1. electronic Long-Term Services & Supports (eLTSS) Initiative All-Hands Workgroup Meeting December 11, 2014 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). From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute All Panelists 2

3. http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29 3 Reminder: Join the eLTSS Initiative 3

4. 4 Agenda TopicPresenter Welcome Meeting Reminders & Announcements eLTSS Roadmap Becky Angeles Evelyn Gallego Pre-Discovery Project Charter Review – Timeline Project Charter Review – Target Outcomes and Expected Deliverables Sections; Standards & Other Reference Materials Evelyn Gallego Discussion: Person-Centered Planning Policy Review Centers for Medicare & Medicaid (CMS) Administration for Community Living (ACL) Jennie Harvell Shawn Terrell Ralph Lollar Next StepsBecky Angeles

5. All Hands Workgroup Meeting Structure Our Community Meetings are scheduled for one hour a week. We believe your time is valuable and appreciate your participation in this initiative. In order to make the most of our time together, we will start the meeting software for all community meetings at 12:25 pm Eastern. – This gives attendees time to log in to the WebEx and then dial in to the teleconference prior to the meeting start. We will begin the All Hands Meetings at precisely at 12:30 pm Eastern with administrative items and announcements. 5 Thank you for your participation and we look forward to working with you in the coming months.

6. Plan for the Coming Weeks All Hands Meetings will be held over the next several weeks to finalize the Project Charter – All Hands Meetings will be held Thursdays from 12:30 to 1:30pm Eastern – Next Meeting is December 18, 2014 – Meeting information can be found on the wiki: http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29 http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29 6 Meeting URLhttps://siframework2.webex.com/siframework2/onstage/g.p hp?t=a&d=662453276 Dial In1-650-479-3208 Passcode662 453 276 Attendee IDProvided by WebEx upon login REMINDER Please check the wiki for the latest meeting schedule. REMINDER Please check the wiki for the latest meeting schedule.

7. Upcoming Meetings ONC Annual Meeting – February 2-3, 2015 – The Office of the National Coordinator for Health IT (ONC) will hold the 2015 Annual Meeting in Washington, D.C. The two-day meeting will gather over 1,200 health IT partners for two days of plenaries and breakout sessions. Space is limited, so please register as soon as possible. Location – Washington Hilton ~ 1919 Connecticut Avenue ~ Washington, DC 20009 Webinar Registration Link – http://www.capconcorp.com/event/onc2015/registration/ http://www.capconcorp.com/event/onc2015/registration/ Agenda and additional details will be posted at the link below as they become available. Check back often: – http://www.healthit.gov/oncmeeting http://www.healthit.gov/oncmeeting 7

8. Upcoming Meetings The Promise of Digital Health Tweet Chat – Tuesday, December 16, at 2 p.m., E.S.T – The Commonwealth Fund’s Breakthrough Opportunities Program (BOP) will host a one-hour tweet chat onto discuss the potential for digital health technologies to transform the health care system. We will be discussing uses of digital technologies inside and outside of the health care sector and how they can help control costs, improve patient-provider communication, and more. Webinar Registration Link – http://click.email- commonwealthfund.org/?qs=01dda44376d3b2028b593ca9c52eb026f23989 dd461fc0f8277924f23912c2e8 http://click.email- commonwealthfund.org/?qs=01dda44376d3b2028b593ca9c52eb026f23989 dd461fc0f8277924f23912c2e8 Please join us on Twitter by following along and tweeting us at #BOPChat 8

9. Upcoming Meetings NQF HCBS Call for Nominations – The National Quality Forum (NQF) is seeking nominations for a multi- stakeholder Committee to provide input on performance measurement gaps in home and community-based services (HCBS). Nominations are due by TUESDAY, DECEMBER 16, 2014 6:00 PM ET Call for Nominations (includes background, timeline, etc.) – http://www.qualityforum.org/Projects/h/Home_and_Communi ty-Based_Services_Quality/Call_for_Nominations.aspx http://www.qualityforum.org/Projects/h/Home_and_Communi ty-Based_Services_Quality/Call_for_Nominations.aspx Submit Nominations here: – http://www.qualityforum.org/nominations/http://www.qualityforum.org/nominations/ 9

