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.
The latest form for Testing Experience and Functional Tools: Functional Assessment Standardized Items (FASI) Based on the CARE Tool (CMS-10243) expires 2023-04-30 and can be found here.
Document Name |
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Supporting Statement B |
Supporting Statement A |
Approved without change |
Revision of a currently approved collection | 2023-04-28 | |
Approved without change |
Revision of a currently approved collection | 2019-12-18 | |
Approved with change |
Reinstatement with change of a previously approved collection | 2016-08-12 | |
Approved without change |
New collection (Request for a new OMB Control Number) | 2007-12-17 |
Federal Enterprise Architecture: Health - Health Care Services
Form CMS-10243 | Consent Form | Fillable Printable | Form and instruction |
Form CMS-10243 | Functional Assessment Standardized Items (FASI) | Fillable Printable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.