electronic LongTerm Services Supports e LTSS FHIR IG

electronic Long-Term Services & Supports (e. LTSS) FHIR IG Jira Tracker Disposition Discussion with HL 7 CBCP WG July 21, 2020

2 e. LTSS FHIR IG Jira Tracker Dispositions Disclaimer • e. LTSS is a joint project of the Centers for Medicare & Medicaid Services (CMS), the Office of the National Coordinator (ONC), and e. LTSS community participants • The e. LTSS Initiative and this document were made possible by funding from CMS • The contents of this document are solely the responsibility of the author(s) and do not represent the official views of CMS, ONC, or any of its affiliates

3 e. LTSS FHIR IG Jira Tracker Dispositions Agenda TOPIC Project Overview e. LTSS FHIR IG Jira Trackers Overview No Change / Question Answered Non-Substantive / Persuasive or Persuasive w/Mod Substantive / Considered for Future Use Next Steps

4 e. LTSS FHIR IG Jira Tracker Dispositions Project Overview

5 e. LTSS FHIR IG Jira Tracker Dispositions e. LTSS Initiative At-A-Glance e. LTSS Informative Document Published by HL 7 e. LTSS Initiative Kick-off Nov ‘ 14 Use Case Complete 2015 e. LTSS Final Dataset Published e. LTSS Dataset Harmonization 2016 Round 1 Pilots 2017 Round 2 Pilots e. LTSS FHIR IG Balloted through HL 7 e. LTSS FHIR IG Published by HL 7 e. LTSS Dataset to HL 7 Mapping Complete 2018 2019 e. LTSS Informative Document Balloted through HL 7 IG to be Tested at HL 7 Sept Connectathon e. LTSS RI Published ONC Git. Hub 2020 e. LTSS Ballot Reconciliation Complete IG Tested at HL 7 Connectathon IG Tested at HL 7 May Connectathon

6 e. LTSS FHIR IG Jira Tracker Dispositions e. LTSS FHIR IG Jira Trackers Overview

7 e. LTSS FHIR IG Jira Tracker Dispositions e. LTSS FHIR IG Jira Trackers

8 e. LTSS FHIR IG Jira Tracker Dispositions No Change / Question Answered

9 e. LTSS FHIR IG Jira Tracker Dispositions 23049: Service Information - Self-Directed Service Indicator Draft Disposition/Resolution Change Type N/A Resolution Considered – Question Answered Disposition Text Per David Pyke from CBCP: You'd need to follow-up with O&O since they are responsible for Service Request. As of right now, there is an extension (http: //build. fhir. org/servicerequestprofiles. html) that is the same that has not been merged into the resource. So, unless O&O changes that, it'll stay an extension. It's unlikely that an extension from an IG would be moved to a core unless the WG really thinks it's needed.

10 e. LTSS FHIR IG Jira Tracker Dispositions Non-Substantive Changes Persuasive / Persuasive with Mod

11 e. LTSS FHIR IG Jira Tracker Dispositions 23045: Beneficiary Demographics - Person Identifier Type - Coding Medicaid ID Draft Disposition/Resolution Change Type Non-substantive Resolution Persuasive Disposition Text Reached out to Brett Marquard to see if he can help with this one. Update the Mapping spreadsheet to include additional guidance when we receive it.

12 e. LTSS FHIR IG Jira Tracker Dispositions 23046: Beneficiary Demographics - Emergency Backup Plan - Emergency Care Plan Resource Draft Disposition/Resolution Change Type Non-substantive Resolution Persuasive Disposition Text Add the following text to Care. Plan. part. Of. comment in structuredefinition-Care. Plan-eltss. xml. "An Emergency Backup Plan linked with Care. Plan->part. Of should have only required elements duplicated from the base Care. Plan. "

13 e. LTSS FHIR IG Jira Tracker Dispositions 23047: Goals & Strengths - Goal - References to Goals for Step or Action or Service request level Draft Disposition/Resolution Change Type Non-substantive Resolution Persuasive Disposition Text Modify the following text in the Goal (row 12), Additional Mapping Details (column G) of the Mapping Spreadsheet (both XML and XLS). "4) A Goal can be referenced from a step or action or from a service. For a goal related to a step or action, use activity->detail->goal. For a service request specific goal use Service. Request->extension. Logically, these goals are exclusive to each other and the same goal isn't duplicated at both levels. "