10. Concert Series Presentations 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 one or more eLTSS settings: home and community-based setting or clinical setting? Does solution incorporate existing or emerging standards and/or other relevant guidance? 10

11. Concert Series Presentations: Logistics Presentations will be scheduled as part of the weekly eLTSS Community Meetings Duration: 15 to 20 mins webinar (or demo); 5 to 10 mins Q&A Presentations will occur following eLTSS Workgroup activities i.e. eLTSS workgroup will work on project charter review during first part of meeting; concert series presentation will occur during second half of meeting 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 11

12. 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 4: 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 12 Initiative Kick Off: 11/06/14 Phase 1: Pre-Discovery Phase 2: Use Case Development & Functional Requirements Phase 3: Standards & Harmonization

13. Goals for the eLTSS Initiative Identify key client 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. We will use Health IT to establish a person-centered electronic LTSS record, one that supports the person, makes him or her central to the process, and recognizes the person as the expert on goals and needs.* * Source: Guidance to HHS Agencies for Implementing Principles of Section 2402(a) of the Affordable Care Act: Standards for Person-Centered Planning and Self-Direction in Home and Community-Based Services Programs 13

14. DateAll Hands WG Meeting TasksHomework (Due Wednesdays by COB) Nov 13 Project Charter Orientation Background Section & Challenge Statement Review: Background Section, Challenge Statement Nov 20 Scope StatementFinalize: Background Section/Challenge Statement Review: Scope Statement Section Nov 27Thanksgiving Holiday: NO MEETING Dec 4 Value StatementFinalize: Scope Statement Section Review: Value Statement Dec 11 Target Outcomes and Expected Deliverables Standards and Other Reference Materials Concert Series Presentation #1 (CMS/ACL Person- Centered Planning Policies) Finalize: Value Statement; Review: Target Outcomes and Expected Deliverables, Standards and Other Reference Materials; Stakeholders and Other Interested Parties Dec 18 Stakeholders and Other Interested Parties Potential Risks Consensus Voting Orientation Finalize: Standards and Other Reference Materials; Review: Stakeholders and Other Interested Parties, Potential Risks, Dec 25 Jan 1 End of Year Holiday: NO MEETINGS Jan 8 End to End Review Project Charter Start Project Charter consensus voting Finalize: Project Charter comments on all Sections Jan 9 - 16 Consensus Voting on Finalized Charter Jan 15 Kick-off Use Case & Functional RequirementsFinalize: Publish Final Project Charter eLTSS Project Charter Review Schedule 14

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16. 16 Draft Project Charter Review Document will be presented on-screen Edits and comments will be added to the document itself Updated version will be posted to wiki Draft Charter wiki page: http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Chart er http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Chart er Document download link will also be posted at the top of this page

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18. Call for Participation To make this initiative a success, we need the help of volunteers who are eager to make rapid progress on this important project We need experts to develop standards, first-movers to pilot new tools, innovators to push the envelope, and patients and providers willing to give feedback Minimum commitment: regular participation in community meetings (1-2 hours / week) and active contribution to one or more workgroups (1-3 hours / month). It is okay to participate in one phase and not another. There will be opportunities for your organization to o Pilot new ways to give providers and beneficiaries’ access to information o Hear about and provide input to the latest policy and standard issues affecting information exchange and individual access o Directly contribute to a potential game-changer for health care 18

19. Next Steps JOIN THE INITIATIVE: The electronic Long-Term Services and Supports Initiative is OPEN for anyone to join. http://wiki.siframework.org/eLTSS+Join+the+Initiative http://wiki.siframework.org/eLTSS+Join+the+Initiative HOMEWORK: Please review and comment on the Proposed Project Charter 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 19

20. 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 20

21. Opportunities for use of S&I Identified Standards Jennie Harvell

22. S&I Framework: The Value of Community Participation 22 ONC Programs Community S&I Framework HIT Standards Committee HIT Policy Committee SDOs State HIE Program & CoPs REC Program & CoPs Beacon Program Technology Vendors System Integrators Government Agencies (National & International) Industry Associations Providers Individuals/Consumers Other Experts HL7 IHE CDISC Other SDOs ENABLING

23. Opportunities for Use of S&I Standards: Some Examples S&I Direct Project S&I Transitions of Care (ToC) Initiative S&I Longitudinal Coordination of Care (LCC) Initiative: – Transitions and Referrals in Care – Care Plans S&I Blue Button+ Other Opportunities

