electronic Long-Term Services & Supports (eLTSS) Initiative All-Hands Workgroup Meeting May 21,

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 eLTSS Plan Content SWG DebriefGrant Kovich10 mins eLTSS Use Case End-to-End ReviewBecky Angeles10 mins Concert Series Presentation: Harmony Information Systems John Byer30 mins

Announcements Funding Opportunity: States encouraged to enhance access to long term services and supports through No Wrong Door Systems Eligible applicants must be from one of the 25 states which received a 2014 Transforming State LTSS Access Programs and Functions into A No Wrong Door System for All Populations and All Payers grant. Applicants must be a state entity and only one application can be submitted per state. The Office of the Governor must designate the state entity to be involved in the development and implementation of its NWD System. View Grant Opportunity: Conference Call for Potential Applicants: May 27, 2015, at 2:00 pm ET Call: Passcode: Webinar Link: Letter of Intent Due: June 14, 2015 Deadline for Application Submission: July 27, 2015, at 11:59 pm ET 4

Announcements HHS, CMS and ONC announced the release of the following on March 20, 2015: – Stage 3 Notice of Proposed Rulemaking (NPRM) for the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Program Stage 3 Notice of Proposed Rulemaking (NPRM) for the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Program specifies new criteria that EPs, EHs, and CAHs must meet to qualify for Medicaid EHR incentive payments proposes criteria that providers must meet to avoid Medicare payment adjustments based on program performance beginning in payment year 2018 – 2015 Edition Health IT Certification Criteria 2015 Edition Health IT Certification Criteria aligns with the path toward interoperability identified in ONC's draft shared Nationwide Interoperability Roadmap builds on past editions of adopted health IT certification criteria, includes new/updated IT functionality and provisions that support the EHR Incentive Programs care improvement, cost reduction, and patient safety across the health system – Comment period ends May 29,

Announcements (continued) PUBLIC COMMENTS: You may submit comments, identified by RIN 0991-AB93, by any of the following methods (please do not submit duplicate comments). Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. Federal eRulemaking Portal: Follow the instructions for submitting comments. Attachments should be in Microsoft Word, Microsoft Excel, or Adobe PDF; however, we prefer Microsoft Word. Regular, Express, or Overnight Mail: Department of Health and Human Services, Office of the National Coordinator for Health Information Technology, Attention: 2015 Edition Health IT Certification Criteria Proposed Rule, Hubert H. Humphrey Building, Suite 729D, 200 Independence Ave, S.W., Washington, D.C Please submit one original and two copies. Hand Delivery or Courier: Office of the National Coordinator for Health Information Technology, Attention: 2015 Edition Health IT Certification Criteria Proposed Rule, Hubert H. Humphrey Building, Suite 729D, 200 Independence Ave, S.W., Washington, D.C Please submit one original and two copies. (Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without federal government identification, commenters are encouraged to leave their comments in the mail drop slots located in the main lobby of the building.) 6

Announcements (continued) 2015 Long Term Post Acute Care (LTPAC) & HIT Summit – What: The LTPAC HIT Summit is the premiere health IT conference for individuals within and working with the LTPAC industry for over 10 years. As the key conference of HIT leaders, policy makers, providers, vendors and professionals, the Summit continues to advance initiatives facing the long term, post acute care industry and priorities from the latest Roadmap for Health IT in LTPAC. – When: June 21-23, 8am-5pm ET – Where: Baltimore, MD in the Baltimore Hilton – To register: 7

Concert Series Presentations 8 Organizations are invited to present on an existing project or initiative that is related to the eLTSS scope of work and/or will help inform the eLTSS target outcomes and deliverables These projects do not have to be technically-focused Criteria for consideration: Has solution, whether it is technical or process driven, been implemented in a one or more of the eLTSS settings: home and community-based setting or clinical setting? Does solution incorporate existing or emerging standards and/or other relevant guidance?

Concert Series Presentations: Logistics Presentations will be scheduled as part of the weekly eLTSS Community Meetings and will occur the last 30 mins of the call Duration: mins webinar (or demo); 5-10 mins Q&A eLTSS Workgroup activities will always take precedence over concert series presentations If you have an interest in participating, please contact Evelyn Gallego ) and Lynette Elliott A pre-planning meeting will be scheduled prior to any public demonstration 9

Upcoming Concert Series Presentations 10 May 28 th : (available) June 4 th : (available) June 11 th : (available) June 18 th : MyDirectives.com (A|D Vault) June 25 th : Right Care Now

