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Quality of Care Measures for Home and Community-Based Services Under Medicaid

The Deficit Reduction Act of 2005 directs the Agency for Healthcare Research and Quality (AHRQ) to develop quality measures for home and community-based services (HCBS) offered under State Medicaid programs. As the first step to implement this legislative mandate, AHRQ is conducting a state-of-the-art environmental scan and assessment of measures and instruments that could be used, or adapted for use, in this HCBS measures development effort.


The "Deficit Reduction Act of 2005," signed into law in February 2006, mandates that AHRQ develop measures for assessing the quality of home and community-based services provided by States under their Medicaid programs. Section 6086(b) of the Act, "Quality of Care Measures," specifies that AHRQ, in consultation with stakeholders:

  • Develop program performance indicators, client function indicators, and measures of client satisfaction.
  • Use these indicators and measures to assess HCBS and their associated outcomes and to assess each State's overall system of providing these services.
  • Make publicly available any best practices identified and the results of a comparative analysis of system features for each State.

The Act appropriates $1 million for the overall "Quality of Care Measures" effort through September 30, 2010. As the initial step in implementing this legislative mandate, AHRQ has initiated the Home and Community-Based Services Measure Scan Project.

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Measure Scan Project


The goal of the Measure Scan Project is to identify and evaluate measures and instruments that could be used, or adapted for use, in assessing the quality of home and community-based services offered under State Medicaid programs and the patient outcomes associated with receiving HCBS under Medicaid.


Home and community-based services to be evaluated as part of the Measure Scan Project are defined very broadly and include all target populations served by the Medicaid program, including dual eligibles and HCBS 1915(c) waiver target populations. Services to be assessed during the Measure Scan Project therefore include a range of health, health-related, and social support services, including—but not limited to—the following:

  • Personal assistance services
    such as bathing, dressing, and eating.
  • Case management.
  • Skilled nursing.
  • Home health care.
  • Homemaker services.
  • Home-delivered meals.
  • Transportation.
  • Habilitation.
  • Behavioral supports.
  • Rehabilitation and therapy services.
  • Supported employment.
  • Respite care.
  • Congregate housing.
  • Consumer-directed care.

HCBS can vary by State and can be delivered in the home, a community-based setting, or an alternative residential setting such as a group home or assisted living facility and can be administered by various State program agencies in addition to Medicaid.

Project Team

The Measure Scan Project Team includes other HHS partners in the Office of the Secretary, the Centers for Medicare & Medicaid Services, and the Administration on Aging as well as a number of outside experts and substantive reviewers. A 23-member Technical Expert Panel has been assembled to advise the Project Team on the methodology for collecting measures and on the criteria for evaluating them.


During 2007, the Measure Scan Project will:

  • Develop a methodology for identifying and obtaining HCBS quality measures.
  • Develop inclusion and exclusion criteria for evaluating measures.
  • Identify data elements to be captured on all measures and instruments.
  • Compile a measures compendium.
  • Prepare a report of criteria for identifying and evaluating HCBS measures.
  • Identify measurement gaps.

Next Step

The Measure Scan Project final report, due in fiscal year 2008, will be used by AHRQ in addressing the next step in its legislative mandate under the Deficit Reduction Act to determine which measures to develop to assess quality of HCBS care under Medicaid.

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For More Information

To find answers, ask a question, or send an E-mail query about the HCBS Measure Scan Project go to:

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Page last reviewed May 2007
Internet Citation: Quality of Care Measures for Home and Community-Based Services Under Medicaid . May 2007. Agency for Healthcare Research and Quality, Rockville, MD.


The information on this page is archived and provided for reference purposes only.


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