24. Opportunities for Use of S&I Standards: Some Examples S&I Direct Project: – Develops specifications for a standards-based way to send encrypted health information directly to recipients over the Internet. Users of Direct include providers, laboratories, hospitals, pharmacies, patients, and States. – Direct Protocol ONC included the Direct Edge Protocols, Version 1.1 in its 2014 Edition EHR Certification Criteria Final Rule

25. Opportunities for Use of S&I Standards: Some Examples S&I Transitions of Care (ToC) Initiative – identified and developed standards for the electronic exchange of clinical information among providers, patients and other authorized entities. Targeted eligible professionals (EPs) and eligible hospitals (EHs), and their software developers and vendors. – ONC included these standards in criteria to support Stage 1 and Stage 2 Meaningful Use ToC requirements (in the ONC 2011 and 2014 Edition EHR Certification Criteria Final Rule). – ONC encouraged vendors for Health IT products used by long- term/post-acute care (LTPAC) and behavioral health (BH) providers to certify their products to this (and other) criteria

26. Opportunities for Use of S&I Standards: Some Examples S&I Longitudinal Coordination of Care (LCC) Initiative: – The S&I LCC Initiative built on the ToC Initiative standards to address gaps in standards for transitions of care and care planning. S&I LCC focused on LTPAC providers and EPs/EHs. S&I standards for ToC and care planning were included in the most recent, published version of the HL7 C-CDA (C- CDA Release 2.0) – The Health IT Policy Committee recommended that ONC and CMS adopt the new standards for ToC and referrals of care in Meaningful Use Stage 3 and 2017 EHR Certification Criteria

27. Opportunities for Use of S&I Standards: Some Examples Blue Button Initiative – Blue Button Plus (BB+) is an S&I Framework Initiative for health information exchange between providers and consumers or consumer-named third parties. – Blue Button+ supports the ability to get patient records in human readable and machine-readable formats and allows the patient send them where they choose. – ONC solicited comments on the adoption of separate EHR certification criteria for Blue Button + capabilities as part of its 2017 Edition rulemaking.

28. Other Opportunities for Use of S&I Standards: Some Examples CMS has referenced the: – Standards identified in ToC Workgroup in the: Medicare Physician Fee Schedule: Chronic Care Management provisions – S&I LCC Workgroup activities in the: preamble to Medicare LTPAC Payment rules (SNF and HHA) Standards advanced through S&I activities have been incorporated into ONC standards and certification regulations and referenced in various grant awards, such as: – CMMI/State Innovation Model grants – SAMHSA grants – HRSA grants

29. Oversight and Assessment of the Administration of Home and Community Services: Section 2402(a) of the Affordable Care Act December 11, 2014 Shawn Terrell Administration for Community Living 29

30. ACA Section 2402(a): Oversight and Assessment of the Administration of Home and Community Based Services The Secretary of Health and Human Services shall ensure that HCBS service systems are designed to: – Allocate resources in a manner that is responsive to changing beneficiary needs and choices; – Provide strategies to maximize independence; – Provide support to design individualized, self- directed, community-supported life; and – HCBS will be designed with more uniformity across HHS programs. 30

31. 2402(a) Overview Standards issued by Secretary Sebelius on June 6, 2014 Guidance includes HHS-Wide Standards for – Person centered planning – Self-direction 31

32. 2402(a) Overview Person centered planning standards must be implemented in all Department of Health and Human Services programs that fund HCBS. – ACL – CMS – HRSA – IHS – SAMHSA – ACF – Others 32

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34. Person Centered Planning: Overview Person-Centered Planning and Practice is the Basis for Community Living – Person centered planning and practice is the foundation for realizing the CMS HCBS settings rule requirements and the vision for community living. – Person centered planning, done correctly, creates a level playing field that supports the optimal balance of freedom, health, and welfare for each person. – The 2402(a) Standards are the framework over which is draped the application, and implementation of person-centered planning and practice across HHS. 34

35. Person Centered Planning: Overview A process that is directed by the person with long-term support needs Identifies the strengths, preferences, service and support needs, and desired outcomes of the person. 35

