Outcome Measurement Program Case Studies

Policy Context

The Centers for Medicare & Medicaid Services (CMS) along with state Medicaid agencies fund Home and Community-Based Services (HCBS) in all states.  Medicaid-funded HCBS are the primary publicly funded resource for individualized long-term services and supports (LTSS), enabling more than three million people who are aging and with disabilities to live in their communities.  HCBS enable individuals, including those with age-related support needs and those with physical, cognitive, or other disabilities, needing LTSS to experience the same access to and opportunities for social, civic, career, educational, and home life as their peers without disabilities.  CMS implemented new HCBS regulations in 2014 .  It will be important to determine if the 2014 rule change improves outcomes for people receiving HCBS-funded LTSS.  To accomplish this, it is essential to accurately assess HCBS impact and make improvements when needed.  

Measurement Program

The National Core Indicators® (NCI®), started in 1997, is administered by the National Association of State Developmental Disabilities Directors (NASDDDS) and the Human Services Research Institute (HSRI; Smith & Ashbaugh, 2001).  Participating states conduct surveys of adults receiving services under the auspices of a state’s Developmental Disabilities (DD) system. States use NCI-IPS (National Core Indicators - In-person Survey) results to assess outcomes and manage services.  46 states and the District of Columbia have participated in the NCI-IPS survey program, allowing for states to compare their performance on key indicators to an overall NCI average.

Key Messages         

Strengths in HCBS measurement for instruments like the NCI-IPS

1. Includes the ability to monitor systems-level quality improvement changes.
2. States have access to their data and to state level reports that allow for data-driven policy and programmatic decisions.
3. Provides flexibility to states to include additional questions relevant to their system monitoring and quality assurance needs.
4. Offers the ability to assess the domain areas outlined by the National Quality Forum (NQF).

Challenges in HCBS measurement for instruments like the NCI-IPS®

1. Requires initial and periodic training to learn about measurement domains and ensure fidelity of the survey process, which requires ongoing state financial commitment.
2. Does not offer the opportunity to use the data to monitor progress towards outcomes or improve services at a provider or individual level.
3. The connection between data collected and the benefit to NCI-IPS respondents is not immediately apparent. Efforts need to be made to explain the connection and value to respondents. Some states do send user-friendly reports to participants.