Settlement Agreement Provision
The Commonwealth’s HCBS waivers shall operate in accordance with the Commonwealth’s CMS-approved waiver quality improvement plan to ensure the needs of individuals enrolled in a waiver are met, that individuals have choice in all aspects of their selection of goals and supports, and that there are effective processes in place to monitor participant health and safety. The plan shall include evaluation of level of care; development and monitoring of individual service plans; assurance of qualified providers; identification, response and prevention of occurrences of abuse, neglect and exploitation; administrative oversight of all waiver functions including contracting; and financial accountability. Review of data shall occur at the local and state levels by the CSBs and DBHDS/DMAS, respectively.
About HCBS Waiver Quality Improvement
The Quality Improvement Strategy can be found in Appendix H of each of the CMS approved Virginia DD Waivers. Under §1915(c) of the Social Security Act and 42 CFR §441.302, the approval of an HCBS waiver requires that CMS determine that the state has made satisfactory assurances concerning the protection of participant health and welfare, financial accountability and other elements of waiver operations. Renewal of an existing waiver is contingent upon review by CMS and a finding by CMS that the assurances have been met.
Each of Virginia’s DD waivers has an identical Waiver Quality Improvement Strategy approved by CMS. Data is collected for each waiver and reported as a single percentage across all three waivers per CMS allowance for waivers that are similar in population supported and scope. The Commonwealth established a Quality Review Committee (QRT) to oversee the Waiver quality improvement strategy. This committee is managed by DBHDS with both DMAS and DBHDS participation. At its quarterly meetings, the QRT reviews the data collected on each of the quality assurances and make recommendations for improvements for any assurance that does not meet the 86% required metric. The QRT reports annually to the DBHDS Quality Improvement Committee on its findings, recommendations and challenges.
A state may offer home and community-based services to state-specified target group(s) of Medicaid who need a level of institutional care that is provided under the Medicaid State plan. The state is expected to establish a minimum level of quality to measure and improve its performance in meeting the waiver assurances that are set forth in the Act. This content area includes supporting documentation and evidence of compliance with the CMS HCBS Waiver Assurance and Quality Improvement Strategy as well as the requirements under the Settlement Agreement Compliance Indicators.
Authorizing Authority
- 1915(c) Social Security Act
- Technical guidance, Application for a 1915(c) Home and Community Waiver Version 3.6, January 2019, CMS Assurances, Quality Improvement Strategy: 42 CFR 441.301 and 42 CFR 441.301
Processes, Protocols and Standards
Instruments and Tools
Guidelines, charters, & plans
- SFY22 3rd and 4th QRT Meeting Summary 2nd Qtr and 3rd Qtr data
- SFY22 QRT 2nd Qtr Meeting Summary from 1st Qtr data
- SFY22 1st Qtr Meeting Summary 4th Qtr Data
- SFY21 QRT 4th Mtg Summary for 3rd Qtr Data
- SFY21 QRT 3rd Qtr Meeting Summary for 2nd Qtr Data
- SFY21 QRT 2nd Qtr Meeting Summary for 1st Qtr Data
For more information about HCBS Waiver Quality Improvement:
www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83396
(download and scroll to Appendix H)