domains: Effectiveness, Efficiency, Person Centeredness/Autonomy, Timeliness, Equity, Access, Qualified Providers, Unmet Need, Quality of Life
Populations: Adults and children who are dually diagnosed with mental health and substance abuse disorders, or who have developmental disabilities
Developer: Piedmont Behavioral Health Care
Use history: Starting in 2005 has been administered annually to a sample of the State's 1915b/c its waiver consumers. In 2006 10,000 surveys were sent out.
States Currently Using: North Carolina
Psychometric Testing: Not specified
Summary: Piedmont Behavioral Healthcare (PBH), a local management entity of the State of North Carolina, collects annual data using a 5-point Likert scale that measures consumers' overall satisfaction with services provided by the PBH Network of Providers. Piedmont provides the Medicaid agency executive summaries of its findings.

Tool or Measure Set: North Carolina's Community Alternatives Program for Children (CAP/C) Participant/Family Survey
Data Source: Consumer survey
Respondent: Parent or guardian
Mode of Data Collection: Mail survey
Total Items/indicators: 8 items, plus limited demographic data
HCBS MS Domains: Unmet Need, Quality of Life
Populations: Children receiving services through the Community Alternatives Waiver
Developer:
Use history: Form is date June, 2006
States Currently Using: North Carolina
Psychometric Testing: Not specified
Summary: This is a very simple mail survey that queries whether the children's needs are being met through services and equipment, and satisfaction with case management and the program overall.

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North Dakota

Tool or Measure Set: North Dakota Client Interview Tool
Data Source: Consumer survey, Provider data
Respondent: Consumer
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: 21
HCBS MS Domains: Person Centeredness/Autonomy, Administrative Oversight, Effectiveness, Timeliness, Health and Welfare, Unmet Need, Safety
Populations: Adults with acquired brain injuries, Elders with physical disabilities, Adults with chronic physical conditions
Developer: North Dakota Department of Human Services, Medical Services, HCBS Division developed tool and used CMS Quality Framework to identify standards.
Use history: Starting in 2006 the tool was used to evaluate home and community based services on a sample of the approximately 3,250 consumers in the State's Medicaid waivers and State-funded programs.
States Currently Using: North Dakota
Psychometric Testing: Not specified
Summary: Mixture of questions addressed to consumer and to interviewer about the consumer. Questions cover four focus areas: (1) Case Management Services; (2) Service Delivery; (3) Rights; and (4) Community Involvement and use a 4-point scale of responses.

Tool or Measure Set: North Dakota Case Management Review
Data Source: Provider data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 26 applicable to all consumers; 4 applicable to only Medicaid waiver consumers; 9 applicable to only State-funded program consumers; 17 applicable to only consumers receiving nurse management or personal care services
HCBS MS Domains: Administrative Oversight, Timeliness, Qualified Providers
Populations: County Social Service Boards that provide case management services to Adults with acquired brain injuries, Elders with physical disabilities, Adults with chronic physical conditions
Developer: North Dakota Department of Human Services, Medical Services, HCBS Division
Use history: Starting in 2006 the tool was used to evaluate home and community based services for the approximately 3,000 consumers in the State's Medicaid waiver and State-funded programs. The Division reportedly does not select statistically valid random samples since it does not have the resources and it knows there are problem providers that need their attention.
States Currently Using: North Dakota
Psychometric Testing: Not specified
Summary: The State indicates that due to a lack of resources it cannot conduct random samples of County Social Service Boards so instead it targets boards where there are concerns. Indicators have a 4-point response Likert scale that prompts reviewers to measure how effectively counties provide HCBS case management services to consumers.

Tool or Measure Set: North Dakota Qualified Service Provider Review
Data Source: Provider data, Claims data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 14
HCBS MS Domains: Administrative Oversight, Qualified Providers, Quality of Life, Timeliness
Populations: Providers for Adults with acquired brain injuries, Elders with physical disabilities, Adults with chronic physical conditions
Developer: North Dakota Department of Human Services, Medical Services, HCBS Division
Use history: Starting in 2006 the tool was used to evaluate home and community based services for the approximately 3,250 consumers in the State's Medicaid waivers and State-funded programs. The Division reportedly does not select statistically valid random samples since it does not have the resources and it knows there are problem providers that need their attention.
States Currently Using: North Dakota
Psychometric Testing: Not specified
Summary: Payment histories are used to target providers for reviews that gauge how accurately providers comply with program standards. Focus areas include: 1) Service Records; 2) Payment Records, and 3) Employee Records. The State indicates that due to a lack of resources it cannot conduct random samples of service providers.

Tool or Measure Set: North Dakota's System Indicators for Adults with Developmental Disabilities
Data Source: Consumer survey
Respondent: Consumer, Guardian, Staff
Mode of Data Collection: Face-to-face interview
Total Items/indicators: 31
HCBS MS Domains: Quality of Life, Person Centeredness/Autonomy, Safety
Populations: Adults with intellectual disabilities (MR/DD)
Developer: Disability Services Division, North Dakota Department of Human Services
Use history: Developed in 2001 for the State's three HCBS waivers that serve this population.
States Currently Using: North Dakota
Psychometric Testing: Not specified
Summary: The Disability Services Division analyzes the data collected through the system indicators to determine trends within the system and to use in system planning, quality assurance and improvement activities.

