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Notes
i. The legislative language implies a one-time, rather than longitudinal, assessment of HCBS services and the system used to deliver them under Medicaid. Furthermore, AHRQ has no regulatory authority over the Medicaid program, which falls under the jurisdiction of the Centers for Medicare & Medicaid Services (CMS). Only CMS can mandate the use of specific measures by State Medicaid programs on an ongoing basis.
ii. Section 6086(b), PL 109-171, included in Appendix VI.
iii. The full methodology for the measure scan is described in Medicaid Home and Community-Based Services Measure Scan: Project Methodology, available at .
iv. 72 Fed Reg 106, 30800-3, June 4, 2007.
v. Refer to, for example, "Selecting Measures for the National Health Care Quality Data Set" and the summaries included in Appendix E of the Institute of Medicine's Envisioning the National Health Care Quality Report (2001).
vi. During its first meeting, the TEP recommended that assessment of level of care and financial integrity of Medicaid payments be taken off the table as dimensions of program performance.
vii. AHRQ'S proprietary measure request was articulated in the formal Call for Measures referenced above (Federal Register, June 4, 2007).
viii. CFR §441.302. These include: consistent determination of level of care for program eligibility; individualized service planning; use of qualified providers; maintenance of participant health and welfare; administrative oversight by the State Medicaid Agency; and integrity of financial payments.
ix. Use of the term "stewardship," in place of promotion, was suggested during the review process, to more broadly describe this function.
x. Historically, persons with intellectual disabilities have been excluded from pain research.
xi. As used in this report, the term "serious reportable adverse health event" is defined as an event that leads to an undesirable outcome (death or serious harm) or significant potential for such an outcome, and the event was not at all expected or acceptable. The term is used broadly to encompass the terms "critical incidents," "sentinel events," and "adverse events."
xii. More information about HEDIS, including the HEDIS performance measures, can be found at http://www.ncqa.org/tabid/59/Default.aspx.
xiii. Available at http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/uspstf/.
xiv. Available at http://hab.hrsa.gov/tools/primarycareguide/.
xv. In response to two congressional mandates included in the Medicare Prescription Drug Improvement and Modernization Act of 2003, the IOM initiated the project Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs. From this project came the report, Performance Measurement: Accelerating Improvement, which called for the development of a national system of performance measurement and reporting based on shared accountability, a system that holds all providers who participate in a person's care responsible for the outcomes of that care.12
xvi. A description of the Prevention Quality Indicators can be found at http://www.qualityindicators.ahrq.gov/Modules/pqi_overview.aspx.
xvii. Several TEP members thought this concept applied more broadly to populations outside of individuals with serious mental illness.
xviii. Cooper, et al.,17 includes an expanded discussion of the need for valid, reliable abuse measures, as well as consensus regarding the definition of abuse.
xix. The Quality Framework can be found online at http://www.cms.hhs.gov/HCBS/downloads/qualityframework.pdf.
xx. Published in 72 Fed Reg 232, 68077-93, December 4, 2007.
xxi. More information is available at http://www.cms.hhs.gov/NursingHomeQualityInits/20_NHQIMDS20.asp.
xxii. Available at http://www.ahrq.gov/research/data/hcup/index.html.
xxiii. More information is available at http://psnet.ahrq.gov/resource.aspx?resourceID=5363.
xxiv. Description available at http://www.pressganey.com/cs/research_and_analysis/patient_satisfaction/home_health_resources.
xxv. More information is available at http://www.aamr.org/content_918.cfm?navID=96.
xxvi. For more information on these and all the CAHPS® tools, go to http://www.ahrq.gov/cahps/index.html.
