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Enrollemt workgroup
Enrollemt workgroup
Enrollemt workgroup
Enrollemt workgroup
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Enrollemt workgroup

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  • 1. HIT Policy Committee Enrollment Workgroup Monday, June 14, 2010 12:00pm ET
  • 2. Agenda Call to Order 1. Call to Order – Judy Sparrow, Office of the National Coordinator for Health Information Technology 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 3. Agenda Intro of W G Members 1. Call to Order 2. Introduction of Workgroup Members – Aneesh Chopra, Chair – Sam Karp, Co-Chair 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 4. HIT Policy & Standards Committees Enrollment Workgroup Aneesh Chopra, Chair Chief Technology Officer, OSTP Sam Karp, Co-Chair California Healthcare Foundation June 14, 2010
  • 5. Workgroup Members Chair: Aneesh Chopra, Federal CTO Co-Chair: Sam Karp, California Healthcare Foundation Members: Ex Officio/Federal: • Cris Ross SureScripts Sharon Parrott, O/S, HHS • James Borland Social Security Administration Nancy DeLew, CMS/HHS • Jessica Shahin U.S. Department of Agriculture Penny Thompson, CMS/HHS • Stacy Dean Center on Budget & Policy Priorities Henry Chao, CMS/HHS • Steve Fletcher CIO, Utah Gary Glickman, OMB • Reed V. Tuckson UnitedHealth Group John Galloway, OMB • Ronan Rooney Curam David Hale, NIH • Rob Restuccia Community Catalyst Paul Swanenberg, SSA • Ruth Kennedy Louisiana Medicaid Department David Hansell, Administration for • Ray Baxter Kaiser Permanente Children & Families, HHS • Deborah Bachrach Consultant Julie Rushin, IRS • Paul Egerman Businessman Farzad Mostashari, ONC • Gopal Khanna CIO, Minnesota Doug Fridsma, ONC • Bill Oates CIO, City of Boston Claudia Williams, ONC • Anne Castro Blue Cross/Blue Shield South Carolina • Oren Michels Mashery • Wilfried Schobeiri InTake1 • Bryan Sivak CTO, Washington, DC • Terri Shaw Children’s Partnership • Sallie Milam West Virginia, Chief Privacy Officer • Dave Molchany Deputy County Executive, Fairfax County
  • 6. Section 1561 of Affordable Care Act 1561. HIT Enrollment, Standards and Protocols. Not later than 180 days after the enactment, the Secretary, in consultation with the HIT Policy and Standards Committees, shall develop interoperable and secure standards and protocols that facilitate enrollment in Federal and State health and human services programs through methods that include providing individuals and authorized 3rd parties notification of eligibility and verification of eligibility.
  • 7. Draft Work Plan • May: Initial Scoping • June 14 – July 16: HIT Policy and Standards Committee Workgroup: Inventory, candidate standards, strategy to address gaps • July 16 – August 27: Standards development, NIEM process • Sept 31: Finalize standards recommendations
  • 8. Draft Workgroup Charge • Inventory of standards in use, identification of gaps, recommendations for candidate standards for federal and state health and human service programs in following areas: – Electronic matching across state and Federal data – Retrieval and submission of electronic documentation for verification – Reuse of eligibility information – Capability for individuals to maintain eligibility information online – Notification of eligibility
  • 9. Potential Deliverables 1. Inventory of standards-based data exchange in use today to enroll in health and human services 2. Candidate standards for data elements and messaging 3. Proposed process to fill in gaps to rapidly turn "requirements" into working prototypes/live implementations to deliver world class eligibility and enrollment services
  • 10. Potential Candidate Standards • Core data elements • Name, address, residence, income, citizenship, etc. • Messaging • Checking eligibility and enrollment • Consumer matching across systems • Retrieving and sending “packages” of verification information including income, employment, citizenship • Communicating enrollment information • Privacy and security • Secure transport • Authentication
  • 11. Standards Requirements We need to conceptualize standards that might be useful and work across a variety of use cases or architectures which might include: • Front end user-facing consumer portal to conduct initial eligibility checks and obtain and forward verification information • Comprehensive eligibility system for Health and Human Services programs • State or Federal exchange portals
  • 12. Draft Policy Principles Do not make policy through standards Standards and technologies must support and be in service to our policy goals: • Consumer at the center • Make enrollment process less burdensome; simplify eligibility process and make it seamless • Enter/obtain information once, reuse for other purposes • Make it easier for consumers to move between programs • Focus on 2014 world
  • 13. Draft Standards Principles • Keep it simple - Think big, but start small. Recommend standards as minimal as required to support necessary policy objective/business need, and then build as you go. – Don’t rip and replace existing interfaces that are working (e.g., with SSA etc.). – Advance adoption of common standards where proven through use (e.g., 270/271). • Don’t let “perfect” be the enemy of “good enough” Go for the 80 percent that everyone can agree on. – Opportunity to standardize the core, shared data elements across programs. – Cannot represent every desired data element. • Keep the implementation cost as low as possible – May be possible to designate a basic set of services and interfaces that can be built once and used by or incorporated by states. – Opportunity to accelerate move to web services. • Do not try to create a one-size-fits-all standard that add burden or complexity to the simple use cases – Opportunity to describe data elements and messaging standards that would be needed regardless of the architecture or precise business rules selected.
