As the Centers for Medicare & Medicaid Services pursued the challenge of strengthening the quality oversight of Home and Community Based Services (HCBS) programs across this nation, Quality Letters became the mechanism we used to communicate with state Medicaid agencies about how CMS exercises federal oversight and improve upon quality.

Quality Action Plan

In response to a letter from Senator Grassely and Senator Breaux in July of 2003 pertaining to the lack of oversight and monitoring of HCBS waiver programs, CMS developed a Quality Action Plan. In short the plan details the goals, objectives and steps CMS implemented to improve quality, oversight and monitoring of HCBS waiver programs. To view the plan in its entirety, scroll to the download section and click on Quality Action Plan.

Quality Framework

In order to facilitate a dialog about quality within Home and Community-Based Services, the Centers of Medicaid and State Operations engaged the services of MEDSTAT, the National Association of State Directors of Developmental Disability Services, the National Association of State Units on Aging, and the Human Services Research Institute to facilitate the development of a Quality Framework.

The   HCBS Quality Framework is intended to serve as a common frame of reference in support of productive dialogue among all parties who have a stake in the quality of services and supports for people with disabilities. The Framework focuses attention on the desired outcomes of HCBS quality management and improvement efforts. The Framework is not regulatory. It is not expected that every state or provider would be engaged in actively monitoring each and every sub-domain.

The framework further delineates the functions of quality.

• Design: Designing quality assurance and improvement strategies into the HCBS program at the initiation of the program
• Discovery: Engaging in a process of discovery to collect data and direct participant experiences in order to assess the ongoing implementation of the program, identifying both concerns as well as other opportunities for improvement.
• Remedy: Taking actions to remedy specific problems or concerns that arise
• Continuous Improvement: Utilizing data and quality information to engage in actions that assure continuous improvement in the HCBS program.

Downloads
Quality Letter #1 - September 11, 2003 - Quality in Home and Community-based Services [PDF, 52KB] Quality Letter #2 - October 1, 2003 - HCBS Quality Tools [PDF, 65KB] Quality Letter #3 - February 10, 2004 -The Quality Framework for Home and Community-based Services (HCBS) [PDF, 53KB] Quality Letter #4 - February 9, 2004 - The Quality Inventory Report [PDF, 55KB] Quality Letter #5 - March 17, 2004 - CMS Future Actions for HCBS Quality in 2003- Status Updates [PDF, 54KB] Quality Letter #6 - May 24, 2004 - Software for the Participant Experience Survey (PES) - Elderly/Disabled Version. [PDF, 114KB] Quality Letter #7 - September 20, 2004 - CMS Future Actions for HCBS Quality - Status Updates. [PDF, 64KB] Quality Letter #8 - February 24, 2005 - Risk Management and Quality in HCBS. [PDF, 79KB] Quality Letter #9 - June 13, 2005 - Quality Management and Discovery Methods in HCBS. [PDF, 138KB] Quality Inventory Report [PDF, 2.OMB] Quality Framework [PDF,293 KB] Quality Action Plan [PDF, 77KB] Quality Letter # 12- February 6, 2007 - Revised IPG and Technical Assistance Products [PDF 157KB]
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Page Last Modified: 03/26/2007 11:43:15 AM
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