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June 13, 2018

HCBS Quality & e-LTSS 

Webinar 
Webinar Agenda 

I. Introduction of the e-LTSS: Jean Close, Deputy Director, Division of 

Community Systems Transformation, Disabled and Elderly Health Programs 

Group, Centers for Medicare & Medicaid Services

II. Discussion of e-LTSS initiative and its intersection with 

HCBS Quality: Elizabeth Palena Hall, LTPAC Coordinator, Office of Policy, 

Office of the National Coordinator for Health Information Technology 

III. A grantee perspective on e-LTSS and the quality of 

services: Beth Munro, Director of Supports Planning, Independence Now, 

Inc. 

V. Question & Answer Session
Introduction

Jean Close, Deputy Director, Division of Community Systems 

Transformation within the division of Disabled and Elderly Programs 

Group at the Center for Medicaid and Medicare Services (CMS) 
HCBS Quality and e-LTSS Webinar

Liz Palena Hall, LTPAC Coordinator, Office of Policy, ONC

Date: June 13th, 2018
Agenda

6

• Background: Purpose & Scope

• eLTSS Stakeholders and Pilot Participants

• eLTSS Dataset Development and Pilot Approach

• eLTSS Results and Final Dataset

• Value Proposition for Standardization

• Next Steps: SDO Engagement and HL7 Process Overview

• Get Engaged! 
Background: What is the electronic Long-Term Services 

& Supports (eLTSS) Initiative? 

• Driven by the requirements of the CMS Testing Experience and 

Functional Tools (TEFT) in Medicaid community-based long 

term services & supports (LTSS) Planning and Demonstration 

Grant Program

• Supports CMS Requirements for Person-Centered Service Plans 

(PCSPs) as defined within the HCBS 1915 (c) Waiver Final Rule

https://www.medicaid.gov/medicaid/ltss/teft-program/index.html
What is the scope of eLTSS? 

1. Identifying components or data elements needed for the 

electronic creation, sharing and exchange of person-centered 

service plans

» Data elements comprise the information needed by users of personcentered service plans; they are the units used to populate forms or 

containers of data for electronic exchange

» Designed so they are “understood” by various user groups:

– Human Readable: e.g. Multi-disciplinary providers, beneficiaries and their caregivers, 

accountable entities and payers

– Machine Readable: e.g. clinical and non-clinical IT systems used by the various 

groups

2. Field testing/piloting these data elements within participating 

organizations (pilots) respective systems (paper based and 

electronic)

8
eLTSS Stakeholder Engagement

32

339 Total 

Members

• 100 Committed Members

• 239 Other Interested Party

• 318 Not Registered (attended 1+ meeting)

Stakeholder Group Type/ Total Participants

Beacon Community, Quality Improvement 

Organizations, or similar organization

4 Research Organization 19

Consumer / Patient Advocate 12 Standards Organization 4

Contractor / Consultant 33 Service Provider (community-based) 13

Federal, State, Local Agency 143 Service Provider Professional (communitybased)11

Health Information Exchange (HIE) / Health Information 

Organization (HIO)

10 Other System IT Vendor (Community-Based IT 

Vendor or Other)

21

Health IT Vendor (EHR, EMR, PHR, HIE) 45 Other 49

Health Professional (DO, MD, DDS, RN, Tech, etc.) 15 Unknown 198

Healthcare Payer/Purchaser or Payer Contractor 5 TEFT Leadership / TA 32

Licensing / Certification Organization 2 ONC Staff / Contractor 26

Provider Organization (institution / clinically based) 9
eLTSS Pilot Organizations

10

TEFT Organizations (Round 1 & 2) Non-TEFT Organizations

CO: Dept. of Health Care Policy & 

Financing

Meals on Wheels of 

Wisconsin (Round 1 & 2)

Care at Hand (Round 1)

CT: Dept. of Social Services Division 

of Health Services

Medical Micrographics 

(Round 2)

eCaring (Round 1)

GA: Dept. of Community Health Therap (Round 1 & 2) Janie Appleseed (Round 1)

KY: Office of Administrative & 

Technology Services

Netsmart (Round 2) Kno2 (Round 1)

MD: Dept. of Health & Mental 

Hygiene

FEI Systems (Round 1 & 2) National Disability Institute

(Round 1)

MN: Dept. of Human Service AD Vault (Round 1) Peer Place (Round 1)

Detailed presentations from each of the Pilot Sites available here: 

http://oncprojectracking.healthit.gov/wiki/display/TechLabSC/eLTSS+Pilots#eLTSSPilots-Round2PilotPlanPresentations
eLTSS Dataset Development Approach

Harmonization (definition): to bring into harmony, accord or agreement

When speaking of standards, relates to process of minimizing redundant or conflicting 

standards which may have evolved independently.

