Functional Measures

Announcements

Welcome to the updated Function page, current as of August 2018.

Background on Post-Acute Quality Initiatives: Function 

In 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) (Pub. L. 113–185) directed the Secretary to specify quality measures on which PAC providers are required under the applicable reporting provisions to submit standardized patient/resident assessment data and other necessary data specified by the Secretary with respect to five (5) quality domains, one of which is functional status, cognitive function, and changes in function and cognitive function.

The development of standardized functional assessment measures across post-acute care settings has been ongoing since 2014; however, efforts to develop uniform, standardized functional assessment measures has been an ongoing effort. A functional measures progress timeline can be accessed in the 'Downloads' section below.

In 2017, CMS launched the Meaningful Measures Initiative, which is one component of the Health and Human Services (HHS) agency-wide Patients over Paperwork Initiative, aimed at evaluating and streamlining regulations with a goal to reduce unnecessary cost and burden, increase efficiencies, and improve beneficiary experience. The Meaningful Measures Initiative is aimed at identifying the highest priority areas for quality measurement and quality improvement in order to assess the core quality of care issues that are most vital to advancing our work to improve patient outcomes. Functional outcomes are included under the quality priority, “Strengthen Person and Family Engagement as Partners in Their Care.” For more information, please visit the Meaningful Measures initiative website.

MEASURE SPECIFICATIONS 

Measure specifications for the functional process and outcome measures adopted for the IRF, LTCH, SNF, and HH QRPs can be found in the downloads section below. In addition, a table providing a list of the self-care and mobility data elements included in Section GG of the Post-Acute Care Item Sets is posted and available in the downloads section below. The table includes Section GG data   in the IRF-PAI version 2.0 (effective October 1, 2018), MDS 3.0 Version 1.16.0 (effective October 1, 2018), LTCH CARE Data Set version 4.00 (effective July 1, 2018), and OASIS-D (effective January 1, 2019).

QM User’s Manuals present the methods used to calculate quality measures that are included in each PAC Quality Reporting Program (QRP). Manuals provide detailed information for each quality measure, including quality measure definitions, inclusion and exclusion criteria and measure calculation specifications. Setting specific QM User’s Manuals are available at setting-specific websites:

FUNCTION REPORTS

2012 ASPE Report on Crosscutting Medicare Functional Status Quality Metrics

A joint effort led by Assistant Secretary for Planning and Evaluation (ASPE) with support from CMS, focused on measure development in the area of functional outcomes. The activities conducted in this joint effort included an environmental scan, the analyses of the CARE Item Set and other functional status data, and integration of extensive input received from a Technical Expert Panel convened by RTI International.  These activities have led to an initial development of two motor functional status quality metrics: self-care and mobility, using the standardized functional status data elements from the CARE Item Set.

The report from this work can be found on the IMPACT Act of 2014 Archived Information website.

2013 Technical Expert Panel (TEP) on the Development of Cross-Setting Functional Status Quality Measures

The Centers for Medicare & Medicaid Services contracted with RTI International to develop functional status quality measures for inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), and skilled nursing facilities (SNFs). As part of the quality measure development work, RTI convened a technical expert panel (TEP) in September 2013.

A summary (PDF) of the TEP can be found on the IMPACT Act of 2014 Archived Information website.

2015 TEP Regarding Cross-Setting Measures Aligned with the IMPACT Act of 2014 report

On October 6, 2014, President Obama signed the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act). The Act requires the development of cross-setting quality measures, including the following settings: Long-Term Care Hospitals (LTCHs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs) and Inpatient Rehabilitation Facilities (IRFs).

This report summarizes discussions amongst TEP members during the February 3, 2015 meeting as well as TEP member responses to specific questions, emailed to TEP members, after the meeting. The report can be found on the IMPACT Act of 2014 Archived Information website.

