NWX-HHS-AOA-1

Moderator: Meredith Raymond

02-21-18/1:00 pm CT

Confirmation # 6852260

Page 3

**NWX-HHS-AOA-1**

**Moderator: Meredith Raymond**

**February 21, 2018**

**1:00 pm CT**

Coordinator:Thank you for standing by and welcome to the HCBS Quality Measurement Tools Webinar. Today’s conference is being recorded. If you have any objections you may disconnect at this time. Your lines have been placed on a listen-only mode until the question and answer session of today’s conference. At that time you may press Star followed by the Number 1 to ask a question. I would now like to turn the conference over to Meredith Raymond, Policy Analyst at the Administration for Community Living. Thank you. You may begin.

Meredith Raymond:Thank you (Michelle). Good afternoon everyone. Thank you for joining us for our fourth event in our HCBS Quality Webinar Series Home and Community Based Services also known as HCBS Quality Measurement Tools. The series consists of informational webinars occurring on a bimonthly basis to build awareness of ACL's commitment to and development of HCBS quality measures and to provide a platform among internal and external stakeholders to share development and collaborate on efforts concerning HCBS quality.

In August we hosted our third Webinar HCBS Measurement Development which provided an overview of ACL funded efforts to ultimately develop a set of measures and procedures to ensure that they support a quality of life outcome for people with disabilities and older adults. Tools such as surveys and assessments play an integral role in measurement development. We are fortunate to have representatives from the Center for Medicare and Medicaid Services, American Institutes for Research and Student Health Analytics to discuss the purpose, background and updates on three quality measurement tools.

The Webinar agenda is as follows. Jean Close, Deputy Director of the Division of Community Systems Transformation within the Division of Disabled and Elderly Programs Group, SDMS will provide a brief overview of the presentation and of the test demonstration. Kerry Lida, also a member of the Division of Community Systems Transformation within the Division of Disabled and Elderly Health Programs, CMCS will discuss the functional assessment standardize items also known as FASI.

Elizabeth Frentzel, Principal Research Scientist on the Survey Development Team at the American Institute for Research will speak on the key features of the HCBS CAHPS Survey. Susan Reitzman, Senior Research Leader on the Survey Development Team has driven health analytics will discuss NQF endorsed measures derived from the HCBS CAHPS Survey and state activities.

The presentation will be followed by a question and answer session. At the conclusion of (Susan)’s presentation the operator will provide direction as to how to enter your questions into the Q&A queue. To begin I’d like to introduce Jean Close. Thank you Jean.

Jean Close:Thanks Meredith. It’s a pleasure to be here today and thank you all for calling in. I know you have very busy schedules but we're hopeful that you’ll learn a lot about a new survey that’s available to states, plans and providers to capture the experience of care of our participants. The HCBS CAHPS Survey is the first cross disability survey of individuals experience receiving Home and Community Based Services. It’s available for volunteer use by states, plans or providers for improvement activities and for public reporting. Meredith you kindly introduced our group today. We have a great team. We're very proud of the work that Kerry Lida, our team lead as well as our technical experts and survey developers have lent to this program. You’ll hear more from them just a very few moments but thank you very much team for all of your work on this excellent survey.

Again we're going to be covering the - very briefly the components of the demonstration that launched our work and was able to provide the underpinnings for the work on the - not only the CAHPS HCBS survey but also functional assessment standardize items activities. And also the work on electronic long-term services supports was encompassed within this demonstration. But today we're just going to focus on the HCBS CAHPS survey and also the implementation by certain states. You can go on to the next slide. 

There are four components of the test demonstration. Again we're going to be focusing on the experience of Care survey today but also Kerry Lida will be talking a little bit about what - the work that’s being done and the measures that are being developed under the functional assessment standardize items component. We have a really important and exciting work in the electronic LTSS standard development that we're working on with the Office of the National Coordinator of Health Information Technology. And the demonstration also encompassed a really important component related to a personal health record for individuals again receiving Home and Community Based Services.

