Appendix III (continued)

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

West Virginia

Tool or Measure Set: Indicators for West Virginia's Aged and Disabled Waiver
Data Source: Multiple: provider monitoring reports, financial data, incident tracking
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 45 indicators/outcomes
HCBS MS Domains: Timeliness, Unmet Need, Person Centeredness/Autonomy, Qualified Providers, Health and Welfare
Populations: Elders with physical and cognitive disabilities, adults with physical disabilities
Developer: West Virginia Department of Health and Human Resources, Bureau for Medical Services
Use history: Indicator list published April 27, 2007
States Currently Using: West Virginia
Psychometric Testing: Not specified
Summary: Indicators are reported in a template designed to provide evidence that the State is meeting the CMS assurances for Medicaid HCBS waivers.

Tool or Measure Set: Indicators for West Virginia's MRDD Waiver
Data Source: Multiple
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 31 indicators
HCBS MS Domains: Qualified Providers, Person Centeredness/Autonomy, Unmet Need, Health and Welfare
Populations: Individuals with intellectual disabilities
Developer: West Virginia Department of Health and Human Resources, Bureau for Medical Services
Use history: 2007 indicator list
States Currently Using: West Virginia
Psychometric Testing: Not specified
Summary: Indicator report organized along the five CMS assurances for Medicaid HCBS waivers, and specifies the numerator and denominator for each indicator. All indicators expressed as a percentage of individuals/entities that meet the assurance and subassurance requirement.

Tool or Measure Set: West Virginia Participant Experience Survey: Traditional and Personal Options Participants
Data Source: Consumer Survey
Respondent: Consumers
Mode of Data Collection: Face-to-face structured interview
Total Items/indicators: 69 close-ended items for participants in the traditional A/D waiver; 78 items for those in the Personal Options program (self-direction)
HCBS MS Domains: Unmet Need, Person Centeredness/Autonomy, Quality of Life, Access
Populations: Elders with physical and cognitive disabilities, adults with physical disabilities
Developer: The Center for Excellence in Disabilities, West Virginia University, in collaboration with The Medstat Group, Inc. Survey development funded through a CMS Real Choice Quality Assurance/Quality Improvement (QA/QI) Systems Change grant
Use history: Tool date July 1, 2006. Survey is being fielded for the first time in 2007
States Currently Using: West Virginia
Psychometric Testing: Field testing still ongoing
Summary: Survey is a modified version of the Participant Experience Survey, elderly/disabled version, with additional items specific to self-direction. Many items apply both to those receiving agency services and those who direct their own services; other modules are specific. Self-direction items include recruitment and retention of direct care staff, backup plans, and support for self-direction, including adequacy of financial management services.

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Wisconsin

Tool or Measure Set: Wisconsin Department of Health and Family Services Participant Outcomes for Community Option Program—Waiver (COP-W) and Community Integration Program II (CIP II) Waiver
Data Source: Consumer Survey
Respondent: Consumers
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: 4
HCBS MS Domains: Person Centeredness/Autonomy, Safety, Health and Welfare, Effectiveness
Populations: Adults with chronic physical conditions, Elders with physical disabilities
Developer: Wisconsin Department of Health and Family Services, Division of Disability and Elder Services, Bureau of Aging and Long Term Care Resources
Use history: The Department piloted the measures in May 2005 as part of supports coordinators routine monitoring visits with participants. This tool is used across the State's Medicaid waiver and State-funded program for people with physical disabilities.
States Currently Using: Wisconsin
Psychometric Testing: Not specified
Summary: This interview tool measures consumer satisfaction in three focus areas: 1) Empowerment to make choices, 2) Physical and mental health (health and safety), and 3) Community and Family Participation. Interview questions are open-ended and interviewers are instructed to identify effective and ineffective supports as well as overall percentages of outcomes that are being achieved, not achieved/not addressed, and not achieved/in progress. Interviewers are also prompted to identify the outcomes that appear to be of high importance to participants. The Department is working on a cross-waiver set of outcome measures.

