1. eLTSS Plan Content Sub-Work Group Week 3 Meeting May 19, 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 Domain Harmonization Matrix Working Session40 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 26, 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 21, 2015 from 12:30–2:00pm Eastern – 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. 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 8

9. eLTSS Initiative Timeline 9 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

10. eLTSS Plan Content SWG Timeline 10 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

11. eLTSS Domains Realigned 11 Person-Centered Planning eLTSS Community ACL Person- Centered Counseling NCI Domains NQF HCBS Domains Community input has eluded to domain realignment:

12. eLTSS Domains Realigned Domain realignment was necessary to satisfy the needs of TEFT States and community members. Previous domains were heavy on clinical information SWG Goal = Identify clinical and non-clinical domains – Allow for true person-centered planning Four key initiatives helped to create new eLTSS Domains: – eLTSS Community-Defined Domains (Previous List) – NCI Domains – NQF HCBS Domains – ACL Person Centered 12

13. eLTSS Domains Realigned National Core Indicators (NCI) provided a unique perspective on service planning while capturing all pertinent information: Person-centered domains that are valid, reliable, and risk adjusted – Presented to All-Hands Community by Mary Lee Fay and Kelsey Walter on March 26Mary Lee FayKelsey WalterMarch 26 Data sources include adult, family, and staff stability surveys New eLTSS Domains: – Individual Outcomes – Health, Wellness, and Rights – System Performance – Family Indicators Very granular sub-domains under each domain 13

14. Domain: Individual Outcomes 14 Sub-DomainDefinition Work People have support to find and maintain community integrated employment. Residence (Aging) NCI Domain for Aging and Disabled (currently being piloted); formal definition forthcoming. Community Inclusion People have support to participate in everyday community activities. Choice & Decision Making People make choices about their lives and are actively engaged in planning their services and supports. Relationships People have friends and relationships. Satisfaction People are satisfied with the services and supports they receive. Self-Determination People have authority and are supported to direct and manage their own services. Person-Centered Profile Interests, goals, preferences, and priorities of a beneficiary written by the beneficiary in their own words.

15. Domain: Health, Wellness, and Rights 15 Sub-DomainDefinition Health People secure needed health services. Respect/Rights People receive the same respect and protections as others in the community. Medications Medications are managed effectively and appropriately. Safety People are safe from abuse, neglect, and injury. Wellness People are supported to maintain healthy habits. Behavioral Needs (Aging) NCI Domain for Aging and Disabled (currently being piloted); formal definition forthcoming. Restraints The system makes limited use of restraints or other restrictive practices.

16. Domain: System Performance 16 Sub-DomainDefinition Access Publicly-funded services are readily available to individuals who need and qualify for them. Service Coordination Services coordinators are accessible, responsive, and support the person’s participation in service planning. Financial/Payer Information Financial information typically includes individual or household income (including wages, benefits, and other income) and general assets. Service Information Includes items that are important for the transfer of information between facilities but were not otherwise captured, such as information on allergies. Staff Stability Direct contact staff turnover ratios are low enough to maintain continuity of supports and efficient use of resources.

17. Domain: Family Indicators 17 Sub-DomainDefinition Choice & Control Families/family members with disabilities determine the services and supports they receive and the individuals or agencies who provide them. Family Outcomes Individual and family supports make a positive difference in the lives of families. Satisfaction Families/family members with disabilities receive adequate and satisfactory supports. Family Involvement Families maintain connections with family members not living at home. Community Connections Families/family members use integrated community services and participate in everyday community activities. Access & Support Delivery Families/family members with disabilities get the services and supports they need. Information & Planning Families/family members with disabilities have the information and support necessary to plan for their services and supports.

18. Cross-Cutting Sub-Domains 18 Sub-DomainDefinition Goals A defined outcome or condition to be achieved in the process of person-centered care. Includes beneficiary defined Goals (e.g., longevity, function, comfort) and clinician specific Goals to achieve desired and agreed upon outcomes. Priorities Actions established in order of importance or urgency to the welfare or purposes of the beneficiary at a given time. Issues Reflect the concerns, current status, risks and barriers to care as well as “likely course” identified by the beneficiary or other Care Team Members that require intervention(s), including education or monitoring, to increase the likelihood of achieving the beneficiary’s or provider’s Goals of care. Interventions Actions taken to maximize the prospects of achieving the beneficiary’s or providers’ Goals of care, including the removal of barriers to success. Instructions and the performance of monitoring are subsets of Interventions. The following sub-domains are not exclusive to a single domain, but rather cross-cut multiple domains:

