TEFT Demonstration Testing Experience and Functional Tools in Community Based LTSS Mike Smith Director, Division of Community Systems Transformation Disabled and Elderly Health Programs Group September 17,

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 2

Why is LTSS Important? 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

CMS Medicaid Alignment with the National Quality Strategy 5

CMS 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 6

TEFT 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 7

State Grantees and TEFT Components Grantee Experience of Care SurveyHCBS FASI HITECH (PHR & e-LTSS Plan) AZ*** CO*** CT*** GA*** KY*** LA* (Round 1) MD** MN*** NH* 8

HCBS 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 9

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 10

Demonstrate 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 11

Develop 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. Term+Services+and+Supports+%28eLTSS%29 Term+Services+and+Supports+%28eLTSS%29 12

Thank you. Contact: Kerry Lida, PhD Phone: /