1. eLTSS Plan Content Sub-Work Group Week 2 Meeting May 12, 2015 11:00am–12:00pm 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 – Hold = Elevator Music = frustrated speakers and participants This meeting is being recorded – 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. – Send comments to All Panelists so they can be addressed publically in the chat, or discussed in the meeting (as appropriate). 2 From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute All Panelists

3. Agenda 3 TopicTime Allotted Welcome and Announcements5 minutes Kickoff Meeting Recap15 minutes Introduction to Domain Harmonization Matrix25 minutes Discussion/Reactions10 minutes Homework and Next Steps5 minutes

4. Meeting Reminders eLTSS Plan Content SWG Meetings are held Tuesdays @ 11:00am – 12:00pm Eastern – Next meeting: May 19, 2015 from 11:00am–12:00pm Eastern – Meeting information can be found on the Wiki: http://wiki.siframework.org/eLTSS+Plan+Content+SWG – Duration: May 5–July 21 (11 Weeks) eLTSS All-Hands Meetings are held Thursdays @ 12:30pm Eastern – Next meeting: May 14, 2015 from 12:30–2:00pm Eastern – This meeting will be a working session for the Plan Content SWG! – 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 4 REMINDER - Please check the Wiki for the latest meeting schedule – meeting link and call in numbers may change.

5. eLTSS Use Case Context for SWG This initiative will identify key domains that will inform the creation of a structured, longitudinal, person-centered electronic LTSS plan for CB-LTSS beneficiaries. The eLTSS plan will be designed in such a way that it can be shared electronically across multiple CB-LTSS settings (e.g., adult day services, beneficiary homes, group homes, foster homes, assisted living, supportive housing, home health and hospice), institutional settings (e.g. hospitals, nursing facilities, primary care, post-acute care) and with beneficiaries and payers. eLTSS Initiative 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 5

6. eLTSS Plan Content SWG Objectives Identify and harmonize a core set of domains that will inform the creation of a structured, longitudinal, person-centered electronic LTSS plan for CB-LTSS beneficiaries: clinical and non-clinical domains with terminology consistent across the seven TEFT states and example set of discrete data elements for the purpose of clarifying the type of information that will be collected per domain area. 6 Primary FocusSecondary Focus TEFT State RequirementsNon-TEFT State Initiative Requirements Common Clinical Data Set Requirements Use Case Requirements

7. eLTSS SWG Focus The eLTSS Plan Content SWG will prioritize TEFT state domain requirements; however, we welcome non-TEFT organizations to provide input and participate in the process based on their respective organization requirements and real-world implementation experience. Non-TEFT organization requirements will be considered for future revisions of the eLTSS Implementation Guide. 7

8. TEFT States… We Need You! (1 of 2) For each state to be able to pilot, we must identify and harmonize relevant domains and data elements: – Understand requirements of each state in greater detail – Pinpoint required domains and develop consensus list Target Populations: Aged, Disabled, TBI, Intellectual/Developmental Disability, SMI – Draft example list of data elements based on final list of domains This SWG will focus specifically on the requirements of the TEFT states, who will use the Implementation Guide (IG) to pilot their eLTSS Solution – Domains and data elements provide framework for IG – By identifying now, do not inhibit IG development later – IG developers can select and harmonize standards that meet the needs of each state’s eLTSS system Public process by nature of S&I Initiative – TEFT State piloting is a priority; will recognize community input but not harmonize at this time By addressing the requirements of the TEFT States, we ensure they are set up for eLTSS System piloting success! 8

9. TEFT States… We Need You! (2 of 2) 9 Community Services Required Neighborhood Support County Services Community Data Neighborhood Information Community Supports Community Needs States: What do you call the domain for service information? Collaboration Among the TEFT states = Key to Initiative Success

10. eLTSS Plan Content SWG Method & Approach The eLTSS Plan Content SWG will: Identify a core set of domains – Pinpoint concrete definitions and key attributes for the domains Define criteria for evaluating each domain – Relate to state, Common Clinical Data Set, and Use Case requirements – Look for synergies within other initiatives (i.e. IMPACT Act, National Core Indicators Domains, NQF Domains, etc.) Perform domain validation – Internal validation tools (e.g. matrix) – Gap mitigation Finalize and present consensus list of domains Outline example data elements based on approved domains 10