And onward next slide. So let’s jump into a bit more depth of the various components. And Kerry Lida will you carry on and tell us more about FASI?

Kerry Lida:Thank you Jean. And FASI is not the primary component of the presentation today which is HCBS CAHPS but we did want to provide you with information on this key area of work that you will see upcoming in the next year. And FASI stands for the Functional Assessment Standardize Items. And it is a set of items to measure functional status and individual preferences related to functions that are being developed for CMS. The FASI items are part of the CAHPS demonstration which Jean noted.

Next slide please. First we're going to briefly review what FASI stands for and why it is important. Primarily FASI is a set of person-centered standardized assessment items for measuring individual functional ability and need for assistance. It contains areas that were uniquely designed for the needs of individuals and community-based long-term services and supports programs but which are also relevant to Medicare beneficiaries including items reflected the supports and services individuals need to complete ADL mobility and IADL tasks.

FASI data elements are designed to be interoperable and may be electronically exchange which allows data to follow the person or the individual. Because this is part of an initiative on data falling into individual cross the care continuum, we'll speak more of this work in a few minutes. Next slide please. Because FASI items were designed to align with functional items used in Medicare they include items measuring activities of daily living such as bathing, dressing and mobility. It also includes IADL activities found in many current state and Medicaid functional assessments such as meal preparation, finances and housework.

At the end and if you look at the bottom of the slide of each functional domain FASI includes opportunities for individuals to describe their personal priorities for each area function. The personal priority items are key to the FASI. This section is an open ended question that asks the individual about his or her own priorities in a given area of function. It lets the individual speak in his or her own words about what he or she would like to cover and work on over the next six months. The personal priority items is helpful in making the assessment process person centered is required in the Medicaid rules. Next slide please. 

As noted on the slide currently the FASI items have been in development since 2015 and the Taft grantees begin piloting in 2017. Next slide please. This graphic provides a big picture regarding assessments data standardization. As noted on the previous slides the FASI items have been designed to align with similar function items in Medicare and in other areas of federal assessments for example the MDS, the Oasis, the Earth Pie and LCDM. But these also contain items such as IADLs, care preference as in support needs that are not in the other existing tools.

As with each of the other tools a small number of items overlap with those used in other programs but each tool has items that are specific to their population and not standardized across the other tools. And you'll note the HCBS FASI in the top middle in the intersections of the other standardized assessment tools. And why is this important? Standardized – data standardization and LTSS is important for comparing impacts across Medicaid and State LTSS programs. Care can better be coordinated and support – supported with the electronic exchange available through the standardized data. Again data follows the person is the focus of this work.

The states use standardized data elements that will be better able to exchange information electronically across each of the program systems. Standardized items are a basic requirement for having electronically exchangeable information to allow data to follow the individual. Currently the FASI items that we are piloting are being integrated into the CMS data elements library and will be available for future use to the public possibly the summer. Next slide please. And I’m delighted to turn the Webinar over to (Susan Reitzman) who is currently leading the HCBS CAHPS Survey and Elizabeth Frentzel and (Coretta Mallory) who are all available for questions. And Elizabeth and (Susan) will be walking us through the next steps of the presentation. Thank you.

Elizabeth Frentzel:Thank you Kerry. What a wonderful introduction. So next slide please. So the HCBS CAHPS Survey focuses on Medicaid HCBS beneficiary experience outcomes and quality of life as a result of receiving services and support. The entire development and testing process began in 2010 and was funded by CMS under two projects the most recent being (Taft).

