Medicaid Functional Eligibility Instrument- Intellectual Disability(MFEI-IDD):

Field Testing Kick-Off Webinar

Presented on 3/28/17 and 3/30/17

Rosemary Chapin, PhD; MFEI Principal Investigator, KU SSW

Carrie Wendel-Hummell, PhD; MFEI Project Manager, KU SSW

Martha Hodgesmith, JD; Project Advisor, KU RTC-IL

MFEI-IDD: Background and Purpose • MFEI-IDD: Medicaid Functional Eligibility Instrument

• The MFEI-IDD will eventually replace the current BASIS assessment. – It will be used for I/DD waiver and ICF-IDD participants,

ages 5 and up.

• The MFEI-IDD will be part of a universal assessment system: – A similar version of the MFEI will be used for participants

in the Frail Elderly (FE), Physical Disability (PD), and Traumatic Brain Injury (TBI) waivers , Program for All-Inclusive Care for the Elderly (PACE), TBI rehab facilities (TBIRF) and Nursing Facilities (NFs).

– Some assessment items will be the same across all programs, and other items will be population specific

– Universal assessment systems are a growing best practice

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MFEI-IDD: Background and Purpose • KDADS needed updated instruments with better

reliability and validity – The I/DD population has changed, and so have the other LTSS

populations

– Reliability: Produces consistent results across different assessors

– Validity: Provides an accurate measure of LTSS needs

• The assessment process will largely remain the same: – CDDOs will assess the functional eligibility and tier level for the

MFEI-IDD populations.

– ADRCs will assess functional eligibility for the original MFEI populations (FE, PD, TBI, PACE, TBIRF, NF)

– MCO care coordinators will complete the careplanning assessment, but this will also be standardized through the MFEI project.

• Functional eligibility and tier policies are not changing through this MFEI-IDD project.

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MFEI-IDD: Current Stage • We now have draft versions of the MFEI-IDD ready for field

testing!

• The following CDDOs will be participating in our field testing: 1. Cowley County CDDO 2. Disability Planning Organization of Kansas (DPOK

• Brown Co.; Futures Unlimited; Nemaha Co.; Reno Co.; Twin Valley

3. Developmental Services of Northwest Kansas (DSNWK) 4. Johnson County CDDO 5. Sedgwick Country CDDO 6. Shawnee County CDDO 7. Southwest Development Services, Inc., (SDSI) 8. Wyandotte County CDDO

• More details on field testing will be shared later during this presentation

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The MFEI-IDD Partnership • KDADS: HCBS commission + ICF/IID

• KU – Center for Research on Aging and Disability Options (CRADO)

in the KU School of Social Welfare – Research and Training Center on Independent Living (RTC/IL)

in the Life Span Institute – KU Medical Center (KUMC)

• Stakeholders: – Monthly MFEI-IDD Advisory Workgroup Meetings, with

CDDO representatives, LTSS providers, MCO representatives, advocates, and family members, along with the KDADS and KU project team members

– Focus groups (2015): 48 consumers/family caregivers and 41 assessors/case managers

– Self Advocates of Kansas (Lawrence and Garden City)

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MFEI-IDD: Development Overview • Initial steps (completed):

– Reviewed best practices in assessment and federal recommendations

– Reviewed assessment instruments used in other states, with workgroup and focus group input

– Selection of interRAI instruments as the foundation (see next slide)

• Following steps: – Adapted the interRAI tools for Kansas, with stakeholder input – Prepared for field testing

• Current Steps: – Field testing, with training (see slides 10-12) – Revise and finalize the MFEI-IDD based on testing results and

stakeholder feedback

• Final steps: – Public comment, CMS approvals, Final revisions – Statewide training and implementation

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The Base Tools: interRAI • InterRAI is an international network of researchers and clinicians

who have developed a set of tools for health care and LTSS settings. – interRAI-Intellectual Disability (iID):HCBS-IDD and ICF-IDD for

ages 18+ – interRAI-Pediatric Home Care (iPedsHC): HCBS-IDD and ICF-IDD

for ages 4-17 – interRAI-Home Care (iHC): HCBS-FE, PD, TBI; PACE; TBIRF; NF

• All interRAI assessments have established reliability and validity; and are updated and maintained by interRAI. – Reliability: Produces consistent results across different assessors – Validity: Provides an accurate measure of LTSS needs

• At least 17 other states and Canada use interRAI assessments. – We received technical assistance and guidance from interRAI and

other user states.

• For more information: http://interrai.org/

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MFEI-IDD: Adapting the interRAI

• InterRAI tools are copyrighted. We are allowed to change a small amount of original interRAI items. We can add as many additional items as we would like.

• The original interRAI tools includes the following key domains: Cognition, Communication, Mood and Behavior, Psychosocial Wellbeing, Functional Status (ADLs, IADLs, mobility), Continence, Health Conditions, Social Supports.

• Our key adaptations include additional detail on employment, communication, and behavioral support needs. We also had to add some items to ensure we are capturing current level-of-care policy in Kansas.

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MFEI-IDD: Sample Measures • Communication

– Making Self Understood --Ability to Understand Others

– Reading --Writing

• Cognition: Safety Judgment

• Independent Activities of Daily Living (IADLs) – Meal Preparation --Ordinary Housework

– Managing Finances --Shopping

• Activities of Daily Living (ADLs) – Bathing -- Personal Hygiene

– Toilet Use -- Transfers

• Behavior – Frequency -- Type of Support Needed

– How Often Support is Needed

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MFEI-IDD: The Field Testing Plan • A draft MFEI-IDD will be tested by CDDO

assessors with Medicaid participants/ applicants from this April thru December 2017.

– The field testing of the MFEI-IDD will not impact participant eligibility.

– KU will compare the draft MFEI-IDD data to the BASIS data to develop a similar functional eligibility and tier scoring method.

– KU will get feedback from every test assessor.

– The field testing information will also be used to improve the MFEI-IDD draft and training materials.

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MFEI-IDD: Field Testing Plan Schedule (subject to change)

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Apr May June July Aug Sept Oct Nov Dec

DPOK X

Johnson Co. X

Wyandotte X

Shawnee X

Sedgwick X

Cowley X

DSNWK X

SDSI X

MFEI-IDD: The Field Testing Plan • Targeted Sample Size

• We also seek a sample that will be representative in terms of age, race/ethnicity, gender, I/DD type, co-occurring diagnoses, and institutional history.

Tier Children Adults Total

0 60 75 135

5 60 75 135

4 40 60 100

3 40 60 100

2 40 60 100

1 40 60 100

Total 280 390 670

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MFEI-IDD: Final Steps • Winter 2017:

– Finalize the instrument, in response to field testing results and stakeholder feedback

– Software development

• Late Winter thru Spring 2018: – Public comment

– CMS review and approvals

– Final changes, as needed in response to public comment and CMS review

– Software development

• Late Spring thru Early Summer 2018 – Phased implementation, with training

– Technical assistance

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Comments and Questions?

You can also email questions to crado@ku.edu

Thank you for joining us today!

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