11. eLTSS Initiative Timeline 11 Phase 1 Pilots & Testing … Standards & Harmonization Use Case & Functional Requirements Pre-Discovery DEC 14JUNJAN FEBMAYJULAUGSEPOCTNOV Kick Off 11/06/14 Evaluation... Content Work Stream Content Work Stream eLTSS All-Hands Work Group Use Case WG 1. eLTSS Use Case eLTSS Plan Content SWG 1.eLTSS Plan Domains & Data Elements Standards & Harmonization WG 1.Candidate Standards 2.Solution Plan 3.Implementation Guide (Phase 1) MARAPRDEC 15JAN 16

12. eLTSS Plan Content SWG Timeline 12 Week Target Date eLTSS Plan Content SWG Meeting Tasks Homework due Fridays 12pm Eastern 15/5 Kickoff Introduction to Domains and Data Elements States begin to identify current relevant domains 25/12 Introduce/Review Domain Harmonization Matrix Validate Domain Mappings Review domain mappings Continue to identify relevant domains 35/19 Finalize Validation of Domain Mappings Validate/Populate Additional State Domains within Matrix Review domain mappings Continue to identify relevant domains 45/26 Finalize List of Additional State Domains Identify Baseline for Domain Standards Evaluation Validate Criteria for Domain Standards Evaluation Review criteria for domain standards evaluation 56/2 Identify Baseline for Domain Standards Evaluation Validate Criteria for Domain Standards Evaluation Review criteria for domain standards evaluation 66/9 Finalize Validation Criteria for Domain Standards Evaluation Begin Evaluation of Domains per Validated Criteria Perform domain evaluation per assigned section 76/16 Continue Evaluation of Domains per Validated Criteria Perform domain evaluation per assigned section

13. Introduction to Domains and Data Elements (1 of 2) For eLTSS Initiative, want to list domains and example data elements present within the eLTSS Plan – Requires input from data sharing experts = YOU Top-down approach to classifying eLTSS plan elements: Domain = High-level description that specifies a sub-domain Sub-Domain = More granular groupings which define categories for individual data elements Data Element = Even more specific term that serves a specific function – Function is described by field labels and definition 13

14. Introduction to Domains and Data Elements (2 of 2) 14 Domain Sub-Domain Data Element Vitals Problems Lab Results Medications Blood Pressure (BP) Heart Rate Systolic BP Diastolic BP Allergies Unit of data for which the definition, identification, representation, and permissible values are specified by means of sets of attributes Logical, high-level groupings that categorize many sub- domains More granular groupings of criteria specified within the domain that is used to define categories for individual data elements Common Clinical Data Set Normal Tachy. Brady.

15. Introduction to Domain Harmonization Matrix (1 of 7) Domain Harmonization Matrix will serve as the primary conduit for identified domains and validation tool within the SWG: Initial spreadsheet created with information from current initiatives Additions to the spreadsheet include: – TEFT State Domains – Use Case Requirements 15 Develop Consensus List of Harmonized Domains Create Domain Harmonization Matrix Add/Validate Use Case Requirements Validate TEFT State Domains Identify TEFT State Domains Repeat Process for Sub-Domains

16. Introduction to Domain Harmonization Matrix (2 of 7) Current Initiatives present in the Domain Harmonization Matrix include: eLTSS Initiative Community (Based on Use Case) CMS Balancing Incentive Program IOM: Capturing Social & Behavioral Domains (Phase I) IMPACT Act NCI Domains and Sub-Domains ACL Person Centered Planning NQF PRO Domains LCC Care Plan Data Set Requirements CARE Item Set Domains MU2 Data Sets (Common Clinical Data Set) 16

17. Introduction to Domain Harmonization Matrix (3 of 7) Internal validation of initiative domains demonstrated that many domains have the same meaning, even though the label may not be consistent Example: Clinical Information Domain vs. Medical Information Domain Varying definitions and labels for the domain across six initiatives Understood that even though definitions/labels vary, the specified domain is collecting the same type of information 17

18. Introduction to Domain Harmonization Matrix (4 of 7) 18 Source eLTSS Community CMS BIP ACL Person Centered Counseling NQF PRO Domains LCC Care Plan Data Set Reqs. CARE Item Set Domain Clinical Information Medical Conditions/ Diagnoses Medical Needs Symptoms and Symptom Burden Health Concerns Medical Status/ Clinical Complexity Definition Push notification, medical conditions/ diagnoses, medication component Medical conditions or diagnoses that can potentially impact an individual’s daily functioning E.g. pain, fatigue Identifies issues, current status, and likely course of Care Team to increase likelihood of achieving goals of care Measure patient medical status and include factors defining complexity in medical diagnoses