It was designed to be a single instrument that could be completed by the broad range of beneficiaries served by Medicaid HCBS programs including but not limited to individuals who are frail, elderly, individuals with a physical disability, individuals with an intellectual or developmental disability, individuals with a brain injury and individuals with a serious mental illness. Next slide please. The development team followed the CAHPS Survey development process, a rigorous and beneficiary involved process. This diagram outlines the three major phases of the development process. In Phase 2 the survey was pilot and field-tested on over 3200 individuals in ten states and 26 HCBS programs using both fee for service and managed long-term services and supports. The survey instrument received the Consumer Assessment of Healthcare Providers and Systems or CAHPS trademark in June 2016. The National Quality Forum endorsed it – the related measures occurred in October 2016. Next slide please. 

The survey is intended to result in reports about a particular program’s performance vis-à-vis beneficiary reported outcome. The unit of analysis is either the HCBS program or the accountable entity. And accountable entity is the operating entity responsible for managing and overseeing a specific HCBS program within a given state. The HCBS CAHPS survey was developed so the comparisons about the quality of services and support can be made across programs or between managed care organizations or other subgroups. Next slide please. 

The development process identified the Home and Community Based Services and supports and providers that would be appropriate for beneficiary input across the disability and HCBS program spectrum. The services and providers listed on the slide are those that are common across Medicaid HCBS program with one exception. Although the employment assistance services are not offered across all programs the technical expert panel encourage the inclusion of items on the services because they are so vitally important for full community participation especially for working age persons served in the HCBS program. Next slide please. 

HCBS CAHPS Surveys consists of two instruments, the core instrument and a supplemental employment module. The 21-employment module is an option for programs that provide employment services. Both the core and the employment module are available in English and in Spanish. Standardized instructions for implementing the survey by phone or in person are provided in a technical assistance guide forthcoming from CMS.

Next Slide please. The HCBS survey items are organized into sections and you can see these in the first column that provide information about specific domains of the HCBS experience that are shown in the second column. Next slide please. The survey was designed including question wording and response sets to be accessible to as many HCBS beneficiaries as possible. However it’s also important that those using the results of the survey have confidence in the results. 

In order to help identify individuals who may not be able to provide reliable information the survey starts with a set of three cognitive screening questions that are related to the questions in the survey. If all three questions are answered in a meaningful way the interviewer continues to administer the remainder of the survey. If the three questions are not answered appropriately it is an indication to stop the interview and acquire about a potential proxy responded or someone else answering on behalf of the respondent.

Next -- and this is an example of the questions -- another key feature is the survey’s incorporation of program and provider specific terms to provide cuing assistance for respondents. The survey was designed so that sponsors can incorporate program specific terms for categories of staff and provider specific terms for individual served staff. The preferred terms can be used throughout the survey. You can see the bracketed italicized text that alerts the person administering the survey to insert the program specific term for these types of staff.

These service identification items and other screening items ensure that the beneficiary answers only questions about the services that they receive. Because not every beneficiary answers all questions, the average survey administration time is (three) minutes. Next slide please. 

Another key survey feature aimed at increasing beneficiary participation is the alternate response option. On the basis of findings from cognitive testing as well as an experiment conducted as part of the field test a simplified response option was determined to be accessible for some individuals. Using both response modes will allow more people to participate in the survey including individuals with intellectual or developmental disabilities.

This Slide shows the alternate response approach in the survey itself. The interviewers starts with a standard CAHPS response option of never, sometimes, usually or always. And if the respondent has difficulty using the question and response format to answer the interviewer then asks the alternate version. The interviewer does this up to three times and if the respondent prefers the alternate version the interviewer then uses only the alternate version for the rest of the survey. An alternate response to numerical ratings is also provided.

Next Slide please. Although feedback communicated directly by HCBS beneficiaries is always preferred proxy respondents are being allowed by CMS for administration of the HCBS CAHPS Survey. It is the state’s choice whether to use proxy. Once an interview has been completed there are a few interviewer questions that record different types of survey assistance including two types of proxy involvement.

Individuals who answer some survey questions on behalf of the respondent and those who answer all the questions on behalf of the respondent. Survey administration documents provide guidance to sponsors on accommodating proxy responses such as rephrasing items and adjusting the results. Next slide please. 

