TEFT DemonstrationTEFT DemonstrationTesting Experience and

Functional Tools in Community Based LTSS

Mike SmithDirector, Division of Community Systems Transformation

Disabled and Elderly Health Programs Group

September 17, 2015

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Why is LTSS Important?Why is LTSS Important?

• As part of the Affordable Care Act (ACA), Congress has provided incentives to promote the use of community-based LTSS and promoted the movement from institutions to communities for people who require LTSS:– Money Follows the Person (DRA and extended through ACA, Section

2403)– Community First Choice (ACA, Section 2401)– Balancing Incentive Program (ACA, Section 10202)– Person-Centered Planning and Self-Direction in Home and

Community-Based Services (ACA, Section 2402(a))• These programs target diverse beneficiary populations, most of

whom are eligible for services provided by the states

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Why is LTSS Important?

All Other Spending$284B

Home and Community Based Services

$75B

Institutional $71B

Source: Medicaid Expenditures for Long-Term Services and Supports in FFY 2013, June 30, 2015 (Available at Medicaid.gov)

Medicaid Expenditures, FFY 2013 (billions)Long-term Services and Supports - Institutional & Home and Community Based

Long-term Services

Medicaid HCBS Expenditures as a Percentage of Total Medicaid HCBS Expenditures, FY 1995 - 2013Medicaid HCBS Expenditures as a Percentage of

Total Medicaid HCBS Expenditures, FY 1995 - 2013

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CMS Medicaid Alignment with the National Quality Strategy

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CMS TEFT Program: BackgroundCMS TEFT Program: Background

• Introduced in Affordable Care Act (ACA) Section 2701• Requirement for HHS to identify and publish initial

voluntary core set of adult quality measures for adults eligible for Medicaid

• In response, CMS established Testing Experience and Functional Tools (TEFT) in Medicaid community-based long term services & supports (LTSS) Planning and Demonstration Grant Program

• March 2014: CMS awarded Demonstration Grants to 9 states: AZ, CO, CT, GA, KY, LA, MD, MN, NH

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TEFT ComponentsTEFT Components

1. Test & demonstrate a Home and Community Based Services (HCBS) Experience of Care Survey

2. Test and demonstrate a set of functional assessment standardized items (FASI) for HCBS (former CARE assessment)

3. Participate in development of, and test, a standard/s for e-LTSS plan

4. Demonstrate use of Personal Health Records (PHRs) for LTSS population/services

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State Grantees and TEFT ComponentsState Grantees and TEFT Components

GranteeExperience of Care Survey HCBS FASI

HITECH (PHR & e-LTSS Plan)

AZ * * *

CO * * *

CT * * *

GA * * *

KY * * *

LA * (Round 1)

MD * *

MN * * *

NH *

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HCBS Experience of Care SurveyHCBS Experience of Care Survey

• Cross-disability survey• Elicits beneficiary feedback on experience

with Medicaid HCBS– Addresses dimensions of quality valued by

program beneficiaries• Aligns with existing CAHPS surveys• Will seek CAHPS trademark• Will seek NQF endorsement

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Functional Assessment Standardized Items for HCBS

Functional Assessment Standardized Items for HCBS

• Adapt Functional Assessment Standardized Items (FASI) for HCBS/LTSS populations– Former Continuity Assessment Record & Evaluation (CARE)

• Standardize assessment across populations and care settings

• Support person-centered care across settings• Facilitate comparisons across settings & states

• Facilitate quality monitoring across providers and settings

• Leverage existing standards developed for the interoperable exchange of FASI items

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Demonstrate Use of PHR SystemsDemonstrate Use of PHR Systems

Benefits of PHRs for LTSS beneficiaries (and caregivers)• Provides information for informed decision-making about care

• Provides access to a range of personal LTSS and health information – Encourages a more active role for beneficiary/caregiver in managing

care– May contribute to better outcomes

• Way to manage LTSS and health care/services– Particularly for beneficiaries who have multiple LTSS

services/providers and physicians, or lengthy medical histories

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Develop a Standard for e-LTSS PlanDevelop a Standard for e-LTSS Plan

• The electronic Long-Term Services & Supports (eLTSS) Initiative is a ONC-CMS partnership that focuses on identifying and harmonizing electronic standards that can enable the creation, exchange and re-use of interoperable service plans for use by health care and community-based long-term services and supports providers, payers and the individuals they serve. These plans can help to improve the coordination of health and social services that support an individual’s mental and physical health.

• http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29

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Thank you.

• Contact: Kerry Lida, PhD• Email: Kerry.Lida@cms.hhs.gov• Phone: 410-786-4826/202-904-0950