[Federal Register Volume 72, Number 106 (Monday, June 4, 2007)]
[Notices]
[Pages 30800-30803]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 07-2732]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Request for Quality Measures for Medicaid Home and Community-
Based Services

AGENCY: Agency for Healthcare Research and Quality (AHRQ), DHHS.

ACTION:  Notice of request for measures.

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SUMMARY: 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 community-based 
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 
109-171, 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, person-centeredness, 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 
long-term 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.

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.

ADDRESSES: Submission should include a brief cover letter, a copy of 
the instrument or items for consideration and supporting information 
(e.g., a users' guide, citation(s) or copies of supporting article(s)) 
as specified under the Submission Criteria below.
    Submissions may be in the form of a letter or e-mail, preferably 
with an electronic file(s) as an e-mail attachment. Responses to this 
request should be submitted to: D.E.B. Potter, Center for Financing, 
Access and Cost Trends; Agency for Healthcare Research and Quality, 540 
Gaither Road, Suite 500, Rockville, MD 20850, Phone: (301) 427-1564, 
Fax: (301) 427-1276; E-mail: [email protected].
    To facilitate handling of submissions, please include full 
information about the instrument developer and/or a designated contact.
     Name
     Title
     Organization
     Mailing address
     Telephone number
     Fax number
     E-mail address
    Also, please submit a copy of the instrument or items for 
consideration, and evidence that it meets the submission criteria 
below. It is requested (but not required) that citation of a peer-
reviewed journal article pertaining to the instrument, to include the 
title of the article, author(s), publication year, journal name, 
volume, issue, and page numbers where article appears be included.
    Submitters must also provide a statement of willingness to grant to 
AHRQ the right to use and authorize others to use submitted measures 
and their documentation as part of any future instrument or measure set 
that may result from developing the statutorily-mandated Medicaid HCBS 
measure set. Electronic submissions are encouraged.

FOR FURTHER INFORMATION CONTACT: D.E.B. Potter at the address above.

SUPPLEMENTARY INFORMATION

Submission Criteria

    Items and instruments submitted must focus on evaluating the 
performance of home and community-based services, client experience of, 
and satisfaction with, these home and community-based 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 self-directed 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,

[[Page 30801]]

person-centeredness, 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 long-term 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:
     Physically- and/or cognitively-impaired elders, including 
those with dementia;
     Adults or children with intellectual or developmental 
disabilities;
     Children whose physical, intellectual and/or mental health 
disabilities significantly impair their ability to participate in age-
appropriate activities (e.g., schooling and play), including children 
with special health care needs;
     Adults with severe and persistent mental illness;
     Adults with acquired brain injuries; and,
     Adults with physical disabilities and/or chronic 
conditions (such as HIV/AIDS) that place them at risk of institutional 
care.
    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 mentally-retarded (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 non-service 
recipients, including measures of staff satisfaction (including family 
caregivers as secondary recipients--as 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 
Community-Based 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:
     Name of the measure(s)/instrument(s)/survey(s) used by (or 
contracted for by) your organization
     Brief description of the measure(s)/instrument(s)/
survey(s)
     Population intended for measurement
     Care provider type (e.g., home health agency, consumer 
directed caregiver, assisted living facility, adult day care provider, 
skills training counselor)]
     Service setting (e.g., group home, client's home, school, 
assisted living facility)
     Domain(s) (i.e., content areas)
     Language(s) the measure(s)/survey(s) (e.g., number of HCBS 
programs, program size(s))
     Where the Submitter's organization has used (fielded), 
and/or is currently using, the measure(s)/instrument(s)/survey(s) 
(e.g., number of HCBS programs, program size(s))
    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 peer-reviewed 
journal articles). Each submission should include the following 
information.
     Name of the measure(s)/instrument(s)/survey(s) developed
     Description of the measure(s)/instrument(s)/surveys(s)
     Population intended for measurement
     Care provider type(s) (e.g., home health agency, consumer 
directed caregiver, assisted living facility, adult day care)
     Service setting (e.g., group home, client's home, school, 
assisted living facility)
     Copy of the relevant measure(s)/instrument(s)/survey)s) 
(e.g., individual items and response categories)
     Domain(s) (i.e., content areas)
     Language(s) the measure(s)/instrument(s)/survey(s) is 
available in
     Reliability of the measure(s)/instrument(s)/survey(s) 
(e.g., internal consistency, test-retest, etc).
     Validity of the measure(s)/instrument(s)/survey(s) (e.g., 
content, construct, criterion-related)
     Response rate(s) obtained when measure(s)/instrument(s)/
survey(s) is used to measure on the intended population
     Methods and results of any cognitive testing associated 
with the measure(s), instrument(s) and/or survey(s)
     Methods and results of any field-testing associate with 
the measure(s), instrument(s) and/or survey(s)
     Data collection protocols (including mode and respondents)
     Description of sampling strategies used for data 
collection
     Where the Submitter's organization has used (fielded), 
and/or is currently using, the measure(s)/instrument(s)/survey(s) 
(e.g., number of HCBS programs, program size(s))
     Information about any professional or organizations 
endorsements associated with the measure(s)/instrument(s)/survey(s)
    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 peer-reviewed journal 
article, if applicable or through the best

