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Background, cont'd

Regardless of the HCBS waiver design, every application must address how a state intends to meet specific CMS requirements known as the HCBS waiver assurances. The assurances were put into place by Congress to address the unique challenges of assuring the quality of services delivered to vulnerable persons living in their community.

A state's HCBS waiver application must include the following:

  • Waiver Design: The population and geographic area to be served, the mix of services offered, the quality standards, including provider qualifications, policies and payment methods.
  • Performance Measures: The standards a state will use to evaluate how well the HCBS waiver is meeting each of the federal assurances.
  • Discovery Methods: The data a state collects to measure how well it is meeting each performance measure; the method and frequency of data collection and analysis; and the person or entity responsible for using the data for decision-making.
  • Remediation: How a state will take action when individual problems are found.
  • System improvement: Method to prevent similiar problems from happening to others or to make the HCBS waiver more effective and efficient.

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