Tool or Measure Set: Wisconsin Department of Health and Family Services Program Review Outcomes and Activities (PROACT) for Community Integration Program I and Brain Injury HCBS Waivers
Data Source: Administrative data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 73
HCBS MS Domains: Unmet Need, Qualified Providers, Safety, Person Centeredness/Autonomy, Health and Safety, Quality of Life
Populations: Adults with intellectual disabilities (DD) and Adults with acquired brain injuries
Developer: Bureau of Long Term Support
Use history: This is an optional quasi-record review that the Bureau conducts on a random consumer sample when resources are available.
States Currently Using: Wisconsin
Psychometric Testing: Not specified
Summary: The purpose of this review is to assess consumer interactions with Department staff and others that support or influence the consumer's independence, for example incidents, guardians, degree of community integration. Reviewers use a 4-point response scale to review selected consumers' case records and make judgments on these five areas: 1) Appropriateness, 2) Work/Day Services, 3) Case Management, 4) Guardian/Family, and 5) Community Inclusion.

Tool or Measure Set: Wisconsin Department of Health and Family Services Parent/Guardian Questionnaire for Community Integration Program I and Brain Injury HCBS Waivers
Data Source: Survey
Respondent: Parent/Guardian
Mode of Data Collection: Mail
Total Items/indicators: 10
HCBS MS Domains: Coordination of Long-Term Care and Other Services, Safety
Populations: Adults with intellectual disabilities (DD) and Adults with acquired brain injuries
Developer: Bureau of Long Term Support
Use history: This annual survey has been suspended, but not cancelled, for the past three years.
States Currently Using: Wisconsin (use currently suspended)
Psychometric Testing: Not specified
Summary: Parents/Guardians of people receiving services from either of these two waivers are prompted to indicate their satisfaction with services delivered using yes/no questions.

Tool or Measure Set: Wisconsin Department of Health and Family Services Case Record Review Tool for Community Integration Program (CIP) I and Brain Injury (BI) HCBS Waivers
Data Source: Administrative data and Consumer interview are done in concert
Respondent: Consumer
Mode of Data Collection: Face-to-Face interviews
Total Items/indicators: 19
HCBS MS Domains: Qualified Providers
Populations: Adults with intellectual disabilities (DD) and Adults with acquired brain injuries
Developer: Bureau of Long Term Support
Use history: Every year DHFS draws a 2% random sample of Community Integration Program and 5% of Brain Injury consumers to conduct a face-to-face interview and make a home visit.
States Currently Using: Wisconsin
Psychometric Testing: Not specified
Summary: Review tool follows CMS's HCBS waiver application's review instrument in prompting reviewers to indicate presence/absence of service-specific criteria.

Tool or Measure Set: Wisconsin Draft Consumer Satisfaction Questions for Family Care Managed Care Organization (MCO) Providers
Data Source: Consumer survey
Respondent: Consumer
Mode of Data Collection: Mail survey
Total Items/indicators: 10
HCBS MS Domains: Person Centeredness/Autonomy, Quality of Life
Populations: Adults and Elderly with physical disabilities
Developer: A collaboration of Department of Health and Family Services waiver staff, managed care staff, consumers, providers, State staff, consultants and other stakeholders.
Use history: One county mailed 155 surveys to consumers in April-May 2006 as a field test.
States Currently Using: Wisconsin; statewide use is proposed
Psychometric Testing: Field tested; content validity via stakeholder involvement
Summary: Wisconsin requires managed care organizations to administer consumer satisfaction surveys on at least an annual basis but to avoid oversurveying consumers, the Department of Health and Family Services is proposing that this core set of questions could be incorporated into the providers own survey tools.

Tool or Measure Set: Wisconsin Department of Health and Family Service's Draft Personal Experience Outcomes
Data Source: Consumer interview
Respondent: Consumer
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: 12
HCBS MS Domains: Person Centeredness/Autonomy, Quality of Life, Health and Welfare, Safety
Populations: Adults and Elderly with physical disabilities
Developer: A collaboration of Department of Health and Family Services waiver staff, managed care staff, consumers, providers, State staff, consultants and other stakeholders.
Use history: The Department plans to release a Request for Proposal in 2007 for a consultant to develop an outcome interview tool and accompanying training program.
States Currently Using: Wisconsin; planned
Psychometric Testing: Content validity via stakeholder involvement, further development and testing planned
Summary: This is a core set of outcomes that the Department could use across programs with minor changes to make applicable to each target group.

