electronic LongTerm Services Supports e LTSS Initiative AllHands

electronic Long-Term Services & Supports (e. LTSS) Initiative All-Hands Workgroup Meeting May 5, 2016 1

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. From S&I Framework to Participants: Hi everyone: remember to keep your items you would like the moderator or other phone on mute 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). All Panelists 2

Agenda Topic Presenter Timeframe Welcome Announcements Lynette Elliott 10 mins Working Session: Service Planning & Coordination component Becky Angeles 80 mins 3

Announcements • Save the Date for upcoming Person Centered Planning (PCP) Training – What: The Administration for Community Living (ACL) will provide an overview and update on HHS requirements for Person-Centered Planning. The session will include the following: • Summary of key requirements within guidance for person-centered planning and for elements that need to be incorporated within a person-centered plan • Emphasis on the relevance of PCP requirements to e. LTSS Plan components – When: Thursday, May 19 th during regular 12: 30 pm-2 pm All-Hands call • Meeting URL: https: //siframework 1. webex. com/siframework 1/onstage/g. php? MTID=ec 62 ac 1 3 afc 469 d 05 c 3 caab 25 c 5 ae 2308 • Dial-In: 1 -650 -479 -3208 • Passcode: 669 251 560 • Attendee ID: Provided by Webex upon login 4

Announcements, cont’d. . . • Centers for Medicare & Medicaid Services Special Open Door Forum – What: CCSQ will host a Special Open Door Forum (SODF) to allow patients, families, caregivers, patient advocacy groups, disabled groups, low-income health patients, other consumers and interested parties to ask questions on the Improving Medicare Post-Acute Care Transformation Act (commonly called the IMPACT Act) and standardizing the assessment of patients across post-acute care settings of Skilled nursing facilities, Home Health Agencies, Inpatient Rehabilitation Facilities, and Long Term Care Hospitals to improve quality of care and quality of life. – When: Thursday, May 12 th from 2 pm-3 pm ET (conference call only) – Dial In: 1 -800 837 -1935 ~ Conference ID: 77707137 – To submit questions: Please submit questions to PACQuality. Initiative@cms. hhs. gov – To download slides: https: //www. cms. gov/Medicare/Quality-Initiatives. Patient-Assessment-Instruments/Post-Acute-Care-Quality 5 Initiatives/IMPACT-Act-of-2014/IMPACT-Act-Downloads-and-Videos. html

Announcements, cont’d. . . • Health 2. 0 Technology for Healthy Communities Pilot – What: Technology for Healthy Communities is a digital health pilot program sponsored by the Robert Wood Johnson Foundation that facilitates technology adoption at the community level by tackling the most pressing local health issues. The inaugural program connects health technology innovators with four underserved communities across the U. S. with the goals of improving health outcomes and building sustainable partnerships. – Participating States: CA, FL, SC, TX – For more Information: http: //www. communityhealthtech. org/ – To apply (deadline May 17, 2016): https: //health 2 conpaxfp. formstack. com/forms/technologyforhealthycommunities 6

Announcements, cont’d. . . • ONC wants ideas on measuring progress in interoperability – What: ONC seeks industry comment on establishing metrics to determine if or to the extent to which electronic health records are interoperable. The agency will focus on three core topics: • “Measurement population” (providers) and key components of interoperability that should be measured. • Current data sources and potential metrics to assess success in meeting MACRA requirements. • Other data sources and metrics that should be considered to support more broad measurements of interoperability. – When: The public comment period extends until June 3 – For more Information: https: //www. federalregister. gov/articles/2016/04/08/2016 -08134/office-of-thenational-coordinator-for-health-information-technology-medicare-access-and-chip 7

Announcements, cont’d… • HL 7 C-CDA Rendering Tool Challenge call for participation – What: The ONC and HL 7 challenge the community to develop a viewer that enables clinicians to more efficiently review clinically relevant patient data from C-CDA documents. Cash prizes for winning submissions: 1 st Place Prize $15, 000, 2 nd Place Prize $5, 000. – When: Submission deadline is May 31, 2016 – To review the rules: http: //www. hl 7. org/events/toolingchallenge. cfm#rules – To submit: http: //www. hl 7. org/events/toolingchallenge. cfm 8

