electronic Long-Term Services & Supports (eLTSS) Initiative All-Hands Workgroup Meeting August 6,

Meeting Etiquette Remember: If you are not speaking, please keep your phone on mute Do not put your phone on hold. If you need to take a call, hang up and dial in again when finished with your other call o Hold = Elevator Music = frustrated speakers and participants This meeting is being recorded o Another reason to keep your phone on mute when not speaking Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know. o Send comments to All Panelists so they can be addressed publically in the chat, or discussed in the meeting (as appropriate). o Please DO NOT use the Q&A—only the presenter sees Q&A, not necessarily the person facilitating the discussion From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute All Panelists 2

3 Agenda TopicPresenterTimeframe Welcome Announcements eLTSS Roadmap Lynette Elliott10 mins Discussion: eLTSS Pilot Guidance – Tiered Approach Grant Kovich15 mins eLTSS Pilot Guidance: Functional Requirements Matrix Overview Lynette Elliott Evelyn Gallego 30 mins

Announcements New Medicaid Innovation Accelerator Program (IAP) on Beneficiaries with Complex Needs and High Costs The Centers for Medicare and Medicaid Services (CMS) is launching a new Medicaid IAP area supporting states' ongoing efforts to improve care for Medicaid beneficiaries with complex needs (BCN) and high costs. Targeted program support is available for states that have ongoing efforts to improve care coordination for Medicaid beneficiaries with complex needs and high costs. Deadline to submit Expression of Interest forms extended to Friday, August 14 th : center/innovation-accelerator-program/beneficiaries-with- complex-needs/beneficiaries-with-complex-needs.htmlhttp:// center/innovation-accelerator-program/beneficiaries-with- complex-needs/beneficiaries-with-complex-needs.html View webinar slides here: resource-center/innovation-accelerator-program/iap- downloads/bcn-information-webinar pdfhttp:// resource-center/innovation-accelerator-program/iap- downloads/bcn-information-webinar pdf 4

Announcements, cont’d... The National Quality Forum (NQF) HCBS Committee has released an Interim Report for Comment on “Addressing Performance Measure Gaps in Home and Community- Based Services to Support Community Living: Initial Components of the Conceptual Framework” – Open for comment through August 17th – 5

Announcements, cont’d… National Association of States United for Aging and Disabilities (NASUAD) “National Home and Community Based Services (HCBS) Conference” – What: The conference always sees a strong presence from U.S. Health and Human Services ranging from the Administration for Community Living including AoA, Office of Disability and IADD to CMS, HRSA, SAMHSA, Office of Developmental Disabilities, and other federal agencies. – When: August 31 – September 3, 2015 (Note: eLTSS and S&I specific workshops are Sept. 2 from 4:15-5:30pm ET) – Where: Washington Hilton ~ Washington, D.C. – To register: & & 6

Announcements, cont’d… mHealth Summit – What: The 2015 mHealth Summit explores what is new in mobile, telehealth and connected health—from the impact on healthcare delivery, clinical care and patient/consumer engagement to new technologies, research, investment activities, policy and shifts in the business environment. – When: December 8 – December 11, 2015 – Where: Gaylord National Resort and Convention Center ~ Washington, D.C. – To register: 7

Announcements, cont’d… CSAC Recommendations on Person and Family Centered Care Phase 2 Measures finalized – More information: ctID= ctID=73867 – Access Final Report: n-_and_Family-Centered_Care_Final_Report_- _Phase_1.aspx n-_and_Family-Centered_Care_Final_Report_- _Phase_1.aspx 8

eLTSS Initiative Timeline 9 Phase 1 Pilots & Testing … Pilot Guide Development Use Case & Functional Requirements Pre-Discovery DEC 14JUNJAN FEBMAYJULAUGSEPOCTNOV Kick Off 11/06/14 Evaluation... Content Work Stream Content Work Stream eLTSS All-Hands Work Group Use Case 1. eLTSS Use Case eLTSS Plan Content SWG 1.eLTSS Plan Domains & Data Elements Pilot Guide Development 1.Candidate Standards & Technologies 2.Three-tiered implementation Approach 3.Functional Requirements Matrix 4.Pilot Guide (Phase 1) MARAPRDEC 15JAN 16 Pilot Execution

eLTSS Artifacts Final published Project Charter is located here: Term+Services+and+Supports+%28eLTSS%29+Charter Term+Services+and+Supports+%28eLTSS%29+Charter eLTSS Glossary posted here: – The eLTSS Glossary is a working document containing eLTSS-relevant terms, abbreviations and definitions as defined by stakeholders – We are looking for your feedback and comments Discussion Thread available Submit any change requests via the Change Request Form located on the wiki Final published Use Case document is located here: – Term+Services+and+Supports+%28eLTSS%29+Use+Case Term+Services+and+Supports+%28eLTSS%29+Use+Case 10

Goals for the eLTSS Initiative Identify key assessment domains and associated data elements to include in an electronic Long-term Services & Supports (eLTSS) plan Create a structured, longitudinal, person-centered eLTSS plan that can be exchanged electronically across and between community-based information systems, clinical care systems and personal health record systems. 11

