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States increasingly use data from standardized assessments to determine eligibility, set budgets, and manage quality for home and community-based services (HCBS) that allow individuals with disabilities and older adults to remain in the community. These standardized assessments capture information about activities of daily living, cognition, behavioral challenges, medical issues, living arrangement and informal supports.
Having reliable and valid assessment data is necessary to successfully implement any data-driven program improvements. In the context of standardized assessments, reliability means different assessors come up with the same response choices, while validity means that items are actually measuring what they are intended to measure.
To capture reliable and valid assessment data, states must 1) use an assessment tool that has established reliability and validity; 2) have assessors who are trained on how to use the tool; and 3) have processes for managing the quality of the assessments.
interRAI is an international organization that offers a suite of tools that assess different populations with disabilities living in different settings, such as in the community or an assisted living facility. The interRAI-Home Care (HC) is a commonly used tool and is designed to assess older adults and younger adults with physical disabilities who are living in the community. So far, the interRAI-HC has been adopted in more than 25 states.
Currently, each state that adopts an interRAI tool must figure out on their own how to incorporate it into existing processes, notably how to replicate or change eligibility and budget assignment algorithms and develop training and quality management infrastructure. In addition, they must do their own research to figure out how to use this enhanced data to improve their programs.
ADvancing States, the association that represents state agencies that support people with disabilities and older adults, is sponsoring an effort to make it easier to implement interRAI tools. ADvancing interRAI is a new initiative aimed at helping states use better data, better. A joint effort by ADvancing States, interRAI, and HCBS Strategies, will provide a package of supports to aid the implementation and use of interRAI assessments and decision support tools. HCBS Strategies will act as the primary project manager for the initiative, ADvancing States as the convening organization, and interRAI as subject matter experts. While the initial focus will be on the use of the interRAI-HC, it may be expanded to include additional interRAI instruments or supplements depending upon the interests of participating states.
The efforts provide states with assistance in incorporating interRAI into their existing business processes (“onboarding”), training, data analyses and reporting, assistance keeping up with best practices and technical assistance. The effort is being funded by the states, but the costs are much lower because they are sharing the infrastructure. In addition to learning from subject matter experts, the effort will facilitate cross-state collaboration and information sharing.
Onboarding assistance includes access to the Onboarding Manual that describes decisions to be made and program operations infrastructure necessary to implement interRAI and opportunities to use interRAI data to enhance program operations. In addition, the ADvancing interRAI team will conduct a review of the state’s HCBS delivery system and provide recommendations for how to integrate interRAI tools within its business operations and how to use the data to enhance programs.
Participating states will also receive in-person and online training. The ADvancing interRAI team includes experienced trainers who can either train assessors directly or support a train-the-trainer approach. The training will also include competency tests that could be used as part of a certification process.
The data integrity and reporting initiatives will start with providing guidance to state staff about how to ensure that data are accurate and usable. Data from all participating states will be uploaded into a central repository and each state will receive a report that summarizes information about the populations that their state serves and provide comparisons to other states. This will allow them for the first time to understand how their program participants directly compare to those in other states. The data repository can also be used to model the impact of potential changes to programs, such as changing eligibility criteria or how budgets are assigned.
Staff from participating states will oversee and guide the effort, allowing the ADvancing interRAI team to continually adapt to better meet states’ needs. The Cross-state Collaboration Workgroup will also help states better recognize how federal actions help or hinder their efforts and allow them to jointly advocate for changes that could benefit states and the larger Medicaid program.
States agencies can find out more about this initiative at http://www.advancingstates.org/advancing-states-information-sign.