National Measures of Quality in HCBS

Describing and achieving high-quality home and community-based services

HCBS help many people with disabilities live independently in their homes and other integrated community settings. Working with our Core Indicators partners and funded by the Administration for Community Living, we’re developing a standardized set of measures to examine the quality of these services nationwide, across payers and delivery systems—with a particular focus on person-centered approaches.


Using National Core Indicators consumer survey tools as the basis (both NCI and NCI-Aging and Disabilities), we’re working to develop a standardized set of measures that will undergird a comprehensive HCBS quality system—one that will support the effective use of tools to develop and monitor the quality of long-term supports and services. These include measures related to person-centered planning and supports.

  • Cognitive testing
  • Training and protocol development
  • Structured tests of inter-rater reliability
  • Psychometric testing

Knowing what to measure

Unlike other aspects of the healthcare and social services system, HCBS lacks any standardized set of quality measures at the federal level. For most Medicaid HCBS programs, states are required to assess quality and implement quality improvement efforts, but without agreed-upon measures and definitions there are gaps and variation. 

The National Core Indicators – Intellectual and Developmental Disabilities and the National Core Indicators – Aging and Disabilities are widely used survey instruments, administered at the state level on a voluntary basis, with a long history of informing the field on state HCBS quality system performance. The Administration for Community Living is working with HSRI and its Core Indicators partners to now develop a set of measures to support a national HCBS quality measurement infrastructure.

Partnering to drive improvement 

This work builds on work conducted by a multistakeholder committee convened by the National Quality Forum. The committee included representatives from social services and other community support services, as well as providers, payers, caregivers, advocates, and HCBS consumers. This work received a groundswell of interest and public comment. 

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The measures we are developing, which seek to capture the many facets of HCBS quality, will be submitted to the National Quality Forum for evaluation and endorsement.

Technical assistance to states

As part of the contract with ACL, we and our National Core Indicators partners, NASDDDS and NASUAD, are provding technical assistance to states to expand their use of NCI and NCI-AD in supporting quality enhancement. This involves: 

  • Training for state staff
  • The development of data briefs and ‘data nuggets’
  • Guidance on sampling procedures
  • Guidance on survey impemetation and interpreting results
  • Examining results in the context system improvement goals and priorities
  • Expanding state participation in NCI and NCI-AD

Administration on Community Living

Project Partner(s):

National Association of State Directors of Developmental Disabilities Services (NASDDDS)

National Association of States United for Aging and Disability (NASUAD)

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