What is the National Quality Forum? How is their work tied to the RTC/OM?

The federal government has not established a national program of evaluation research on home and community-based services for people with disabilities. Additionally, states are not required to adopt a specific approach to study quality outcomes. However, national policy could be a catalyst for states to approach service quality evaluation in a uniform way.

CMS established its Quality Framework identifying the areas in which state LTSS programs funded by Medicaid would be held accountable. A key feature of the Quality Framework is the expectation that states will gather and respond to data on “system performance” in outcome areas such as access, person-centered services, participant outcomes and satisfaction, participant safeguards and participant rights.

The National Quality Forum (NQF), under a contract with the Department of Health and Human Service (HHS), convened a multistakeholder Committee to develop recommendations for the inclusion and prioritization of elements to address in HCBS quality measurement. In their sessions, the NQF decided upon a framework of 11 core elements of quality. Some of the included elements relate to personal outcomes of those with disabilities. Others relate to the service provision system at large. The 11 domains include:

  • Equity
  • Person-centered planning and coordination
  • Choice and control
  • Community inclusion
  • Human and legal rights
  • Holistic health and functioning
  • Service delivery and effectiveness
  • System performance and accountability
  • Recipient leadership in system development
  • Workforce
  • Caregiver support

Furthermore, each of these core areas of quality is further broken down into parts which, the NQF proposes, could be considered for measurement.

Over the next several years, the RTC/OM will use the National Quality Forum Framework to address the context and definition of quality in service provision with stakeholders from around the United States. Furthermore, the RTC/OM will make specific recommendations to federal agencies, state agencies, and service providers as to how to measure these elements in a way that is accurate, valid, sensitive, and true to the values and needs of the disability community.

NQF Endorsement 

In their Blueprint for the CMS Measures Management System (2017) [1], CMS outlines a scientifically rigorous process and Measure Lifecycle for developing, implementing, evaluating, and maintaining measures. A key part of the measure implementation phase of the CMS Measure Lifecycle is evaluation by the National Quality Forum (NQF).  The NQF has established a process for evaluating and endorsing measures for use in public and private payment systems. Measure developers submit information about a measure related to five key evaluation areas: 

  • Importance to Measure and Report
  • Scientific Acceptability of Measure Properties
  • Feasiblity
  • Usability and Use
  • Related and Competing Measures


The NQF uses a standardized review criteria to evaluate the suitability of submitted measures and then makes a recommendation for or against endorsement [2].  Using both NQF and CMS guidelines as well as standard psychometric principles, the RTC/OM has followed a rigorous measure development process with the ultimate goal of seeking and obtaining NQF endorsement. 



[1] CMS. (2017). Blueprint for the CMS Measures Management System Version 13.0 May 2017.

[2] National Quality Forum (2017). Measure Evaluation Criteria and Guidance for Evaluating Measures for Endorsement.