Timelines for Consideration: Two Pilot Phases, SDO Ballot Cycles eLTSS Initiative Roadmap Q3 ‘14Q4 ‘14Q1 ‘15Q2 ‘15Q3 ‘15Q4 ‘15Q4 ‘17 Phase 4: Pilots & Testing Pilot site readiness Implementation of solution Test User Stories and Scenarios Monitor Progress & Outcomes Utilize Requirements Traceability Matrix Phase 5: Evaluation Evaluate outcomes against Success Metrics and Criteria Update Implementation Guidance Develop, review, and finalize the Use Case and Functional Requirements Pre-Planning Call for Participation Conduct Environmental Scan Success Criteria Stakeholder Engagement Finalize Candidate Standards Standards Gap Analysis Technical & Standards Design Develop Requirements Traceability Matrix Develop Implementation Guide Launch initiative Review and Finalize Charter Review initial Candidate Standards 11 Initiative Kick Off: 11/06/14 Phase 1: Pre-Discovery Phase 2: Use Case Development & Functional Requirements Phase 3: Standards & Harmonization

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. 12

eLTSS Use Case Development: Domain Identification 13

eLTSS Plan: Proposed Domains & Sub-Domains 14 Individual Outcomes WorkResidenceCommunity InclusionChoice & Decision MakingRelationshipsSatisfactionSelf-DeterminationPerson-Centered Profile Health, Wellness, and Rights HealthRespect/ RightsMedicationsSafetyWellnessBehavioral NeedsRestraints System Performance AccessService Coordination Financial/ Payer Information Service InformationStaff Stability Family Indicators Choice & ControlFamily OutcomesSatisfactionFamily InvolvementCommunity ConnectionsAccess & Support DeliveryInformation & Planning Domains Sub-domains Cross-cutting Domains

eLTSS Plan Content SWG Information Sign up for the eLTSS Plan Content SWG on the Wiki – – Joining the eLTSS Plan Content SWG ensures that you are included on workgroup communications and announcements. Next eLTSS Plan Content SWG Meeting – Tuesdays (weekly) from 11:00am – 12:00pm Eastern – Thank you! Your commitment and participation are critical to our success. 15

Project Charter and eLTSS Glossary FINAL Published Project Charter 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 – Reminder: the Glossary is a living document and content may change as the initiative progresses 16

Wk. Target Date (2015) All Hands WG Meeting Tasks Review & Comments from Community via Wiki page due following Tuesday by 8 P.M. Eastern 1-51/22-2/19 Use Case Kick-Off & UC Process Overview Use Case Value Framing Discussions Review and Answer Value Framing Questions on wiki 62/26 Review: Consolidated UC Value Framing Introduce: Context Diagram & User Stories Review: Context Diagram & User Stories 73/12Finalize: Context Diagram & User StoriesReview: User Stories 83/19Review: User Stories CommentsReview: User Stories, Glossary 93/26 Review: User Stories Introduce: Actors & Roles Review: User Stories, Actors & Roles 104/2 Finalize: Actors & Roles Introduce: In/Out of Scope Review: In/Out of Scope 114/9 Finalize: In/Out of Scope Introduce: Assumptions & Pre/Post Conditions Review: Assumptions & Pre/Post Conditions 124/16 Finalize: Scope, Assumptions & Pre/Post Conditions Introduce: Activity Diagram & Base Flow Review: Activity Diagram & Base Flow 134/23 Finalize: Activity Diagram & Base Flow Introduce: Functional Requirements & Sequence Diagram Review: Functional Requirements & Sequence Diagram 144/30 Finalize: Functional Requirements & Sequence Diagram Introduce: Data Requirements Review: Data Requirements 155/7 Finalize: User Stories Introduce: Risks, Issues & Obstacles Review: Risks, Issues & Obstacles 165/14Dataset Requirements – eLTSS Plan Content SWGReview: Refer to SWG Homework 175/21Begin End-to-End ReviewEnd-to-End Review by community (Ends 5/28 at 8pm ET) 185/28End-to-End Comments Review & disposition 196/4Finalize End-to-End Review Comments & Begin ConsensusCast Consensus Vote 206/11Consensus Vote* Proposed Use Case Development Timeline 17

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Use Case End-to-End Review & Consensus Timeline DateItem 5/21Open End-to-End Review 5/28Review End-to-End Comments (Close End-to-End Review at 8pm ET) 5/29-6/3End-to-End Review Comment Dispositions 6/4Open Consensus Voting 6/11Close Consensus Voting at 8:00pm ET 6/12-17Consolidate Votes and Address “No” Votes 6/18Review Final Comment Dispositions and Complete all Outstanding Votes Verbally 6/19Publish Consensus Voting Results 19

eLTSS Use Case End-to-End Review The eLTSS Plan Use Case is ready for End-to- End RevieweLTSS Plan Use Case This is your final chance to review and provide modifications prior to Consensus Voting Please review the Use Case and provide comments: – Via the Wiki Comment FormWiki Comment Form – Via to Comment Period Closes Thursday, May 28 th at 8pm ET 20

