CMS Announces Unprecedented Quality Measure Set for Home- and Community-Based Services

Home Health Care News | By Andrew Donlan

The Centers for Medicare & Medicaid Services (CMS) released its first ever home- and community-based services (HCBS) quality measures Thursday.

The agency said the measures will promote “consistent quality measurement within and across state Medicaid HCBS programs” and are a “critical step to promoting health equity among the millions of older adults and people with disabilities who need LTSS.”

The measures are built around three pillars: access, a rebalancing of HCBS spend versus institutional care spend and community integration. For now, the measures are voluntary – with one caveat. 

“While use of this measure set is voluntary at this time, CMS plans to incorporate use of the measure set into the reporting requirements for specific authorities and programs, including the Money Follows the Person (MFP) program and future section 1115 demonstrations that include HCBS,” a state Medicaid director letter read.

The MFP program is a CMS-directed way to get individuals out of institutional-based care and back into their homes and communities to receive HCBS. As recently as March, CMS put forward $110 million to boost MFP, and therefore HCBS services, across the country.

In other words, following the measure set is strongly encouraged for states.

“CMS is using every lever available to protect and expand coverage for all people eligible for Medicaid,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “We are working to expand their access to care across settings – including in the setting of their choice.”

While the home health industry is highly – and very consistently – regulated across the country, the personal home care industry has not been historically.

Strictly private-pay providers will still not be affected necessarily by the CMS quality measure set, but it is a sizable step to industry standardization, particularly among Medicaid-focused, HCBS providers.

“Today’s announcement provides states with tools to better understand and compare health outcomes across groups receiving home- and community-based services,” Brooks-LaSure continued. “The use of consistent quality measures across the country is another step toward reducing health disparities and ensuring that people with disabilities, and older adults enrolled in Medicaid, have access to and receive high-quality services in the community.”

The measures are aiming to obtain the aforementioned three goals:

• Increased access, defined as beneficiary and caregiver awareness of resources that support overall well being and HCBS.

• A rebalancing, which is aimed at finding a more equitable balance between spending on institutional care and HCBS care in communities

• Community integration, which is focused on “ensuring the self-determination, independence, empowerment and full inclusion” of children, adults and older adults in the Medicaid program receiving HCBS 

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Monkeypox a Federal Public Health Emergency

On 08/04/2022, the Biden administration declared a federal public health emergency (PHE) for monkeypox.

During a call with reporters, HHS Secretary Xavier Becerra said that some 6,600 cases of the virus had already been reported for the week compared to less than 5,000 the week before.

The virus has spread primarily through close contact with someone who is infected. Treatment includes isolation and pain management, often at home. It is rarely fatal.

Designating the outbreak as a PHE allows federal agencies to access emergency funding and allocate funds and other resources to help prevent the spread of the virus. Such declarations also permit the waiver of some laws and requirements to allow healthcare providers to respond to the disease.

On July 23 the World Health Organization (WHO) declared a global health emergency over the outbreak.

CMS Seeks Public Feedback to Improve Medicare Advantage

Today, the Centers for Medicare & Medicaid Services (CMS) released a Request for Information seeking public comment on the Medicare Advantage program. CMS is asking for input on ways to achieve the agency’s vision so that all parts of Medicare are working towards a future where people with Medicare receive more equitable, high quality, and person-centered care that is affordable and sustainable.

“Medicare Advantage is a critical part of CMS’ vision to advance health equity; expand access to affordable coverage and care; drive high quality, person-centered care; and promote affordability and sustainability of Medicare,” said CMS Administrator Chiquita Brooks-LaSure. “Medicare Advantage plans are essential partners in this work.”

“We see a huge opportunity for partnership with as many stakeholders as possible to better understand how care innovations are changing outcomes and costs and how Medicare Advantage is working for enrollees,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare. “It’s important that CMS engage as many stakeholders as possible to achieve our collective vision of equity, access, quality and affordability.”

The CMS Strategic Pillars prioritize increased engagement with the agency’s partners and the communities we serve throughout the policy development and implementation process. CMS is committed to creating additional opportunities to engage the public and drive innovation in ways that best serve people with Medicare.

In the Medicare Advantage program – also known as Medicare Part C – Medicare contracts with private insurers that must offer all Traditional Medicare services to people with Medicare and may offer added supplemental benefits, such as vision or dental benefits. Most Medicare Advantage Plans also include prescription drug coverage (Part D).

CMS encourages the public to submit comments to the Request for Information. Feedback from plans, providers, beneficiary advocates, states, employers and unions, and other partners to this Request for Information will help inform the Medicare Advantage policy development and implementation process.

The Request for Information can be accessed from the Federal Register at: https://www.federalregister.gov/public-inspection/2022-16463/request-for-information-medicare-program