CMS Unveils HCBS Quality Metrics for Patient Outcomes

The Centers for Medicare and Medicaid Services (CMS) published a set of quality metrics for home and community-based services (HCBS) to assess patient health outcomes. According to CMS, the ratings will provide insight into HCBS programs and will enable states to determine the success of long-term services and support programs offered through Medicaid programs.

From CMS Administrator Chiquita Brooks-LaSure via the CMS press release:

Today’s announcement provides states with tools to better understand and compare health outcomes across groups receiving home- and community-based services. The use of consistent quality measures across the country is another step toward 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.

Reporting on the measures is currently voluntary, Modern Healthcare reports, but states will be encouraged to incorporate the quality assessments into other existing reporting requirements and to use the results within performance evaluations and the creation of quality improvement plans. Furthermore, states will use information from claims, patient records and beneficiary surveys to collect comparative quality data across programs.

Healthcare Finance News notes that more than 7 million people receive HCBS under Medicaid, accounting for a total of $125 billion annually in state and federal spending. While nursing facility care is required for qualifying adults, HCBS has historically remained optional for state programs.

Senior care advocates like LeadingAge have long supported improvements of HCBS policies. While Meredith Chillemi, director of Medicaid and HCBS policy at LeadingAge supports nationally standardized quality metrics for these programs, she told McKnight’s Senior Living that funding and access to HCBS services remains a concern:

But knowing their options does not guarantee consumers’ ability to access needed services. Longstanding, chronic underfunding of HCBS in our country, and the resulting workforce shortages — exacerbated by the pandemic — mean millions of older adults and families’ requests for care are going unfilled.