CMS sets quality measures for state-funded home care programs


The Centers for Medicare and Medicaid Services announced the release of voluntary quality measures for state Medicaid home and community-based service programs to assess patient health outcomes.

While reporting on the measures is currently voluntary, CMS said it encourages states to incorporate the quality assessments into existing home and community-based service reporting requirements, evaluating their performance biannually, setting targets and developing a quality improvement plan.

“The use of consistent quality measures across the country is another step towards reducing health disparities and ensuring that people with disabilities, and older adults enrolled in Medicaid, have access to and receive high-quality services in the community,” CMS Administrator Chiquita Brooks- LaSure said in a news release.

To collect comparative quality data across programs and promote standardized care quality practices using the measures, states will pull information from claims, patient records and existing beneficiary surveys such as the Consumer Assessment of Healthcare Providers and Systems.

The measures were created to assess quality and outcomes across a wide range of key areas, although some are only applicable for certain types of care delivery systems, CMS said.

One major focus is to gauge the level of access that beneficiaries and their caregivers have to resources that support their overall well-being, such as peer and crisis support services, and informational and referral services.

In addition to health equity and disparities, the quality measures are meant to direct attention to community integration and ensuring older adults and individuals with disabilities are independent, empowered and have their social needs met. Another goal is to achieve a more equitable balance between spending, services and supports delivered in home and community-based settings versus institutional care.

More than seven million people receive home and community-based services through Medicaid, according to CMS. In 2020, these services cost $125 billion, around 62% of the federal amount spent on Medicaid long-term services and supports.

States have until March 2025 to use the 10-percentage-point increase in federal Medicaid matching funds for home and community-based services authorized in 2021 as part of the COVID-19 relief legislation passed by Congress.

Both the House and President Joe Biden’s administration have pushed for additional funding for home and community-based services, although the efforts were stalled last year.

CMS said it is able to offer states technical assistance to support the implementation of the new quality measures, as well as Federal Financial Participation funding for developing or making improvements to claims processing and information retrieval systems.

The agency plans to add measures that address gaps in existing quality measures for home and community-based services.


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