Indicators of long-term care system performance: Development and implementation

A growing number of elders and close to 19 percent of adults in the U.S. today report having a disability due to physical, intellectual, or mental disorders. These individuals require long-term services and supports to live independently in the community. Federal mandates and initiatives, including the Americans with Disabilities Act, Olmstead Decision, and the New Freedom Initiative, provide the impetus for Medicaid State Agencies to pursue community integration for all individuals. As states continue to reform their long-term care systems, there is an interest in determining their success in attaining and maintaining a more equitable balance between the provision of Medicaid institutional and community-based services and related expenditures. Research is underway to bolster these “rebalancing” efforts, and to measure them. The National Balancing Indicator Contract project team, funded by the Centers for Medicare & Medicaid Services (CMS), has identified and evaluated existing indicators of long-term care rebalancing, and is developing new measures intended to depict the extent to which states operate long-term support systems that offer consumers choice and control over services and maximal community integration. In this presentation, we will describe our framework for rebalancing and the principles upon which the framework was founded. Proposed indicators for use by CMS and Medicaid State Agencies will be presented, along with a discussion of data-related and other challenges to development and implementation of the NBIC indicators across ten State Profile Tool grantees.