It is the state’s choice to conduct data collection in-house or use a vendor. At this time CMS does not approve – need to approve vendors for the CAHPS Home and Community-based Services Survey. And NCQA survey vendor certification for CAHPS is not required. However states and other survey sponsors may choose to ask vendors about this qualification through the RFP process or to require it among bidders. As shown training in certain qualifications are highly recommended for data collection entity. And that’s the end of my presentation and so I turn it over to (Susan).

(Susan Reitzman):Thank you Elizabeth. Next Slide please. The 19 NQS endorsed measures are derived from the HCBS CAHPS survey. These are experience and outcome measures. The HCBS CAHPS Survey supports seven composite or scale measures and 12 single item measures covering the topics shown on this slide. The single item measures pertain to global ratings, recommendations, unmet needs and personal safety.

The next few slide show some examples of the composite measures and the survey items that comprise them. Beneficiaries provided input to the Survey Development Team on the best labels for these measures. Next slide please. 

This is the composite staff listened and communicate well which is made up of 11 individual items. These items focus on aspects of service and support such as how often staff show courtesy and respect, whether explanations staff give are hard to understand because of language barriers, how often staff treat the beneficiary the way he or she wants to be treated, how often staff explains things in a way that is easy to understand, how often staff listen carefully to the beneficiary and whether staff know what kind of help the beneficiary needs with every day activities.

Next Slide. This slide shows the composite labeled planning your time and activities. And it shows it’s really a community integration measure. It asks about how often the beneficiary gets together with family members or friends who live nearby if they want to do so, how often the beneficiary does things in the community that he or she likes when he or she wants to do so, whether the beneficiary needs more help to do things in the community, whether the beneficiary takes part in deciding what to do with his or her time and when he or she does those things each day.

Next Slide please. This slide is an example of how measure results can be presented. It shows the pilot and field test values for composites and global ratings. The values are calculated as adjusted top box scores and they're ranked from highest to lowest.

Next Slide please. And this slide shows another example of how the measured results can be presented. In this case it’s the ratings of the case management services by different HCBS populations. So these – each of the columns is a different HCBS program that was surveyed during the field and pilot test. Again the values are calculated as top box adjusted scores.

Next Slide please. The measures derived from the HCBS CAHPS survey can be used in a variety of ways for program quality management. First they can help document program successes. In addition by fielding the survey over a short time period of no more than a few months users can get a point in time performance snapshot and identify areas needing improvement. Further investigation may be required to determine the cause of any performance problem identified.

Users can repeat survey administrations in order to track performance over time and monitor changes for example, comparing performance before and after implementation of a program improvement project can provide an assessment of the project’s impact. 

Provided there is sufficient beneficiary sample for each program or subprogram group the HCBS CAHPS Survey can make comparisons among programs serving individuals with different types of disabilities. HCBS CAHPS Survey results can be used to convey performance information to a variety of stakeholders. And because the measures align with some of CMS’s quality requirements for the various HCBS Medicaid authorities the survey can assist states engaged in compliance with those requirements. Finally there is the potential to compare results across states. And this would be with - if states choose to share their results with each other.

Next Slide please. The measures derived from the HCBS CAHPS survey fit into CMS’s national strategy for optimizing and aligning quality measurement across settings and programs. This slide shows some of the recommendations for adding the measures to existing programs. The measures are also being integrated into other frameworks such as the managed long-term services and supports association.

Next Slide please. So now I’m going to turn and provide some examples of how states are using the survey. Next slide please. As noted CMS is encouraging states to voluntarily use the HCBS CAHPS Survey for quality management in their programs. Aspects of the survey that make it appealing to users are listed here. And I’m just going to mention a few in particular, the ability to use the survey with a broad range of individuals with disabilities. This means that results from different programs can be compared to implementing – can be compared by implementing a single survey instrument.

