Summary

What it measures:

• FASI is a set of reliable and valid person-centered items that can be used to evaluate a person's need for assistance with everyday activities.
• The items were developed to measure the functional status of people receiving home and community-based services (HCBS) in the following areas: self-care, mobility, instrumental activities of daily living (IADL), assistive devices for everyday activities, current living arrangements, and availability of paid and unpaid assistance.
• In the first three sections, the person is asked to describe up to two personal priorities in each area for the next six months.
• FASI originated from three sources:
  • CMS assessment tools that had been standardized across Medicare programs, including the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), Minimum Data Set (MDS) 3.0, the Long-Term Care Hospital Continuity Assessment Record and Evaluation (LTCH-CARE), and the Outcome and Assessment Information Set (OASIS)
  • State assessment tools for HCBS
  • Additional mobility items that reflect a broader range of functional community mobility tasks

ICF Domain(s):      

• Activity
• Participation
• Environmental Factors                                                                              

ICF Categories:

• Mobility
• Self-Care
• Domestic Life
• Major Life Areas

Target Population:

• FASI was tested and validated for use across the following populations commonly served by Medicaid HCBS programs:
  • Older Adults
  • Persons with Physical Disabilities
  • Persons with Intellectual or Developmental Disabilities
  • Persons with Acquired Brain Injury
  • Persons with Mental Health or Substance Use Disorders

Taskforce Recommendations

FASI is part of the Centers for Medicare and Medicaid Service (CMS) effort to develop standardized, interoperable data elements that enable the transfer of data across care and service settings.

Clinical Insights:

FASI focuses on the need for assistance with functional activities. The items are intended to be integrated with other assessment domains (eg, memory, cognition, psychosocial) to provide a holistic picture of a person's service and support needs. It is not a comprehensive HCBS assessment.

• Following extensive psychometric testing, the FASI team concluded that FASI is valid and reliable. The evidence was generally strong for content validity— the extent to which the items in question cover the concept of interest and structural validity—the extent to which the ordering of steps and items was logical. Evidence for convergent validity—the alignment of 3-day (usual) and last month (most dependent) scores—and interrater reliability were usually strong. The least strong evidence was for concurrent validity, which measures how these items were distinguished among populations with mixed evidence.
• Descriptive statistics were used to assess assistive device items. The top 5 assistive devices needed to complete self-care, mobility, or IADL across populations were (1) glasses, (2) contacts, (3) shower chair, (4) 3:1 commode, and (5) grab bars.
• CMS has 2 performance measures derived from FASI that allow a uniform approach to measuring functional needs across all care settings and enable cross-setting comparisons of service provision and quality. These efforts align with the goal of improving the quality of services and support for people receiving HCBS so that they can live successfully in the community.
• Identifying Personal Priorities for Functional Assessment Standardized Items Needs, which is endorsed by a consensus-based entity (CBE), as of July 2021 (CMS Measures Inventory Tool [CMIT] Measure ID #969): The percentage of HCBS participants aged 18 years or older who have identified as many total personal priorities (up to 3) as needs in the areas of self-care, mobility, or instrumental activities of daily living as determined by their most recent FASI assessment.
• Alignment of Person-Centered Service Plan with Functional Needs, CBE-endorsed as of July 2023 (CMIT Measure ID #970): The percentage of HCBS participants aged 18 years or older whose person-centered service planning documentation addresses needs in the areas of self-care, mobility, and instrumental activities of daily living as determined by the most recent FASI assessment.
• When adopting the entire FASI set:
  • Substantive validity is maintained across HCBS stakeholder groups (persons who are older adults, persons with physical disabilities, persons with intellectual or developmental disabilities, persons with acquired brain injury, or persons with mental health or substance use disorders). Substantive validity indicates the items (eg, upper body dressing) and concepts (eg, self-care) were found to be important to measure the construct of function in HCBS.
  • A comprehensive assessment of function is provided.
  • Person-centeredness is enhanced as a person's personal preferences for improvement are documented in each functional area.
  • Interoperability of functional data across the continuum of care is supported to ensure necessary information for health care decision-making, and service planning follows the person as they move across programs and settings.
  • The intended structure of previously developed performance measures aligns with a person's personal priorities within each domain.
• When adopting a subset of FASI:
  • An entity could individualize specific items directly related to the functional items of interest.
  • The overall time of completing the items is decreased.
  • The validity and reliability of the complete FASI set are not guaranteed and may not be assumed to apply.
  • A comprehensive evaluation of function cannot be assumed.
• If a subset of FASI is used, consider the following strategies:
  • Train assessors to the same degree as that provided in the field test to increase reliability in scoring individual items.
  • Recognize that using select items may better align with the needs of specific populations and programs in a state, so long as careful planning is used to select specific items.
  • Adopting FASI-based performance measures may be difficult as they require completed items.
  • Interoperability is still supported as each FASI item is represented in the CMS Data Element Library (DEL)³ and has specific Logical Observation Identifiers Names and Codes (LOINC).