1. electronic Long-Term Services & Supports (eLTSS) Initiative All-Hands Workgroup Meeting March 26, 2015 1

2. 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. 3 Agenda TopicPresenterTimeframe Welcome Announcements eLTSS Roadmap Lynette Elliott / Evelyn Gallego 10 mins Use Case Working Session: User Story Actors & Roles Becky Angeles / eLTSS Community 45 mins Homework / Next StepsBecky Angeles5 mins Concert Series Presentation: NASDDDS National Core Indicators Mary Lee Fay / Kelsey Walter 30 mins

4. Announcements ONC issued the Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0 – The draft Roadmap is a proposal to deliver better care and result in healthier people through the safe and secure exchange and use of electronic health information. – Includes Person-Centered Planning and eLTSS initiative – Several areas of alignment with eLTSS (see next slide) 4

5. eLTSS Alignment to Nationwide Interoperability Roadmap 5 Roadmap SectionRoadmap Category C. Individuals are empowered to be active managers of their health C1. Cultural change for individuals including demanding and using their electronic information C2. Providers and technology developers supporting individual empowerment C3. Privacy and Security for Individuals C4. Education and digital health literacy for Individuals D. Care providers partner with individuals to deliver high value care D2. Providers embrace a culture of interoperability and work with vendors and other supporting entities to improve interoperability D7. Transparency of value and engagement of patients, families, and caregivers G. Consistent representation of permission to collect, share, and use identifiable health information G4. Technical standards for basic choice I. Stakeholder assurance that Health IT is interoperable I2. Certification Programs J. Consistent Data Formats and Semantics J3. Develop and pilot new standards for priorities

6. Interoperability Roadmap, cont’d… More detailed alignment slides are available on the wiki: – http://wiki.siframework.org/file/view/eLTSS%20align ment%20to%20Interoperability%20Roadmap_2015- 03- 24.pptx/545411734/eLTSS%20alignment%20to%20Int eroperability%20Roadmap_2015-03-24.pptx http://wiki.siframework.org/file/view/eLTSS%20align ment%20to%20Interoperability%20Roadmap_2015- 03- 24.pptx/545411734/eLTSS%20alignment%20to%20Int eroperability%20Roadmap_2015-03-24.pptx Submit comments before 5pm ET April 3, 2015 here: http://www.healthit.gov/policy-researchers- implementers/interoperability-roadmap-public- comments http://www.healthit.gov/policy-researchers- implementers/interoperability-roadmap-public- comments 6

7. Announcements (continued) 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, 2015 7

8. 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. http://www.regulations.gov.http://www.regulations.gov 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. 20201. 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. 20201. 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.) 8

9. Announcements (continued) HIMSS Interoperability Showcase is being held April 12-16, 2015 in Chicago, IL – Live interactive demonstration where health IT solution providers collaborate to maximize the collective impact of their technologies – Highlight seamless health information exchange in multiple care settings – More information: http://www.himss.org/Events/EventDetail.aspx?ItemNumb er=27978 http://www.himss.org/Events/EventDetail.aspx?ItemNumb er=27978 9

10. New Funding Announcement Advance Interoperable Health Information Technology Services to Support Health Information Exchange Funding Opportunity Announcement Advance Interoperable Health Information Technology Services to Support Health Information Exchange Funding Opportunity Announcement – Letters of Intent Due: March 2, 2015; Application Deadline: April 6, 2015 – Leverages investments and lessons learned from HITECH State HIE Program to accelerate widespread adoption and use of HIE infrastructure – Grantees MUST select at least one eligible care provider and at least two non-eligible care providers for their target populations: 10

11. Concert Series Presentations 11 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?

12. 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: 15-20 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 (evelyn.gallego@siframework.org ) and Lynette Elliott (lynette.elliott@esacinc.com)evelyn.gallego@siframework.orglynette.elliott@esacinc.com A pre-planning meeting will be scheduled prior to any public demonstration 12

13. Upcoming Concert Series Presentations 13 April 2 nd : Person-Centered Planning Tools April 9 th : PeerPlace April 16 th : MyDirectives.com / A|D Vault, Inc. April 23 rd : Care at Hand April 30 th : State of Colorado May 7 th : (available) May 14 th : State of Minnesota

14. 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 14 Initiative Kick Off: 11/06/14 Phase 1: Pre-Discovery Phase 2: Use Case Development & Functional Requirements Phase 3: Standards & Harmonization

