eLTSS Plan Content SWG
Homework 2: Validate Initial State Domain Mappings
Issue Date: May 14, 2015
Due Date: May 18, 2015 by 12:00pm Eastern
Assignment:
Use the document below to validate the initial domain mapping of your state’s domains to the domains
defined by the eLTSS Community. While performing the mapping, use the Mapping Feedback column to
provide feedback on the mapping. Example statements include 1:1, broad to narrow, narrow to broad,
sub-domain under particular domain, etc.
When you have completed the domain mapping exercise, then list the population(s) to which the
domains correspond below the table. This exercise is a preliminary high-level mapping of your state’s
domains to those defined by the eLTSS Community and will serve as a basis for discussion during
subsequent SWG meetings.
Homework 2: Validate Initial State Domain Mappings
Due Date: May 18, 2015 by 12:00pm Eastern
Definitions for eLTSS Community Identified Domains:
Domain
Brief Person-Centered
Profile/My Personal
Story
Clinical Information
Care Team
Functional Status
Cognitive Function
and Memory/Learning
Behavior Concerns
Service Information
Social Support,
Engagement, and
Integration
Financial/Payer
Information
Definition
Interests, goals, preferences, and priorities of a patient written by the
patient in their own words.
Medical conditions or diagnoses (e.g., cerebral palsy, HIV/AIDS, stroke,
epilepsy, quadriplegia, autism, schizophrenia) can potentially impact an
individual’s daily functioning. Common categories of medical
conditions/diagnoses for exploration include eating disorders, skin
conditions, heart disease, musculoskeletal disease, neurological/cognitive
disease or diagnosis, respiratory disease, behavioral diagnoses,
gastrointestinal disease, autoimmune disease, and cancer.
Group of individuals that are responsible for the care of a patient, including
patients, their caregivers, and clinicians proposed by multiple providers and
disciplines for multiple conditions to coordinate care of the patient during
the continuum of care for a patient.
These items include screening items on impairments (e.g. bladder, bowel,
swallowing, vision, hearing, weight-bearing, grip strength, respiratory status,
and endurance), as well as measures of self-care, mobility, and safetyrelated functions (medication management, phone management), and other
items relevant to less impaired populations.
Problems with memory or cognitive functioning can interfere at home,
school, work, or in the community. Areas to explore might include:
limitations with cognitive functioning attributable to a diagnosed condition
(e.g., intellectual disability, traumatic brain injury, Alzheimer’s disease) or
noted difficulties in the areas of attention/concentration, learning,
perception, task completion, awareness, communication, decision-making,
memory, planning or problem-solving. For children, these skills must be
assessed against age-appropriate developmental expectations for children of
a similar age.
Challenging behaviors are commonly characterized as those behaviors that
are self-injurious, hurtful to others, destructive to property, disruptive,
unusual or repetitive, socially offensive, uncooperative, or withdrawn or
inattentive.
Includes items that are important for the transfer of information between
facilities but were not otherwise captured, such as information on allergies.
These items target social support issues, including information on structural
barriers in the home, living situations, caregiver availability, and the need for
assistance, as well as issues related to discharge complications.
Financial information typically includes individual or household income
(including wages, benefits, and other income) and general assets.
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Homework 2: Validate Initial State Domain Mappings
Due Date: May 18, 2015 by 12:00pm Eastern
Georgia Domain Mappings:
eLTSS Community
Brief Person-Centered Profile/My
Personal Story
Clinical Information
Care Team
Functional Status
Cognitive Function and
Memory/Learning
Behavior Concerns
Service Information
Demographic/Background
Information
ADLs
IADLs
Social Support, Engagement, and
Integration
Financial/Payer Information
Georgia
Beneficiary Identifying
Information
Beneficiary Background
Care Team Contact Info
Equipment and Supplies
Required for Month
Home Modifications
Plan Information and Important
Dates,
Service Information
Beneficiary Background
ADLs/IADLs
ADLs/IADLs
Beneficiary Background
Beneficiary Goals
Signatures and Dates
Notes/Comments
Target Populations:
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Mapping Feedback