Performance Measures in MLTSS Programs: Research Brief. Experience of Care and Quality of Life


States often turn to member surveys as a way to measure person-centered outcomes. CMS' MLTSS guidance makes it clear that states should assess members' experience of care and quality of life, typically accomplished through surveys.

MLTSS programs rely on an array of surveys for measuring LTSS outcomes and quality of life including the family of Participant Experience Surveys (for intellectual disabilities/developmental disabilities [ID/DD], Aged/Disabled and Brain Injured HCBS populations),5 the participant survey associated with Core Indicators6 (for the ID/DD population), and the Mental Health Statistic Improvement Program Survey (for persons receiving behavioral health services). In addition, some states have developed their own surveys.

CMS cautions states about employing survey instruments and approaches that have not undergone rigorous testing on the population(s) served by their MLTSS program.7 Relying on an instrument not validated on the target population can lead to erroneous results. Managed care member surveys of the non-LTSS population often rely on phone, Internet and mail survey modes. These survey approaches may not be appropriate for members with intellectual and/or sensory impairments. Accurate feedback from members with such impairments may require in-person survey administration.

Two promising LTSS survey development initiatives are under way. One is for the Aged/Disabled population modeled after the ID/DD Core Indicators survey8 and another is a cross-disability experience of care survey. The latter is being funded by CMS, modeled on the Consumer Assessment of Healthcare Providers and Systems (CAHPS)9 approach, and will support comparison of person-centered outcomes across populations, programs (including fee-for-service and MLTSS) and states.10

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