1. Longitudinal Coordination of Care LCP SWG Monday, August 12, 2013

2. Agenda 2 TopicPresenterTime Allotted Announcements and RemindersEvelyn5 minutes Care Plan C-CDA RevisionsLantana55 minutes

3. A Report to Congress on the Application of EHR Payment Incentives for Providers Not Receiving Other Incentive Payments was issued last week –The report has been uploaded to the LCC Reference Materials wiki herehere –The full study can be found here: http://aspe.hhs.gov/daltcp/reports/2013/ehrpi.shtml http://aspe.hhs.gov/daltcp/reports/2013/ehrpi.shtml Announcements 3

4. Call for Pilot Participation! –LCC Pilot Wiki Page: http://wiki.siframework.org/LCC+Pilot+Plan http://wiki.siframework.org/LCC+Pilot+Plan Contains Pilot Survey, Pilot Overview Document, and Planning Template –Pilots Launch is set for September 16th Meeting Reminders –LCC HL7 Tiger Team SWG meeting – Wednesday at 11am ET –LCP SWG meeting – Thursday at 5pm ET 4 Reminders

5. © 2011 Lantana Consulting Group, www.lantanagroup.com 5 Care Plan - CDA Document Type Development

6. © 2011 Lantana Consulting Group, www.lantanagroup.com 6 HAS SUPPORT HAS REASON Relationships (Happy Path) Health Concern (code= CONCERN or RISK) [mood EVN] Goal [mood GOL] Outcome Observation [mood EVN] Intervention [mood: INT/ RQO/ etc.] [mood: EVN] Observation [mood EVN] REFERS TO HAS COMPONENT EVALUATES Progress Toward Goal Observation [mood EVN] SUPPORTS REFERS TO EVALUATIONS/OUTCOMES HAS COMPONENT HAS REASON

7. © 2011 Lantana Consulting Group, www.lantanagroup.com 7 Changed code on Health Concern Act (CONCERN/RISK) Can relate a Health Risk to a Health Concern Example in sample file Overview of Risk Modeling

8. © 2011 Lantana Consulting Group, www.lantanagroup.com 8 New participants on document header authenticator (patient sign-off) participant (Caregiver/relative) documentationOf (responsible providers) performer (healthcare providers) relatedDocument Care Plan Review

9. © 2011 Lantana Consulting Group, www.lantanagroup.com 9 Questions: 3 – Certification Period o Seems to be about certifying that the patient does need home health care, so that it can be paid for from federal funds o How does it relate to the other dates? Form 485 – Sample File

10. © 2011 Lantana Consulting Group, www.lantanagroup.com 10 Questions: Describe the relations/roles of dates and personnel, so we can put the right words in comments, e.g. "This is the person who performs the home health care." o 3 Certification period [from, to] o 2 Start of care date o 25 Date of HHA [Home Health Agency] Received Signed POT [Plan of Treatment] o 23 Nurse's Signature and Date of Verbal SOC [Start of Care, Referral Date] Where Applicable o 5 Provider No o 7 Provider's Name, Address, and Telephone No o 24 Physician's Name and Address o 27 Attending Physician's Signature and Date Signed Form 485 – Sample File

11. © 2011 Lantana Consulting Group, www.lantanagroup.com 11 Questions: 18B – Activities Permitted o "Activities permitted – crutches" – is it an instruction to the patient or a description of the patient's mobility (functional status)? Form 485 – Sample File

12. © 2011 Lantana Consulting Group, www.lantanagroup.com 12 Questions: Patient IDs: Medical Record No - is this the facility patient ID? Patient's HI Claim Number Form 485 – Sample File