Tool or Measure Set: North Dakota's System Indicators for Families of Children under 18 with Developmental Disabilities Living at Home
Data Source: Parent Interview
Respondent: Parents/Guardians
Mode of Data Collection: Interview
Total Items/indicators: 10
HCBS MS Domains: Access, Person Centeredness/Autonomy, Unmet Needs
Populations: Families of children with developmental disabilities
Developer: Disability Services Division, North Dakota Department of Human Services
Use history: Developed and used annually since 2001.
States Currently Using: North Dakota
Psychometric Testing: Not specified
Summary: The Disability Services Division analyzes the data collected through the system indicators to determine trends within the system and to use in system planning, quality assurance and improvement activities.

Tool or Measure Set: North Dakota's System Indicators for Families of Children under 18 with Developmental Disabilities Living Out of the Home
Data Source: Parent Interview
Respondent: Parents/Guardians
Mode of Data Collection: Interview
Total Items/indicators: 26
HCBS MS Domains: Access, Person Centeredness/Autonomy, Unmet Needs, Quality of Life
Populations: Families of children with developmental disabilities
Developer: Disability Services Division, North Dakota Department of Human Services
Use history: Developed and used annually since 2001.
States Currently Using: North Dakota
Psychometric Testing: Not specified
Summary: The Disability Services Division analyzes the data collected through the system indicators to determine trends within the system and to use in system planning, quality assurance and improvement activities.

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Ohio

Tool or Measure Set: Ohio Health Plans Bureau of Home & Community Services Administered HCBS Waivers
Data Source: Provider data, Consumer survey, Administrative data,
Respondent: Consumers
Mode of Data Collection: Telephone interviews, Case Record Reviews
Total Items/indicators: 132
HCBS MS Domains: Access, Unmet Need, Timeliness, Safety, Health and Welfare
Populations: Adults with intellectual disabilities, Elders with physical disabilities, Adults with chronic physical conditions
Developer: Ohio Department of Jobs and Family Services developed the tool and included some of the Participant Experience Survey indicators.
Use history: Completed in May 2007. Some standards are not yet defined.
States Currently Using: Ohio
Psychometric Testing: State participated in field test of the Participant Experience Survey, other testing not specified
Summary: This list of indicators aggregates information from the State's case management provider agency and the Bureau's QA activities.

Tool or Measure Set: Ohio HCBS Performance Indicators
Data Source: Administrative data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 21
HCBS MS Domains: Access, Person Centeredness/Autonomy, Unmet Need, Safety, Timeliness, Qualified Providers
Populations: Elders with physical or cognitive disabilities, Adults with chronic physical conditions, Adults and children with intellectual disabilities, medically fragile children
Developer: The Ohio Medicaid agency, the Ohio Department of Jobs and Family Services, developed these indicators and the specifications for calculating them through an interagency quality steering committee.
Use history: The Medicaid agency is verifying that its operating agencies will have the capacity to produce each of these new indicators by May 2007. Their goal is to develop an initial quality report by late summer 2007.
States Currently Using: Ohio-planned
Psychometric Testing: Measures still under development
Summary: Indicators are organized according to the CMS Quality Framework's domains. These indicators are not intended to supplant the Medicaid agency's oversight mechanisms which it will continue to gather through interactions with its operating agencies.

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Oklahoma

Tool or Measure Set: Oklahoma Developmental Disabilities Services Division Evaluation of Agency Performance
Data Source: Administrative data generated through onsite review
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 330
HCBS MS Domains: Access, Person Centeredness/Autonomy, Unmet Need, Safety, Timeliness, Qualified Providers
Populations: Adults and children with intellectual disabilities
Developer: Oklahoma Department of Human Services, Developmental Disabilities Services Division, Quality Assurance Unit
Use history: Reviews are conducted annually. Agencies have 60 days to address deficiencies identified during the review.
States Currently Using: Oklahoma
Psychometric Testing: Not specified
Summary: This review tool contains 330 conditions that are rated as either "met" or "not met," and are organized by the following focus areas (not all apply for all waiver participants): Services and Supports for Individuals; Agency Administration; Health Services; Residential Services; Employment Services; In-Home Supports Waiver

Tool or Measure Set: Oklahoma Developmental Disabilities Services Division In-Home Supports Waiver Survey
Data Source: Consumer Survey
Respondent: Consumer or Proxy (parent, guardian, other)
Mode of Data Collection: Mail
Total Items/indicators: 7
HCBS MS Domains: Quality of Life, Timeliness
Populations: Adults and children with intellectual disabilities
Developer: Oklahoma Department of Human Services, Developmental Disabilities Services Division, Quality Assurance Unit
Use history: Mailed to program participants annually
States Currently Using: Oklahoma
Psychometric Testing: Not specified
Summary: This mail-out tool consists of 7 statements regarding client experience and satisfaction, for which respondents can check "yes" or "no." Sample items include "I received my services in a timely manner" and "I have contacted my case manager with all my concerns." Demographic data include country and type of residence (own home, etc.) In addition, data on type of proxy respondent is collected.

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/hcbsapiiig.html