2016 SNF Function TEP Report

RTI International, on behalf of the Centers for Medicare & Medicaid Services (CMS), convened a Technical Expert Panel (TEP) to seek expert input on the development of Functional Outcome Quality Measures for Skilled Nursing Facilities (SNFs). This all-day, in-person TEP meeting was held on May 5, 2016, in Baltimore, MD. This TEP summary report provides describes that TEP proceedings, detailing key issues related to measure development, and TEP discussion around those issues. This report also provides a summary of the background, the process for the TEP meetings, and the organization of the TEP report.

The TEP summary document (PDF)for the development of Functional Outcome Quality Measures for Skilled Nursing Facilities (SNFs) can be found on the IMPACT Act of 2014 Archived Information website.

2016 Home Health TEP Report

CMS has contracted with Abt Associates to develop standardized measures for the home health (HH) setting in the quality measure domain Function Status, Cognitive Function, and Changes in Function and Cognitive Function. The Function Technical Expert Panel (TEP) met in-person on October 17-18, 2016 in-person in Linthicum, MD. The TEP was composed of a diverse group of stakeholders with HH, PAC and functional assessment expertise. A summary (PDF) of the TEP meeting, including the objectives and proposed measure concepts can be found on the IMPACT Act of 2014 Archived Information website.

NATIONAL QUALITY FORUM (NQF) ENDORSEMENT

In 2014, in a response to NQF’s Call for Measures for Person- and Family-Centered Care Measures Project, CMS submitted for endorsement 6 functional status quality measures. The measures information and specifications are listed below.

a) Percent of Long-Term Care Hospital (LTCH) Patients With an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)

Measure overview and specifications can be found on NQF website.

b) Long-Term Care Hospital (LTCH) Functional Outcome Measure: Change in Mobility Among Patients Requiring Ventilator Support (NQF #2632) 

Measure overview and specifications can be found on NQF website.

c) Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients (NQF #2633)

Measure overview and specifications can be found on NQF website.

d) Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients (NQF #2634) 

Measure overview and specifications can be found on NQF website.

e) Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Discharge Self-Care Score for Medical Rehabilitation Patients (NQF #2635) 

Measure overview and specifications can be found on NQF website.

f) Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636)

Measure overview and specifications can be found on NQF website.

REGULATIONS

Function QMs adopted through rulemaking for LTCH, IRF, SNF, and HH QRPs:

LTCH QRP

FY2015

LTCH PPS final rule - FR 79 (50291) – August 22, 2014

1. Percent of Long-Term Care Hospital (LTCH) Patients With an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)

2. Long-Term Care Hospital (LTCH) Functional Outcome Measure: Change in Mobility Among Patients Requiring Ventilator Support (NQF #2632)

FY2016

LTCH PPS Final Rule FR 80 – August 17, 2015

1. Application of Percent of LTCH Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)

IRF QRP

FY2016

IRF PPS Final Rule FR 80 – August 6, 2015

1. Application of Percent of LTCH Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)

2. Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients (NQF #2633)

3. Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients (NQF #2634)

4. Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Discharge Self-Care Score for Medical Rehabilitation Patients (NQF #2635)

5. Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636)

SNF QRP

FY2016

SNF PPS Final Rule FR 80 – August 4, 2015

1. Application of Percent of LTCH Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)

FY2018

SNF PPS Final Rule FR 82 – August 4, 2017

1. Application of Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients (NQF #2633)

2. Application of Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients (NQF #2634) 3. Application of Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Discharge Self-Care Score for Medical Rehabilitation Patients (NQF #2635)

4. Application of the Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636)

HH QRP

CY2018

HH PPS Final Rule FR 82 – November 7, 2017

1. Application of Percent of Long-Term Care Hospital Patients With an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)

More Information:

This web site contains key documents related to the development of function measures for the Inpatient Rehabilitation Facility (IRF), Long-term Care Hospital (LTCH), Skilled Nursing Facility (SNF) and Home Health Agency (HHA) settings.

Please note that many of these documents are historical. For the most up to date information about the measures currently adopted in the quality reporting programs (QRP), please visit setting-specific web sites:

Page Last Modified:
01/28/2019 10:34 AM