Functional Assessment Standardized Items (FASI)

The FASI is a set of standardized items evaluated across post-acute care settings.  It was designed from three sources: Centers for Medicare and Medicaid Services (CMS) assessment tools for Medicare programs, state assessment tools for community-based long-term services, and additional criteria used to reflect a broader range of functional community mobility tasks. 

• FASI Example 

The Long Term 101 and 104 (LT-101 and LT-104) assessments are homegrown assessments developed by the Wyoming Department of Health, and are currently used to determine institutional level of care for skilled nursing facilities (SNFs) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), respectively.  These assessments are not standardized and have not been validated.

The LT-101 assessment is administered by Wyoming Public Health Nurses and measures activities of daily living (ADLs) and instrumental activities of daily living (IADLs).  This assessment typically takes between 45 minutes to an hour and a half to complete.  This assessment is conducted on individuals who apply for or receive services on the Community Choices Waiver, who have an acquired brain injury and apply for or receive services on the Comprehensive or Supports (DD) Waivers, or who apply for or receive other non-waiver SNF services.

The LT-104 was developed in 1999 to assess the supervision and functional needs of individuals who apply for or receive DD Waiver services, or services at the Wyoming Life Resource Center, Wyoming’s only intermediate care facility for individuals with Intellectual and developmental disabilities (ICF/IID).  Although the Division makes the final determination on participant eligibility, the LT-104 is currently administered by the individual’s case manager, which could be construed as a conflict of interest.  The LT-104 takes approximately five minutes to complete. 

The continued use of these assessments makes the State of Wyoming vulnerable to federal compliance violations, including but not limited to under-serving eligible populations, serving populations that do not meet eligibility requirements, and violating conflict of interest requirements.

• Phase I – Pilot Project – Adult participants of all HCBS Waivers 
  • WIND will conduct the FASI on approximately 400 participants between June 2023 and August 2024.
  • WIND will conduct data validation and generate a final data sheet by January 2025
• Phase II – Pilot Project – Child participants of DD Waivers 
  • WIND will conduct the FASI on approximately 400 participants between August 2023 and October 2024
  • WIND will conduct data validation and generation a final data sheet by January 2025
• Phase III – Non-Waiver nursing facility residents
  • WIND will crosswalk current LT101 assessment results with FASI measures to calculate scores.  WIND will conduct validation assessments on approximately 100 nursing home residents between June 2023 and November 2023
  • WIND will conduct data validation and generate a final data sheet by February 2024
• Phase IV – Exploration of assessment as a resource allocation tool
  • If the FASI is found to be appropriate to determine ICF/IID and SNF level of care, the Division will expand this project to determine how the FASI can be used to update the current methodology that is used to calculate individual budget amounts for participants on the Comprehensive Waiver.

• If you are selected, you will be contacted by a representative of the Wyoming Institute for Disabilities (WIND) to schedule a meeting time that is convenient for you.
• During the meeting, which is expected to last approximately one hour, you will be asked to respond to questions related to:
  • Self-care
  • Functional mobility
  • Ambulatory mobility
  • Wheelchair mobility
  • Activities of daily living, such as bathing, dressing, getting in and out of bed, using the restroom, and eating
  • Instrumental activities of daily living, such as cooking, cleaning, transportation, laundry, and managing finances
  • Living arrangements, available supports, and caregiver assistance
• WIND will analyze all of the data they collect during the pilot project, compare it to current LT101 and LT104 assessment results, and provide the Division with a final report and recommendation on how the FASI could impact participant eligibility, if adopted.

It is not the intent of the pilot project to tighten or restrict current HCBS Waiver participant eligibility requirements.  The intent of the project is to help the Division evaluate if the FASI is a feasible tool to determine institutional level of care for Wyoming HCBS Waiver program participants. 

Formal feedback sessions will be offered throughout the project.  Dates, times, and participation information will be shared as it becomes available

• May 31, 2023 Stakeholder Education and Feedback Session
  • Recorded Presentation / Slide Deck

If you would like to provide written feedback, please submit it to wdh-fasi@wyo.gov

Centers for Medicare and Medicaid Services – FASI Webpage

FASI Flyer for Case Managers