Federal Register: June 4, 2007 (Volume 72, Number 106)
DOCID: fr04jn07-42 FR Doc 07-2732
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
DOCUMENT ACTION: Notice of request for measures.
Request for Quality Measures for Medicaid Home and Community- Based Services
DATES: Please submit data collection instruments and supporting information about their development and/or use no later than 30 days after publication of this notice. AHRQ will not respond individually to submitters, but will consider all submitted items and instruments and publicly report the results of the review of the submission in an aggregated form.
The Agency for Healthcare Research and Quality (AHRQ) is soliciting the submission of survey instruments and items that could be used to measure the quality of Medicaid home and communitybased service (HCBS) programs. Specifically, AHRQ is interested in metrics related to assessing the performance of such programs, client functional outcomes and client experience of, and satisfaction with, Medicaid HCBS services and supports. This initiative is in response to the mandate within the Deficit Reduction Act (DRA) of 2005, Public Law 109171, Section 6086(b) that AHRQ develop such measures, in consultation with relevant stakeholders. In preparation for this task, AHRQ is conducting an environmental scan of existing tools that could be adapted or used for assessing the quality of Medicaid HCBS services and supports.
Based on the agency's initial methodological work, there are several quality domains the resulting measure set could assess, including: timeliness of determining need and providing services and supports, personcenteredness, safety, equity, efficiency and, effectiveness of services and supports, qualifications of providers, client health and welfare, program administrative oversight, access, unmet need among current program participants, and coordination of longterm care services with other service providers. For example, relevant measures might include items from a consumer survey that ask about receipt of services or experience with select providers, or metrics that use program administrative data to determine if providers meet program qualifications or if assessments are done on a timely basis.
Consumers’ home health care experiences; request for instruments or items that measure perceptions of home health care quality,
FOR FURTHER INFORMATION CONTACT
D.E.B. Potter at the address above. SUPPLEMENTARY INFORMATION
Items and instruments submitted must focus on evaluating the performance of home and communitybased services, client experience of, and satisfaction with, these home and communitybased services and supports, as well as related client functional outcomes. Such services are defined broadly to include at a minimum the array of services included as HCBS under Section 1915(b), (c), or (b) and (c) of the Social Security Act (the Act), HCBS as a State plan option under Section 1915(i), as well as selfdirected personal assistance services under Section 1915(j), and HCBS under Section 1115 of the Act, and HCBS demonstrations, as authorized under Section 6071 of the Deficit Reduction Act of 2005. For the purpose of this call for measures, the listed services are interpreted broadly to include Medicaid home health care services, Medicaid personal care services, and Medicaid targeted case management services.
Submitted materials should be designed to measure (i.e., quantify)
program performance, client functional outcomes (including social role
functioning), and/or client experience related to any of the following
areas: The timeliness of determining need and providing services and supports,
personcenteredness, safety, equity, efficiency and effectiveness of services and supports, qualifications of providers, client health and welfare, program administrative oversight, access, unmet need among current program participants, and coordination of longterm care services with other service providers.
Measures submitted must be relevant or readily adaptable to collection of information on the Medicaid HCBS service experience of people with chronic disabilities, including the following populations:
Unless such measures can be adapted to HCBS, measures related exclusively to institutional services, specifically those provided in a skilled nursing facility, nursing home, State hospital, or intermediate care facility for the mentallyretarded (ICF/MR), will not be considered, although those that apply to alternative residential settings eligible for Medicaid HCBS funding, such as small group homes and assisted living facilities will be. Measures specific to the process of applying for Medicaid HCBS services (e.g., waiting lists) are also within the scope of this request. In addition, measures should be designed to quantify the experience of current Medicaid HCBS service recipients; including caregivers who receive such services directly (e.g., respite care or family therapy). Measures related to nonservice recipients, including measures of staff satisfaction (including family caregivers as secondary recipientsas distinguished from direct recipients) are considered to be outside the scope of this effort. For a more detailed list of the home and community based services, see the SUPPLEMENTARY INFORMATION section below entitled ``Types of Home and CommunityBased Services'':
AHRQ is particularly interested in soliciting information from three types of submitters:
1. Organizations (or persons) who use (or contract for the use of) another organization's survey (or survey item(s)) and the survey/items used are applicable to (or could be adapted to) HCBS.
2. Organizations (or persons) who developed a survey (or survey item(s)) and the survey/items are applicable to (or could be adapted to) HCBS.
3. Organizations (or persons) who use another organization's survey
but have modified the original survey (added items to, taken items away
or changed the wording) and the resulting hybrid survey is applicable to (or could be adapted to) HCBS.