36. Person Centered Planning: Overview (cont) The person’s personally-defined outcomes, preferred methods for achieving them, training supports, therapies, treatments, and other services needed to achieve those outcomes become part of a written services and support plan. The plan must be consistent with the person’s health, (including behavioral health), cultural preferences, housing, family, employment, community integration, and social supports needs (e.g. employment, meaningful relationships). 36

37. Person Centered Planning: Overview (cont.) Modifications: Any effort to restrict the right of the person to realize preferences or goals must be justified by a specific and individualized assessed safety need and documented in the Person Centered Plan. 37

38. Person Centered Planning and Practice Implementation Training and Credentialing – PCP is a set of skills that are mastered over a long period of time Create administrative structures that support person centered planning facilitators to do their work. – Person centered thinking at all levels – Conflict of interest – Functional assessments and person centered planning – Services and support needs unrelated to agency work (e.g. housing). 38

39. Person Centered Planning and Practice: Monitoring – Ensure that the paid and unpaid services and supports are delivered – Progress toward achieving the person’s goals is monitored, that the plan is reviewed according to the established timeline – Feedback mechanism for the person to report on progress, issues, and problems – grievance and complaint process. 39

40. 2402(a) Next Steps ACL to form cross HHS work team – Develop plan for HHS programs to implement PCP and SD standards – Share lessons and best practices – Report to the Secretary annually ACL is working on a training program for PCP and credentialing standards for practitioners. Work with ONC to include PCP standards in eLTSS standards. 40

41. Resources HHS Standards for Person-Centered Planning and Self-Direction. – http://www.acl.gov/NewsRoom/blog/2014/2014_07_ 09.aspx http://www.acl.gov/NewsRoom/blog/2014/2014_07_ 09.aspx CMS Final HCBS Rule: – http://www.medicaid.gov/Medicaid-CHIP-Program- Information/By-Topics/Long-Term-Services-and- Supports/Home-and-Community-Based- Services/Home-and-Community-Based-Services.html http://www.medicaid.gov/Medicaid-CHIP-Program- Information/By-Topics/Long-Term-Services-and- Supports/Home-and-Community-Based- Services/Home-and-Community-Based-Services.html 41

42. CMS Person-Centered Planning Regulations Ralph Lollar

43. CMS HCBS Regulation Person-Centered Planning Provisions Final rule became effective on March 17, 2014 The person-centered provisions are consistent with the ACA requirements 43

44. Person-Centered Service Plans Final rule includes changes to the requirements regarding person-centered service plans for HCBS waivers under 1915(c) and HCBS state plan benefits under 1915(i) - Identical for 1915(c) and 1915(i) The person-centered service plan must be developed through a person-centered planning process 44

45. 1915(c) and 1915(i) Home and Community-Based Services Person-Centered Service Plans The person-centered planning process is driven by the individual Includes people chosen by the individual Provides necessary information and support to the individual to ensure that the individual directs the process to the maximum extent possible Is timely and occurs at times/locations of convenience to the individual 45

46. 1915(c) and 1915(i) Home and Community-Based Services Person-Centered Service Plans Reflects cultural considerations/uses plain language Includes strategies for solving disagreement Offers choices to the individual regarding services and supports the individual receives and from whom Provides method to request updates 46

47. 1915(c) and 1915(i) Home and Community-Based Services Person-Centered Service Plans Conducted to reflect what is important to the individual to ensure delivery of services in a manner reflecting personal preferences and ensuring health and welfare Identifies the strengths, preferences, needs (clinical and support), and desired outcomes of the individual 47

48. 1915(c) and 1915(i) Home and Community-Based Services Person-Centered Service Plans May include whether and what services are self-directed Includes individually identified goals and preferences related to relationships, community participation, employment, income and savings, healthcare and wellness, education and others 48

49. 1915(c) and 1915(i) Home and Community-Based Services Written Person-Centered Service Plan Documentation Risk factors and measures in place to minimize risk Individualized backup plans and strategies when needed Individuals important in supporting individual Individuals responsible for monitoring plan 49

50. 1915(c) and 1915(i) Home and Community-Based Services Written Person-Centered Service Plan Documentation Distributed to the individual and others involved in plan Includes purchase/control of self-directed services Exclude unnecessary or inappropriate services and supports 50

51. Questions/Comments? 51