The Recommendations for Improving the Home and Community-Based Services (HCBS) Quality Measure Set: Summary of a Workgroup Review of the 2028 HCBS Quality Measure Set, has been released.
In 2024, the Centers for Medicare and Medicaid Services (CMS) updated the home and community-based services (HCBS) Quality Measure Set to standardize quality measures in HCBS programs across States and drive improvements in care and outcomes. In 2025, the HCBS Quality Measure Set underwent a Workgroup review process to assess the existing measure set and recommend measures for removal from or addition, with the goal of strengthening and improving the 2028 HCBS Quality Measure Set.
Updates and Recommendations
In summary, the Workgroup recommended removing three measures from the 2028 HCBS Quality Measure Set related to increased administrative burden and the measures assessing compliance rather than quality of care:
- FFS LTSS/MLTSS-1: Comprehensive Assessment and Update (LTSS-1),
- FFS LTSS/MLTSS-2: Comprehensive Person-Centered Plan and Update (LTSS-2), and,
- FFS LTSS/MLTSS-3: Shared Person-Centered Plan with Primary Care Provider (LTSS-3).
- The Workgroup recommended adding four measures to the 2028 HCBS Quality Measure Set, noting these are primarily single item questions:
- NCI[1]IDD: The Percentage of People who Report that They Know Whom to Talk to if they Want to Change Services,
- NCI-AD: Percentage Of People Who Know Whom To Contact If They Have A Complaint About Their Services,
- NCI-AD: Percentage Of People Who Have Access To Mental Health Services If They Want Them, and
- NCI-AD: Percentage Of People Who Have Needed Assistive Equipment And Devices (Exhibit ES.2).
Next Steps
CMS will review the final report to inform decisions about updates to the 2028 HCBS Quality Measures Set. As of this writing, CMS has not yet released the proposed draft 2028 HCBS Quality Measure Set in the Federal Register for public comment. The final 2028 HCBS Quality Measure Set is expected to be posted in the Federal Register by December 31, 2026.
AHCA/NCAL has advocated for the removal of the
Access Rule in which the HCBS Quality Measures Set is included. AHCA/NCAL is monitoring this and will provide updates as they become available.