e. LTSS Initiative Roadmap Q 3 ‘ 14 Q 4 ‘ 14 Q 1 ‘ 15 Q 2 ‘ 15 Q 3 ‘ 15 Q 4 ‘ 16 Q 4 ‘ 17 Initiative Kick Off: 11/06/14 Pre-Planning • Call for Participation • Conduct Environmental Scan • Success Criteria • Stakeholder Engagement Phase 4: Pilots & Testing Phase 2: Use Case Development & Functional Requirements • Develop, review, and finalize the Use Case and Functional Requirements Phase 1: Pre-Discovery • Launch initiative • Review and Finalize Charter • Review initial Candidate Standards • • • Pilot site readiness Implementation of solution Test User Stories and Scenarios Monitor Progress & Outcomes Utilize Requirements Traceability Matrix Phase 3: Pilot Guide Development • • Finalize Candidate Standards Gap Analysis Technical & Standards Design Develop Requirements Traceability Matrix Phase 5: Evaluation • Evaluate outcomes against Success Metrics and Criteria Timelines for Consideration: Two Pilot Phases, SDO Ballot Cycles 9

Reminder: Join the e. LTSS Initiative • To join the electronic Long Term Services and Supports (e. LTSS) Initiative, go here: http: //wiki. siframework. org/e. LTSS+Join+the+Initiative. • Registered Members are included on all initiative communications, updates and announcements. – You may join as an Interested Party or a Committed Member. (More information about these options on the Join page. ) • Thank you! Your commitment and participation are critical to the success of the e. LTSS initiative. 10

LTSS Plan Alignment/Harmonization Timeline March 2016 April 2016 May 2016 June 2016 July 2016 August 2016 LTSS Plan Submission Harmonization Team Populates Crosswalk Harmonization Phase (need LTSS Plan Data Experts) Harmonized LTSS Plan 11

Harmonization Approach 2 1 Core Components Common Across All Grantee Service Plans Service Planning & Coordination • Budget • Money Mgmt • Cost Estimate etc. 1 2 Service Information • Frequency of Service • Service Provider Name • Service Provider Type • Units of Service/Support Per Provider etc. Back-Up Information • Contact • Back-Up Plan etc. Additional Person Centered Plan Components • Family Information • Community Connections • Work Information • Community Inclusion • Choice & Decision Making • Relationships • Behavioral Health • Self-Direction • Safety • Restrictions etc. Core Component Harmonization: Focus on harmonizing across all information components already captured in TEFT Grantee Service Plans. Ensure Beneficiary Goals, Preferences, Needs and Outcomes are reflected in elements. Additional PCP Harmonization: Identify additional PCP components that must be included in Plan and are reflective of requirements within ACA Section 2402(a) and authorized under CMS HCBS 1915 (c)Regulation. These are not currently being captured all TEFT Grantee Service Plans. Captured using ACA in 2402 (a) Person-Centered Planning Process

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Wiki Updates • Past discussion items are tracked and posted in a matrix following each meeting and can be found on our e. LTSS wiki here • Our upcoming data harmonization discussion schedule is available here on our e. LTSS wiki • Updates will be posted each week in the Announcements section of our e. LTSS wiki 14

Recap from Last Week e. LTSS Element Standard? Area N Y N Harmonized Element Name Datatype Cardin Comments ality Plan Overall Plan Comments / Comments Narrative Text Program Type. Program Name Text Plan Status Text 0. . * 1. . * 0. . 1 Grantees/pilots currently use this field for administrative purposes or any items from assessments that can't be put in another field. Includes: Overall Comments (KY), Narrative (MD), Overview Comments (FEI) Core element for the e. LTSS Plan, but each implementation will have a different list of values specific to their state/pilot. Includes: HCBS Waiver Program / Program (CO), Recommendation (GA), Program (KY), Program Type (MD), Program (MN), Person is Enrolled In (FEI) These elements are administrative in nature and are largely used for internal purposes. Includes: Plan Status (KY), POC Status (MD) N Plan Type / Category Text 0. . 1 These elements are administrative in nature and are largely used for internal purposes. Includes: Service Plan Type (CO), Care Plan Type (GA), Category of Plan (KY), Plan of Service Type (MD), PSS 15 Type (FEI)

Service Planning & Coordination Component – Signature and Financial Elements • We will focus on elements in the Service Planning & Coordination component that represent the overview or administrative portions of an e. LTSS Plan • This week’s elements/areas of focus include: – Plan Signatures • • Who? Printed Name Needed? Signature Type / Signature on File Type of Service Provided to accompany Service Provider signature? – Financial Information at the Plan Level • Plan Total, Monthly, and Miscellaneous Cost elements • Plan Budget-related elements • Funding/Source of Payment at the Plan Level 16

