Home and Community-Based Services Quality Measures
Consumer Assessment of Healthcare Providers and Systems Home and Community-Based Services Survey (HCBS CAHPS®) Quality Measures
CMS is the measure steward for 19 quality measures derived from the HCBS CAHPS Survey, some from individual instrument items and some from a composite of multiple instrument items. A Consensus-Based Entity endorsed the HCBS CAHPS Survey quality measures in 2016 (CMS Measure Inventory Tool [CMIT] Measure ID #95).
| Category | Quality Measure Name | Measure Composition |
|---|---|---|
| Scale Measures | Staff are reliable and helpful | Top-box score composed of 6 survey items |
| Staff listen and communicate well | Top-box score composed of 11 survey items | |
| Case manager is helpful | Top-box score composed of 3 survey items | |
| Choosing the services that matter to you | Top-box score composed of 2 survey items | |
| Transportation to medical appointments | Top-box score composed of 3 survey items | |
| Personal safety and respect | Top-box score composed of 3 survey items | |
| Planning your time and activities | Top-box score composed of 6 survey items | |
| Global Rating Measures | Global rating of personal assistance and behavioral health staff | Top-box score on a 0–10 scale |
| Global rating of homemaker | Top-box score on a 0–10 scale | |
| Global rating of case manager | Top-box score on a 0–10 scale | |
| Recommendation Measures | Would recommend personal assistance/behavioral health staff to family and friends | Top-box score on a 1–4 scale |
| Would recommend homemaker to family and friends | Top-box score on a 1–4 scale | |
| Would recommend case manager to family and friends | Top-box score on a 1–4 scale | |
| Unmet Need Measures | Unmet need in dressing/bathing due to lack of help | Top-box score on a Yes/No scale |
| Unmet need in meal preparation/eating due to lack of help | Top-box score on a Yes/No scale | |
| Unmet need in medication administration due to lack of help | Top-box score on a Yes/No scale | |
| Unmet need in toileting due to lack of help | Top-box score on a Yes/No scale | |
| Unmet need with household tasks due to lack of help | Top-box score on a Yes/No scale | |
| Physical Safety Measure | Hit or hurt by staff | Top-box score on a Yes/No scale |
HCBS CAHPS Survey adoption is included among measures in CMS’s Medicaid and Children's Health Insurance Program (CHIP) Scorecard, in the category of State Use of Experience of Care Surveys for Beneficiaries Using Long-Term Services and Supports. The Scorecard was developed to increase public transparency about Medicaid and CHIP administration and outcomes. Measures such as the HCBS CAHPS Survey show how states provide person-centered care to Medicaid and CHIP beneficiaries.
State Medicaid agencies and the managed care plans with which they contract can submit the results of the HCBS CAHPS Survey to the Agency for Healthcare Research and Quality’s HCBS CAHPS Database. The HCBS CAHPS Database provides individual feedback reports to submitters and aggregates the data in an annual HCBS CAHPS Chartbook . The reports provide information to users of the HCBS CAHPS Survey about performance in measurement areas, including reliability of HCBS staff and choice of services. Participation in the HCBS CAHPS Database is free and voluntary.
CMS maintenance of HCBS CAHPS measures includes ongoing review of the technical specifications through information gathering and stakeholder input. Updates on HCBS CAHPS measures will be published on this page. Additional HCBS CAHPS technical assistance materials are available here.
Functional Assessment Standardized Items (FASI) Quality Measures
CMS is the measure steward for two performance measures, derived from Functional Assessment Standardized Items (FASI), that assess and compare state performance related to person-centered planning. These measures enable comparisons of the quality of care across settings and can help address the critical challenges states face in using meaningful HCBS quality measures to improve service delivery, to move toward person-centered planning, and to support core participant outcomes. A consensus-based entity has endorsed the FASI performance measures (CMIT Measure ID #969 and #970).
- Identifying Personal Priorities for FASI Needs. Percentage of HCBS participants aged 18 years or older who have documented needs determined by FASI and who have identified at least as many total personal priorities (up to three) as functional needs in the areas of self-care, mobility, or instrumental activities of daily living as determined by their most recent FASI assessment.
- Alignment of Person-Centered Service Plan with FASI Needs. Percentage of HCBS participants aged 18 years or older who have documented needs determined by FASI and documentation of a comprehensive Person-Centered Service Plan that addressed identified functional needs within the reporting period.
Additional information is available on FASI.
Long-Term Services and Supports (LTSS) Quality Measures
CMS is the measure steward for 15 nationally standardized LTSS quality measures including managed care and fee-for service (FFS) quality measures delivered by states through their Medicaid programs. The MLTSS and FFS LTSS measures are aligned pairs, collectively referred to as LTSS quality measures, with unique technical specifications focused on MLTSS and FFS delivery systems. The LTSS quality measures are can be grouped into three categories of quality measures: assessment and care planning, falls risk assessment and rebalancing and utilization.
Assessment and Person-Centered Planning Quality Measures
- Comprehensive Assessment and Update (MLTSS-1 and FFS LTSS-1; CMIT Measure ID #960)
- Comprehensive Person-Centered Plan and Update (MLTSS-2 and FFS LTSS-2; CMIT Measure ID #961)
- Shared Person-Centered Plan with Primary Care Provider (MLTSS-3 and FFS LTSS-3; CMIT Measure ID #963)
- Reassessment and Person-Centered Plan after Inpatient Discharge (MLTSS-4 and FFS LTSS-4; CMIT Measure ID #962)
Falls Risk Screening Quality Measure
LTSS Rebalancing and Utilization Quality Measures
- Admission to a Facility from the Community (MLTSS-6 and FFS LTSS-6; CMIT Measure ID #20)
- Minimizing Facility Length of Stay (MLTSS-7 and FFS LTSS-7; CMIT Measure ID #968)
- Successful Transition after Long-Term Facility Stay (MLTSS-8 and FFS LTSS-8; CMIT Measure ID #414)
Quality Measures Developed under the Medicaid Innovation Accelerator Program
Under the Medicaid Innovation Accelerator Program (IAP), CMS developed or refined several measures in the following areas: