electronic Long-Term Services &
Supports (eLTSS) Initiative
All-Hands Workgroup Meeting
May 21, 2015
1
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
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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
S&I Framework to Participants:
addressed publically in the chat, or discussed in the From
Hi everyone: remember to keep your phone
on mute 
meeting (as appropriate).
o Please DO NOT use the Q&A—only the presenter
All Panelists
sees Q&A, not necessarily the person facilitating the
discussion
2
Agenda
Topic
Presenter
Timeframe
Welcome
Announcements
eLTSS Roadmap
Lynette Elliott
10 mins
eLTSS Plan Content SWG Debrief
Grant Kovich
10 mins
eLTSS Use Case End-to-End Review
Becky Angeles
10 mins
Concert Series Presentation: Harmony
Information Systems
John Byer
30 mins
3
Announcements
Funding Opportunity: States encouraged to enhance access to long
term services and supports through No Wrong Door Systems
Eligible applicants must be from one of the 25 states which received a 2014 Transforming
State LTSS Access Programs and Functions into A No Wrong Door System for All
Populations and All Payers grant. Applicants must be a state entity and only one
application can be submitted per state. The Office of the Governor must designate the
state entity to be involved in the development and implementation of its NWD System.
View Grant Opportunity:
http://www.grants.gov/web/grants/view-opportunity.html?oppId=276621
http://acl.gov/Funding_Opportunities/Announcements/Index.aspx
Conference Call for Potential Applicants: May 27, 2015, at 2:00 pm ET
Call: 888-282-1672
Passcode: 3363664
Webinar Link: https://optum.webex.com/optum/j.php?MTID=m3ce54d749f5a3de764704b75de321bc3
Letter of Intent Due: June 14, 2015
Deadline for Application Submission: July 27, 2015, at 11:59 pm ET
4
Announcements
HHS, CMS and ONC announced the release of the following
on March 20, 2015:
– Stage 3 Notice of Proposed Rulemaking (NPRM) for the Medicare and
Medicaid Electronic Health Records (EHRs) Incentive Program
• specifies new criteria that EPs, EHs, and CAHs must meet to qualify for Medicaid
EHR incentive payments
• proposes criteria that providers must meet to avoid Medicare payment
adjustments based on program performance beginning in payment year 2018
– 2015 Edition Health IT Certification Criteria
• aligns with the path toward interoperability identified in ONC's draft shared
Nationwide Interoperability Roadmap
• builds on past editions of adopted health IT certification criteria,
• includes new/updated IT functionality and provisions that support the EHR
Incentive Programs care improvement, cost reduction, and patient safety across
the health system
– Comment period ends May 29, 2015
5
Announcements (continued)
• PUBLIC COMMENTS: You may submit comments, identified by RIN 0991-AB93,
by any of the following methods (please do not submit duplicate comments).
Because of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
•
•
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Federal eRulemaking Portal: Follow the instructions for submitting comments.
Attachments should be in Microsoft Word, Microsoft Excel, or Adobe PDF; however, we
prefer Microsoft Word. http://www.regulations.gov .
Regular, Express, or Overnight Mail: Department of Health and Human Services, Office of
the National Coordinator for Health Information Technology, Attention: 2015 Edition
Health IT Certification Criteria Proposed Rule, Hubert H. Humphrey Building, Suite 729D,
200 Independence Ave, S.W., Washington, D.C. 20201. Please submit one original and two
copies.
Hand Delivery or Courier: Office of the National Coordinator for Health Information
Technology, Attention: 2015 Edition Health IT Certification Criteria Proposed Rule, Hubert
H. Humphrey Building, Suite 729D, 200 Independence Ave, S.W., Washington, D.C. 20201.
Please submit one original and two copies. (Because access to the interior of the Hubert
H. Humphrey Building is not readily available to persons without federal government
identification, commenters are encouraged to leave their comments in the mail drop slots
6
located in the main lobby of the building.)
Announcements (continued)
• 2015 Long Term Post Acute Care (LTPAC) & HIT
Summit
– What: The LTPAC HIT Summit is the premiere health IT
conference for individuals within and working with the
LTPAC industry for over 10 years. As the key conference of
HIT leaders, policy makers, providers, vendors and
professionals, the Summit continues to advance initiatives
facing the long term, post acute care industry and
priorities from the latest Roadmap for Health IT in LTPAC.
– When: June 21-23, 8am-5pm ET
– Where: Baltimore, MD in the Baltimore Hilton
– To register: http://www.ahima.org/events/2015june-ltpac
7
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 a one or more of
the eLTSS settings: home and community-based setting or
clinical setting?
• Does solution incorporate existing or emerging standards
and/or other relevant guidance?
8
Concert Series Presentations: Logistics
• Presentations will be scheduled as part of the weekly eLTSS
Community Meetings and will occur the last 30 mins of the call
• Duration: 15-20 mins webinar (or demo); 5-10 mins Q&A
• 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)
• A pre-planning meeting will be scheduled prior to any public
demonstration
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Upcoming Concert Series Presentations
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May 28th: (available)
June 4th: (available)
June 11th: (available)
June 18th: MyDirectives.com (A|D Vault)
June 25th: Right Care Now
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eLTSS Initiative Roadmap
Q3 ‘14
Q4 ‘14
Q1 ‘15
Q2 ‘15
Q3 ‘15
Q4 ‘15
Q4 ‘17
Initiative Kick Off: 11/06/14
Pre-Planning
• Call for
Participation
• Conduct
Environmental
Scan
• Success Criteria
• Stakeholder
Engagement
Phase 2: Use Case Development
& Functional Requirements
Phase 1: Pre-Discovery
• Launch initiative
• Review and Finalize Charter
• Review initial Candidate
Standards
Phase 4: Pilots &
Testing
• Pilot site readiness
• Implementation of
• Develop, review, and finalize
solution
the Use Case and Functional
• Test User Stories and
Requirements
Scenarios
• Monitor Progress &
Phase 3: Standards & Harmonization Outcomes Phase 5:
Evaluation
• Finalize Candidate Standards
• Utilize Requirements
Traceability Matrix
• Standards Gap Analysis
• Evaluate outcomes
• Technical & Standards Design
against Success
• Develop Requirements Traceability
Metrics and
Matrix
Criteria
• Develop Implementation Guide
• Update
Implementation
Guidance
Timelines for Consideration: Two Pilot Phases, SDO Ballot Cycles
11
Goals for the eLTSS Initiative
• Identify key 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.
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eLTSS Use Case Development:
Domain Identification
13
Domains
eLTSS Plan:
Proposed Domains & Sub-Domains
Individual
Outcomes
Health, Wellness,
and Rights
System
Performance
Family Indicators
Work
Health
Access
Choice & Control
Residence
Sub-domains
Community Inclusion
Respect/ Rights
Service Coordination
Medications
Choice & Decision Making
Safety
Relationships
Satisfaction
Self-Determination
Satisfaction
Financial/ Payer
Information
Family Involvement
Wellness
Community Connections
Service Information
Behavioral Needs
Restraints
Access & Support Delivery
Staff Stability
Information & Planning
Cross-cutting
Domains
Person-Centered Profile
Family Outcomes
14
eLTSS Plan Content SWG Information
• Sign up for the eLTSS Plan Content SWG on the Wiki
– http://wiki.siframework.org/eLTSS+Plan+Content+SWG
– Joining the eLTSS Plan Content SWG ensures that you are included on
workgroup communications and announcements.
• Next eLTSS Plan Content SWG Meeting
– Tuesdays (weekly) from 11:00am – 12:00pm Eastern
– http://wiki.siframework.org/eLTSS+Plan+Content+SWG
• Thank you! Your commitment and participation are critical to
our success.
15
Project Charter and eLTSS Glossary
• FINAL Published Project Charter located here:
http://wiki.siframework.org/electronic+LongTerm+Services+and+Supports+%28eLTSS%29+Charter
• eLTSS Glossary posted here:
http://wiki.siframework.org/eLTSS+Glossary
– The eLTSS Glossary is a working document containing eLTSS-relevant
terms, abbreviations and definitions as defined by stakeholders
– We are looking for your feedback and comments
• Discussion Thread available
• Submit any change requests via the Change Request Form located
on the wiki
– Reminder: the Glossary is a living document and content may change
as the initiative progresses
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Proposed Use Case Development Timeline
Wk.
Target Date
(2015)
1-5
1/22-2/19
Use Case Kick-Off & UC Process Overview
Use Case Value Framing Discussions
Review and Answer Value Framing Questions on wiki
6
2/26
Review: Consolidated UC Value Framing
Introduce: Context Diagram & User Stories
Review: Context Diagram & User Stories
7
3/12
Finalize: Context Diagram & User Stories
Review: User Stories
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3/19
Review: User Stories Comments
Review: User Stories, Glossary
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3/26
Review: User Stories
Introduce: Actors & Roles
Review: User Stories, Actors & Roles
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4/2
Finalize: Actors & Roles
Introduce: In/Out of Scope
Review: In/Out of Scope
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4/9
Finalize: In/Out of Scope
Introduce: Assumptions & Pre/Post Conditions
Review: Assumptions & Pre/Post Conditions
12
4/16
Finalize: Scope, Assumptions & Pre/Post Conditions
Introduce: Activity Diagram & Base Flow
Review: Activity Diagram & Base Flow
13
4/23
Finalize: Activity Diagram & Base Flow
Introduce: Functional Requirements & Sequence Diagram
Review: Functional Requirements & Sequence Diagram
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4/30
Finalize: Functional Requirements & Sequence Diagram
Introduce: Data Requirements
Review: Data Requirements
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5/7
Finalize: User Stories
Introduce: Risks, Issues & Obstacles
Review: Risks, Issues & Obstacles
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5/14
Dataset Requirements – eLTSS Plan Content SWG
Review: Refer to SWG Homework
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5/21
Begin End-to-End Review
End-to-End Review by community (Ends 5/28 at 8pm ET)
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5/28
End-to-End Comments Review & disposition
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6/4
Finalize End-to-End Review Comments & Begin Consensus
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6/11
Consensus Vote*
All Hands WG Meeting Tasks
Review & Comments from Community via Wiki page
due following Tuesday by 8 P.M. Eastern
Cast Consensus Vote
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18
Use Case End-to-End Review & Consensus
Timeline
Date
Item
5/21
Open End-to-End Review
5/28
Review End-to-End Comments (Close End-to-End Review at 8pm ET)
5/29-6/3
End-to-End Review Comment Dispositions
6/4
Open Consensus Voting
6/11
Close Consensus Voting at 8:00pm ET
6/12-17
Consolidate Votes and Address “No” Votes
6/18
Review Final Comment Dispositions and Complete all Outstanding Votes
Verbally
6/19
Publish Consensus Voting Results
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eLTSS Use Case End-to-End Review
• The eLTSS Plan Use Case is ready for End-toEnd Review
• This is your final chance to review and provide
modifications prior to Consensus Voting
• Please review the Use Case and provide
comments:
– Via the Wiki Comment Form
– Via email to becky.angeles@esacinc.com
• Comment Period Closes Thursday, May 28th at
8pm ET
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Consensus on the Use Case
• On June 4th, Committed members will be asked to cast a vote on the
“eLTSS Plan Use Case”
– Yes
• A Yes vote does not necessarily mean that the deliverable is the ideal one from the
perspective of the Initiative Member, but that it is better to move forward than to block
the deliverable
– Yes with comments
• If a Consensus Process attracts significant comments (through Yes with comment votes),
it is expected that the comments be addressed in a future revision of the deliverable.
– Formal Objection- with comments indicating a path to address the objection
in a way that meets the known concerns of other members of the Community
of Interest. "Formal Objection" vote without such comments will be
considered Abstain votes.
• A Formal Objection means that the objector cannot proceed with the project unless the
objections are met. It is acceptable and expected to use a Formal Objection in a first
consensus round to communicate a point of view or process issue that has not been
addressed in the drafting of the initial deliverable.
• Should a Consensus Process attract even one "Formal Objection" vote with comments
from an Initiative Member, the deliverable must be revised to address the "Formal
Objection" vote (unless an exceptional process is declared).
– Abstain (decline to vote)
Note: Each Organization, no matter the number of Committed Members only receives 1 Vote. If there
are multiple committed members from your organization please verify your collective vote with them
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Submitting Your Vote
http://wiki.siframework.org/electronic+Lo
ngTerm+Services+and+Supports+%28eLTSS%
29+Consensus
1. Review the eLTSS Plan Use Case:
– Final document will be available
6/3/2015
2. Complete the Voting Form:
1
– NOTE: You must be a Committed
Member to Vote
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Yes
Yes with comments.
Formal Objection
Abstain (decline to vote)
2
3.
Submit your Vote
4.
A message is displayed verifying your
vote was recorded
3
4
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Viewing Your Vote
5. You can view and track your Vote (located directly below the Voting Form)
•
Note: you may need to refresh your browser a few times to see your vote
5
Note: All Consensus Votes are due June 11th by 8:00 pm ET
23
Become a Committed Member
• Only Committed Members are allowed to
VOTE on the Use Case
• If you are signed up as an Other Interested
Party, you are not able to vote. However, you
can change your status to Committed Member
(so you can vote) here:
– http://wiki.siframework.org/eLTSS+Join+the+Initia
tive
• Please contact Saurav Chowdhury (saurav.chowdhury@esacinc.com) if you would
like to confirm your submission, change your status, or if you have any other
membership/wiki concerns.
24
eLTSS All-Hands Next Steps
• Complete an end-to-end review of the Use
Case and provide comments/feedback by
Thursday, May 28th at 8pm ET
• Join us next Thursday, May 28th to review the
end-to-end comments
• We are looking for technical experts that have
solutions for the next phase of our eLTSS
work. Please spread the word to those you
think could help us and have them join our
Thursday All-Hands meetings.
25
26
eLTSS All-Hands Workgroup
Concert Series Presentation
May 21, 2015
John Byer, VP of Sales and Business Development
jbyer@harmonyis.com
Agenda
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•
•
•
•
Who we are
Medicaid-funded LTSS Perspectives
Context for eLTSS Plan
Key Concepts and Lessons Learned
Trends
28
Purpose Built for LTSS Collaboration
o Agencies, providers, MCOs,
caregivers, families and
beneficiaries work
collaboratively around a
single consumer view
o Unified and interoperable
data
o Processes are real-time
avoiding action taken based
on outdated information
o Process changes
accommodated quickly
o Engaged families and
caregivers improve outcomes
29
Purpose Built Technology for HCB LTSS
o Helps streamline access to
LTSS
o Facilitates creation of
meaningful longitudinal data
sets at participant and
program levels
o Shortens payment cycles for
providers
o Helps payers reduce risk,
manage costs
o Enables collaboration,
Person-Centered Planning
and Interoperability
o “Future-Proof”
30
Technology for HCB LTSS
o Modular, end-to-end
automation
o Intake
o Level 1 Screen
o Level 2 Assessment
o Eligibility
o Enrollment
o Planning
o Authorizations
o Service Delivery
o Billing
o Oversight
o Outcomes
o Re-Assessment and ReEnrollment
o Interoperable
31
Our Focus and Customers
• Helping to Optimize Long Term Services and
Supports (LTSS)/Home and Community Based
Services (HCBS) since 1994
• Customers
• State Level
• Medicaid funded LTSS, including departments
of Medicaid and other state agencies
overseeing waivers (I/DD, People with
Disabilities, Frail Elders, etc.), MCOs and other
stakeholders
• Other LTSS Programs, including OAA
• Local
• Regional LTSS Agencies, AAAs, Providers,
CBOs and other partners
• In 2015 will surpass 30,000 end users – all LTSS
stakeholders
32
Agenda
•
•
•
•
•
Who we are
Medicaid-funded LTSS Perspectives
Context for eLTSS Plan
Key Concepts and Lessons Learned
Trends
33
Perspectives of State Agencies With
Medicaid-funded LTSS Programs
• Traditional
• Visibility
• Accountability
• Quality
• Waitlists
• Provider Oversight/Incident Investigation
• Outcomes
• Efficacy
• Financials
• Reconciliation
• Fraud
• Security
• Emerging
• Managed LTSS
• Person Centered Approaches
• Interoperability
• Quality Indicators and Analytics
34
Agenda
•
•
•
•
•
Who we are
Medicaid-funded LTSS Perspectives
Context for eLTSS Plan
Key Concepts and Lessons Learned
Trends
35
eLTSS Use Case
(From eLTSS Initiative Use Case)
36
Streamlining LTSS: State View
Beneficiary,
Caregivers,
other Team
Members
Participants
Intake, Assessment and
Eligibility
Case
assignment
 Interoperable
 Innovative
 Flexible
eLTSS
Plan
Families
Driven by needs of
Individual
MedicaidFunded Plans
come with
some strings
Dashboards
Authorizations
Person
Centered
LTSS
Incident &
complaint
mgmt.
Delivery
Billing,
Payment
Monitoring
Enrollment Process for LTSS
Financial
Eligibility
MMIS
NWD
Level 1
Screen
Level 2
Level of Care
Determination
Choices
Counseling
MCI
Enrollment
MPI
38
Streamlining LTSS: State View
Streamlining LTSS
MPI
Participants
Assessment and Uniform
Clinical/SNF Level of Care
Determination
Case
assignment
 Interoperable
 Flexible
eLTSS
Plan
Families
Driven by needs of
Individual
Dashboards
Authorizations
Person
Centered
LTSS
Incident &
complaint
mgmt.
MMIS
Delivery
Billing,
Payment
Monitoring
Agenda
•
•
•
•
•
Who we are
Medicaid-funded LTSS Perspectives
Context for eLTSS Plan
Key Concepts and Lessons Learned
Trends
40
Data Follows the Person
Longitudinal
Access, Inform, Assess
& Enroll
•
•
•
•
Call centers
Web self-service
Assessments
Eligibility determination
Care Coordination
Measure & Analyze
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•
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•
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Person- Centered planning
Team Engagement
Service authorization,
delivery and
reimbursement
Ongoing assessment and
planning
Confidential Information
Outcomes
Core quality measures
Provider Oversight
Financial and budget
performance
41
Harmony Helping to Optimize HCBS



Over 8 million participants receiving HCB LTSS
167 million service delivery records
$12 Billion in HCB LTSS services
42
Helping to Identify Unmet Needs and Establish
Clinical Eligibility




Over 3.5 million consumers assessed
Almost 10 million assessments sessions created
Over 1 billion assessment questions answered
All tracked longitudinally
43
Sample Assessment Interface
Confidential Information
44
Cross-walking Longitudinal Assessment Data
Confidential Information
45
Input from Consumer & Informal Supports
Confidential Information
46
interRAI Clinical Assessment Protocols (CAPS)
Confidential Information
47
Mobile Assessments
Confidential Information
48
Mobile Assessments
Confidential Information
49
Lessons Learned - Assessments
 Uniform Assessment Instruments

Can be difficult politically
 Core Data Set



Cross walking data important
Managing change
Maintaining longitudinal integrity can be hard
Confidential Information
50
Consumer/Caregiver Module: Access Planned
Services
Confidential Information
51
Consumer/Caregiver Module: Access Support Plans
Confidential Information
52
Lessons Learned – Consumer/Caregiver Portal
 Adoption is a work in progress
 Competing Needs
 Clear trend, gaining momentum
Confidential Information
53
Rapid Change
Healthcare
Long Term
Services and
Supports
Blending Healthcare and LTSS
Integration – Interoperability – Security - Consent
54
Lessons Learned – Risk
 Time, Cost, Success/Failure



Outside Factors
Political/Institutional Resistance
Custom Development
Confidential Information
55
Lessons Learned - Stakeholders
 Many influencers within state enterprise







Participants/Advocates
State Agencies
Legislatures, Governors
CIOs
Internal IT
CMS
Providers
 Some have the ability to enable adoption of
interoperable eLTSS Plan and others have the ability
to block it
 Must fit within state’s plan for security and access
control
Confidential Information
56
Agenda
•
•
•
•
•
Who we are
Medicaid-funded LTSS Perspectives
Context for eLTSS Plan
Key Concepts and Lessons Learned
Trends
57
Trends
•
•
•
Managed LTSS
Person-centered approaches
Interoperability
• Influenced by states
• Closed systems phased out
• One-off custom IT projects?
58
Thank You
John Byer – VP of Sales and Business Development
jbyer@harmonyis.com
eLTSS Initiative: Project Team Leads
•
ONC Leads
–
–
•
CMS Lead
–
•
Grant Kovich (grant.kovich@accenture.com)
Standards Development Support
–
•
Becky Angeles (becky.angeles@esacinc.com)
eLTSS Plan Content SWG Lead
–
•
Lynette Elliott (lynette.elliott@esacinc.com)
Use Case & Functional Requirements Development
–
•
Evelyn Gallego-Haag (evelyn.gallego@siframework.org)
Project Management & Pilots Lead
–
•
Andrey Ostrovsky (andrey@careathand.com)
Nancy Thaler (nthaler@nasddds.org)
Terry O’Malley (tomalley@mgh.harvard.edu)
Initiative Coordinator
–
•
Jennie Harvell (jennie.harvell@hhs.gov)
Community Leads
–
–
–
•
Kerry Lida (Kerry.Lida@cms.hhs.gov)
Federal Lead
–
•
Elizabeth Palena-Hall (elizabeth.palenahall@hhs.gov)
Patricia Greim (Patricia.Greim@hhs.gov)
Angelique Cortez (angelique.j.cortez@accenture.com)
Harmonization
–
Atanu Sen (atanu.sen@accenture.com)
60