19. Domain Harmonization Matrix Working Session 19 eLTSS DomainsSub-DomainsKentucky DomainsMapping Success Individual Outcomes Work Residence (Aging) Community InclusionSocial Support Choice & Decision Making Cognitive Function and Memory/Learning Relationships Satisfaction Self-Determination Person-Centered Profile Person Profile/Social History, Demographic Health, Wellness, and Rights Health Functional Status/Lifestyle, Clinical Information Respect/RightsBehavior Concerns MedicationsClinical Information Safety WellnessClinical Information Behavioral Health Needs (Aging) Restraints

20. Domain Harmonization Matrix Working Session 20 eLTSS DomainsSub-DomainsKentucky DomainsMapping Success System Performance Access Service Coordination Financial/Payer Information Service Information Staff StabilityCare Team Family Indicators Choice & Control Family Outcomes Satisfaction Family Involvement Community Connections Access & Support Delivery Information & Planning Target Population: Intellectual/Developmental Disability, Aging, Brain Injury, Physical Disability, Ventilator Dependent

21. Domain Harmonization Matrix Working Session 21 eLTSS DomainsSub-DomainsMaryland DomainsMapping Success Individual Outcomes Work Client Common Program Information InterRAI Assessment Sub-Domains Residence (Aging) Client Common Program Information Community Inclusion Client Common Program Information Choice & Decision Making Client Common Program Information Relationships Client Common Program Information Satisfaction Client Common Program Information Self-Determination Client Common Program Information Person-Centered Profile Client Common Program Information Health, Wellness, and Rights Health Client Common Program Information Respect/Rights Client Common Program Information Medications Client Common Program Information Safety Client Common Program Information Wellness Client Common Program Information Behavioral Health Needs (Aging) Client Common Program Information Restraints Client Common Program Information

22. Domain Harmonization Matrix Working Session 22 eLTSS DomainsSub-DomainsMaryland DomainsMapping Success System Performance Access Outside of eLTSS (may be in MMIS) Service CoordinationAgency Staff Information Depends on what is contained within the sub-domain Financial/Payer Information ISAS, Agency Staff Information, Money Follows the Person, Client Program Information Service Information ISAS, Client Program Information Staff Stability Client Common Program Information, Agency Staff Information, Client Program Information Family Indicators Choice & Control Client Common Program Information Family Outcomes Client Common Program Information Satisfaction Client Common Program Information Family Involvement Client Common Program Information Community Connections Client Common Program Information Access & Support Delivery Client Common Program Information Information & Planning Client Common Program Information Target Population: TBI Waiver, Community Options Waiver

23. Domain Harmonization Matrix Working Session 23 eLTSS DomainsSub-DomainsMinnesota DomainsMapping Success Individual Outcomes Work Residence (Aging) Community Inclusion Choice & Decision Making Support Options and Strengths, Summary of Services Sub-Domains: Cognitive and Behavior Supports, Prevention of Abuse and Neglect Relationships Satisfaction Self-Determination Person-Centered ProfilePerson Information Sub-Domains: Name, Demographics, Person Master Index Number Health, Wellness, and Rights HealthSupport Options and Strengths Also includes items that are mapped to Functional Status. Sub-Domains: Personal Assistance, Home Management and Supportive Services Respect/Rights Medications Safety Wellness Behavioral Health Needs (Aging) Restraints Support Options and Strengths, Summary of Services Sub-Domains: Personal Security and Cognitive and Behavior and Supports, Prevention of Abuse and Neglect

24. Domain Harmonization Matrix Working Session 24 eLTSS DomainsSub-DomainsMinnesota DomainsMapping Success System Performance Access Service Coordination Financial/Payer Information Funding the Plan, Summary of Services Service InformationSummary of Services1:1 Staff Stability Emergency and Back-Up Plan for Services and Supports, Person Information, Coordinated Services and Support Plan Signatures Sub-Domains: Managed Care Provider, Assessor, Case Manager/Care Coordinator, Emergency Contact, Physician/Health Care Provider, Hospital, Signatures Family Indicators Choice & Control Family Outcomes Satisfaction Family Involvement Community Connections Community Support, Support Options and Strengths Sub-Domains: Training and Skill Building; Supportive Services Access & Support Delivery Information & Planning Target Population: All applicants/participants of all ages in Medical Assistance (MA) personal care assistance (PCA) services, Alternative Care (AC) and MA waiver programs, including Elderly Waiver (EW), Developmental Disability (DD) Waiver, Community Alternative Care (CAC) Waiver, Community Alternatives for Disabled Individuals (CADI) Waiver, Brain Injury (BI) Waiver, State-funded programs that are non-MA and are HCBS (such as Essential Community Supports and Title III Services), as well as non-eligible people who get assessment and support planning (this can be anyone with long term care and chronic needs in MN)

