Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Endnotes: Citations, Additional Information, and Web Addresses


  1. Beth Jackson is the author of this appendix. CMS funded the development of this appendix on quality management systems.

  2. CMS’s expectations for state responsibility for quality in Medicaid HCBS programs is most clearly articulated for the §1915(c) waiver programs; however, the agency increasingly is looking to the §1915(c) quality requirements as a model for further articulation of quality requirements for home and community-based services provided under other Medicaid authorities, such as the §1915(a) and §1915(b) authorities and the §1115 demonstration authority.

  3. U.S. Government Accountability Office. Long-Term Care: Federal Oversight of Growing Medicaid Home and Community-Based Waivers Should Be Strengthened.GAO-03-576, June 2003.

  4. Version 3.1 of the waiver application was issued in a Word format in 2005. In November 2006, CMS launched the application in a web-based format under Version 3.4. In January 2008, CMS released Version 3.5 where the quality-related portions were re-designed to elicit even more specific information from the states on quality monitoring and improvement. As of April 1, 2010, use of the web-based application is mandatory.

  5. Assumes a Confidence Level of .95 and a Confidence Interval (Margin of Error) of +/–5.

  6. Typically, stratification violates the simple random sample assumption that every unit within the sample contributes equally. The sample size of the strata are often disproportionate to their representation in the population, and thus the sample must be statistically adjusted so that an estimate of the entire population can be made, and to avoid having members of any one subgroup (strata) contributing more or less than a member of another subgroup.

  7. This quality review process was instituted by CMS in January 2004 when they issued Interim Procedural Guidance. CMS updated aspects of this process in February 2007 with the Revised Interim Procedural Guidanceissued under Quality Communication #12 from the Director of the Disabled and Elderly Health Programs Group.

  8. From 2001-2008, the CMS-funded National Quality Contractor provided technical assistance to states. In October 2008, CMS changed the funding mechanism to a grant and renamed it the National Quality Enterprise.

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