Also the survey was designed to be as accessible as possible to all HCBS beneficiaries. And Elizabeth talked about some of those features. They include having both in person and a phone mode of administration, the alternate response options being able to tailor the survey language so that it’s recognizable to the individual and the use of proxy respondents. Also the survey was designed to align with CAHPS principles. This means that the content focuses on services - service and support issues that are important to beneficiaries. In addition the CAHPS trademark ensures that rigorous methods were used in its development and that providers recognize that trademark. There is an opportunity for users to add the supplemental employment module that was described earlier or other state specific questions that the survey sponsor may be interested in. And finally because CMS provides the HCBS CAHPS survey to the public there is no cost to access the instrument or supporting documents and additional resources are available for help in using the survey. Next slide please.

 This table shows the range of beneficiaries that have participated in the HCBS CAHPS surveys throughout the test demonstration. Starting in 2016 after the field and pilot test was completed (Taft) grantees are now administering the HCBS CAHPS survey to demonstrate their use of the survey and the measures that derive from it. In general most grantees intend to use the performance stated to inform program quality improvement initiatives in their states Medicaid HCBS programs but specific plans range from comparing beneficiary experience, person centered care and other aspects of performance across programs to identifying quality improvement opportunities for managed care organizations within the state to collaborate on, to potentially replacing other surveys used by the state for quality improvement, to exploring whether future managed LTS (unintelligible) programs should use the instruments and the resulting performance data. Next slide please. 

One of the test grantees is Connecticut. Connecticut recently described publicly how it aims to migrate all 11 Medicaid HCBS programs to a single quality improvement survey for setting and measuring benchmarks. And it will – it is doing that through the HCBS CAHPS Survey. In addition to the three Connecticut HCBS programs currently using the survey the state's mental health and IDDD agencies are now considering using the survey as a next step.

Next Slide please. Connecticut reported that the HCBS CAHPS Survey and measures are being used to consistently compare quality for case management contractors in five different regions of the state. Performance bonus incentives were added to those contracts a few years ago and payouts are based on quality benchmarks for three composite measures, the one shown here, case managers helpful, choosing the services that matter to you and personal safety and respect. Going forward Connecticut says it intends to publish the survey and performance results on an annual basis.

Next Slide please. The HCBS CAHPS survey measures will be put into volunteer use by non-test state programs as well and they will use it for quality improvement initiatives and service planning. For example Pennsylvania recently described publicly its plan to use the survey and performance data for two purposes, to establish a baseline for transitioning fee for service programs to manage long-term services and supports and also for annual statewide monitoring by those managed care organizations that contract for the Community Health Choices program in Pennsylvania. Next slide please. 

Okay we just have one more slide. We wanted one more if you could go to the next slide. Thanks. We lastly wanted to just point to the HCBS CAHPS Web page on the CMS Web site. It is a key source for individuals wanting more information about the survey. Some of the resources that can be accessed through this Web page include the survey instruments in both English and Spanish, both the core instrument and the employment supplement.

In addition technical assistance documents those include two forthcoming guides on administering the survey and on preparing survey data for analysis and calculating the measure scores. There's also a link on that Web page to – for the HCBS CAHPS mailbox where questions can be asked or requests related to technical assistance can be launched I guess. And mailbox staff will answer generic questions and including identifying relevant available resources.

And public users can also access technical assistance through various training Webinars and other presentations that CMS sponsors. And last but not least there's more information about the measures themselves on the NQF Web site. And that’s the last slide for us. Thank you.

Meredith Raymond:Thank you (Susan). Now we will be in our Q&A session. Operator (Michelle) would you please provide directions on how to call in questions?

Coordinator:Thank you Meredith. At this time if you do have any questions or comments you may press Star 1. Again that is Star 1 on your telephone if you do have any questions.

Meredith Raymond:Thank you (Michelle). We'll give one or two minutes for folks to enter in their question.

Coordinator:We do have a question. Would you like to take that?

Meredith Raymond:Yes please. Thank you.

Coordinator:(Amber Decker) you may go ahead.