  • 14. Agenda Overview of W G Role & Charge 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge – Aneesh Chopra, Chair – Sam Karp, Co-Chair 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 15. Agenda Intro to Panel Presentations 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations – Aneesh Chopra, Chair 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 16. Agenda Penny Thompson - Panel 1 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 – Penny R. Thompson, Centers for Medicare & Medicaid Services 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 17. Agenda Alice W eiss - Panel 1 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 – Alice Weiss, National Academy for State Health Policy 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 18. Agenda Discuss Panel 1 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 – Discussion 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 19. Agenda Steve Fletcher - Panel 2 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts – Steve Fletcher, Chief Information Officer, Utah 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 20. State eHuman Services Efforts HIT Policy Committee June 14, 2010 J. Stephen Fletcher Chief Information Officer
  • 21. Utah Health Info Utah Health Information Network • UHIN is a State not-for-profit company • UHIN is a broad-based coalition of nearly all the hospitals, ambulatory surgery centers, national laboratories, insurers, and approximately 90% of the medical providers in Utah as well as the Utah State government. • All parties exchange data in a standard format using standard codes – Administrative costs savings – Opens the door to improving patient care and safety
  • 22. cHIE Clinical Health Information Exchange (cHIE) • Statewide system makes more complete patient information securely available to authorized providers • Gives providers the capacity to render more informed care and patients have more control over their information • Provides the means to locate and view information available from the health care entities that participate in this community effort
  • 23. cHIE cont’d Clinical Health Information Exchange (cHIE) • 11 entities are exchanging data • 9 Sites are actively pursuing a connection • 13 Organizations are collaborating with UHIN • 12 Electronic medical records vendors are pursuing a connection with the exchange
  • 24. Potential Issues w/HIE Potential Issues with HIE • Assumes that since these are government programs, there is no option for the provider (clinicians and facilities) to opt-out of participating in the HIE and no option for the patient to decide to opt-out of their information being involved in the HIE • Accurate, unambiguous, non-duplicative provider identification system provided by HIE – Liability protection – Lack resources – Primary identity focus is on keeping the patient identities unique and unambiguous, not the provider
  • 25. Utah state eREP State of Utah eREP: Front End Eligibility Check • eREP has a Rules Engine that cascades all information entered and suggests the optimal program according to eligibility rules • Data linking is done through web services links – Link to common shared customer information across several state applications – Use common standards for linking to certain Federal data sources such as Social Security, PARIS match, IRS, National New Hire – Mostly use Mainframe standards, use web services where available – Currently in the process of changing financial transactions to web services
  • 26. Utah State eREP cont’d State of Utah eREP: Front End Eligibility Check (continued) • Programs Included – CHIP and various related programs for adults – All Medicaid and cost sharing programs including several optional and waiver programs – TANF/FEP and Refugee financial programs – Several State optional financial programs – Food stamps – Child care assistance
  • 27. eREP Multiple Program Eligibility State of Utah eREP: Multiple Program Eligibility • Interfaces used to obtain electronic verification information: – All available Federal and State electronic match data, including the complete array of Social Security information such as BENDEX, SDX, Wire Third Party, SOLQ, SVES, Prison Match, Death Match. – IRS data including BEERS and the 1099 information provided on matching clients. – State/Federal consortiums such as PARIS match for civil service and veterans benefits, as well as the National New Hire Registry for TANF/FEP.
