(PAS) Project Overview Prepared for: DHS Meeting November 28, 2017 Prepared by: Pam McCoy, FEi Systems
Supporting Goals Enhance access to and improve coordination of medical care Create a person-driven, long-term support system in which people have choice, control, and access to a full array of quality services that provide independence, health, and quality of life PA Assessment System (PAS) Functional Eligibility Determination (FED) interrai HC TM Needs Assessment Instrument 12/7/2017 2
PA Assessment System Workflow IEB (Maximus) Applicant and Enrollment Updates Functional Eligibility Determinations PA Assessment System (PAS) interrai HC Data and Results UPMC interrai HC Data and Results AmeriHealth Caritas PA Health and Wellness interrai HC Data and Results 12/7/2017 3
Functional Eligibility Determination Instrument Purpose: CHC Clinical Eligibility Determination Successor to current LCD used in PA today PA Assessment System FED instrument developed by Dr. Steven Albert from U Pitt Reviewed 86,682 individual PA LCD assessments with full data completed between 2013-15. Assessed change and stability in disability through a review of 23,000 individuals with multiple LCD assessments Reviewed other states approaches to eligibility for long term care services Comprised of a subset of questions from the interrai HC TM instrument Administered to applicants by AAA assessors to determine: NFI Nursing Facility Ineligible NFCE Nursing Facility Clinically Eligible 12/7/2017 4
Functional Eligibility Determination Instrument NFI Determination: PA Assessment System Applicant may be eligible for other types of county or state Aging assistance programs FED results sent to IEB for non-chc benefits consideration NFCE Determination: FED results sent to IEB for financial eligibility determination and subsequent CHC enrollment 12/7/2017 5
FED vs Current Level of Care Determination (LCD) From Dr. Albert: LCD is subjective and may leave NFCE judgment to assessor Problems Length (takes as much as 90 min to complete) Non-standardization (assessors can skip across sections) Contains detailed cognitive assessment (SLUMS) but not required and often not completed Unrealistic for assessors to attribute disability to specific physiologic systems or medical conditions Review of 87,000 unduplicated LCDs (2013-15) suggests mismatch between disability domains and NFCE determination Some consumers with disability in key domain areas (ADL, toileting, cognition, mobility, eating) were not designated NFCE 12/7/2017 6
Using FED (From Dr. Albert) Checks applicant reports relative to reports from family members Probes applicant s strengths and assets and integrates information from observation and self and family reports Assessors do not make a determination of NFCE or NFI; determination based on applicant s overall level of disability and skilled care needs (via algorithm) 12/7/2017 7
FED Beta Conclusions (From Dr. Albert) FED is practical and feasible in the real world setting of NFCE determination. It can be completed in 20 min with very little missing data. FED is effective for eliciting cognitive status, which is a challenge in the LCD. The FED identifies disability more effectively than LCD and is highly concordant with LCD for more severe levels of disability. 12/7/2017 8
IEB Interactions with PAS Post-FED Determination For CHC applicants determined to be NFCE: IEB continues CHC eligibility using FED determination as one part of the eligibility criteria IEB provides critical profile and enrollment updates to PAS throughout the eligibility process Upon CHC approval: IEB contacts enrollee to determine choice of SCE/MCO IEB updates PAS with enrollee s SCE/MCO choice and MA number 12/7/2017 9
SCE /MCO New Enrollee interrai HC TM Assessment Purpose: Needs assessment post-eligibility determination to inform and guide subsequent care and service planning Process: Assessment required to be completed within 5 business days SCE / MCO meets with enrollee and administers interrai HC TM assessment o MCOs will use their own systems for interrai assessments starting January 2018 o SCEs will use PAS for interrai assessments starting July 1, 2018 Assessments can be administered in online or offline mode, offering flexibility to assessors in areas of low or no internet availability Results: Clinical Assessment Protocols (CAPs) Scales 12/7/2017 10