(Amber Decker):Hi. I just would like to know if Telco which provides care management in different states will be surveyed if it will be surveyed separately or as a part of a HCBS service?

Jean Close:Hi.

(Amber Decker):Some of the states – I’m sorry go ahead yes go ahead.

Jean Close:Sure let me start off by saying Health Homes is a very specific service within Medicaid. And it has its own quality requirements that are included in it. Actually they’re not - they're voluntary provisions for quality measurements within health homes. And so although we do definitely consider that service part of the variety or the menu of services it can be considered Home and Community Based Services it has its own special provisions in those related to quality.

(Amber Decker):Okay thank you. I just have one more question. I’m just curious to know if you’re not including a list of services and examples that are within HCBS then how are you going to get answers that are honest if individuals that are approved for HCBS services are not even aware of what the services are? I mean that’s how bad it is unfortunately.

Jean Close:Yes I hear - this is Jean Close. I hear what you’re saying. When the - and I’ll ask my subject matter experts to assist with on what population the HCBS CAHPS Survey was tested and that might be helpful. We're literally looking at that experience of care from the participant’s perspective rather than necessarily a related to a particular covered service. But may ask either Elizabeth or Kerry to help with that.

Elizabeth Frentzel:This is Elizabeth. I’d be happy to. So the way I think about it is - and actually you make an excellent point first of all. And in our original testing we did some focus groups and interviews to try and figure out what language to use for the providers and the services. And what we identified was a, you know, you could identify a certain number of provider services and they change dramatically from waiver program to waiver program to state to state in terms of what they offer.

And then from there you have different names in different titles. So what we did is we came back and we talked to our technical expert panel and they helped us to identify and also updated a literature review that (Truvan) had originally developed to identify what the core provider services that HCBS covers. And the reason that – for that is because ultimately we want to be able to compare. So if one service, one waiver program covers a way to, you know, if they need termination of bugs to come to the house but most others don’t we wouldn't cover that. And so we identified that personal care attendants, behavioral health attendants, home makers, case managers and transportation...

(Amber Decker):Care support too is another one right and community habilitation is also another one. And I’m just speaking from a personal perspective. I'm a consumer and I'm actually am also a caregiver so I’ve been reaching out to try to provide input and it’s not been easy. So I’m looking forward to receiving any kind of survey that would allow for direct consumer in - specifically in New York State so thank you very much for helping clarify that.

Jean Close:Yes.

(Susan Reitzman):And this is (Susan Reitzman). The other thing I would just say is that this survey has a rather unique feature for these types of this population which is – it has a cognitive screening section. So there are questions that are intended to identify people who, you know, would hopefully be able to provide reliable answers.

(Amber Decker):Great. Thank you.

Meredith Raymond:Thank you everyone. Operator do we have any other questions in the queue?

Coordinator:Once again that is Star 1 if you like to ask a question. (Naomi Sachs) you may go ahead.

(Naomi Sachs):Hi yes. I was just wondering if you could talk a little bit about any comparisons, strengths or compared to the national core indicators aging and disability or the national core indicators?

(Susan Reitzman):This is (Susan Reitzman). We feel like we’re best suited to describe the survey, you know, because we developed it and we're familiar with it and, you know, would leave others to describe, you know, the MCI. At least that’s how I generally thought about this.

(Naomi Sachs):Okay I was just hoping you could talk about some of the comparative strengths of yours to focus on yours but in comparison because, you know, our state might not want to do both and we just want to understand if we're going to make a choice between the two, you know, what do they – how do they compare so...

Elizabeth Frentzel:This is Elizabeth. I would say my understanding is that one of the major comparisons is we do – the NCI is face to face. And this offers both options face to face or phone. And we noted that – and NCI has I believe has a different system but we found that the phone worked well. And that’s mainly I don’t know what the cost of - actually I don’t really – I wasn’t privy of information on the cost for any state so I don’t know if how much or exactly how that might affect cost.

