Quality measurement and improvement

(a) Development and publication of core and supplemental sets of HCBS quality measures (1) In general The Secretary shall identify and publish a core set and supplemental set of home and community-based services quality measures for use by State Medicaid programs, health plans and managed care entities that enter into contracts with such programs, and providers of items and services under such programs. (2) Regular reviews and updates The Secretary shall review and update the core set and supplemental set of home and community-based services quality measures published under paragraph (1) not less frequently than once every year. (3) Requirements (A) Interagency collaboration; stakeholder input In developing the core set and supplemental set of home and community-based services quality measures under paragraph (1), and subsequently reviewing and updating such core and supplemental sets, the Secretary shall— (i) collaborate with subagency heads determined appropriate by the Secretary; and (ii) ensure that such core and supplemental sets are informed by input from stakeholders, including recipients of home and community-based services, family caregivers of such recipients, providers, health plans, direct care workers, chosen representatives of direct care workers, and aging, disability, and workforce advocates, with the goal that at least half of such input is from current and potential recipients of home and community-based services and family caregivers. (B) Reflective of full array of services Such core set and supplemental set of home and community-based services quality measures shall— (i) reflect the full array of home and community-based services and recipients of such services, including adults and children; and (ii) include— (I) outcomes-based measures; (II) measures of availability of services; (III) measures of provider capacity and availability; (IV) measures related to person-centered care; (V) measures specific to self-directed care; (VI) measures related to transitions to and from institutional care; (VII) beneficiary and family caregiver surveys; and (VIII) measures related to outcomes by race/ethnicity, language, sex, gender identity, geography, and other demographic factors to track and reduce health disparities. (C) Demographics Such core set and supplemental set of home and community-based services quality measures shall allow for the collection of data that is disaggregated by demographics (as defined in section 2 but including any additional category determined by the Secretary). (4) Funding Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary for purposes of carrying out this subsection, $10,000,000 for fiscal year 2026, to remain available until expended. (b) State adoption and reports (1) In general Not later than 2 years after the date on which the Secretary publishes the core set and supplemental set of home and community-based services quality measures under subsection (a)(1), and annually thereafter, each State Medicaid program shall use such core and supplemental sets (or an alternative set of quality measures approved by the Secretary) to report information to the Secretary regarding the quality of home and community-based services provided under such program. (2) Process The information required under paragraph (1) shall be reported using a standardized format and procedures established by the Secretary. Such procedures shall allow a State Medicaid program to report such information separately or as part of the annual reports required under sections 1139A(c) and 1139B(d) of the Social Security Act (42 U.S.C. 1320b–9a, 1320b–9b). (3) Publication of quality measures Each State Medicaid program shall annually make the information reported to the Secretary under paragraph (1) available to the public. (4) Increased Federal matching rate for adoption and reporting Section 1903(a)(3) of the Social Security Act (42 U.S.C. 1396b(a)(3)) is amended— (A) in subparagraph (F)(ii), by striking plus after the semicolon and inserting and; and (B) by inserting after subparagraph (F), the following: (G) 80 percent of so much of the sums expended during such quarter as are attributable to the reporting of information regarding the quality of home and community-based services in accordance with section 107(b) of the HCBS Access Act; and. (c) Ombudsman Each State shall establish an HCBS ombudsman office that— (1) operates independently from the State Medicaid agency and managed care entities; (2) provides direct assistance to beneficiaries and their families; and (3) identifies and reports systemic problems to State officials, the public, and the Secretary.