“Home and community-based services play a vital role in empowering Americans living with disabilities, multiple chronic conditions, serious mental illness, or other conditions, to live meaningful lives in their communities,” said Marcia Wilson, NQF’s senior vice president of quality measurement. “This work is a much-needed starting point for developing a comprehensive, standardized system for measuring HBCS quality across states, programs, populations, and payers to ensure that individuals receive the highest quality of care possible.”

Reliance on HCBS services is increasing as baby boomers choose to age at home or in other community settings. In addition, many states are using Medicaid managed care plans to provide HCBS. Medicaid—the nation’s largest funder of HCBS—announced earlier this year new managed care regulations that require states to address HCBS quality using standard measures in certain areas, such as quality of life. Although little information is collected about HCBS quality, data are critical to drive effective change, tie performance to outcomes, enable consumers to make informed decisions, and compare the effectiveness of different HCBS models.

The report summarizes the work of a multistakeholder Committee of experts convened by NQF to develop a shared understanding and approach for measuring HCBS quality. The Committee includes representatives from social services and other community support services, as well as providers, payers, caregivers, advocates, and HCBS consumers.

In addition to recommending the development of a standardized core set of measures for HCBS, the Committee suggests developing a menu of supplemental measures that can be tailored to specific populations, settings, and programs and calls for the development and implementation of a standardized approach to data collection, analysis, and reporting. The Committee also recommends that emerging technologies support quality measurement and suggests convening a panel of HCBS experts to evaluate and approve HCBS measures.

The Committee highlights 11 areas for HCBS measure development, such as person-centered planning and coordination, caregiver support, and choice and control. These areas encompass 40 measurement topics, with recommendations for short-term, intermediate, and long-term action, along with measure concepts that are promising for further development.

The Committee notes challenges to measuring HCBS quality, including the lack of standardized HCBS measures; the decentralized nature of the HCBS system; variability of reporting requirements across federal, state, local, and privately funded programs; and the administrative burden of collecting, reporting, and using data for quality improvement.

In a forward to the report, Committee members note “tremendous collective interest in moving the state of HCBS forward,” evidenced by the large volume of public comment regarding the work—among the most ever received for an NQF report. They express their hope that the work is a starting point for a robust system of HCBS measurement and that it is useful to states and advocates designing and implementing HCBS programs.