15. 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. 15

16. Project Charter and eLTSS Glossary FINAL Published Project Charter located here: http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Charter http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Charter eLTSS Glossary posted here: http://wiki.siframework.org/eLTSS+Glossary http://wiki.siframework.org/eLTSS+Glossary – 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

17. eLTSS Plan vs. eLTSS Record The S&I eLTSS leads and the eLTSS community defined the scope of this Initiative to the LTSS Plan because: The concept of a “LTSS record” is: – not defined and not specified in HIT standards – Would require work to define (time and money) – While potentially useful, even once defined, may not immediately result in something (information) that is exchangeable The concept of “LTSS plan” is: – narrower (than a record) – more easy to define (than the concept of a record) – more aligned w/ CMS requirements for a “person centered service plan” – more easy to link to available HIT standards 17

18. 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: User Stories, 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 114/16 Finalize: Assumptions & Pre/Post Conditions Introduce: Activity Diagram & Base Flow Review: Activity Diagram & Base Flow 124/23 Finalize: Activity Diagram & Base Flow Introduce: Functional Requirements & Sequence Diagram Review: Functional Requirements & Sequence Diagram 134/30 Finalize: Functional Requirements & Sequence Diagram Introduce: Data Requirements Review: Data Requirements 145/7Review: Data Requirements 155/14 Finalize: Finalize Data Requirements Introduce: Risks & Issues Review: Risks & Issues 165/21 Finalize: Risks and Issues Begin End-to-End Review End-to-End Review by community 175/28End-to-End Comments Review & dispositionEnd-to-End Review ends 186/4Finalize End-to-End Review Comments & Begin ConsensusBegin casting consensus vote 196/11Consensus Vote*Conclude consensus voting Proposed Use Case Development Timeline 18

19. We Need YOU! In order to stick to our timeline and to ensure that the artifacts we develop fit the need of our stakeholders (you), we need your feedback, comments and participation Each week, please review the use case content and provide comments via the wiki at: http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Use+Case http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Use+Case Thank you for providing input for our eLTSS Use Case Framing Questions (via the wiki, live discussions or email). – We have consolidated the responses and posted the document on the eLTSS wiki at: http://wiki.siframework.org/electronic+Long+Term+Services+and+Supports+Use+Case+Value+Framing+Questions http://wiki.siframework.org/electronic+Long+Term+Services+and+Supports+Use+Case+Value+Framing+Questions – This document and YOUR responses will be used as input for various sections of the eLTSS Use Case Artifact 19

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21. User Story Actors & Roles Actors are a person or organization (e.g., Beneficiary, Service Provider, Payer, etc.) in the creation/sharing/exchange of the eLTSS Plan requirements for each scenario Actor must use a System (e.g., LTSS, PHR, EHR, etc.) to participate in the creation/sharing/exchange of the eLTSS Plan System or System Actor has Roles (e.g., send, receive, update, display, etc.) in relation to the creation/sharing/exchange of the eLTSS Plan 21

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23. Next Steps HOMEWORK – Due by COB Tuesday, March 31st: –User Story Actor and Roles –Utilize Comment Form at http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Use+Casehttp://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Use+Case –Email feedback / comments to becky.angeles@esacinc.com or evelyn.gallego@siframework.orgbecky.angeles@esacinc.com NEXT WEEK: –Finalize User Stories and Actors / Roles –Introduce Scope –Concert Series Presentation: Person-Centered Planning Tools Join the eLTSS Initiative: http://wiki.siframework.org/eLTSS+Join+the+Initiative http://wiki.siframework.org/eLTSS+Join+the+Initiative –Included on the eLTSS distribution list –Committed Members can vote on artifacts 23

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25. An Overview of NCI and NCI-AD Mary Lee Fay National Association of State Departments of Developmental Disabilities MLFay@nasddds.org Kelsey Walter National Association of States United for Aging and Disabilities Kwalter@nasuad.org

26. Overview of NCI in the I/DD Community Overview of NCI-AD in the Aging and Disability Community Agenda 26

27. National Core Indicators Background Launched in 1997 in 13 participating states Collaboration between NASDDDS, HSRI and 43 participating state DD agencies (including DC) and 22 sub-state regional entities. Current data base includes approximately 20,000 individuals receiving services and supports NCI tools assess performance in several areas, including: employment, community inclusion, choice, rights, and health and safety National Core Indicators (NCI)

28. NCI AND NCI-AD M EASURES O FFER A U NIQUE V IEW Person-centered Individual characteristics of people receiving services The locations where people live The activities they engage in during the day including whether they are working The nature of their experiences with the supports that they receive (e.g., with case managers, ability to make choices, self-direction) The context of their lives – friends, community involvement, safety Health and well-being, access to healthcare National Core Indicators (NCI)