[[Page 30802]]

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 34-42 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 Community-Based Services

    Both the type and extent of home and community-based 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.
     24 Hour Supervision/Monitoring
     Activities Therapy
     Adaptive Health and Wellness Services
     Adult Companion Services
     Adult Day Care
     Adult Day Health
     Adult Foster Care
     Adult Residential Care
     Alternative Living/Alternative Care Facility
     Assisted Living
     Assistive Technology
     Assistive Technology Evaluation
     Assistive Technology Repairs
     Attendant Care
     Attendant Care--Rent/Food for Unrelated Live-In Caretaker
     Augmentative Communication
     Behavior Management and Consultation
     Bereavement Counseling
     Case Management
     Case Management Aide
     Chore/Home Maintenance
     Clinic Services
     Clinical Supports
     Coaching/Cueing
     Cognitive/Behavior Services
     Cognitive Rehabilitation
     Community Access
     Community Connection
     Community Integration Training
     Community Membership
     Community Specialist
     Community Transition Services
     Companion Services
     Congregate Meals
     Consolidated Developmental Services
     Consultative Clinical and Therapeutic Services
     Consumer/Family/Caregiver Training
     Counseling
     Crisis Intervention Services/Support
     Day Habilitation
     Day Program
     Dental
     Developmental Day Care
     Early Intervention
     Educational Services Habilitation
     Electronic Home Response
     Emergency Move
     Environmental Adaptations/Home Modifications
     Environmental Engineering
     Escort/Outings
     Exercise Therapy
     Family Counseling
     Financial Counseling and Training
     Financial Risk Reduction
     Fiscal/Employer Agent/Management Services
     Group Homes
     Habilitation
     Home Accessibility Adaptations
     Home-Based Supportive Care
     Home Delivered Meals
     Home Health Aide
     Home Health Care
     Home Maintenance/Repair
     Homemaker Services
     Hospice
     Housing Access Coordination
     Housing Start-Up
     Independent Living Provider
     Independent Living Skills Training
     Individual Directed Goods and Services
     Integrated Therapeutic Network
     Interdisciplinary Team
     Life Skills Training
     Live-in Caregiver
     Meal Services
     Medical Equipment/Supplies
     Medical Nutritional Support
     Medically-Related Direct Therapies
     Medication Administration
     Medication Management
     Mental Health Day Treatment Services
     Mental Illness/Clinic
     Mental Illness/Day Treatment/Partial Hospitalization
     Mental Illness/Psychosocial Rehabilitation
     Money Management
     Moving Assistance

[[Page 30803]]

     Night Supervision
     Non-Legend/Non-Formulary Drugs
     Non-Medical Transportation
     Nursing Home Diversion Program
     Nutrition Therapy
     Nutritional Counseling/Assistance
     Nutritional Risk
     Nutritional Supplements
     Occupational Therapy
     Optometry Services
     Over-the-Counter Drugs
     Pediatric Community Transitional Home Services
     Periodic Nursing Evaluations
     Person Centered Planning
     Personal Adjustment Counseling
     Personal Agent
     Personal Care
     Personal Care Assistance
     Personal Care Coordination
     Personal Care--Rent/Food for Unrelated Live-In Caretaker
     Personalized Emergency Response Systems
     Phone Reassurance Monitoring
     Physical Risk Reduction
     Physical Therapy
     Physical Therapy--Extended State Plan Services
     Physician Services
     Podiatry Services
     Prescribed Drugs
     Prescription Drug Co-Pay
     Preventative/Consultative
     Prevocational Services Habilitation
     Private Duty Nursing
     Professional Care Assistant
     Professional Services
     Protective Services
     Psychiatrist Services
     Psychologist Services
     Psychosocial Counseling
     Psychosocial Nutrition
     Psychosocial Rehabilitation
     Rehabilitation Engineering
     Renal Dialysis
     Residential Care
     Residential Habilitation
     Respiratory Therapy
     Respite Care
     Restorative Assistance
     Retainer Payment for Personal Caregivers
     Shared Nursing
     Skill Building
     Skilled Nursing
     Socialization/Recreation
     Social Reassurance Therapeutic Counseling
     Social Work Services
     Special Therapeutic Services
     Specialized Child Care
     Specialized Consultation Services
     Specialized Medical Equipment and Supplies
     Specialized Psychiatric Services
     Specialized Therapies
     Speech, Hearing, and Language
     Staff/Family Consultation Training
     Subsidized Housing
     Substance Abuse Treatment/Counseling
     Support Brokerage
     Support Coordination
     Support Services
     Supported Employment Habilitation
     Supported Living
     Therapeutic Counseling
     Therapeutic Living
     Therapeutic Management
     Therapeutic Massage
     Therapeutic Resources
     Therapeutic Social and Recreational Program
     Therapeutic Supplies
     Training and Counseling Services for Unpaid Caregivers
     Transitional Case Management
     Transitional Living
     Transportation
     Vehicle Modifications
     Visual/Mobility Therapy
     Wandering Alarm System
     Wellness Monitoring
     Wrap-Around Services
     Extended State Plan 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 Community-Based 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,
Director.
[FR Doc. 07-2732 Filed 6-1-07; 8:45 am]
BILLING CODE 4160-90-M