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State Long-term Care Programs: Balancing Cost, Quality, and Access

Federal Quality Assurance Initiatives


Mary Jean Duckett, M.S.P., Director, Division of Benefits, Coverage, and Payment, Disabled and Elderly Health Programs Group, Center for Medicare and State Operations, Centers for Medicare & Medicaid Services (CMS), U.S. Department of Health and Human Services, Baltimore, MD.

The Center for Medicare & Medicaid Services (CMS) has altered its approach to quality on home care services from prospective assurances and retrospective review a more proactive strategy. Mary Jean Duckett, Director of the Disabled and Elderly Health Programs Group, described five CMS quality initiatives.

The first initiative creates a framework for quality that describes specific domains, identifies relevant strategies for States to implement, and conducts research to establish the "state of the art."

The second initiative will produce tools for states such as reliable and valid consumer experience surveys and measures for consumer directed programs. CMS will develop tools for its own use such as an expanded data base on home and community based services (HCBS) programs and identifying data that is available and useful for planning.

Quality assessment and improvement have begun through the use by CMS Regional Offices of a waiver quality review protocol and a guide for conducting reviews of State programs.

CMS is also providing technical assistance to States through the compilation of promising practices and the compilation of data-driven quality improvement activities which will lead to the preparation and dissemination of technical assistance briefs.

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