(Naomi Sachs):Okay, appreciate your thoughts. Thank you.

Coordinator:We do have a few more questions...

Jean Close:This is Jean Close. I’d like to add a bit more to that. There’s lots of activity going on in the measurement of Home and Community Based Services. And it’s an exciting time that we're living in. Actually over a year ago the National Quality Forum put out a report that identified gaps in HCBS measurement. And even though there is over - there’s literally thousands of measures out there in the area of HCBS there are actually some areas of gaps. And they provide a great service and NQF convened a lot of stakeholders at that time. And it wasn’t just people working for the federal government. It was actually only those who were working in the field directly with individuals that had represented plans and stakeholders, states, Medicaid programs identified about 11 or 12 domains that they felt were really important for those who are receiving Home and Community Based Services.

And it really provides a useful framework for us to consider. And we're really glad that, that work was done. With the HCBS CAHPS Survey we think we filled one, filled a gap along with other surveys that are out there certainly that helped to fill that gap. There’s also an opportunity for other researchers or - and entities to look at what’s going to be really important in this arena for us to – in order to get the information we need in order to continuously improve the quality of care that individuals receiving HCBS services received.

So that said, you know, with the HCBS CAHPS survey we think it really is a useful contribution to and tool, voluntary tool that's available to anyone to use. Has one of its strengths is that it was tested on a cross disability group, that is individuals with physical disabilities, intellectual disabilities intellectuals who are aging. And I always leave out oh, individuals with chronic mental illness were all included in the group that was encompassed in the original testing. So we think that’s also important to have a experience of care survey that can capture those kinds of experiences and contribute to state's efforts to continuously improve quality. 

At this point our 1915 C waiver programs are able to serve a variety of groups. And in the past it was that, you know, a waiver program would serve one particular target group. At this point states are able to serve – have several 1915 C waiver programs going. And again this might be an opportunity to be able to implement such a survey across those programs should they – should a state wish to undertake it.

(Naomi Sachs):Thanks.

Meredith Raymond:Thank you Jean. That was very helpful. Operator (Michelle) do we have any other questions in the queue?

Coordinator:We do have a few more questions. (Craig Newton) you may go ahead.

(Craig Newton):Yes thank you. Are there any links to documents outlining findings across the states that were tested? On the CMS Web site there aren't any available but things that would tell us response rates for different modalities or methods to select sample frames?

(Susan Reitzman):The – this is (Susan Reitzman). The findings - there’s a couple there’s findings from a couple of different stages. The findings from the pilot in the field tests were presented in quite a bit of detail a year ago January of 2017 in two national trainings. And those slides and the transcripts are actually on a different Web page on the Web page for the test demonstration itself. 

So if you were to Google CMS test demonstration you would get to that page. And if you look down right under the Experience of Care you’ll find those two trainings. And they like I said they go into a lot of detail about exactly what you’re asking about response rates and numbers and things like that. And I – in terms of the more recent state experience individually Connecticut is the main one that I believe has publicly presented its results. I think Colorado also shared some of their results at the 2017 HCBS Annual conference. And those are the ones that I am aware of so far that have done a publicly.

(Craig Newton):Okay thank you.

Coordinator:Thank you. (Kathy McGevi) you may ask your question.

(Kathy McGevi):Actually the previous question was my question just to kind of see if there was anything out there. We're in the process right now of working in our workgroups to try to look at quality improvement initiatives and things. And we just wanted to see if anything was already out there. And I’m also looking at the publication that came out after that which answered a lot of my questions once I was able to click and find that. So...

(Susan Reitzman):And sorry, this is (Susan). I would also add that if you, you know, use those resources or you can’t find them or you’ve use them and you still have other questions by all means use the HCBS CAHPS mailbox too, you know, send your questions and we'll make sure that you get the information you’re looking for if it exists.

(Kathy McGevi):Thank you very much.