Consensus on the Use Case On June 4th, Committed members will be asked to cast a vote on the “eLTSS Plan Use Case” – Yes A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Initiative Member, but that it is better to move forward than to block the deliverable – Yes with comments If a Consensus Process attracts significant comments (through Yes with comment votes), it is expected that the comments be addressed in a future revision of the deliverable. – Formal Objection- with comments indicating a path to address the objection in a way that meets the known concerns of other members of the Community of Interest. "Formal Objection" vote without such comments will be considered Abstain votes. A Formal Objection means that the objector cannot proceed with the project unless the objections are met. It is acceptable and expected to use a Formal Objection in a first consensus round to communicate a point of view or process issue that has not been addressed in the drafting of the initial deliverable. Should a Consensus Process attract even one "Formal Objection" vote with comments from an Initiative Member, the deliverable must be revised to address the "Formal Objection" vote (unless an exceptional process is declared). – Abstain (decline to vote) 21 Note: Each Organization, no matter the number of Committed Members only receives 1 Vote. If there are multiple committed members from your organization please verify your collective vote with them

Submitting Your Vote ng- Term+Services+and+Supports+%28eLTSS% 29+Consensus 1.Review the eLTSS Plan Use Case: – Final document will be available 6/3/ Complete the Voting Form: – NOTE: You must be a Committed Member to Vote Yes Yes with comments. Formal Objection Abstain (decline to vote) 3.Submit your Vote 4.A message is displayed verifying your vote was recorded

Viewing Your Vote 5. You can view and track your Vote (located directly below the Voting Form) Note: you may need to refresh your browser a few times to see your vote 23 Note: All Consensus Votes are due June 11 th by 8:00 pm ET 5 5

Become a Committed Member Only Committed Members are allowed to VOTE on the Use Case If you are signed up as an Other Interested Party, you are not able to vote. However, you can change your status to Committed Member (so you can vote) here: – tive tive Please contact Saurav Chowdhury if you would like to confirm your submission, change your status, or if you have any other membership/wiki 24

eLTSS All-Hands Next Steps Complete an end-to-end review of the Use Case and provide comments/feedback by Thursday, May 28 th at 8pm ET Join us next Thursday, May 28 th to review the end-to-end comments We are looking for technical experts that have solutions for the next phase of our eLTSS work. Please spread the word to those you think could help us and have them join our Thursday All-Hands meetings. 25

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John Byer, VP of Sales and Business Development eLTSS All-Hands Workgroup Concert Series Presentation May 21, 2015

Agenda Who we are Medicaid-funded LTSS Perspectives Context for eLTSS Plan Key Concepts and Lessons Learned Trends 28

Purpose Built for LTSS Collaboration o Agencies, providers, MCOs, caregivers, families and beneficiaries work collaboratively around a single consumer view o Unified and interoperable data o Processes are real-time avoiding action taken based on outdated information o Process changes accommodated quickly o Engaged families and caregivers improve outcomes 29

30 Purpose Built Technology for HCB LTSS o Helps streamline access to LTSS o Facilitates creation of meaningful longitudinal data sets at participant and program levels o Shortens payment cycles for providers o Helps payers reduce risk, manage costs o Enables collaboration, Person-Centered Planning and Interoperability o “Future-Proof”

31 Technology for HCB LTSS o Modular, end-to-end automation o Intake o Level 1 Screen o Level 2 Assessment o Eligibility o Enrollment o Planning o Authorizations o Service Delivery o Billing o Oversight o Outcomes o Re-Assessment and Re- Enrollment o Interoperable

Our Focus and Customers 32 Helping to Optimize Long Term Services and Supports (LTSS)/Home and Community Based Services (HCBS) since 1994 Customers State Level Medicaid funded LTSS, including departments of Medicaid and other state agencies overseeing waivers (I/DD, People with Disabilities, Frail Elders, etc.), MCOs and other stakeholders Other LTSS Programs, including OAA Local Regional LTSS Agencies, AAAs, Providers, CBOs and other partners In 2015 will surpass 30,000 end users – all LTSS stakeholders

Agenda Who we are Medicaid-funded LTSS Perspectives Context for eLTSS Plan Key Concepts and Lessons Learned Trends 33