25. Domain Harmonization Matrix Working Session 25 eLTSS DomainsSub-DomainsConnecticut DomainsMapping Success Individual Outcomes Work Residence (Aging) Community Inclusion Choice & Decision Making Cognition, Psychosocial Well-being Relationships Satisfaction Self-Determination Person-Centered ProfileIdentification Information Health, Wellness, and Rights Health Diagnosis and Health Conditions, Communication/Hearing and Vision Post Assessment Outcomes, Assistive Technology/Durable Medical Equipment/ Specialized Medical Equipment, Environmental and Overall Status, ADLs, IADLs Respect/Rights Medications Safety Wellness Behavioral Health Needs (Aging) RestraintsMood and Behavior

26. Domain Harmonization Matrix Working Session 26 eLTSS DomainsSub-DomainsConnecticut DomainsMapping Success System Performance Access Service Coordination Financial/Payer Information Service Information History and Resources, Institutional Data Staff Stability Informant, Additional Contacts Family Indicators Choice & Control Family Outcomes Satisfaction Family Involvement Community Connections Formal and Informal Supports, Living Situation Access & Support Delivery Information & Planning Target Population:

27. Domain Harmonization Matrix Working Session 27 eLTSS DomainsSub-DomainsColorado DomainsMapping Success Individual Outcomes Work Residence (Aging) Community Inclusion Choice & Decision Making Behavior or Memory/Cognition under Supervision Relationships Satisfaction Self-Determination Person-Centered Profile Current Living Situation Applicant Information; Areas of Concern Health, Wellness, and Rights Health Emergency Room Data, ADLs – ULTC 100.2, ADLs, Long Term Care Assessment for Instrumental Activities of Daily Living Respect/Rights Medications Safety Wellness Behavioral Health Needs (Aging) RestraintsSupervision, Behaviors

28. Domain Harmonization Matrix Working Session 28 eLTSS DomainsSub-DomainsColorado DomainsMapping Success System Performance Access Service Coordination Financial/Payer InformationClaims Data Service Information Authorized Services, Eligibility Span Information Staff Stability Case Manager or other HCPB Provider Family Indicators Choice & Control Family Outcomes Satisfaction Family Involvement Community Connections Social Supports, Participation in Activities, External Resources Access & Support Delivery Information & Planning Target Population: Elderly, Blind, Disabled, Intellectually Disabled, Developmental Disability

29. Domain Harmonization Matrix Working Session 29 eLTSS DomainsSub-DomainsGeorgia DomainsMapping Success Individual Outcomes Work Residence (Aging) Community Inclusion Choice & Decision Making Captured in assessment. Not explicitly included in the plan unless relevant services are being provided. Relationships Satisfaction Self-Determination Person-Centered Profile Beneficiary Goals, Beneficiary Identifying Information Health, Wellness, and Rights HealthADLs/IADLs Clinical information is not captured within a plan in Georgia. Other documents/forms are used to capture and hold that information. Respect/Rights Medications Safety Wellness Behavioral Health Needs (Aging) Restraints May be captured in Comments/Notes

30. Domain Harmonization Matrix Working Session 30 eLTSS DomainsSub-DomainsGeorgia DomainsMapping Success System Performance Access Service Coordination Financial/Payer Information Financial information is included on a per service basis under ‘Service Information’ Service Information Staff StabilityCare Team Contact Information Family Indicators Choice & Control Family Outcomes Satisfaction Family Involvement Community ConnectionsBeneficiary Background Beneficiary background includes other items such as living arrangements, community activities, and preferred medical providers Access & Support Delivery Information & Planning Not Mapped to eLTSS Domains Plan Info and Important Dates Signatures and Dates Home Modifications Equipment and Supplies Required for Month Notes/Comments Target Population: Elderly, Physical Disability, TBI

31. Discussion Discussion/Reactions 31

32. 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 Friday, May 22 Next eLTSS Plan Content SWG Meeting – Tuesday, May 26 from 11:00am – 12:00pm 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. 32

33. 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.comlynette.elliott@esacinc.com 33