14 e. LTSS FHIR IG Jira Tracker Dispositions 23058: Service Provider Information - Support Planner Name - Same as Support Planner Printed Name Draft Disposition/Resolution Change Type Non-substantive Resolution Persuasive with mod Disposition Text Update the "Additional Mapping Details" column in the mapping spreadsheet (Web and XLS version) to include the following text to Support Planner Name and Support Planner Printed Name: "The values for Support Planner Name and Support Planner Printed Name would include the same information. " Update the "Additional Mapping Details" column in the mapping spreadsheet (Web and XLS version) to include the following text to Plan Monitor Name and Plan Monitor Printed Name: "The values for Plan Monitor Name and Plan Monitor Printed Name would include the same information. "

15 e. LTSS FHIR IG Jira Tracker Dispositions 23059: Service Provider Information - Service Provider Name - Same as Service Provider Printed Name Draft Disposition/Resolution Change Type Non-substantive Resolution Persuasive Disposition Text Update the "Additional Mapping Details" column in the mapping spreadsheet (Web and XLS version) to include the following text to Service Provider Name and Service Provider Printed Name: "The values for Service Provider Name and Service Provider Printed Name would include the same information. "

16 e. LTSS FHIR IG Jira Tracker Dispositions 24901: Practitioner. identifier. system for NPI needs updating in examples Draft Disposition/Resolution Change Type Non-substantive Resolution Persuasive Disposition Text Update the. system values in the Care. Plan and Planner examples to http: //hl 7. org/fhir/sid/us-npi

17 e. LTSS FHIR IG Jira Tracker Dispositions 24902: Update e. LTSS Risk. Assessment binding Draft Disposition/Resolution Change Type Non-substantive Resolution Persuasive Disposition Text Remove the "unbound" hyperlink from Risk. Assessment. prediction. outcome to model it the way the base resource does.

18 e. LTSS FHIR IG Jira Tracker Dispositions *NEW* - e. LTSS Service. Request Profile – updates needed on location. Reference Draft Disposition/Resolution Draft Tracker Details Type Change Request Change Type Non-Substantive Specification US Electronic Long-Term Services and Supports (ELTSS) (FHIR) Resolution Persuasive Disposition Text Update the Profile Differential Tab Description & Constraints column from "Service Location" to "Service Delivery Address“ for Service. Request. location. Reference. Raised in Version R 4 Work Group Community-Based Care and Privacy Related Artifact(s) Service. Request Description The e. LTSS “name” for Service. Request. location. Reference should be “Service Delivery Address”.

19 e. LTSS FHIR IG Jira Tracker Dispositions *NEW* - e. LTSS Location Profile – Add explanatory statement Draft Tracker Details Draft Disposition/Resolution Type Change Request Change Type Non-Substantive Specification US Electronic Long-Term Services and Supports (ELTSS) (FHIR) Resolution Persuasive Disposition Text Add explanatory text to the Location Profile "This profile should only be used for Service Delivery Address when the service or support is provided outside the person's home address. Use Person. address when service or support is provided in the person's residence. " Raised in Version R 4 Work Group Community-Based Care and Privacy Related Artifact(s) Location Description The e. LTSS Location Profile should only be used to identify the Service Delivery Address when a service or support is provided outside the person's home. If the service is to be provided at the person's home, the Person. address element should be utilized. Add explanatory text to the Location Profile "This profile should only be used for Service Delivery Address when the service or support is provided outside the person's home address. Use Person. address when service or support is provided in the person's residence. "

20 e. LTSS FHIR IG Jira Tracker Dispositions Substantive / Non-Compatible Considered for Future Use

21 e. LTSS FHIR IG Jira Tracker Dispositions 23048: Person Centered Planning - Plan Monitor Name/Number - Use of Encounter and Episode. Of. Care references Draft Disposition/Resolution Change Type Substantive Resolution Considered for Future Use Disposition Text This needs additional discussion on this from implementers before making any changes. Suggestions: * Remove the Episode. Of. Care e. LTSS Profile. * Add a Care. Team e. LTSS Profile and include the mapping for Plan. Monitor name and phone number. * Update Mapping spreadsheet XML and HTML. * Add a SNOMED Code for Plan Monitor. Questions for implementers: * Do other e. LTSS "provider" mappings need to be updated to go through Care. Team? If so, do SNOMED codes exist for them? * Is there a SNOMED code that could be used for Plan Monitor? (note: Case Manager and Plan Monitor are different people)

22 e. LTSS FHIR IG Jira Tracker Dispositions 23054 + 23055: Service Information - Service Start/End Date - Use of occurrence. Timing or occurrence. Period Draft Disposition/Resolution Change Type Substantive Resolution Considered for Future Use Disposition Text Service. Request. occurrence is 0. . 1. In order to accommodate the service start/end dates as well as the interval and quantity elements, occurrence. Timing is used. Two options to discuss with O&O WG: 1. Change the cardinality on Service. Request. occurrence from 0. . 1 to 0. . * to allow occurence. Period for service start/end date and occurrence. Timing for service interval/quantity elements. 2. Add a new element Service. Request. period to record start and end date. If option 1 is executed, update the mappings and profiles for Service Start and End Date to map to Service. Request. occurrence. Period. If option 2 is executed, update the mappings and profiles for Service Start and End Date to map to Service. Request. period (or whatever the new element is called).