Source: http://ulstandards.ul.com/about/harmonizing-standards/
eLTSS Dataset Development and Pilot Approach

• Identified and validated through 2 rounds of public-facing pilots and 

harmonization activities

• After each round, dataset went through a public comment and 

disposition period

• Extensive education and outreach to facilitate pilots

» ONC developed Pilot Starter Kit to inform how pilots can plan for and 

execute on an eLTSS Pilot

• Round 1: pilots provided LTSS service plans where common question 

fields and expected answers identified

» Core elements—necessary to include in eLTSS plan

» Non-Core Elements—important but not necessary to include

• Round 2: pilots tested 47 core data elements with 3 or more distinct 

provider types

» Pilots updated current service plans with new elements and sent to 

providers via fax and/or email for feedback

» All TEFT grantees, with exception of CT, tested data elements using 

electronic method
eLTSS Results: Incremental Electronic Testing

13

Text

Tier III

Basic, Non-Electronic Information Exchange

• Establish information infrastructure for Tiers II and III

• Information can be exchanged by paper, fax, or other secure method

Tier II

Tier I

Text

Complete eLTSS Data Model and Exchange

•Implement complete eLTSS data model

•Import/export eLTSS data via robust technologies

Secure, Electronic Information Exchange

• Exchange data, reports, and files defined in Tier I

• Leverage established content and transport standards

* Minimum requirements for TEFT round 1 Pilots

TEFT Grantees successfully demonstrated shift from nonelectronic testing (Tier I) of dataset to electronic testing (Tier II) 
eLTSS Final Dataset

• Total Number of Elements: 56

Beneficiary 

Demographics:

10 Elements

Person Name

Person Identifier

Person Identifier Type

Person Date of Birth

Person Phone Number

Person Address

Emergency Contact 

Name

Emergency Contact 

Relationship

Emergency Contact 

Phone Number

Emergency Backup Plan

Goals & Strengths:

3 Elements

Goal

Step or Action

Strength

Plan Information: 

1 Element

Plan Effective Date

Plan Signatures: 

12 Elements

Person Signature

Person Printed Name

Person Signature Date

Guardian/Legal 

Representative Signature 

Guardian/Legal 

Representative Printed 

Name

Guardian/Legal 

Representative Signature 

Date

Support Planner Signature

Support Planner Printed 

Name

Support Planner Signature 

Date

Service Provider Signature

Service Provider Printed 

Name

Service Provider Signature 

Date

Risks: 2 Elements

Identified Risk

Risk Management Plan

Person Centered 

Planning: 

11 Elements

Assessed Need

Preference

Person Setting Choice 

Indicator

Person Setting Choice 

Options

Service Options Given 

Indicator

Service Selection 

Indicator

Service Provider Options 

Given Indicator

Service Provider 

Selection Agreement 

Indicator

Service Plan Agreement 

Indicator

Plan Monitor Name

Plan Monitor Phone 

Number

Service Provider 

Information:

5 Elements

Support Planner Name

Support Planner Phone 

Number

Service Provider Name

Service Provider Phone 

Number

Non-Paid Provider 

Relationship

Service Information: 

12 Elements

Service Name

Self-Directed Service 

Indicator

Service Start Date

Service End Date

Service Delivery Address

Service Comment

Service Funding Source

Service Unit Quantity

Unit of Service Type

Service Unit Quantity 

Interval

Service Rate per Unit

Total Cost of Service

Final dataset and information on HL7 engagement 

available at: 

https://oncprojectracking.healthit.gov/wiki/display/

TechLabSC/eLTSS+Home
eLTSS Results

• Successful completion of two rounds of testing (pilots)