Perspectives of State Agencies With Medicaid-funded LTSS Programs 34 Traditional Visibility Accountability Quality Waitlists Provider Oversight/Incident Investigation Outcomes Efficacy Financials Reconciliation Fraud Security Emerging Managed LTSS Person Centered Approaches Interoperability Quality Indicators and Analytics

Agenda Who we are Medicaid-funded LTSS Perspectives Context for eLTSS Plan Key Concepts and Lessons Learned Trends 35

eLTSS Use Case 36 (From eLTSS Initiative Use Case)

Streamlining LTSS: State View eLTSS Plan Authorizations Delivery Monitoring Billing, Payment Incident & complaint mgmt. Dashboards Case assignment Person Centered LTSS Interoperable Innovative Flexible Interoperable Innovative Flexible Beneficiary, Caregivers, other Team Members Participants Families Intake, Assessment and Eligibility Driven by needs of Individual Medicaid- Funded Plans come with some strings

38 Financial Eligibility NWD Level 1 Screen Level 2 Level of Care Determination Choices Counseling MMIS Enrollment Enrollment Process for LTSS MCI MPI

Streamlining LTSS: State View eLTSS Plan Authorizations Delivery Monitoring Billing, Payment Incident & complaint mgmt. Dashboards Case assignment Person Centered LTSS Person Centered LTSS Interoperable Flexible Interoperable Flexible Participants Families Assessment and Uniform Clinical/SNF Level of Care Determination Driven by needs of Individual Streamlining LTSS MPI MMIS

Agenda Who we are Medicaid-funded LTSS Perspectives Context for eLTSS Plan Key Concepts and Lessons Learned Trends 40

Data Follows the Person Access, Inform, Assess & Enroll Call centers Web self-service Assessments Eligibility determination Care Coordination Person- Centered planning Team Engagement Service authorization, delivery and reimbursement Ongoing assessment and planning Measure & Analyze Outcomes Core quality measures Provider Oversight Financial and budget performance Longitudinal 41 Confidential Information

4242 Harmony Helping to Optimize HCBS Over 8 million participants receiving HCB LTSS 167 million service delivery records $12 Billion in HCB LTSS services

4343 Helping to Identify Unmet Needs and Establish Clinical Eligibility Over 3.5 million consumers assessed Almost 10 million assessments sessions created Over 1 billion assessment questions answered All tracked longitudinally

Sample Assessment Interface 44Confidential Information

Cross-walking Longitudinal Assessment Data 45Confidential Information

Input from Consumer & Informal Supports 46Confidential Information

interRAI Clinical Assessment Protocols (CAPS) 47Confidential Information

48Confidential Information48 Mobile Assessments

49Confidential Information49 Mobile Assessments

Lessons Learned - Assessments 50Confidential Information  Uniform Assessment Instruments Can be difficult politically  Core Data Set Cross walking data important Managing change Maintaining longitudinal integrity can be hard

Consumer/Caregiver Module: Access Planned Services 51Confidential Information

Consumer/Caregiver Module: Access Support Plans 52Confidential Information

Lessons Learned – Consumer/Caregiver Portal 53Confidential Information  Adoption is a work in progress  Competing Needs  Clear trend, gaining momentum

Rapid Change Healthcare Long Term Services and Supports 54 Blending Healthcare and LTSS Integration – Interoperability – Security - Consent

Lessons Learned – Risk 55Confidential Information  Time, Cost, Success/Failure Outside Factors Political/Institutional Resistance Custom Development

Lessons Learned - Stakeholders 56Confidential Information  Many influencers within state enterprise Participants/Advocates State Agencies Legislatures, Governors CIOs Internal IT CMS Providers  Some have the ability to enable adoption of interoperable eLTSS Plan and others have the ability to block it  Must fit within state’s plan for security and access control

Agenda Who we are Medicaid-funded LTSS Perspectives Context for eLTSS Plan Key Concepts and Lessons Learned Trends 57

Trends Managed LTSS Person-centered approaches Interoperability Influenced by states Closed systems phased out One-off custom IT projects? 58

John Byer – VP of Sales and Business Development Thank You

eLTSS Initiative: Project Team Leads ONC Leads – Elizabeth Palena-Hall – Patricia Greim CMS Lead – Kerry Lida Federal Lead – Jennie Harvell Community Leads – Andrey Ostrovsky – Nancy Thaler – Terry O’Malley Initiative Coordinator – Evelyn Gallego-Haag Project Management & Pilots Lead – Lynette Elliott Use Case & Functional Requirements Development – Becky Angeles eLTSS Plan Content SWG Lead – Grant Kovich Standards Development Support – Angelique Cortez Harmonization – Atanu Sen 60