  • 28. Multiple Program Eligibility cont’d State of Utah eREP: Multiple Program Eligibility (continued) • Standards Used – Mainframe file transfer protocols established by the Federal partner (NDM transactions) • Data Elements for Consumer Entry – On-line application which creates an imaged document real time – State worker manually inputs the information from the imaged application into eREP • Consumer Authentication – Consumer verifies through electronic signature – Consumer then participates in immediate interview with no appointment necessary
  • 29. eREP Sending Packets State of Utah eREP: Sending Packets • Business Rules are maintained at the program level – All business rules are applied centrally at the application level, allowing the cascading process to select any and all appropriate programs • Standards used for messaging are IBM Websphere MQ and JMS
  • 30. Agenda Bobbie W ilbur - Panel 2 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts – Bobbie Wilbur, Social Interest Solutions 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 31. Social Interest Solutions Testimony HIT Policy Committee Enrollment Workgroup Meeting Washington, DC June 14, 2010
  • 32. Social Interest Solutions • Independent, mission-driven non-profit organization • Systems development, implementation, maintenance and enhancement • Integrated eligibility and case management systems and other solutions to support consumers • Support a range of state, county and city jurisdictions • Handle a range of public and private programs • One-e-App is the SIS signature product for eligibility and enrollment in programs ©2010 SIS Confidential and Proprietary
  • 33. The One-e-App Approach • Web-based system • Consumer-centric channels via: – Self-service – Call center – Assisted application support • Offers a secure single point of entry • Provides simultaneous preliminary and/or final eligibility determination across multiple public and private programs ©2010 SIS Confidential and Proprietary
  • 34. More on the approach . . . • Verifies applicant information via automated verification, scan, fax and e-mail and stores and manages verifications for submission to other systems and for future re-use • Supports telephonic and a variety of electronic signatures • Provides a consumer “home page” to allow for self-management of new applications, change in circumstances (modify), renewals (re-certification) for all programs • Provides consumer (and assistors) communication and notification via e-mail, text messaging and paper • Integrated across a range of public and private systems ©2010 SIS Confidential and Proprietary
  • 35. What Makes One-e-App Work • Careful, deliberate and complete gathering of consumer information • Real-time information verification through system and process integration • Searching enrollment systems for existing or prior benefit coverages • Real-time eligibility determination or routing • Augmenting the capabilities of existing legacy systems • Configurable client administration • Never accepting “it can’t be done” ©2010 SIS Confidential and Proprietary
  • 36. Standards and Integration • Innovative system integration using a range of tools from “mash ups” to complex web services • Translators that provide for data exchange across a continuum from HL7 to X12 to XML to . . . • Utilizing existing standards including: – ADA – HIPAA (Privacy and Trading Data (Transactional) – MITA – US Postal Standards • Augmenting the capabilities of existing legacy systems ©2010 SIS Confidential and Proprietary
  • 37. Consumer Access Consumer Access Outreach Certified Consumer Provider Community Provider Call Center Mail-In Paper County Self-Assistance Assistor Assistor Assistor Assistor Application Assistor • Match Birth Record • Apply, Modify, Renew Applications • Submit Applications Electronically • Submit Verification Documents Electronically • Select Medical Home or Provider • Look Up Eligibility Status • Manage Outreach, Notifications, Case • Access Data Mart • Other Features ©2010 SIS Confidential and Proprietary
  • 38. The One-e-App Architecture One-3-App Architecture . . . MITA architecture with services that can be Enterprise Integration Portal leveraged to augment legacy systems Authentication Data Transformation Data Validation Information Services Services Service Verification Service Workflow Dispatcher Document Business Engine Services Management Service Intelligence System Integration Other Services Engine Enterprise Service Bus Web Web Web Web Web Web Web Service Service Service Service Service Service Service Verification State & County USPS Patient Clearinghouse State Other Systems: Systems Eligibility Management Systems Medicaid Kaiser, Utility, School, Systems Systems Systems City, Health Plan, . . . ©2010 SIS Confidential and Proprietary
  • 39. Enrollment Across Programs • Health Programs: – Medicaid – SCHIP – EPSDT – Medicare Cost Sharing – County Indigent Care Programs – County, Clinic and Hospital Sliding Fee Programs – Hospital Charity Care Programs – County Expansion or Access Programs – Kaiser Permanente Child Health Plan and Kaiser Bridge – CaliforniaKids – Express Lane Eligibility (school lunch / MC linkage) – Pharmacy Discount Programs ©2010 SIS Confidential and Proprietary
  • 40. More Programs . . . • Food Stamps (SNAP) • Low Income Auto Insurance • TANF (Temporary Aid to Needy • Employment Assistance (WIA) Families) (Coming Soon) • Supplemental Nutrition for • Family Planning Women, Infants and Children • Cancer Detection and Treatment (WIC) Programs • Earned Income Tax Credit • General Assistance (EITC) • Drug and Alcohol Rehab Program • Child Tax Credit • Homeless Assistance • Voter Registration • Others • Low Income Energy Programs ©2010 SIS Confidential and Proprietary
  • 41. Reach • Arizona: Health-e-Arizona • Indiana: Ind-e-App • Maryland: Health-e-Link and Healthy Maryland (Coming Soon!) • California: – One-e-App • 15 California Counties • City of Los Angeles • Los Angeles Unified School District – Health-e-App – Statewide • Kaiser Permanente Child Health Plan • PG&E CARE Program • CaliforniaKids • Pharmaceutical Patient Assistance Programs (Coming Soon) ©2010 SIS Confidential and Proprietary
  • 42. ACA Player Summary ACA Player Summary Federal Portal State Portal •Information •Information •Routed to State Portal •Routed to Eligibility and Enrollment Systems Medicaid •Coverage Updates •Information •Consumer Portal •Application Support in Medicaid System Social Services •Exchange with Verification Systems •Information •Referral to Other Programs •Application Support in Social Service System •Coverage to Other Players •Exchange with Verification Systems •Coverage Management •Referral to Other Programs •Cost of Coverage •Coverage to Other Players State Exchange •Coverage Management •Information •Application Support for Private Insurance Insurance Companies on the State •Determine If Medicaid Prior to Private Insurance Exchange •Exchange with Verification Systems •Information •Referral to Other Programs •Coverage to Other Players •Consumer Coverage Confirmation State High Risk Insurance Risk •Coverage from Medicaid and State High •Track Changes in Consumer Coverage •Billing and Collecting Employee •Information •Referral to Medicaid Prior to High Risk Insurance •Determine Other Programs IRS •Coverage ManagementHigh Risk Insurance •Application Support for •Records Match •Cost of Coverage •Exchange with Verification Systems •Report No Coverage Consumer •Referral to Other Programs •Long term, should incorporate the ability to apply through •Coverage to Other Players tax return •Coverage Management •Assess penalty to non-covered ©2010 SIS Confidential and Proprietary
  • 43. ACA Players Must Employ Electronic Matching to serve as evidence of eligibility in lieu of paper ☐ Vital Records ☐ Employment history ACA Players Must ☐ Enrollment system ☐ Tax records ☐ Other Simplify verification and submission of documents ☐ Digitization of documents ☐ System verification Reuse of stored eligibility information to assist with retention of eligible individuals Provide Online access for individuals to: ☐ Apply ☐ Recertify ☐ Manage eligibility information Expand enrollment systems to: ☐ Integrate new programs ☐ Integrate new rules ☐ Integrate new functionalities ☐ Operate at increased volumes ☐ Apply the streamlined eligibility and verification processes to other Federal and State programs Notify parties of eligibility, recertification and other needed communication by: ☐ Email ☐ Cell Phone (e.g., text messaging, Apps) ☐ Other Provide other functionalities to streamline the enrollment process ©2010 SIS Confidential and Proprietary
  • 44. ACA Player Summary Health Plans ACA Player Summary County and Community Safety Net Programs Federal Portal State Portal •Information •Information •Routed to State Portal •Routed to Eligibility and Enrollment Systems Medicaid •Coverage Updates •Information •Consumer Portal •Application Support in Medicaid System Social Services •Exchange with Verification Systems •Information •Referral to Other Programs •Application Support in Social Service System •Coverage to Other Players •Exchange with Verification Systems •Coverage Management •Referral to Other Programs •Cost of Coverage •Coverage to Other Players State Exchange •Coverage Management •Information •Application Support for Private Insurance Insurance Companies on the State •Determine If Medicaid Prior to Private Insurance Exchange •Exchange with Verification Systems •Information •Referral to Other Programs •Coverage to Other Players •Consumer Coverage Confirmation State High Risk Insurance Risk •Coverage from Medicaid and State High •Track Changes in Consumer Coverage •Billing and Collecting Employee •Information •Referral to Medicaid Prior to High Risk Insurance •Determine Other Programs IRS •Coverage ManagementHigh Risk Insurance •Application Support for •Records Match •Cost of Coverage •Exchange with Verification Systems •Report No Coverage Consumer •Referral to Other Programs •Long term, should incorporate the ability to apply through •Coverage to Other Players tax return •Coverage Management •Assess penalty to non-covered PatientSIS Confidential and Proprietary ©2010 Management and EHR
  • 45. Leverage, Leverage… Leverage Consumer- Medicaid to Real-Time Support Centric ACA Verifications & Underpinnings Results! Eligibility for Insurance Build on MITA Determinations Exchange and Standard Other Architecture for Programs High Re-use Augment Legacy Systems Allow for new external Adopt Existing Standards with Minimal programs and services via Modifications ESB ©2010 SIS Confidential and Proprietary
  • 46. Contact Bobbie Wilbur Co-Director 916-566-2643 bwilbur@socialinterest.org Claudia Page Co-Director 510-273-4641 cpage@socialinterest.org www.socialinterest.org ©2010 SIS Confidential and Proprietary
  • 47. Agenda Ruth Kennedy - Panel 2 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts – Ruth Kennedy, Louisiana Medicaid 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 48. Electronic Eligibility Processes in Louisiana A State Perspective Louisiana Medicaid & CHIP Eligibility Division HIT Eligibility Workgroup Meeting June 14, 2010 J. Ruth Kennedy La. Dept of Health & Hospitals
  • 49. The Case for Eligibility Automation in Louisiana  Genuine desire to reduce number of uninsured, increase enrollment & access  Accelerate (faster) enrollment and maximization of retention  Advances in technology presented new opportunities  Severe state budget shortfalls  Eligibility workloads spiraling out of control  We believed it was possible to do so without compromising program integrity
  • 50. Starting Assumptions  Important differences in eligibility for public health coverage and TANF/SNAP  Less need for income preciseness  Underlying philosophy and goals  Automated processes will increase enrollment and retention of eligible individuals  Integrating IT into eligibility business processes is a heavy lift— about more than standards!
  • 51. Electronic Case Records (ECR)= Transformative  Totally paperless, web-based eligibility case records  Includes images of all incoming and outgoing documents  All eligibility employees in state can create, add to and access the ECR  Now institutionalized—conversion was completed in July, 2005
  • 52. Why Convert to Electronic Eligibility Case Records?  Major savings Labor and rental costs  Postage, filing systems, paper, printing costs, toner  Immediate accessibility to documents and data  better customer service  makes paperless eligibility business processes practical
  • 53. Trolley
  • 54. Files
  • 55. Ex Parte Renewals Using SNAP Data Since 2001  High level of confidence in SNAP income data  Match with DSS system identifies & flags children due for renewal with active SNAP case  Caseworkers still play major role in decision making  Income in SNAP system for Medicaid/CHIP income unit members is cross walked  ~ 2/3 of Medicaid children in active SNAP case  Has resulted in dramatic reduction in procedural (paperwork) closures
  • 56. Can We Built a Better Mousetrap?  Federal regs (42CFR 435.9160) mandate periodic redetermination ―at least every 12 months‖  In the 21st Century, is there a better way to do so for low risk cases?  Intensive data mining to determine case characteristics  Extensive testing and refining prior to implementation
  • 57. Web-Based Applications  We believe electronic signature is critically important  Focus groups indicate families appreciate the option  Eliminates the need for scanning; data electronically goes to ECR  Continuous improvement in functionality
  • 58. 4 photos LaChip
  • 59. Express Lane Eligibility(ELE)  CHIPRA option to use eligibility decisions by other agencies  Electronic eligibility data from SNAP agency  Over 14,000 children < age 19 have been automatically enrolled
  • 60. Some Lessons From the ELE Bleeding Edge  Simplification isn’t simple!  Data matching isn’t ―magic‖ or totally clean  ―Automatic‖ is relative  Human intervention is still important
  • 61. Beware the Watchman!! ―The government are very keen on amassing statistics. They collect them, add them, raise them to the Nth power, take the cube root and prepare wonderful diagrams. But you must never forget that every one of these figures comes in the first instance from the village watchman, who just puts down what he . . . pleases.” --Sir Josiah Stamp, 1880-1944 Head, Bank of England Yikes!!
  • 62. ―Organizational Change‖ is Essential to Maximize IT  Even more important than technology  Caseworkers ―open‖ and ―close‖ the door  Requires fundamental change in approach to eligibility  Major changes in expectations of caseworkers and managers  It’s about winning hearts & minds
  • 63. Louisiana’s Eligibility HIT Wish List for HHS  Enhanced FFP for ―standalone‖ Medicaid/CHIP eligibility systems  Data standards  Reporting requirements  Dissemination of information about state HIT eligibility innovations and ―lessons learned‖  ELE-type eligibility processes for adults as well as children
  • 64. Never doubt that a small group of thoughtful, caring people can change the world Indeed, it is the only thing that ever has !— Dr. Margaret Mead Ruth Kennedy LaCHIP Director & Medicaid Deputy Director Louisiana Department of Health & Hospitals P.O. Box 91030 Baton Rouge, LA 70821-9030 Telephone: 225 342 3032 Blackberry: 225 241 1437 Fax: 225 342 9508 E-Mail: ruth.kennedy@la.gov www.lachip.org
  • 65. Agenda Discuss Panel 2 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts – Discussion 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 66. Agenda W es Rishel - Panel 3 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform – Wes Rishel, Gartner 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 67. Enrollment Working Group Testimony Wes Rishel Distinguished Analyst 14 June 2010 Washington DC (via telephone) This presentation, including any supporting materials, is owned by Gartner, Inc. and/or its affiliates and is for the sole use of the intended Gartner audience or other authorized recipients. This presentation may contain information that is confidential, proprietary or otherwise legally protected, and it may not be further copied, distributed or publicly displayed without the express written permission of Gartner, Inc. or its affiliates. © 2010 Gartner, Inc. and/or its affiliates. All rights reserved.
  • 68. Why is interoperability so darn hard? An Interoperability Joke: Mrs. Johnson brings little Johnny in for his first day of school. After meeting the teacher in a group of moms, she pulls the teacher aside and says: Johnny is very sensitive, So, if he misbehaves, don’t hit him. Hit the kid next to him. That will scare him and he will straighten up.