» Pilots included 6 TEFT grantees and 12 non-TEFT grantees

» Round 1 results: 692 total data elements narrowed down to 47 core 

data elements

» Round 2 results: Over 270 comments received and request for 114 new 

data elements; narrowed down to 56 core data elements and 36 noncore data elements

• Broad public engagement and contribution to eLTSS dataset

» Increased from 200 to 339 members over 2 years

» Members include non-TEFT participants across HCBS, government, health 

and technology industries

• Outreach and Education

» +130 different organizations contacted over course of initiative

» 5 Federal Partner Webinars

» 27 public outreach presentations 
Standardization: Ideal State

16

**Standardization at the data level, not IT system level. 

Information can be captured in different IT systems to include EHRs, PHRs, care 

coordination systems, HCBS/LTSS systems.
Vision for eLTSS Dataset Integration

17

eLTSS Dataset can be 

incorporated into various 

programs and 

health/wellness IT 

systems

Wearables

Transport Systems

Housing Systems

Mobile Health Systems

Clinical and nonclinical IT Systems

Education Programs Nutrition Programs

Wellness Programs

For interoperability, eLTSS

dataset needs to be 

represented using 

nationally recognized 

vocabularies and content 

standards
eLTSS Dataset Next Steps: 

Standards Development Organization(SDO) 

• In order for the eLTSS dataset to be incorporated into any electronic LTSS 

system and made interoperable and machine-readable with other 

electronic systems, it needs to be formatted using nationally and 

internationally recognized health IT standards. 

» A health IT standard provides the fundamental definitions for and structures of 

the data that can be communicated across a wide variety of health and servicebased use cases. 

• SDOs provide a level of legitimacy and formality to a technical 

innovation.

• SDOs serve to identify, publish and curate global standards for the exchange, 

integration, sharing and retrieval of electronic information. 

» SDO published standards can be enforced by inclusion in regulatory 

specifications by government agencies (both at the Federal and State level). 

» Many in the vendor community look to SDOs to help provide solutions that can 

be incorporated into a product offering. 

• HL7 is one of the SDOs whose standards are referenced by ONC
The HL7 SDO Ballot Process: 24-36 months 

Submit PSS to 

Technical 

Steering 

Committee (TSC)

Ballot Pool Opens 

for Voting **

Ballot 

Type

Submit PSS to US 

Realm Steering 

Committee

Establish Project 

Scope Statement 

(PSS) for HL7 *

Consensus 

Group Signup 

Begins

Ballot Reconciliation 

Deadline

Draft Notice For Intent 

to Ballot (NIB) -

Sponsoring Working Group 

(WG) Co-Chair will submit 

NIB

Harmonize Dataset 

and/or draft an 

Implementation Guide 

(IG)

Comment 

Only Informative

Standard for 

Trial Use 

(STU)

Normative Submit to 

ANSI for 

American 

National 

Standards

* PSS should be clear to US Realm 

Steering Committee, SD, TSC, & WG in 

terms of: Submission of scope and 

deliverables; Be relatable to other 

projects and activities of other WG’s

PSS encompasses SDO Charter 

Development; identifies Use Cases and 

Functional Requirements 

** Ballot pools must be open for 30 days 

before closing

*** 3 Cycles/year

Submit PSS to 

Steering Division 

(SD)

Consensus 

Group Signup 

Closes

WG Meeting 

***

Project Facilitator submits to US 

Realm for review and approval of 

appropriate placement of work

SD focuses on providing 

fundamental tools & building 

blocks to build standards and 

approval 

TSC develops projects and 

products providing direct 

support to Work Groups to work 

efficiently 

| |

|

Submit Ballot 

Content 

Steps 6-12 Repeat Until “Normative 

Status” is achieved (24-36 months)

Note: Not all projects will 

require an IG or a dataset

1 2

9

3 4

6 5

8 7

10 11 12
HL7 Ballot Process

• Process is rigorous and outlined by HL7 – those who ballot are required to adhere to the HL7 

process

» HL7 is ANSI accredited and as such must maintain a strict processes

• Projects are circulated with HL7 leadership prior to formally starting the ballot process.

