Project Update July 2025
The Division of Healthcare Financing, Home and Community-Based Services (HCBS) Section recently concluded its project to review the Functional Assessment of Standardized Items (FASI) assessment tool. The FASI project aimed to determine the feasibility of using a new assessment tool to determine institutional level of care for Wyoming’s HCBS and Skilled Nursing Facility (SNF) programs. Pilot projects were implemented throughout the state within target populations to assess the impact on participant eligibility. The Wyoming Institute for Disabilities (WIND) analyzed the data collected during the pilot, compared it to our current assessment methodology and outcomes, and provided the Division with a final report and recommendation about how the FASI could affect participant eligibility if adopted.
After careful consideration, it was determined that the FASI assessment tool is not a viable option for assessing level of care eligibility criteria for the State’s Medicaid waiver programs at this time. The Division intends to move forward using the current assessments, confident they will continue to meet participants’ needs.
Background
CMS requires all states with Medicaid HCBS waiver programs to assess participants initially and annually to determine if individuals require an institutional level of care. CMS must approve the assessment procedures and criteria used.
Although CMS has approved the assessments currently used in Wyoming, the current institutional level of care assessments being used are inconsistently administered across waiver populations and leave the state vulnerable to CMS compliance findings.
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.
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- The LT-101 assessment is administered by Public Health Nurses and measures activities of daily living (ADLs) and instrumental activities of daily living (IADLs). This assessment typically takes 45 -90 minutes to complete and is given to 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 services.
- The LT-104 assessment, developed in 1999, assesses the supervision and functional needs of individuals applying for or receiving 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, potentially creating a conflict of interest. It takes approximately five minutes to complete.
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Additional Information
Formal feedback sessions offered throughout the project are posted below. For questions or to provide written feedback, please email wdh-fasi@wyo.gov.
May 31, 2023 Stakeholder Education and Feedback Session
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