  • 69. Things To Consider Standardizing • Core data elements • Name, address, residence, income, citizenship, etc. • Codes and structure (e.g., citizenship and ethnicity) • Signature: Electronic and/or digital; applicant, third-party data source • Data Formats • Business Functions • Checking eligibility and enrollment • Consumer matching across systems • Retrieving and sending “packages” of verification information including income, employment, citizenship • Communicating enrollment information • Privacy and security • Auditing and other provisions for detecting, investigating and proving fraud • Secure transport • Authentication • Identity vetting • Package integrity
  • 70. Impedance Matching: The Interoperability Metaphor Source Receiving Computer or Computer or Organization Organization • The maximum high-fidelity data transfer occurs when the representation of data and the process are the same in both systems/organizations • The maximum interoperability is probably << half the total understanding of semantics and process at either end
  • 71. Incremental Interoperability: Variable Impedance Matching Highly "Informatical" Systems * 1001 0100 0100 1011 1110 0101 1001 0100 0100 1011 1110 0101 * 1001 0100 0100 *More Structure or Less; 1011 1110 0101 Older Not All or None System
  • 72. Preventing FIS: Frozen Interface Syndrome • Make incremental interoperability a fundamental business premise - Variable structure - Require mappable code upgrades - Flexible utterances • Use business incentives to drive upgrades to system informatical levels • Make interface negotiation a part of the infrastructure
  • 73. Vision: Putting the Consumer in Charge Control v. Transparency; Source Authenticity Consumer Policies and Compliance Rules Data User • Creates and signs data sets • Establishes identity Trusted Data Bank relationship with consumer • Edits self-signed data sets • Establishes identity Consumer Account • Retrieves authorized data relationships with other data • Edits self-signed data sets sources Data Set • Validates seals of authenticity • Authorizes one-time and • Provides history and status ongoing transfers Data Set updates as signed data sets • View all data sets (with few Data Set • Maintains valid seal of limitations) authenticity (for verifying • Deletes self-signed and authorization and audit logs) selected other data sets • Creates externally attached 3rd Party Data Source comments on other-sourced Trusted Data Bank data sets • Establishes identity • Provides APIs and user relationships consumer • Authorizes services of 3rd party interface for stakeholders advocates • Provides signed authorized • Continually meets compliance data requirements for security and privacy • Maintains valid seal of authenticity • Provides forensic-quality logs • Warrants to hand off data to Source’s Seal of other trusted data banks Authenticity
  • 74. Invention Quote Invention, it must be humbly admitted, does not consist in creating out of void, but out of chaos.
  • 75. Agenda Julie Rushin - Panel 3 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform – Julie A. Rushin, Deputy CIO, IRS 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 76. IRS - FAFSA Internal Revenue Service (IRS) Free Application For Federal Student Aid (FAFSA) June 14, 2010
  • 77. Project Overview- Background  Federal Student Aid (FSA) mandated through the American Recovery and Reinvestment Act to simplify the Free Application for Federal Student Aid (FAFSA) process  IRS and FSA data exchange discussions begin (December 2007)  Decision made to allow students and parents access to IRS tax data needed to complete the FAFSA (March 2009)  The IRS solution, the Federal Student Aid-Datashare (FSA-D) application, successfully deployed January 28, 2010.
  • 78. FSA-D Interface with Dept. Of Ed.  FSA-D is accessible from within the FAFSA application process only.  FSA-D has no direct interface with the Department of Education.  FSA-D has external interfaces to taxpayer (and 3rd party) web browsers and IRS programs.  Data is transferred to and from the Department of Education through an 128 bit SSL encrypted HTTP Post via the taxpayer’s browser.
  • 79. Modernized Production Systems and Services  FSA-D interacts with production programming to retrieve information from the Individual Return Transaction File (IRTF).  FSA-D logs messages to the Security Audit and Analysis System (SAAS) which implements a data warehousing solution to provide on-line analytical processing of audit trail data.
  • 80. Department of Ed Process  ED Applicant (Student or Parent) initiates the on-line process for Free Application For Student Aid (FAFSA)  Includes application for a PIN (if not previously secured)  User provides SSN, Name, DOB, Address and selects a challenge question to activate the PIN  User information validated through Social Security Administration (SSA)  User- or ED-created PIN provided to user instantly, via email or through postal service  PIN considered conditional until validated by SSA and can only be used to sign the FAFSA (SSA validation completed within one to three days)  Applicant completes the applicable FAFSA On The Web (FOTW) Input Screens  User’s SSN, DOB, Name and PIN collected  Link to IRS FSA-D is displayed
  • 81. IRS FSA-D Input Screen
  • 82. IRS FSA-D Data Elements to User
  • 83. User Returns to on-line FAFSA
  • 84. Current Statistics  Statistics from 1/28/2010 through 6/10/2010  612,279 users requested access  324,018 users successfully authenticated (52.9 % of volume)  303,118 users transferred tax information to FAFSA (49.5% of volume)
  • 85. Planned Enhancements  *Changes to the FAFSA question numbers  Change the design to display the FAFSA form question numbers that correspond to the version of the form being completed by the applicant.  *Return Correlation ID of all FSA-D Users  Improves the user experience by enabling ED to return users exiting the FSA-D to the appropriate section of the FAFSA.  *Spanish language version  Mirror the features and functionality of the English language FSA-D.  Non-editable date of birth field  Enhance the Security and Privacy of the FSA-D application by changing the Date of Birth field on the Authentication Page from an editable to a non-editable field (Requested by Privacy) *Denotes Department of Education (ED) request.