» Done at HL7 Face-to-Face Workgroup Meetings

• HL7 has 3 ballot cycles per year which follow the Face-to-Face Workgroup Meetings

» Winter – January

» Spring – May (often International destination for this meeting)

» Fall - September

• A typical project takes 24-48 months to complete the entire ballot cycle

» Once a project makes it to Standard for Trial Use (STU) it is generally balloted 2-4 times as an STU 

before going Normative

– Normative ballots are the final ballots before the standard becomes a sanctioned/formally 

recognized standard
• One of the TEFT Grantees, GA, provided supplemental 

funding to advance the standardization of the eLTSS dataset 

through HL7

• HL7 will provide guidance on best available standards and 

revisions needed to update the dataset so they can be 

included in a standard

• GA will develop concept whitepaper and reference data 

model to:

» identify existing standards gaps with the eLTSS dataset

» describe how eLTSS dataset can be incorporated into existing 

content standards (C-CDA and FHIR)

21

eLTSS Standardization: Next Steps
• Get updates and announcements regarding eLTSS:

https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/Join+eL

TSS

• FHIR mini-Connectathon Thursday, June 28, 2018 in Atlanta, GA.

Details and sign-up: 

https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/eLTSS+F

HIR+mini-Connectathon

• eLTSS Community All Hands: July 19, 2018 12:30pm-1:30pm ET

https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/eLTSS+Home

• Learn more about the eLTSS Initiative:

» eLTSS Wiki: 

https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/eLTSS

+Home

» eLTSS Final Dataset and Summary: https://tinyurl.com/y8xczjhp

22

Get engaged! 
eLTSS Initiative: Project Team Leads

• ONC Leadership

» Elizabeth Palena Hall (elizabeth.palenahall@hhs.gov) 

» Stacy Perchem (anastasia.perchem@hhs.gov )

• CMS Leadership

» Kerry Lida (Kerry.Lida@cms.hhs.gov)

• Initiative Coordinator

» Evelyn Gallego (evelyn.gallego@emiadvisors.net) 

• Project Management 

» Jenny Brush (jennifer.brush@esacinc.com )

• Use Case & Functional Requirements Development

» Becky Angeles (becky.angeles@carradora.com) 

• Pilots Management

» Jamie Parker (jamie.parker@carradora.com)
Beth Munro

bmunro@innow.org

Director, Support Planning

Independence Now Center for Independent Living
Independence Now SPA:

 Very small – three full time Support Planners

 Currently serve 136 people

 Consumers range in age from 11 to 102 years old

 Consumers speak 22 different languages/dialects

 Supports Planners work from IN office vs from home as is true in most 

larger agencies

 Currently serve only Montgomery County, Maryland
BETH INTRO

 Director IN SPA 3 years this fall

 Personal passions:

• Deinstitutionalization

• Person centered thinking and planning

• Self-directed services

• Family supports

 Prior years primarily in Developmental Disabilities

 Arc Maryland – public policy

 Managed DHMH grant for family support, transition plans during 

ICF/MR closure and downsizing

 MAPS/PATH/ELP/MAD
SUPPORTS PLANNERS & QUALITY

 Training in Person Centered Thinking and underlying rationale

 Understanding of choice and control

 Where & when of meeting

 Who attends meeting – persons “voice” is loudest

 Service preferences

 Understanding of dignity of risk – especially with institutional 

transitions

 Training in basic person centered planning tools and even scripts, if 

necessary, to obtain basic information such as Important To/Important 

For
Maryland eLTSS

 Enables Transparency

 Tracking of service delivery

 Communication between providers

 Auditing for SP performance/compliance

 State auditing for compliance

 New Provider Portal allows more information sharing

 New MY LTSS

 Consumer control & reporting

 Advantageous to out of area family members
Maryland eLTSS &Person Centered Training

 Upon SPA assignment enough information in LTSS to enable “good fit” 

Support Planner assignment as well potential provider lists

 Age

 Disability

 Support Needs

 Preferred language/preferences for interpretation

 Natural supports/other programs

 Geography

 Risks

 Goals
LOOKING FORWARD TO:

 Department led and required for Support Planners - Person Centered 

Planning training 

 Self-Directed 
Q&A SESSION 

31