MEDICAID QUALITY MEASURES FOR PERSONS WITH DISABILITIES

CRITICAL QUALITY ISSUES FOR PERSONS WITH DISABILITIES:

NON-DATABASE RETRIEVABLE MEASURES

DELMARVA FOUNDATION
MARGARET MASTAL. PhD, RN
mastalm@dfmc.org
 MEDICAID QUALITY INDICATORS FOR INDIVIDUALS WITH DISABILITIES
NIDDR PROJECT: MEASURE ADVISORY PANEL (MAP)

Composite Table: Non Database Retrievable Quality Measures *

Quality Management-Sensitive Benefits and Services

No. Measure Working Definition Suggested Monitoring Methods Source/Owner
1 Adequacy of Type and availability of durable medical CAHPS NIDRR MAP
Durable Medical equipment (DME) meets needs of Beneficiary/caregiver satisfaction survey
Equipment beneficiaries who use DME
2 Adequacy of Type and availability of medical supplies CAHPS NIDRR MAP
Medical Supplies meet needs of beneficiaries who use medical Beneficiary/caregiver satisfaction survey
supplies
3 Adequacy of Type and availability of therapy meets needs CAHPS NIDRR MAP
OT/PT/Speech of beneficiaries who use therapy services Beneficiary/caregiver satisfaction survey
Therapy
4 Adequacy of Type and availability of transportation CAHPS NIDRR MAP
Transportation services meet beneficiaries’ needs Beneficiary/caregiver satisfaction survey
Services
Management: Medications, Functional Status, Pain, Weight
5 Medication % beneficiaries with disabilities having Medical record review ACOVE***
management annual drug regimen review.
% beneficiaries with disabilities with ER visits Medical record review NQF ****
for drug reaction and/or side effects.
6 Management of % beneficiaries with disabilities screened for Medical record review NHPG*****
Functional Status physical and cognitive functional ability.
% beneficiaries with disabilities whose ADL Medical record review CMS
assessment has been maintained or
improved.
% beneficiaries with disabilities whose IADL Medical record review CMS
assessment has been maintained or
improved.

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 Management: Medications, Functional Status, Pain, Weight (cont’d)
No. Measure Working Definition Suggested Monitoring Method Source/Owner
7 Management of % beneficiaries with disabilities screened for Medical record review CMS
pain pain levels. NQF
8 Management of % beneficiaries with disabilities with weight Medical record review CMS
weight recorded within the past 3 mos. NQF
% beneficiaries with disabilities with a Medical record review MAP
diagnosis of morbid obesity.
% beneficiaries with disabilities with Medical record review MAP
diagnosis of underweight.
Self-Determination, Community Integration, Health/Safety
9 Self determination Beneficiaries have choice of where and with CAHPS WPP******
and Choice whom they live Other type survey methodology
Beneficiaries are able to choose their daily CAHPS WPP
routine Other type survey methodology
Beneficiaries are able to choose the services CAHPS WPP
they receive Other type survey methodology
Beneficiaries are treated fairly and with CAHPS WPP
dignity and respect Other type survey methodology
Beneficiaries receive appropriate health CAHPS WPP
education materials Other type survey methodology
Health education materials available in CAHPS MAP
alternative formats. Other type survey methodology
10 Community Beneficiaries participate in the life of the CAHPS WPP
Integration community Other type survey methodology
Beneficiaries are connected to informal CAHPS WPP
support networks Other type survey methodology

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 Self-Determination, Community Integration, Health/Safety (cont’d)
No. Measure Working Definition Suggested Monitoring Method Source/Owner
11 Health and Safety Beneficiaries perceive themselves free from CAHPS WPP
abuse and neglect Other type survey methodology
% of home safety assessments conducted CAHPS WPP
Other type survey methodology
Beneficiaries perceive they have privacy CAHPS WPP
Other type survey methodology
Beneficiaries feel safe and secure in their CAHPS WPP
residence Other type survey methodology
Serious Reportable Events
12 Beneficiary death Still in final definition stages by the National Medical record review/audit NQF
or serious disability Quality Forum Provider quality audit
due to a fall while in
an institution
13 Beneficiary death Still in final definition stages by the National Medical record review/audit NQF
or serious disability Quality Forum Provider quality audit
due to a medication
or prescription
error
Satisfaction Levels
14 Member Member satisfaction with program benefits Survey methodology
Satisfaction and services
No single instrument common among
different programs
15 Provider Provider satisfaction with program services Survey methodology
Satisfaction and provider relations.
No single instrument common among
different programs
16 Staff Satisfaction Satisfaction of staff employed by the program Survey methodology
with intra-organizational
No single instrument common among
different programs

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*Quality measures identified as important for disability care coordination organizations to monitor and report but are NOT available for
retrieval from electronic databases.

** Measurement Advisory Panel for the research project of the National Institute for Disability and Rehabilitation Research, U.S.
Department of Education.

***ACOVE is a collaborative between Rand and Pfizer, Inc whereby a national panel of geriatrics experts identified the
medical conditions prevalent among older adults that contribute most to morbidity, mortality, and functional
decline; that could be measured; and for which effective methods of treatment or prevention are available.

****National Quality Forum, Voluntary Consensus Standards for Ambulatory Care: An Initial Physician Focused Performance Measure
Set

*****The National Health Policy Group (NHPG) is a national health policy and consulting group established to help improve health care
policy and practice in care of high-risk beneficiaries. NHPG clients include Medicare and Medicaid plans, health and long-term care
systems, government agencies and national associations.

******Wisconsin Partnership Program (WPP) is an integrated health and long term care program for frail elderly and people with
disabilities. The Partnership Program consists of several community-based organizations located in different geographical regions of
Wisconsin. Over time, each site will be able to serve 600 members. The goals of Partnership are to: 1. Improve quality of health care
and service delivery while containing costs; 2. Reduce fragmentation and inefficiency in the existing health care delivery system; 3.
Increase the ability of people to live in the community and participate in decisions regarding their own health care.