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Overview You’ve drafted a Use Case with User Stories You’ve identified Domains and Subdomains You’ve identified Exemplar Question/Answer Sets You’ve defined a Tiered Approach for Pilots What now? – Identify sample coded data sets or sample coded data elements derived from questions/answers – Map Use Case functional requirements to technical solutions, existing standards and compliance with existing regulations/rules How can we operationalize all this activity for Pilots? 14

Artifacts and Tools 15 These are familiar... – Use Case and User Stories – eLTSS Glossary – Domain Harmonization Matrix – Three Tiered Pilots Approach And a NEW artifact will be used to map Use Case functional requirements to technical solutions and existing standards – Functional Requirements Matrix

What Is a Functional Requirements Matrix? The Functional Requirements Matrix breaks down the Use Case line by line into functions, activities and Pilot Tiers to help organizations plan their Pilot work – Functions are grouped by Use Case activity (eg. Create Plan, Modify Plan, Send/Receive Plan, etc.) It specifies Use Case Actor, Input, Output and Use Case Receiver for each function It identifies applicable Pilot tiers for each activity (Tier I, II, and III) It specifies Exemplar Tech Solutions, Exemplar Standards and relevant Standards Development Organizations for each function It crosswalks each function to existing regulations/rules 16

What does the FRM Look Like? 17 It’s a big, scary looking spreadsheet And how do you use it? We’ll show you...

How to Operationalize the FRM for Pilots Revisit the “big picture” Walk through simplified Use Case User Story steps and describe “Create Plan” grouping Show “Create Plan” grouping in the FRM document with all the info that relates to those functions 18

RECAP: eLTSS Plan Conceptual Framework Displays eLTSS Plan Updates and displays eLTSS Plan; stores/submits data Extract, Transform, & Load eLTSS Plan Data Updates and displays eLTSS Plan; stores/transmits data Generates, updates and displays eLTSS Plan; stores/transmits data eLTSS Plan Groupings Create Plan Approve Services Send/Receive Plan Access/View Plan Update Plan

User Story Walk-through: Create Plan Ruth is approved to receive long-term services and supports in her home. Joan, an eLTSS Plan developer, meets with Ruth and Ruth’s daughter, Amy, in Ruth’s home. Joan explains the person-centered planning process and walks through the information needed to develop an eLTSS Plan. Artifact 1: eLTSS Domains/Sub- Domains/Exemplar Data Elements. Ruth provides Joan with other forms of information she has on hand to inform the eLTSS Plan (eligibility form data, brief person- centered profile, information sharing resource). Together, all three woman assemble the eLTSS plan based on the questions posed within each of the eLTSS Plan sub-domains. The eLTSS Plan is assembled within Joan’s information system (can be electronic or paper-based). 1 1.Eligibility Form 2.Person-Centered Profile 3.Information Sharing Resource INPUTS OUTPUT eLTSS Plan

What is in an eLTSS Plan? 21 Person Information WorkResidenceCommunity InclusionChoice & Decision MakingRelationshipsSelf-DirectionDemographicsPerson-Centered Profile Health, Wellness, and Rights HealthMedicationsADLs/ IADLsSafetyWellnessBehavioral NeedsRestrictions Service Planning and Coordination Service Coordination Personal Finance Information Service Information Family Family InformationCommunity ConnectionsAccess & Support DeliveryInformation & Planning Domains Sub-domains Cross-cutting Domains Employment Status: Retired Volunteer Status: Active Employment Status: Retired Volunteer Status: Active First Name: Ruth Last Name: Smith Gender: Female Address: 213 Cox Avenue First Name: Ruth Last Name: Smith Gender: Female Address: 213 Cox Avenue Diet and Nutrition: Low Salt Exercise Activity: walking Diet and Nutrition: Low Salt Exercise Activity: walking

What do we mean by Coded Elements? 22 First Name: Ruth Demographics

Recap 23 Revisited the big picture and how the parts fit together Walked through “Create Plan” grouping today We will go through additional groupings using the sample user story in upcoming weeks – Approve/Authorize Plan/Services – Access/View/Review Plan – Modify Plan – Send/Receive Plan – Out of Scope This will help identify the tier, groupings and domains that make the most sense for your organization to pilot

Next Steps and Homework Pick a sample grouping and think about which tier you can or would like to pilot – Think about whether you want to focus on content or process – Come back with questions Complete eLTSS Pilot Interest Survey ces+and+Supports+Pilot+Interest+Survey ces+and+Supports+Pilot+Interest+Survey – We are actively seeking organizations to pilot the eLTSS Plan using the candidate technologies and standards that will be identified in the eLTSS Pilot Guide 24

eLTSS Initiative: Project Team Leads ONC Leads – Elizabeth Palena-Hall – Patricia Greim CMS Lead – Kerry Lida Federal Lead – Jennie Harvell Community Leads – Andrey Ostrovsky – Mary Sowers – Terry O’Malley Initiative Coordinator – Evelyn Gallego-Haag Project Management & Pilots Lead – Lynette Elliott – Jamie Parker Use Case & Functional Requirements Development – Becky Angeles eLTSS Plan Content SWG Lead – Grant Kovich Standards Development Support – Angelique Cortez Harmonization – Atanu Sen 25