Tool or Measure Set: Wisconsin HCBS Children's Waiver: Family Survey
Data Source: Interviews with parents
Respondent: Parents
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: 44
HCBS MS Domains: Health and Welfare, Safety, Coordination of Long-Term Care and Other Services, Unmet Need, Access, Quality of Life, Qualified Providers
Populations: Children with physical disabilities and children with intellectual disabilities (DD)
Developer: The Waisman Center, a national researcher that focuses on human development and developmental disabilities.
Use history: The Wisconsin Department of Health and Family Services has conducted annual family satisfaction surveys since the waiver's inception in 2004. In 2006 the State used this survey tool to conduct a 100% review of all the children consumer's families.
States Currently Using: Wisconsin
Psychometric Testing: Not specified
Summary: The survey tool contains four focus areas:1) Child's Health and Safety, 2) Child's Quality of Life, 3) Impact of Caregiving on your Family, 4) Experience with Home and Community Based Children's Medicaid Waiver. There is also a final section soliciting information on the child and family. Most questions use a 5-point Likert satisfaction response scale or have multiple choice answers.

Tool or Measure Set: Wisconsin Ensuring Quality Assurance and Technical Assistance Elements (EQUATE) Outcomes Table
Data Source: Compilation of Family Interviews and Provider, Utilization, and Administrative Data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 48
HCBS Domains: Qualified Providers, Access, Equity, Other: Coordination With Medical Services, Effectiveness, Quality of Life, Health and Welfare
Populations: Children with physical disabilities and children with intellectual disabilities (DD)
Developer: The Wisconsin Department of Health and Family Services
Use history: N/A
States Currently Using: Wisconsin
Psychometric Testing: Not specified
Summary: This table is an illustration of the outcomes, quality indicators and performance measures that the Department obtains from its various monitoring activities to assess the quality of its two Medicaid waivers for children. Quality indicators and performance measures are connected to five major outcomes or focus areas: 1) Access, 2) Choice, 3) Coordination, 4) Quality, and 5) Funding.

Tool or Measure Set: Personal Experience Outcomes iNtegrated Interview and Evaluation System (PEONIES) for Adults with Developmental or Physical Disabilities and Frail Elders in Wisconsin's Medicaid-Funded HCBS and Managed Long-Term Care Programs
Data Source: Consumer survey (planned)
Respondent: To be determined
Mode of Data Collection: N/A
Total Items/indicators: 12 outcomes
HCBS Domains: Quality of Life, Health and Welfare, Safety, Person Centeredness/Autonomy
Populations: Adults with Developmental or Physical Disabilities and Frail Elders
Developer: The Center for Health Systems Research and Analysis (CHSRA) at the University of Wisconsin, under contract to Wisconsin Department of Health and Family Services
Use history: Project is estimated to be complete by December 2007.
States Currently Using: Wisconsin (planned)
Psychometric Testing: Planned
Summary: This project is under development, and interview tools are currently being developed. The project will include four major activities: Develop interview tools to guide Care Managers and Quality Reviewers in learning about Personal Experience Outcomes; Develop a manual to help people use the interview tools; Develop a training program to teach people to use the interview tools; Conduct reliability tests to make sure that interview tools, manual, and training program are working properly.

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Wyoming

Tool or Measure Set: Wyoming's Draft Field Review Tool for Providers Elderly/Disabled and Assisted Living HCBS Waivers
Data Source: Administrative data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 131, however many indicators are service specific so will not apply to all consumers
HCBS MS Domains: Administrative Oversight, Unmet Need, Coordination of Long-Term Care and Other Services, Effectiveness
Populations: Adults and Elderly with physical disabilities
Developer: Aging Division, Wyoming Department of Health
Use history: Provider review tool has been used one time.
States Currently Using: Wyoming
Psychometric Testing: Not specified
Summary: This review tool will be used to assess providers having met documentation requirements. It is divided into sections for reviewing consumer records at both the case management and service delivery provider levels.

Tool or Measure Set: Wyoming Department of Health, Developmental Disabilities Division's Day Habilitation Checklist
Data Source: Interviews with consumers receiving day habilitation services.
Respondent: Consumer
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: 10 open-ended questions
HCBS MS Domains: Quality of Life, Access
Populations: Adults with intellectual disabilities (MRDD) and Adults with acquired brain injuries
Developer: Checklist developed by team of providers, independent service coordinators, area resource specialists, and program integrity staff with CMS Regional Office input.
Use history: Every year the Division uses this checklist to conduct interviews on a random sample of consumers receiving day habilitation services through either the adult DD or acquired brain injury Medicaid waivers.
States Currently Using: Wyoming
Psychometric Testing: Not specified
Summary: The Division's Program Integrity Section conducts consumer interviews with this checklist as one activity in its CARF accreditation process for day habilitation providers. The Department of Health uses the information obtained through these interviews, combined with information obtained from the Program Integrity's other accreditation activities, to identify and report to CMS its focus areas for making HCBS waiver improvements.