Plan Signatures – Who? • Types of Role/People’s Signatures provided by Grantees/Pilots: – – – – – Person (FEI) Georgia: Do you Person or Guardian/Legal Representative (MN) capture the Client (MD, CO) person’s signature Participant (CT) on the plan? Individual (KY) Support Planner (MD) HHS guidance on Person-Centered Planning states: The Case Manager (FEI, KY, CO) plan must include the signatures of everyone with Universal Case Manager (CT) responsibility for its implementation including the person and/or representative, his or her case manager, the Care Coordinator (GA) support broker/agent (where applicable), and a timeline Person Who Developed This Plan (MN) for review. The plan should be discussed with family/friends/caregivers designated by the individual so Care Coordinator Collaborator (GA) that they fully understand it and their role(s). DSS CO Staff (CT) Provider (MD, FEI) Does anyone capture the review Emergency Backup (MD) timeline in their plans now? Backup Provider (FEI) Other (MN) QUESTION: Which signature(s) are “required” or Additional Legal Guardian (CO) expected to be on a Service Plan? 17

Plan Signatures – Printed Name Needed? • KY, MD, FEI have an element for a printed version of the Signature Name • QUESTION: Should this be included as a core element? 18

Signature Type / Signature on File • MD and FEI Capture the Type of Signature – Values include: • • Signed Paper Copy on File Signed by Representative Not Signed • CO, KY, MD and FEI have elements regarding whether or not a signature is “on file” or a person “signed a signature sheet” • QUESTION: Should the Signature Type / Signature on File element be included as a core component? 19

For Service Providers – Type of Service Provided • MD and FEI have a field to capture the actual name of the service provided by the Service Provider (in the signature section) • QUESTION: Should this be included as “core” to the Plan (if Service Provider signature is “required”)? 20

Financial, Budget and Cost Elements • We will focus on the financial, budget and cost elements that are specific to the plan itself (and not at the service level) at this time • Is it important to capture and share both budget and cost information related to the plan itself? – Or is this important only at the service level? – Majority of Pilots capture Plan Cost, but capturing budget information at the plan level is not as prevalent • Does anyone capture goals or risks related to budget, money management or income? 21

Total Plan Costs Colorado Connecticut Georgia Kentucky Maryland Minnesota FEI Element Name Sections 1 -4 total? Total Plan of Care Cost Requested? Total POS Cost Total Plan Cost Total PSS Cost Format / Type Calculated / $ Numeric Auto-calculated / $ Numeric Textbox / $ Numeric • Are there other elements that Grantees/Pilots use in respect to cost of the plan in general? • Is it important for the Beneficiary and Providers to see this information when a plan is shared? • QUESTION: Should this be included as a core element? 22

Miscellaneous Cost Elements Colorado Element Name (s) Connecticut Sections 1 - 4 Total Costs Georgia Kentucky Maryland Total Traditional Services Cost Annual Waiver Services Total Projected Annual Cost of Service Minnesota FEI Waiver Services Total Cost Annual State Plan Services Total Participant Directed Services Cost Annual Non. Medicaid Services Total MFP Flexible Funds Total Cost Neutrality Limit • Are these elements that the Beneficiary needs to see in their plan? • Can these elements be standardized across Grantees/Pilots? • Are these elements important when a plan is shared among providers and beneficiaries? • QUESTION: Should this be included as a core element? 23

Budget-related Elements Colorado Element Name (s) Connecticut Georgia CFC Total Budget Allocation CFC Monthly Budget Allocation CDPSS Budget (Monthly) Liability Kentucky Maryland Minnesota Total Prior Authorized Amount CFC Fixed Budget Total EW/AC Case Mix Monthly Maximum Budget CFC Flexible Budget Total CDCS Annual Budget FEI Participant Contributions (Waiver Obligation / AC Fee) Authorized Daily Amount for CAC, CADI, BI, DD Waiver Authorized Monthly Amount for CAC, CADI, BI or DD Waiver • It appears that Grantees capture budget allocations in a variety of ways. How can we standardize this? 24 • QUESTION: Should this be included as a core element?

Funding / Source of Payment Colorado Connecticut Georgia Kentucky Maryland Minnesota Element Name Funding Source (at the service level) Source of Payment Funding the Plan Format / Type Select from List Textbox / Free Text Select from List + Free Text Private Insurance Private insurance/health plan Medicare FEI N/A - Does not apply Medical Assistance (MA) Managed Care Other Medicaid State Plan … • Is this redundant with the Program Name element we discussed last week? 25 • QUESTION: Should this be included as a core element?