29. NCI Domains Individual Outcomes Employment Community Participation Choice & Decision making Personal Relationships Family Outcomes Choice and Control Family Involvement Information & Planning Access, community connections Crisis Response Health, Welfare, System Health and Welfare Respect for Rights Medications Safety Service Coordination Staff Stability

30. National Core Indicators Design Valid Measure what is intended to be measuredReliable Provide consistent results over time and interviewers Risk Adjusted Provides multiple state comparisons

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32. What are the Data Sources? 32 Family Surveys Staff Stability Survey Adult Survey

33. NCI State Participation 2014-15 HI WA AZ OK KY AL NC PA MA TX AR GA NM NJ MO NH OH* IL LA NY Wash DC FL CA* SD OR MN UT CO KS MS TN SC WI MI IN VA DE MD State contract awarded in 2014-15 through AIDD funding CA*- Includes 21 Regional Centers OH*- Also includes the Mid-East Ohio Regional Council 41 states, the District of Columbia and 22 sub-state regions ME VT CT RI

34. Review of Selected Findings from the 2013-2014 Adult Consumer Survey Use of Data to Identify Specific Policy Issues

35. Where People Live 35

36. Basic Exams & Screenings 36

37. Use of Psychotropic Medications and Obesity 37

38. Selected Findings 2013-14 Adult and Child Family Surveys Families with Adults with ID/DD Living at Home 38

39. Age of Care Givers 39

40. Family Income 44% Below $25,000 2014 HHS Poverty Guidelines for a Family of Four: $23,850* *http://aspe.hhs.gov/poverty/14poverty.cfm

41. How States Use NCI Data.

42. Strengthening Service Delivery and Quality System-Wide  Providing NCI survey findings to state and regional quality councils for review, analysis and feedback  Identifying quality concerns and prioritizing service improvement activities  Comparing the state’s performance against that of other states  Targeting areas for remediation and improvement at the state and system levels in line with CMS requirements 42

43. National Core Indicators-Aging and Disabilities (NCI-AD) Kelsey Walter, National Association of States United for Aging and Disabilities

44. Benefits of Participation ■ Provides timely and actionable data over time; ■ State owns their own data; ■ Receive state specific data reports and technical assistance; ■ Captures the performance of state LTSS systems regardless of funding source (Medicaid/non-Medicaid/Older Americans Act) or setting (home, SNF); ■ Gathers information directly from randomly-selected consumers through face-to-face interviews; ■ Focuses on how consumers experience services and how services impact their quality of life (goes beyond service satisfaction); and ■ Provides state-to-state comparisons. 44

45. Development Process Mar 2015 Jan 2015 Dec 2014 Sep 2014 Aug 2014 Jan 2014 Dec 2013 Nov 2013 Sep 2013 Jul 2013 Jun 2013 45 1 st meeting with Steering Committee to discuss each potential indicator 1 st Draft of survey ready for review Steering Committee met to discuss survey Focus groups with service recipients in Massachusetts Small Sample testing with services recipients in Maine Draft survey finalized for pilot states (7 revisions) Began pilot in three states End of pilot, data sent to HSRI for analysis Steering Committee discussion of preliminary pilot results and needed revisions Draft survey finalized for small sample pilot in Georgia (2 more revisions) Final survey ready for nationwide rollout

46. Domains 46 Consumer Outcomes:  Community Participation  Choice and Decision- making  Relationships  Satisfaction  Service and Care Coordination  Access  Self-Direction of Care  Work/Employment  Rights and Respect  Health, Safety, and Wellness  Everyday Living and Affordability  Planning for the Future  Functional Competence

47. Adult Consumer Survey ■ Pre-survey Form  Used to setup interviews, for use by the interviewers only ■ Background Information  Gathers data about the consumer from agency records ■ Consumer Survey  Includes subjective satisfaction-related questions that can only be answered by the consumer, and objective questions that can be answered by the consumer or, if needed, their proxy ■ Interviewer Feedback Sheet  Helped us to gather feedback about the pilot survey 47

48. How does NCI-AD Work? ■ States work with HSRI and NASUAD to design the sampling strategy. ■ Baseline sample of 400 older adults and individuals with physical disabilities receiving publicly-funded services. Including:  skilled nursing facilities  Medicaid waivers  Medicaid state plans  State-funded programs, and  Older Americans Act programs 48