CAPs Used to inform care and service planning (See appendix for detailed CAPS measures) Not intended to automate care planning Help assessor focus on key issues identified during assessment Enable intervention decisions to be explored with the person Scales Status and outcomes measures Used to evaluate an individual s current clinical status Enables changes in clinical status over time to be evaluated and compared Comparable to industry gold standard measures 12/7/2017 11
CAPS Results in PAS 12/7/2017 12
CAPS and Scales Results in PAS 12/7/2017 13
interrai HC TM Data Storage Interfaces developed between MCO systems and PAS interrai HC TM assessment data and results sent from MCO systems to PAS nightly PAS sends interrai HC TM assessment data and results to DHS data warehouse weekly FEi required by license to send anonymized interrai HC TM data to University of Michigan on a yearly basis 12/7/2017 14
interrai HC TM Best Practices Frequency: Initially upon program enrollment Annually to re-assess care needs On-demand assessments when a change in condition detected Used over time, interrai HC TM provides indications of the enrollee s response to care or services interrai HC TM can be used to assess persons with chronic needs for care as well as those with post-acute care needs 12/7/2017 15
interrai HC TM Experience from Mississippi PA Assessment System Implemented interrai HC TM as a replacement for Pre-Admission Screen (PAS), a homegrown tool in existence for about a decade Recognize interrai HC TM as a more objective and standardized assessment Assessors reported that the interrai HC TM brings more objectivity to the care planning process because assessors no longer scale individuals based on their perceptions of needs and abilities More objective, less subjective questions such as In the last 3 days, how much help did the person need preparing meals? 12/7/2017 16
Questions? 12/7/2017 17
Appendix 12/7/2017 18
CAPS Results Detailed Data Element Data Type Acceptable Values Description cabuse 1 : Triggered - moderate risk 2 : Triggered - high risk Abusive Relationship (CAPS) cadl 1 : Triggered - prevent decline 2 : Triggered - facilitate improvement Activities of Daily Living (CAPS) cdrug 1 : Triggered Appropriate Medications (CAPS) 0 : NotTriggered cbehav 1 : Triggered - prevent almost daily behavior 2 : Triggered - reduce daily behavior Behavior (CAPS) -1: NotCalculated cbowel 1 : Triggered - risk of decline 2 : Triggered - facilitate improvement Bowel Conditions (CAPS) ccardio 1 : Triggered Cardiorespiratory Conditions (CAPS) ccognit 1 : Triggered - monitor 2 : Triggered - prevent decline Cognitive Loss (CAPS) 1 : Triggered - potential for improvement ccommun Communication (CAPS) 2 : Triggered - risk of decline 1 : Triggered - low level cdehyd 2 : Triggered - high level Dehydration (CAPS) cdelir 1 : Triggered Delirium (CAPS) 12/7/2017 19
CAPS Results Detailed cenvir 1 : Triggered Environmental Compensation (Home Environment Optimization) (CAPS) cfalls 1 : Triggered Falls (CAPS) cfeedtb 1 : Triggered Feeding Tube (CAPS) ciadl 1 : Triggered Instrument Activities of Daily Living (CAPS) cbritsu 1 : Triggered Informal Support (CAPS) crisk 1 : Triggered Institutional Risk (CAPS) cmood 1 : Triggered Mood (CAPS) cpain 1 : Triggered - medium priority 2 : Triggered - high priority Pain (CAPS) cpactiv 1 : Triggered Physical Activities Promotion (CAPS) 1 : Triggered - has stage 2 ulcer cpulcer 2 : Triggered - at risk has stage 1 ulcer Pressure Ulcer (CAPS) 3 : Triggered - at risk no ulcer now 1 : Triggered - physician visit cpreven Prevention (CAPS) 2 : Triggered - no physician visit 12/7/2017 20