Plan for Next Week • We will continue to work through the Service Planning & Coordination component • Sample elements/areas of focus include: – Exceptions for Services – Service Delivery Preferences – Emergency Contact Information 26

FACA Meetings (Federal Advisory Committees) Upcoming FACA Meetings • Joint Interoperability Experience Task Force - May 6 • 2017 Interoperability Standards Advisory Task Force - May 6 and May 10 • Joint Interoperability Experience Task Force - May 11 • Precision Medicine Task Force - May 11 • Joint HIT Committee Meeting – May 17 • 2017 Interoperability Standards Advisory Task Force – May 23 • Precision Medicine Task Force – May 25 Public attendance is encouraged https: //www. healthit. gov/facas/calendar/2016/1 27

e. LTSS Initiative: Project Team Leads • ONC Leadership – Mera Choi (mera. choi@hhs. gov) – Elizabeth Palena-Hall (elizabeth. palenahall@hhs. gov) • CMS Leadership – Kerry Lida (Kerry. Lida@cms. hhs. gov) • Community Leadership – Mary Sowers (msowers@nasddds. org) – Terry O’Malley (tomalley@mgh. harvard. edu) • Federal Leadership – Shawn Terrell (shawnterrell@acl. hhs. gov) – Caroline Ryan (caroline. ryan@acl. hhs. gov) – Marisa Scala-Foley (marisa. scala-foley@acl. hhs. gov) • Initiative Coordinator – Evelyn Gallego-Haag (evelyn. gallego@emiadvisors. net) • Project Management – Lynette Elliott (lynette. elliott@esacinc. com) • Use Case & Functional Requirements Development – Becky Angeles (becky. angeles@esacinc. com) • Pilot Guide Development – Grant Kovich (grant. kovich@accenturefederal. com) • Pilots Management – Jamie Parker (jamie. parker@esacinc. com) • Standards and Technologies Identification – Angelique Cortez (Angelique. j. cortez@accenturefederal. com) 28

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4/28: e. LTSS Plan Type/Category Colorado Georgia Kentucky Maryland FEI Element Name Service Plan Type Care Plan Type Category of Plan of Service Type PSS Type Format Radio Buttons List Radio Button Dropdown Values 6 Month Review Initial CCT Certification Extension Continued Stay Review Deinstitutionalization (DI) Employment Site Initial/Enrollment 4/28 Decision: These elements are administrative in nature and are largely Reverse Deinstitutionalization used for. Revision internal purposes. This will NOT be included as a core element in the e. LTSS Standard. Unscheduled Review Recertification Provisional Annual Reassessment 30 Day CCP Review • QUESTION: Should this element be included the e. LTSS Plan Standard as a core component element? 4/28: No. These elements are administrative in nature and are largely used for internal purposes. Readmission 30

4/28: e. LTSS Plan Status CO CT GA KY MD Element Name Plan Status POC Status Format Dropdown Auto-generated Values Draft In Progress MN FEI Pending Case Supervisor Review Under Case Supervisor Review Pending Case Management Admin Review Under Case Management Admin Review Pending Plan Reviewer Review Under Plan Reviewer Review Pending Supervisor Review Pending CHFS Review Pending QIO Review Partial Current Submitted Current Pending Start Date Annual Recertification Historic 4/28 Decision: These elements are administrative in nature and are largely Revision Requested Case. NOT Supervisor used for internal purposes. This bywill be included as a core element in the e. LTSS Standard. Revision Requested by Plan Reviewer Revisions Requested by Case Management Admin Revisions Requested by Supervisor 31

4/28: Program Type Colorado Georgia Kentucky Maryland Minnesota FEI Element Name HCBS Waiver Program Recommendation Program Type Program Person is Enrolled In Format Checkbox List Dropdown Free Text ? Sample Values Brain Injury (BI) CCSP Acquired Brain Injury – Long Term Care (ABI-LTC) Acquired Brain Injury (ABI)-Acute Brain Injury (BI) Developmental Disabilities (DD) / Colorado Choice Transitions - HCBS-DD Nursing Facility Home and Community Based (HCB) Community First Choice (CFC) Supported Living Services / Colorado Choice Transitions - HCBS-SLS Skilled Waiver Service Model II Community Options (CO) Community Mental Health Supports (CMHS) / Colorado Choice Transitions - HCBSCMHS Other Michelle P. Waiver (MPW) Community Personal Assistance Services (CPAS) (not mapped across grantees and not a complete list) Program Colorado Choice Transitions - HCBS-BI Elderly, Blind, and Disabled Supports for Increased Community 4/28 Decision: This WILL be included in the e. LTSS Standard. (EBD) / Colorado Choice Community Living Services (ICS) Transitionsimplementation-specific. - HCBS-EBD/18(SCL) 64 / Colorado Choice Name (text) (1. . *) Transitions. Program - HCBS-EBD/65+ …. . The values will be …. 32