49. How it Works Cont… ■ State or their contractor then conducts in-person NCI-AD interviews with survey participants. ■ State compiles final data and shares data with HSRI. ■ HSRI interprets data and provides state-specific report and state-to-state comparison report. 49

50. Selected results from Pilot – Services and supports ■ Did person help plan services? ■ Person helped plan some or all services, by program: 50 OAAPD WaiverAging Waiver State 2 54%82%60% State 3 57%77%67% noyes, someyes, all State 1 12%16%67% State 2 30%19%48% State 3 25%16%53%

51. Selected results from Pilot – Services and supports ■ Services meet needs: ■ All service needs met, by program: ■ Additional services needed: PCA, transportation, homemaker, nutritional assistance, health/mental/dental care, housing assistance, environmental adaptations, social/relationships, heating/cooling assistance, respite/family caregiver support 51 nosome needs/ some servicesyes State 1 3%6%90% State 2 2%12%84% State 3 3%16%80% OAAPD WaiverAging Waiver State 2 81% 88% State 3 83%63%85%

52. Selected results from Pilot – Services and supports ■ Case manager talked to person about services that might help meet need: ■ Person is in charge of services: 52 nomaybe, not sureyesDK/ Unclear State 1 16%13%51%20% State 2 36%13%49%3% State 3 36%9%52%3% no sometimes, some servicesyes State 1 9%10%78% State 2 16%11%67% State 3 9%13%74%

53. How States Can Use NCI-AD Data ■ Budget justifications to state legislatures; ■ Providing “big picture” data on the population served; ■ Quality improvement efforts; ■ Communicating with family and advocates; ■ Identifying issues states can flag for deeper analysis; ■ Comparing MCOs, AAAs, regions, and/or programs; and ■ Quality improvement in MLTSS systems; ■ Benchmarking and comparing data nationally; and ■ Meeting CMS quality assurances and compliance to new HCBS settings regulation. 53

54. Nationwide Rollout ■ Ongoing introductory conversations with interested states ■ Interested in including all public payers and all settings in each state’s sample ■ June 2014 – All-state technical assistance calls ■ Fall 2014 – Began state-specific TA and project planning calls ■ 10 new states and 3 pilot states committed to Year 1 54

55. Two Rounds of Data Collection 55

56. NCI Website State Reports Annual Reports Data Briefs Articles National data Chart function Technical reports

57. eLTSS Initiative: Project Team Leads ONC Leads – Elizabeth Palena-Hall (elizabeth.palenahall@hhs.gov)elizabeth.palenahall@hhs.gov – Patricia Greim (Patricia.Greim@hhs.gov)Patricia.Greim@hhs.gov CMS Lead – Kerry Lida (Kerry.Lida@cms.hhs.gov)Kerry.Lida@cms.hhs.gov Federal Lead – Jennie Harvell (jennie.harvell@hhs.gov)jennie.harvell@hhs.gov Initiative Coordinator – Evelyn Gallego-Haag (evelyn.gallego@siframework.org)evelyn.gallego@siframework.org Project Management & Pilots Lead – Lynette Elliott (lynette.elliott@esacinc.com)lynette.elliott@esacinc.com Use Case & Functional Requirements Development – Becky Angeles (becky.angeles@esacinc.com)becky.angeles@esacinc.com Standards Development Support – Angelique Cortez (angelique.j.cortez@accenture.com)angelique.j.cortez@accenture.com Harmonization – Atanu Sen (atanu.sen@accenture.com)atanu.sen@accenture.com 57

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59. Use Case Outline Tailored for each Initiative 59 1.0 Preface and Introduction** 2.0 Initiative Overview – 2.1 Initiative Challenge Statement** 3.0 Use Case Scope – 3.1 Background** – 3.2 In Scope – 3.3 Out of Scope – 3.4 Communities of Interest** 4.0 Value Statement** 5.0 Use Case Assumptions 6.0 Pre-Conditions 7.0 Post Conditions 8.0 Actors and Roles 9.0 Use Case Diagram 10.0 Scenario: Generic Provider Workflow – 10.1 User Story 1, 2, x, … – 10.2 Activity Diagram o 10.2.1 Base Flow o 10.2.2 Alternate Flow – 10.3 Functional Requirements o 10.3.1 Information Interchange Requirements o 10.3.2 System Requirements – 10.4 Sequence Diagram 11.0 Risks, Issues and Obstacles 12.0 Dataset Requirements Appendices – Related Use Cases – Previous Work Efforts – References ** Leverage content from Project Charter