23 e. LTSS FHIR IG Jira Tracker Dispositions 23056: Service Information - Service Unit Quantity - representing more complex service internal/quantity scenarios Draft Disposition/Resolution Change Type Substantive Resolution Considered for Future Use Disposition Text This depends on what happens with 23054 and 23055 (i. e. , cardinality on occurrence). occurrence. Timing seems to be the right data element to describe timing with frequency ("how many"), duration (hrs, days, etc. ) and period ("per day", "per week"). quantity. Ratio is not meant to describe frequency per day etc. since that is not a ratio and the units seem to be represented as free text instead of coded units. Suggest speaking with O&O on this.

24 e. LTSS FHIR IG Jira Tracker Dispositions 23057: Service Information - Service Rate per Unit/Total Cost of Service - Use of Claim Resource Draft Disposition/Resolution Change Type Substantive Resolution Considered for Future Use Disposition Text Healthcare. Service seems to be the best fit – and suggesting add an extension for the cost since it fits in the workflow. (Claim is after the service has been provided, and Service Request is the request of the service). Suggest talking with FM (Claim), O&O (Service. Request), and Patient Administration (Healthcare. Service) to determine where cost fits best for a service.

25 e. LTSS FHIR IG Jira Tracker Dispositions *NEW* - e. LTSS Patient Profile – Add Must. Support flag to address. district Draft Tracker Details Draft Disposition/Resolution Type Change Request Change Type Substantive Specification US Electronic Long-Term Services and Supports (ELTSS) (FHIR) Resolution Considered for Future Use Disposition Text Raised in Version R 4 Work Group Community-Based Care and Privacy Related Artifact(s) Person Description e. LTSS needs the county that the person resides in for service provider jurisdiction reasons. There is already a Must Support flag on the e. LTSS Location Profile (for service delivery not at a person's residence). Add the Must Support flag to the Patient. address. district element for when services are provided at the person's residence. With the limited uptake in e. LTSS, we suggest adding the Must. Support flag to Person. address. district to ensure the county is captured for the cases when a service is provided at a person’s address. This ensures that the county will be collected if known.

26 e. LTSS FHIR IG Jira Tracker Dispositions *NEW* - e. LTSS Observation Profile – Add Must. Support flag to Observation. subject Draft Tracker Details Draft Disposition/Resolution Type Change Request Change Type Substantive Specification US Electronic Long-Term Services and Supports (ELTSS) (FHIR) Resolution Considered for Future Use Disposition Text Add a must support flag to subject in the e. LTSS Observation profile. Raised in Version R 4 Work Group Community-Based Care and Privacy Related Artifact(s) Observation Description In order to tie the Observation (i. e. , strength or preference) to the Patient, the Observation. subject element must be populated with the patient that the Observation is for.

27 e. LTSS FHIR IG Jira Tracker Dispositions *NEW* - New Profile – e. LTSS Questionnaire. Response – include a Must. Support flag on Questionnaire. Response. subject Draft Tracker Details Draft Disposition/Resolution Type Change Request Change Type Substantive Specification US Electronic Long-Term Services and Supports (ELTSS) (FHIR) Resolution Considered for Future Use Disposition Text Create a new e. LTSS Questionnaire. Response profile and add a must support flag on Questionnaire. Response. subject. Raised in Version R 4 Work Group Community-Based Care and Privacy Related Artifact(s) Questionnaire. Response Description In order to tie the Questionnaire. Response (and the Questionnaire) to the Patient, the Questionnaire. Response. subject element must be populated with the patient that the Questionnaire. Response is for.

28 e. LTSS FHIR IG Jira Tracker Dispositions Next Steps

29 Presentation Title Next Steps • Block Vote? • STU Update?

30 e. LTSS Community Update Team e. LTSS • ONC Project Leads • Stacy Perchem (Anastasia. perchem@hhs. gov) • Elizabeth Palena-Hall (elizabeth. palenahall@hhs. gov) • CMS Project Lead • Kerry Lida (Kerry. Lida@cms. hhs. gov) • Program Manager • Johnathan Coleman (jc@securityrs. com) • Project Managers • Amber Patel (ayp@securityrs. com) • Greg White (gw@securityrs. com) • Harmonization Lead • Becky Angeles (becky. angeles@carradora. com)

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