State assessment systems must address both technical and policy issues as assessments and accountability practices are developed and implemented. These technical and policy issues have been expanded from traditional large-scale assessment to new alternative assessment approaches required by law and developed in every state. The primary purpose of federally required alternate assessments in state or district assessment systems is the same as the primary purpose of federally required large-scale assessments, that is, accountability. This report reviews technical and policy considerations involved in high quality alternate assessment. Based on research from early implementation and what are considered to be best practice approaches, this synthesis describes five steps in alternate assessment test development processes that allow for interpretation and use of results in reporting and accountability: (1) careful stakeholder and policymaker development of desired student outcomes for the population, reflecting the best understanding of research and practice; (2) careful development, testing, and refinement of assessment methods; (3) scoring of evidence according to professionally accepted standards; (4) standard-setting process to allow use of results in reporting and accountability systems; and (5) continuous improvement of the assessment process. Three state examples illustrate different methods of incorporating alternate assessment results into accountability systems. (Contains 23 references). (Author/CR)