Tool or Measure Set: Wyoming Department of Health, Developmental Disabilities Division's Residential Habilitation Checklist
Data Source: Interviews with consumers receiving residential habilitation services.
Respondent: Consumers
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: 14 open-ended questions
HCBS MS Domains: Quality of Life, Access, Unmet Need, Health and Welfare
Populations: Adults with intellectual disabilities (MRDD) and Adults with acquired brain injuries
Developer: Checklist developed by team of providers, independent service coordinators, area resource specialists, and program integrity staff with CMS Regional Office input.
Use history: Every year the Division uses this checklist to conduct interviews on a random sample of consumers receiving residential habilitation services through the adult DD or acquired brain injury Medicaid waivers.
States Currently Using: Wyoming
Psychometric Testing: Not specified
Summary: The Division's Program Integrity Section conducts consumer interviews with this checklist as one activity in its Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation process for residential habilitation providers. The Department of Health uses the information obtained through these interviews, combined with information obtained from the Program Integrity's other accreditation activities, to identify and report to CMS its focus areas for making HCBS waiver improvements.

Tool or Measure Set: Wyoming Department of Health, Developmental Disabilities Division's Health and Safety Checklist
Data Source: Consumer Interviews
Respondent: Consumers/Parents
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: 16 open-ended questions and an additional 4 open-ended questions for consumers who do not require 24 hour staffing
HCBS MS Domains: Quality of Life, Access, Unmet Needs, Health and Welfare, Safety, Coordination of Long-Term Care and Other Services
Populations: Adults with intellectual disabilities (MRDD) and Adults with acquired brain injuries
Developer: Checklist developed by team of providers, independent service coordinators, area resource specialists, and program integrity staff with CMS Regional Office input.
Use history: Every year the Division uses this checklist to conduct interviews on a random sample of consumers in the adult DD and acquired brain injury Medicaid waivers.
States Currently Using: Wyoming
Psychometric Testing: Not specified
Summary: The Division's Program Integrity Section conducts consumer interviews with this checklist as one activity in its CARF accreditation process for all providers. The Department of Health uses the information obtained through these interviews, combined with information obtained from the Program Integrity's other accreditation activities, to identify and report to CMS its focus areas for making HCBS waiver improvements.

Tool or Measure Set: Wyoming Department of Health, Developmental Disabilities Division's Checklist for Individually Selected Service Coordinators
Data Source: Service Coordinator Interviews
Respondent: Service Coordinators
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: 20 open-ended questions
HCBS MS Domains: Unmet Need, Health and Welfare, Safety, Quality of Life, Qualified Providers
Populations: Service Coordinators who work with Adults and children with intellectual disabilities (MRDD) and Adults with acquired brain injuries
Developer: Checklist developed by team of providers, independent service coordinators, area resource specialists, and program integrity staff with CMS Regional Office input.
Use history: Every year the Division uses this checklist to interview a random sample of supports coordinators that provide services to consumers in the adult DD, children with DD, and acquired brain injury Medicaid waivers.
States Currently Using: Wyoming
Psychometric Testing: Not specified
Summary: The Division's Program Integrity Section conducts consumer interviews with this checklist as one activity in its CARF accreditation process for supports coordination providers. The Department of Health uses the information obtained through these interviews, combined with information obtained from the Program Integrity's other accreditation activities, to identify and report to CMS its focus areas for making HCBS waiver improvements.

