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Connections - 08.31.22

5 Things to Know About the Historic Plan to Measure HCBS Quality

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Recently, the Centers for Medicare & Medicaid Services (CMS) released a first-ever home and community-based services (HCBS) quality measure set to states in order to promote consistent quality measurement within and across state Medicaid HCBS programs. HCBS providers have responded positively, lauding it as an important first step for a sector that consistently provides quality care but often lacks consistent data.

Before you dive in, opt out, or just wait and watch, here are 5 things you need to know:

1. The measure set is intended to provide insights into the quality of HCBS programs and enable states to measure and improve health outcomes for people relying on long-term care services and supports (LTSS) in Medicaid.

CMS sees the release of this voluntary measure set as a critical step to promoting health equity among the millions of older adults and people with disabilities who need LTSS because of age, developmental or physical disability, or chronic illnesses.

2. This is happening now because CMS is looking at the growth of HCBS in Medicaid spending, which has risen significantly in recent years.

In a letter to State Medicaid Directors announcing the measure set, CMS said, “As a result of state and federal efforts to expand access to HCBS, Medicaid spending on HCBS now exceeds spending on institutional services.” In fact, HCBS expenditures accounted for only 13% of federal and state expenditures for Medicaid LTSS in 1992; by 2020, this number had risen to 62%. Furthermore, CMS acknowledges that in 2016, the National Quality Forum issued a report stating that HCBS lacks any standardized set of quality measures. CMS recognized this and, in 2020, set out through a public information opportunity to seek input into how quality should be measured in the service.

3. At this time, use of the quality measure set is voluntary for states to use.

CMS suggests that it could be mandatory, at least in some areas, down the line. In fact, CMS has said that it plans to incorporate the use of this measure set into the reporting requirements for specific authorities and programs, including the Money Follows the Person program.

4. The measure set identifies measures that address HCBS quality in three key priority areas.

These are 1) access, the level to which beneficiary/family caregiver/natural support is aware of and able to access resources; 2) rebalancing, achieving a more equitable balance between the share of spending and the use of services/supports delivered in HCBS settings relative to institutional care; and 3) community integration, focused on ensuring the self-determination, independence, empowerment and full inclusion of children and adults with disabilities and older adults in all parts of society.

5. The specific measures address various issues.

These include flu vaccination, realization of personal goals, social connectedness, freedom from abuse/neglect, sufficient privacy, ability to choose/change services, access to transportation, comprehensive assessments and updates, successful transition after long-term care facility stay, and identification of person-centered priorities.

CMS hopes this measure set will impact various aspects of HCBS including access and equity. As a next step, providers should look through the measures and get a sense of what is involved and what measures and service outcomes CMS considers to be important. Understanding the measures can help providers determine how to tailor services and assess quality and outcomes.

Since pharmacy services are integral to yielding high quality outcomes, providers should consider these solutions carefully. If you’d like to learn more about Pharmacy Alternatives by PharMerica, visit PALRx.com.

Esmé Grewal is Vice President of Government Relations at BrightSpring Health Services.