  • 86. Questions and Comments
  • 87. Agenda Paul Swanenburg - Panel 3 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform – Paul Swanenburg, Social Security Administration 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 88. CHIPRA Citizenship Match With SSA (SCHIP) CHIPRA Citizenship Match SCHIP State 1 •Provides name, SSN, DOB and MEDICAID & CHIP SSA citizenship matching Agencies within Provides Name, Existing-Approved •Uses an existing and approved 2 SSN, DOB and Network Citizenship telecommunications network in Matching place between SSA and all states-File Transfer Management System (FTMS) 2 3 •Uses an existing batch query in place with all states – State Verifications and Exchange State System (SVES) MEDICAID or CHIP 1 Agencies outside •Part of existing data exchange Approved Network agreement between STATES and MEDICAID 4 SSA (CMPPA & IEA) for MEDICAID & CHIP and CHIP Agency Diagram 1
  • 89. Affordable Care Act Citizenship Match with SSA 90 Day Requirement (SCHIP) SCHIP (90 Day) Affordable Care Act – 90 Day Requirement •To meet 90 day (06/21/10) requirement-use CHIPRA SCHIP Query State 1 SSA •Opting In Provides Name, •Use existing FTMS & SVES •HRP within SSN, DOB and Network/Query Umbrella of Citizenship 2 DHS/STC Matching •Modify existing information exchange agreements (IEA) with States •Opt out States using HHS contractor and States requiring new Computer Matching and Privacy Protection Act (CMPPA) State agreements would not meet 90 •Opting Out day criteria •Opting In but HRP outside of DHS/STC Diagram 2
  • 90. Affordable Care Act Citizenship Match with SSA States Administering Own High Risk Pool (HRP) Affordable Care Act - HRP SCHIP (06/21/10 – 12/31/13) •Use CHIPRA SCHIP Query State 1 SSA •Use existing FTMS & SVES •Opting In Provides Name, Network/Query •HRP within SSN, DOB and Umbrella of Citizenship •Modify existing information DHS/STC 2 Matching exchange agreements (IEA) with States within umbrella of DHS/STC 2 3 •Create new agreements/security approvals for HRPs outside of existing/approved DHS/STC umbrella State •Opting In •HRP outside of 1 DHS/STC 4 HRP Diagram 3
  • 91. Affordable Care Act Citizenship Match with SSA States Opting Out-Fallback SCHIP (06/21/10 – 12/31/13) Affordable Care Act – State Fallback •Use CHIPRA SCHIP Query •Operate within approved FTMS Multiple network using SVES based query Sources Input for •Create new CMPPA/IEA Enrollment Process agreements 1 SSA 2 ASSUMPTIONS: Provides Name, (NFC) SSN, DOB and 1. Queries will not be routed Citizenship through PA DPW Administering Opt 3 Matching 2. NFC approved site will administer Out States HRPs all opt out states 3. FTMS approved network technology will be used 4. Administered through 12/31/13 Diagram 4
  • 92. Agenda Bryan Sivak - Panel 3 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform – Bryan Sivak, CIO, Government of D.C. 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 93. Agenda Discuss Panel 3 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform – Discussion 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 94. Agenda W G Discussion 1. Call to Order 2. Introduction of Workgroup Members 3. Overview of Workgroup Role & Charge 4. Introduction to Panel Presentations 5. Panel 1: Enrollment in 2014 6. Panel 2: State/Local eHuman Services Efforts 7. Break 8. Panel 3: Internet/Web Services /Consumer Data Platform 9. Workgroup Discussion 10. Public Comment 11. Adjourn
  • 95. Adjourn Meeting Adjourned

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