We appreciate
CMS' agreement to submit non-substantive revisions to forms as a
non-substantive change and to a 30-day comment period for
substantive form revisions, if any.
Inventory as of this Action
Requested
Previously Approved
12/31/2019
36 Months From Approved
03/31/2011
5,650
0
244,234
2,825
0
179,341
0
0
0
In 2012, the Disabled & Elderly
Health Programs Group (DEHPG), within the Center for Medicaid and
Children’s Health Insurance Program Services (CMCS) of the Centers
for Medicare & Medicaid Services (CMS), funded a project
entitled, Technical Assistance to States for Testing Experience and
Functional Tools (TEFT) Grants. One component of this demonstration
is to amend and test the reliability of a setting-agnostic,
interoperable set of data elements, called “items,” that can
support standardized assessment of individuals across the continuum
of care. Items that were created for use in post-acute care
settings using the Continuity Assessment Record and Evaluation
(CARE) tool have been adopted, modified, or supplemented for use in
community-based long-term services and supports (CB-LTSS) programs.
This project will test the reliability and validity of the
function-related assessment items, now referred to as Functional
Assessment Standardized Items (FASI), when applied in community
settings, and in various populations: elders (65 years and older);
younger adults (18-64) with physical disabilities; and adults of
any age with intellectual or developmental disabilities, with
severe mental illness, or with traumatic brain injury. Data will be
collected through interviews with individuals, conducted in their
homes or another setting of their choosing. Assessment interviews
will be conducted by trained assessors who already work with these
clients to conduct assessments for the Medicaid Home and
Community-Based Services (HCBS) coverage. Data will be collected
using a modification of their current form in an electronic PDF
format and uploaded to Truven Health Analytics through a secure
electronic transfer file (ETF) application.
This is a request to use the
reinstated CARE tool authorization. The PAC CARE was established in
2007 for use in the Post-Acute Care Payment Reform Demonstration.
Some of the items have since been incorporated into the Federal
assessment tools required in the nursing facilities (e.g., the
Minimum Data Set (MDS), and other related assessment tools used in
Medicare payment and quality reporting requirements related to
post-acute care services. The TEFT demonstration would like to use
the reinstated authorization so that the adapted CARE items in the
FASI can be tested for reliability and validity in the
community-based long term services and supports (CB-LTSS)
populations. The data burden for the FASI items is much smaller
than the earlier CARE item set as the average time to complete each
section is five minutes and the total burden estimate for the
complete set of FASI items is 28 minutes. The title of the package
is also being changed to reflect that the FASI item set is only a
subset of the original CARE items. The new title reflects this
while also referring back to the source items in the CARE
tool.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Form CMS-10243 Functional Assessment Standardized Items (FASI): Round 2
Response to AHCA Questions 081806.docx
Functional Assessment Standardized Items (FASI): Round 2