Additional Submission Instructions
Submitter Type 1
Each submission should include the following information:
Submission of copies of existing report formats developed by the Agency using the survey to disclose findings to consumers and providers is desirable, but not required. Additionally, information about existing database(s) (particularly at the state level) for collecting results gathered using the instrument(s) or items submitted is helpful, but not required for submission.
A partial response by a Submitter Type 1 could be ``* * * our Agency uses the National Core Indicator's (NCI) Child Family Survey (Phase VII version) for our State's 1915(c) waiver for children with special health care needs * * * for our HCBS program for elders with Alzheimer's we use the Participant Experience Survey (PES) Elder/ Disabled Version (Version 1) * * *''
Submitter Type 2
Information about the instrument that you and/or your organization
developed may be provided (in part) through submission of peerreviewed
journal articles). Each submission should include the following information.
Submission of copies of existing report formats developed to
disclose findings to consumers and providers is desirable, but not
required. Additionally, information about existing database(s)
collecting results gathered using the instrument(s) or items submitted
is helpful, but not required for submission. Information about the
instrument may be provided through submission of peerreviewed journal article, if applicable or through the best
evidence available at the time of submission.
In submitting measures, submitters agree to relinquish ownership of any items developed by the submitter/organization that are selected to be pat of the measure set(s) developed by AHRQ for public use (beginning in 2008 as required by Section 6086(b) of the DRA). However, item ownership will be protected during the initial measure can, and during any subsequent measure development efforts AHRQ might undertake. Submitter Type 3
Information about the original survey measures and the nature of any survey measure modifications (including new, changed or deleted items) is requested for submission.
For the measures/items based directly on an existing survey/ measure(s) (and without any changes to the items), the information described under Submission Submitter Type 1 is requested along with copies of the relevant measures that are actually used (e.g., individual items and response categories).
In addition to the original measures information (requested in the previously paragraph), information about the modified measures/items is requested. Modifications may include question wording changes, the addition of new items/measures, and/or the deletion or original survey items. For the modified items, the following is requested:
For measures/items based directly on the original survey items, but modified with question wording changes, information (if available) described under Submission Submitter Type 2 is requested for modified items. The reason(s) for question wording change(s) is also requested, but not required. At a minimum, a copy of the modified measures, how the measures are used and some information about how the measures were developed is required.
For new items added to an existing survey, information described under Submission Submitter Type 2 is requested. Also requested, but not required, is (are) the reason(s) for the addition of the new items. An example of the latter might be along the lines of ``* * * for our HCBS program for elders with Alzheimer's we use the PES Elder/Disabled Version (Version 1) but have also added a module to capture information about medication management/administration for clients in a residential settings.* * *'' At a minimum, a copy of the modified measures, now the measures are used and some information about how the measures were developed is required.
In situations where the modifications to the original survey are simply a deletion(s) of original survey items (and with new items added) a description on of what items were deleted and why is also requested. An example of the latter might be ``* * * for our HCBS program for elders we use the ABC Survey but drop questions 3442 at the Agency does not use this information.''
In submitting modified measures, submitters agree to relinquish ownership of any items developed by the submitter/organization and that are selected for use in the measure set(s) developed and adopted by AHRQ (beginning in 2008 as required by Section 6086(b) of the DRA). However, item ownership will be protected during the initial measure scan, and during any subsequent measure development efforts AHRQ might undertake.
Submitters Types 1, 2 and 3
It is not necessary to submit any actual data generated from using the survey instruments.
Types of Home and CommunityBased Services
Both the type and extent of home and communitybased services
provided under Medicaid can vary from program to program. Below is a
partial list of the broad range of services that have been provided by
States under their Medicaid HCBS programs; States may provide additional services.
[cir] Home health care services
[cir] Physical therapy
[cir] Occupational therapy
[cir] Speech, hearing and language services
[cir] Prescribed drugs, except drugs furnished to participants who are eligible for Medicare Part D benefits
[cir] Dental services
For additional information on HCBS service, please refer to
Appendix C: Participant Services (pages 99 to 162) of the Application
for a section 1915(c) Home and CommunityBased Waiver [Version 3.4]
Instructions, Technical Guide and Review Criteria Release Date:
November 2006, Disabled and Elderly Health Programs Group, Center for
Medicaid and State Operations, Centers for Medicare & Medicaid
Services, Department of Health and Human Services, available at: http://www.cms.hhs.gov/HCBS/02_QualityToolkit.asp#TopOfPage .
Dated: May 27, 2007.
Carolyn M. Clancy,
[FR Doc. 072732 Filed 6107; 8:45 am]
BILLING CODE 416090M