CAPS Results Detailed cadd 1 : Triggered Smoking and Drinking (Tobacco and Alcohol Use) (CAPS) csocfunc 1 : Triggered Social Relationships (CAPS) - poor decision making at baseline curin scps, from -1-6 sdrs digit, from 0-14 sadlh digit, from 0: 6 1 : Not triggered - continent at baseline 2 : Triggered - prevent decline 3 : Triggered - facilitate improvement 0 = INTACT 1 = BORDERLINE INTACT 2 = MILD IMPAIRMENT 3 = MODERATE IMPAIRMENT 4 = MODERATE OR SEVERE IMPAIRMENT 5 = SEVERE IMPAIRMENT 6 = VERY SEVERE IMPAIRMENT 0-2: No Depression 3-14: Possible Depression 0: INDEPENDENT 1: SUPERVISION REQUIRED 2: LIMITED IMPAIRMENT 3: EXTENSIVE ASSISTANCE REQUIRED - 1 4: EXTENSIVE ASSISTANCE REQUIRED - 2 Urinary Incontinence (CAPS) Cognitive Performance Scale Depression Rating Scale ADL Hierarchy Scale 5: DEPENDENT 6: TOTAL DEPENDENCE 0: NO PAIN spain digit, from 0-4 1: LESS THAN DAILY PAIN 2: DAILY PAIN BUT NOT SEVERE 3: DAILY SEVERE PAIN 4: DAILY EXCRUCIATING PAIN Pain Scale 12/7/2017 21
CAPS Results Detailed 0: No ADL Impairment 1: Scale 1 of ADL Impairment 2: Scale 2 of ADL Impairment 3: Scale 3 of ADL Impairment 4: Scale 4 of ADL Impairment 5: Scale 5 of ADL Impairment 6: Scale 6 of ADL Impairment 7: Scale 7 of ADL Impairment 8: Scale 8 of ADL Impairment sadlsf digit, from 0-16 ADL Scale - Short form Scale 9: Scale 9 of ADL Impairment 10: Scale 10 of ADL Impairment 11: Scale 11 of ADL Impairment 12: Scale 12 of ADL Impairment 13: Scale 13 of ADL Impairment 14: Scale 14 of ADL Impairment 15: Scale 15 of ADL Impairment 16: High ADL Impairment sage digit, 0-130 Age in Years Scale 0: NO SIGNS OF AGGRESSION sabs digit, 0-16 sbmi double, 5-70 scomm digit, 0-8 1-4: MILD TO MODERATE AGGRESSION 5+: MORE SEVERE AGGRESSION 0: INTACT 1: BORDERLINE INTACT 2: MILD IMPAIRMENT 3: MILD/MODERATE IMPAIRMENT 4: MODERATE IMPAIRMENT 5: MODERATE/SEVERE IMPAIRMENT 6: SEVERE IMPAIRMENT 7: SEVERE/VERY SEVERE IMPAIRMENT Aggressive Behavior Scale May-70 Body Mass Index Scale Communication Scale 8: VERY SEVERE IMPAIRMENT 12/7/2017 22
CAPS Results Detailed 0: BOTH SENSES INTACT 1: ONE SENSE INTACT AND THE OTHER MILD/MODERATELY IMPAIRED sdbsi digit, 0-5 2: ONE SENSE INTACT AND THE OTHER SEVERELY IMPAIRED 3: BOTH SENSES MILD/MODERATELY IMPAIRED Deafblind Severity Index Scale 4: ONE SENSE MILD/MODERATELY AND THE OTHER SEVERELY IMPAIRED 5: BOTH SENSES SEVERELY IMPAIRED 0: OK sfunh digit, 0-11 1: IADL early 1 2: IADL early 2 3: some IADL Mid 1 4: IADL Mid 1 5: IADL Dep 6: 4 IADL-ADL Trans 1 7: 5 IADL-ADL Trans 2 8: Early ADL 9: 1 Mid-Late ADL 10: 2 Mid-Late ADL 11: Dep ADL Functional Hierarchy Scale 0: OK - NO DIFFICULTY siadlch digit, 0-6 1: SOME DIFFICULTIES 1 2: SOME DIFFICULTIES 2-3 3: SOME DIFFICULTIES 4 PLUS 4: SOME DEPENDENCE 5: MOST DEPENDENCE 6: ALL DEPENDENCE Instrumental Hierarchy - Capacity Scale 0: INTACT 1 scps2 digit, 0-8 1: INTACT 2 2: BORDERLINE INTACT 1 3: BORDERLINE INTACT 2 4: MODERATELY IMPAIRED 1 5: MODERATELY IMPAIRED 2 6: SEVERE 1 7: SEVERE 2 8: VERY SEVERE IMPAIRMENT Cognitive Performance Scale 2 12/7/2017 23
CAPS Results Detailed sdivert digit, 0-6 amaple digit, 0-5 spurs digit, 0-8 1: LOWEST RISK FOR FUTURE ED USE 2: Scale 2 of RISK FOR FUTURE ED USE 3: Scale 3 of RISK FOR FUTURE ED USE 4: Scale 4 of RISK FOR FUTURE ED USE 5: Scale 5 of RISK FOR FUTURE ED USE 6: HIGHEST RISK FOR FUTURE ED USE 1: Low 2: Mild 3: Moderate 4: High 5: Very High 0: Very low risk 1: Low risk 2: Low risk 3: Moderate risk 4: High risk 5: High risk 6: Very high risk 7: Very high risk 8: Very high risk DIVERT Scale Method for Assigning Priority Levels Pressure Ulcer Rating Scale 12/7/2017 24
CAPS Results Detailed 0: No ADL Impairment sadllf digit, 0-28 1: Scale 1 of ADL Impairment 2: Scale 2 of ADL Impairment 3: Scale 3 of ADL Impairment 4: Scale 4 of ADL Impairment 5: Scale 5 of ADL Impairment 6: Scale 6 of ADL Impairment 7: Scale 7 of ADL Impairment 8: Scale 8 of ADL Impairment 9: Scale 9 of ADL Impairment 10: Scale 10 of ADL Impairment 11: Scale 11 of ADL Impairment 12: Scale 12 of ADL Impairment 13: Scale 13 of ADL Impairment 14: Scale 14 of ADL Impairment 15: Scale 15 of ADL Impairment 16: Scale 16 of ADL Impairment 17: Scale 17 of ADL Impairment 18: Scale 18 of ADL Impairment 19: Scale 19 of ADL Impairment 20: Scale 20 of ADL Impairment 21: Scale 21 of ADL Impairment 22: Scale 22 of ADL Impairment 23: Scale 23 of ADL Impairment 24: Scale 24 of ADL Impairment 25: Scale 25 of ADL Impairment 26: Scale 26 of ADL Impairment 27: Scale 27 of ADL Impairment 28: High ADL Impairment ADL LONG FORMAT SCALE 0: NOT TRIGGERED cnutr Digit, 0-2 1: TRIGGERED RISK 2: TRIGGERED - HIGH RISK NUTRITION CAP 12/7/2017 25