19. Introduction to Domain Harmonization Matrix (5 of 7) 19 Source eLTSS Community CMS BIP ACL Person Centered Counseling NQF PRO Domains LCC Care Plan Data Set Reqs. CARE Item Set Domain Clinical Information Medical Conditions/ Diagnoses Medical Needs Symptoms and Symptom Burden Health Concerns Medical Status/ Clinical Complexity Sub- Domains Current Diagnosis Current Health Status Health Status Evaluation Medication Mgmt. Nursing Concerns Surgical Concerns

20. Introduction to Domain Harmonization Matrix (6 of 7) 20 Source eLTSS Community CMS BIPIOM LCC Care Plan Data Set Reqs. Domain Demographic/ Background Info Individual Factors/ Socio- demographic Patient Data Definition Basic contact and demographic info for the individual applying for services or supports Demographic and clinical data used for any document

21. Introduction to Domain Harmonization Matrix (7 of 7) 21 Source eLTSS Community CMS BIPIOM LCC Care Plan Data Set Reqs. Domain Demographic/ Background Info Individual Factors/ Socio- demographic Patient Data Sub-Domains Country of Origin Sexual Orientation Gender Race/Ethnicity Education Employment Food and Housing Insecurity

22. Domain Harmonization Matrix Working Session 22 eLTSS Domain Person Centered Profile Clinical Info Care Team Functional Status Cognitive Function Behavior Concerns Service Info Demographic /Background Info ADLsIADLs Social Support Financial /Payer Info MN Domain Person Info Support Options and Strengths Summary of Services Health and Safety Cognitive and Behavioral Support Plan Summary of Services Person Information Support Options and Strengths Community Support Funding the Plan Homework 1: TEFT States Identify Current Relevant Domains Responses added to Matrix and harmonized with current validation criteria (based on community and initiatives) Working Session will take place during Thursday’s All-Hands Meeting

23. Discussion Discussion/Reactions 23

24. eLTSS Plan Content SWG Next Steps Sign up for the eLTSS Plan Content SWG on the Wiki – http://wiki.siframework.org/eLTSS+Plan+Content+SWG http://wiki.siframework.org/eLTSS+Plan+Content+SWG – Joining the eLTSS Plan Content SWG ensures that you are included on workgroup communications and announcements. Homework – Verification of domains provided by TEFT States by SWG team – Due Thursday, May 14 Next eLTSS Plan Content SWG Meeting – Working session during Thursday’s All-Hands meeting – Thursday, May 14 from 12:30 – 2:00pm Eastern http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29 http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29 Thank you! Your commitment and participation are critical to our success. 24

25. eLTSS Plan Content SWG Contact Information For questions, please contact your support leads: – eLTSS Plan Content SWG Lead: Grant Kovich, grant.kovich@accenture.comgrant.kovich@accenture.com – eLTSS Plan Content SWG Co-Lead (Arizona): Lauren Wiggins-Prole, lauren.wiggins@azahcccs.gov lauren.wiggins@azahcccs.gov – eLTSS Plan Content SWG Co-Lead (Colorado): Pam Russell, prussell@corhio.org prussell@corhio.org – eLTSS Plan Content SWG Co-Lead (Connecticut): Dr. Minakshi Tikoo, tikoo@uchc.edu tikoo@uchc.edu – eLTSS Plan Content SWG Co-Lead (Georgia): Irina Connelly, irina.connelly@gtri.gatech.edu irina.connelly@gtri.gatech.edu – eLTSS Plan Content SWG Co-Lead (Kentucky): Sheena Batts, sheena.batts@ky.gov sheena.batts@ky.gov – eLTSS Plan Content SWG Co-Lead (Maryland): David Wertheimer, david.wertheimer@Maryland.gov david.wertheimer@Maryland.gov – eLTSS Plan Content SWG Co-Lead (Minnesota): Tom Gossett, tom.l.gossett@state.mn.us tom.l.gossett@state.mn.us – Initiative Coordinator: Evelyn Gallego, evelyn.gallego@siframework.orgevelyn.gallego@siframework.org – Project Manager: Lynette Elliott, lynette.elliott@esacinc.orglynette.elliott@esacinc.org 25