4/28: Program Type Discussion • QUESTION: What is the purpose of this element? – Is it the Program that is FUNDING the Plan? • QUESTION: Is it a multi-select list? 4/28: It could be more than one. – – – MN: Only 1 CO: Only 1 for “HCBS Waiver Program”. What about “Program”? KY: Only 1? MD: ? FEI: ? GA: ? • QUESTION: Should this element be included as a core component? 4/28: Yes. • QUESTION: Can we harmonize the list or will the Program names vary by State? 4/28: Program list will vary by state. 33

4/28: Plan Comments / Narrative Text Colorado Connecticut Georgia Kentucky Maryland Minnesota FEI Element Name Overall Comments Narrative Overview Comments Format / Type Textbox / Free Text • What are examples of text for these fields? • Who enters the comments/narrative content? • QUESTION: Should this be included as a core element? • 4/28: No. Grantees/pilots currently use this field for administrative purposes or any items from assessments that can't be put in another field. 34

4/21: e. LTSS Plan Period / Plan Effective Dates Element Name (s) Connecticut Colorado Georgia Kentucky Maryland Minnesota FEI Care Plan Effective Date ? Care Plan Period Proposed Start Date POS Effective Date Time Period Covered by the CSSP Start Date Effective Date Level of Care End Date Time Period Covered by the CSSP End Date Type Textbox ? Date Range Date Picker Format MM/DD/YYYY ? MM/DD/YYYY MM/DD/YYYY • QUESTION to the e. LTSS Community: Should this element be included the e. LTSS Plan Standard as core component element? YES • Harmonized Name: Plan Effective Date • Harmonized Datatype: Interval of date/time (i. e. HL 7 effective. Time (IVL<TS>) • Harmonized Format: Interval of MM/DD/YYYY (start date required) -MM/DD/YYYY (end date optional) • 4/14 Discussion: e. LTSS Community discussed that the Effective Date of a Plan may vary state by state. Some Grantees stated that a Plan is effective for 1 year, others stated the Plan is effective until a revision or reassessment occurs. • 4/21 Follow-up Question: Should this element be included in the e. LTSS Standard IF the definition of the effective date can’t be agreed upon due to processes and policies that are 35 state-specific? YES. Making the end date optional works for all Grantees.

4/21: e. LTSS Plan Created Date Connecticut Colorado Georgia Element Name Date Entered Care Plan Visit Date Type Textbox Date Picker Textbox Format MM/DD/YYYY Kentucky date and timestamp of submission of the plan in MWMA Maryland Minnesota FEI Created Date Support Plan was mailed/given on Created Date Auto-generated Date Picker MM/DD/YYYY • Plan submissions identified these elements as native to the plan and not drawn from an assessment or intake form • 4/14 Discussion: e. LTSS Community discussed that the Plan Created Date may vary state by state and is determined by state policy. Some Grantees stated this the date the plan was mailed/given to the individual and others stated this date is when it is entered into a system. • 4/21 Follow-up Question: Should this element be included in the e. LTSS Standard IF the definition of the Created Date can’t be agreed upon due to processes and policies that are state-specific? After a lengthy discussion, it was determined that this date could be included as Optional in the standard. • Harmonized Name: Plan Created Date • Harmonized Type: Date 36 • Harmonized Format: MM/DD/YYYY

4/21: Miscellaneous Dates possibly related to the Plan (discussed with Grantees offline) • Authorization Date (CO) – First date of Medicaid eligibility for a client enrolling in LTSS; services can’t start prior to this date • Staffing Date (CO) – The date a meeting took place between the case manager, the client and any other care team members • Start / End Cover Dates (CO) – Correspond to functional eligibility • Long Term Care Certification Span: Start and End Dates (CO) – Specific to an assessment and represent an eligibility span 37

4/21: Miscellaneous Dates possibly related to the Plan – cont’d (discussed with Grantees offline) • Level of Care Start / End Dates (KY) – Does the Level of Care Start Date pertain to the Plan itself? • Medicaid Start / End Dates (FEI) – Are these related to the Plan itself or are they specific to eligibility? • Are there Other Dates that we should look at that are specific to the overall LTSS Plan? 38