Colorado Assessment Tool Project

Colorado Assessment ToolProjectReview of Tools Under ConsiderationPresentation for CM Training Workgroup1Colorado Department of Health Care Policy and Financing

Agenda Overview of Tools In-depth Discussion of Tools Discussion/Questions/Comments2Colorado Department of Health Care Policy and Financing

OVERVIEW OF TOOLS UNDERCONSIDERATION3Colorado Department of Health Care Policy and Financing

Selection Criteria UsedOne of more of the following characteristics: Established reliability and/or validityPerson-centered componentsAutomated versions availableComprehensive-holistic approachSuitable for broad range of populationsUseful for establishing eligibility for multiple programsDomains appropriate for the specific needs of Colorado’s LTSSpopulation Able to provide information for decisions in support planning Established training manuals and methods Usefulness in resource allocation4Colorado Department of Health Care Policy and Financing

Tools Selected for Review Tools developed to establish standardization nationally:– interRAI Home Care (interRAI-HC) Intellectual Disabilities (interRAI-ID) Community Mental Health (interRAI-CMH)– Continuity Assessment Record and Evaluation (CARE) Cross-population tools developed by states:––––Wisconsin Functional Screen/AssessmentMnCHOICESMassachusetts Real Choice Functional Needs AssessmentComprehensive Assessment Reporting Evaluation (CAREWashington State) IDD specific tool:– Support Intensity Scale (SIS)– Inventory for Client and Agency Planning (ICAP)5Colorado Department of Health Care Policy and Financing

Considerations for This Effort Consider whether to adopt a new tool vs. adapt existingtool(s) If decision is to consider adoption of new tool, leadingcontenders include:– interRAI– CMS tool – Continuity Assessment Record and Evaluation(CARE)– Will examine other tools Whether the decision is a new tool or modifications toexisting tools, it will be necessary to adapt the tool toinclude certain desired components, such as PersonCentered components.6Colorado Department of Health Care Policy and Financing

Tools Developed to EstablishStandardization Nationally interRAI––––Grew out of MDSCreated and refined by a research collaborativeOne or more tools adopted in 20 states and several other countriesTool being used to support a wide variety of business processes Collaborative model allows states to benefit from work done in other states andcountries– Not endorsed by CMS and items are drifting from MDS 3.0 CARE– CMS-funded effort– Original purpose was to establish common tool across Medicare-fundedpost acute settings– CMS developing a catalogue of items with established reliability– Expanding effort to include LTSS populations– Funding efforts to use items to support quality improvement, but notother business processes– Although items used in existing Medicare tools, no states are usingCARE items yetColorado Department of Health Care Policy and Financing7

TOOL SPECIFIC DISCUSSION8Colorado Department of Health Care Policy and Financing

MnCHOICES Developed as a universal assessment tool for all LTSSprograms and populations Modular design with some required modules and otherscompleted depending on answers to trigger questions Includes person-centered components Automated Used for eligibility determination, support planning andresource allocation Includes modules on employment, caregivers, andcapacity for self-direction Public domain9Colorado Department of Health Care Policy and Financing

MnCHOICES ConsiderationsAdvantagesChallenges Person-centered Informs support plandevelopment Comprehensive – used forall LTSS programs andpopulations and coverswide scope of domainswith some triggered byinterest or need Public domain- would allowCO to consider broadcustomizations Not extensively testedfor reliability and validitybeyond state use May require CO to doconsiderable work ondevelopment of training,support planning tools,manuals Length of assessmentmay be of some concernColorado Department of Health Care Policy and Financing10

interRAI-HC Part of a suite of validated tools used in 20 states andinternationally by developers of MDS First developed in 1994 and modified in 1999 and 2007 Tool and manuals copyrighted and users must pay anominal licensing fee Tool covers 17 areas and includes functional, healthand environmental factors Collects a minimum data set to which adopters canadd domains/items to fit their needs Used in conjunction with other decision support toolssuch as clinical assessment protocols, screeningsystems for outreach and care pathways, qualitymonitoring and case-mix system (RUGS III)Colorado Department of Health Care Policy and Financing11

Inter-RAI-HC ConsiderationsAdvantagesChallenges Reliable and validated toolfor eligibility and resourceallocation Decision support toolsavailable Training manuals available Part of larger network ofusers and researchers –data comparison Good structure forautomation and access tosoftware vendors thatknow interRAI Would need to developperson centeredcomponents Some stakeholders react tonumber and content ofitems (e.g., IDD see it astoo oriented towardmedical needs) Need to expand someareas to generate sufficientinfo for support plandevelopment (e.g.,employment)12Colorado Department of Health Care Policy and Financing

CARE Developed to look at improving the standardization ofassessment data and payment across post acute-care settings Sponsored by CMS as part of demonstration under DeficitReduction Act 2005 Measures health and function (e.g., ADL and IADL) Does not include care planning components Validated and reliable data items for post-acute care Worked with clinicians, providers, and other stakeholders toidentify relevant domains and items Tool and materials are in the public domain CMS appears to have interest and investment in expandinguse to include additional populations (e.g., IDD) and scope ofservice (e.g., LTSS)13Colorado Department of Health Care Policy and Financing

CARE ConsiderationsAdvantagesChallenges CMS is investing time andfunding into expansion If CMS continues to movetoward use in LTSS,adoption would put state ingood position down theroad Consistent with interest inPHR systems Technical assistance maybe available from federalcontractors Not vetted with statesoperating LTSS Little LTSS HCBS operationssupport -eligibility andresource allocation Not person centered andused for clinical purposes Not adequate for supportplanning in LTSS Not currently applicable toother populations (e.g.IDD)Colorado Department of Health Care Policy and Financing14

interRAICAREWIMNWAMASISICAPPerson-CenteredCould AddCould AddCould AddIncludedCould AddCould AddLimitedLimitedSelf-DirectionCould AddCould AddCould AddIncludedCould AddCould tesFacilitatesFacilitatesLimitedLimitedCould AddCould Add3 itemsIncludedCould tal YesYesNoNoYesYesBrain InjuryYesDevelopingYesYesYesYesNoNoSpinal Cord InjuryYesDevelopingYesYesYesYesNoNoChildrenYesNo PlansYesYesNoNoNoNoExistingCould tate-specificNoNoDevelopingCould tate-specificNoNoIDDExistingCould ficState-specificBrain InjuryExistingCould tate-specificNoNoSpinal Cord InjuryExistingCould pecificNoNoNoNoIntake & Triage toolsExistingCould DevelopCould oNoSupport Planning ToolsExistingCould DevelopCould esYesClinical/Functional IssuesExistingYesState-specificCould DevelopYesCould DevelopNoNoCould AddDevelopingCould AddState-specificCould AddCould AddCould DevelopCould DevelopEmpirically ValidatedYesYesYesNoYesMDS portionYesYesUsed in other StatesMultipleNo1 State1 State1 State1 StateMultipleMultipleNoYesNoNoNoNoNoNoCoordination w/ medical servicesDetermining Eligibility forDifferent PopulationsEmploymentResource AllocationEBDMental HealthChildrenQualityOpera-tionsQuality of Live/ ParticipantExperienceCMS EndorsedHCBS Strategies, IncApril 2014Driving SystemsChangeCrosswalk of by Tool Uses15Colorado Department of Health Care Policy and Financing

Input andQuestions?16Colorado Department of Health Care Policy and Financing

Colorado Department of Health Care Policy and Financing Considerations for This Effort Consider whether to adopt a new tool vs. adapt existing tool(s) If decision is to consider adoption of new tool, leading contenders include: –interRAI –CMS tool –Continuity Assessment Record and Eva