Coordinator:Thank you. Once again that is Star 1 if you like to ask a question. At this time I am showing no further questions.

Meredith Raymond:Okay we will give it a couple more minutes, two more minutes if anyone else wants to enter any question. If you’ve answered in a question via chat or Q&A online please submit it through the direction the operator mentioned. Thank you.

Coordinator:We do have another question. And again that is Star 1 if you would like to ask a question. (Daniel Goetz) you may go ahead.

(Daniel Goetz):Thank you. Do you know if any states plan to move to the CAHPS from an external quality review organization or do you know of any external quality review organizations that are adapting the CAHPS? Thank you.

Jean Close:This is Jean Close. I’ll start off and then I’ll have (Susan) or Elizabeth assist with the question too. One thing that we're really happy to see is that the Managed Long-term Services and Support Association which is an association of health plans has included the measures among theirs among many, many others. And I believe NCIs are included in this. Some of their measures are included in this as well as other measures are included. So again it’s going to be up to a particular, a plan what they choose to select for their quality improvement initiatives. But (Susan) and Elizabeth do you have any other insight you can share?

(Susan Reitzman):Hi. This is (Susan). I am – I don’t have complete knowledge about...

Jean Close:Yes.

(Susan Reitzman):...every state and what they’re doing. So the ones that I am aware of they are not doing what you’re proposing. They're, you know, incorporating it into their existing monitoring and sources of information.

Elizabeth Frentzel:Yes I haven’t heard anything.

Coordinator:And once again that is Star 1 if you would like to ask a question.

Meredith Raymond:We have a question here operator (Michelle) to ask.

Woman:Yes we received a question through the chat line Jean and company if you could answer. "How will some beneficiaries participate in surveys if they don’t have active phone or can’t hear or understand well over the phone?"

Jean Close:That’s a great question. And our provisions within the survey for a what is the term? I’m going to say surrogate but that’s not the right term.

(Susan Reitzman):Proxy?

Jean Close:Proxy thank you, to administer the – to answer the survey. But again Elizabeth or (Susan).

Elizabeth Frentzel:Yes this is Elizabeth. I just want to clarify so first off is both phone and in person. So there is that option of in person. And I wasn’t sure if that also meant if that meant the person couldn’t hear but could still understand in which case, you know, there’s the option of actually, you know, the state, the sponsor of it may also just show the question to the respondent or be able to sign if the person signs. If the person has other ways of communication working with that other way of communicating is another option. If the person has cognitive disability then it might be necessary to use a proxy. And you would do that by asking the first three questions and seeing if they can respond reliably. And then if not you would ask to have a proxy answer the question. Do I have that question right then to be able to answer?

Meredith Raymond:I believe so yes.

Elizabeth Frentzel:Great.

Meredith Raymond:Thank you.

Jean Close:And I would just reinforce that in some of those tests states what we’ve heard is that the - oftentimes the approach that they’ve taken is to when they're recruiting participants is to offer both options either in person or on the phone. And at least one of the states has found that those people that choose in person tend more often to have assistance in the form of another person with them or have some type of communication challenge where, you know, doing the survey in person is helpful.

Meredith Raymond:Okay thank you. We have five minutes left. Operator are there any other questions in the queue?

Coordinator:Again that is Star 1 if you would like to ask a question. At this time I am showing no further questions.

Meredith Raymond:Okay we will give it one more minute and if there are no further questions we will conclude the Webinar.

Coordinator:And I’m showing no further questions.

Meredith Raymond:Okay well thank you everyone so much for your attendance and thank you to all of our speakers for your very informative presentations and the helpful Q&A. Please stay tuned for our future Webinars and discussions on HCBS quality. If you have any further feedback or questions please send an email to hcbs-quality@acl.hhs.gov. The slides and the transcripts and this webinar will be posted to our website early next week. Thank you again everyone for your time and have a great afternoon.

Coordinator:And thank you. This concludes today’s conference call. You may go ahead and disconnect at this time.

END