Tool or Measure Set: Wyoming Department of Health, Developmental Disabilities Division's Checklist for Direct Support Staff
Data Source: Direct Support Staff Interviews
Respondent: Direct Support Staff
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: 25 open-ended questions
HCBS MS Domains: Quality of Life, Unmet Need, Health and Welfare, Safety, Qualified Providers
Populations: Direct support staff who work with Adults and children with intellectual disabilities (MRDD) and Adults with acquired brain injuries
Developer: Checklist developed by team of providers, independent service coordinators, area resource specialists, and program integrity staff with CMS Regional Office input.
Use history: Every year the Division uses this checklist to interview a random sample of supports coordinators that provide services to consumers in the adult DD, children with DD, and acquired brain injury Medicaid waivers.
States Currently Using: Wyoming
Psychometric Testing: Not specified
Summary: The Division's Program Integrity Section conducts consumer interviews with this checklist as one activity in its CARF accreditation process for all providers. The Department of Health uses the information obtained through these interviews, combined with information obtained from the Program Integrity's other accreditation activities, to identify and report to CMS its focus areas for making HCBS waiver improvements.

Tool or Measure Set: Wyoming Department of Health, Developmental Disabilities Division's Employment Checklist
Data Source: Interviews with consumers who are working or are interested in being employed
Respondent: Consumers
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: 14 open-ended questions
HCBS MS Domains: Quality of Life, Unmet Need
Populations: Adults with intellectual disabilities (MRDD) and Adults with acquired brain injuries
Developer: Checklist developed by team of providers, independent service coordinators, area resource specialists, and program integrity staff with CMS Regional Office input.
Use history: Every year the Division uses this checklist to interview a random sample of consumers from its adults with DD and acquired brain injuries waivers who are either employed or interested in being employed.
States Currently Using: Wyoming
Psychometric Testing: Not specified
Summary: The Division's Program Integrity Section conducts consumer interviews related to employment issues with this checklist as one activity in its CARF accreditation process for all providers. The Department of Health uses the information obtained through these interviews, combined with information obtained from the Program Integrity's other accreditation activities, to identify and report to CMS its focus areas for making HCBS waiver improvements.

Tool or Measure Set: Wyoming Department of Health, Developmental Disabilities Division's Family Satisfaction Checklist
Data Source: Family Interviews
Respondent: Parents
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: 12 open-ended questions
HCBS MS Domains: Health and Welfare, Safety, Quality of Life
Populations: Families of Adults and children with intellectual disabilities (MRDD) and Adults with acquired brain injuries
Developer: Checklist developed by team of providers, independent service coordinators, area resource specialists, and program integrity staff with CMS Regional Office input.
Use history: Every year the Division selects a random sample of consumers from its adult with DD, children with DD, and acquired brain injury waivers to use this checklist to conduct interviews with their families.
States Currently Using: Wyoming
Psychometric Testing: Not specified
Summary: The Division's Program Integrity Section conducts consumer interviews related to employment issues with this checklist as one activity in its CARF accreditation process for all providers. The Department of Health uses the information obtained through these interviews, combined with information obtained from the Program Integrity's other accreditation activities, to identify and report to CMS its focus areas for making HCBS waiver improvements.

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Abbreviations


AbbreviationFull Name
AAAArea agency on aging
ADHCAdult day health care
ADLsActivities of daily living
ADRCAging and Disability Resource Center
AHRQAgency for Healthcare Research and Quality
AoAAdministration on Aging
CAHPS®Consumer Assessment of Healthcare Providers and Systems (CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality.)
CARFCommission on Accreditation of Rehabilitation Facilities
CMHSCenter for Mental Health Services
CMSCenters for Medicare & Medicaid Services
CQLCouncil on Quality and Leadership
DDDevelopmental disabilities
DHHSDepartment of Health and Human Services
FYFiscal year
HCBSHome and community-based services
HCBWHome and community-based waiver
HEDIS®Healthcare Effectiveness Data and Information Set (HEDIS® is a registered trademark of the National Committee for Quality Assurance)
HSRIHuman Services Research Institute
IADLsInstrumental activities of daily living
ITInformation technology
LTCLong-term care
MDSMinimum Data Set
MR/DDMental retardation/development disabilities
NCINational Core Indicators
NIDRRNational Institute on Disability and Rehabilitation Research
OASISOutcome and Assessment Information Set
NQFNational Quality Forum
NCQANational Committee for Quality Assurance
PASPersonal assistance services
PESParticipant Experience Survey
POMPPerformance Outcome Measurement Project
QA/QIQuality assurance/quality improvement
QIOQuality Improvement Organization
QOLQuality of life
SAMHSASubstance Abuse and Mental Health Services Administration

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Index to Tools and Measures and Their Developers

{To be developed based upon the final version of the Compendium of Measures.}

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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/hcbsapiiij.html