Feedback/Questions from States on HRSA Overview : Alabama would like to work with HRSA. Alabama’s Medicaid Medical Director has joined the Alabama Primary Care Association and Alabama would like to work together to use MITA and FQHC involvement If most FQHCs are going to use VISTA or one or two other software packages and you are creating interfaces; are those interfaces public domain. When purchasing proprietary using HRSA funding, it doesn’t turn into open source. Modifications on IHS system will be shared and incorporated on both VISTA and IHS systems with some leveraging on an informal basis. Jim Kutz – SAMSHA: License requires availability. Medsphere used VISTA but they changed it. I-Care, which is the HIS chronic disease management tool will work with specific models. Arizona asked if any states are writing interfaces with specific EMRs. Georgia has designated 5 interfaces; Missouri 0 but requires HL7 data standard used in Cyber tool). Missouri is overlaying MMIS HRSA: NY has let vendors know that if they are working with community centers they need to have certain functional specifications related to reporting and population health Arizona: suggested joint meetings with HRSA grantees
NASMD Multi-State Collaboration for Medicaid Transformation
NASMD Multi-State Collaboration for Medicaid Transformation Third Meeting August 16, 2007 DRAFT MINUTES
Attendees : Martha Roherty, NASMD Greg Hunt, NASMD Tony Rogers, Arizona (chair) Carol Herrmann-Steckel, Alabama Commissioner (vice chair) Kim Davis-Allen, Alabama MTG Director Paul Brannan, MMIS Coordinator/Privacy Officer Alabama Sanchez, Texas (telephone) Lisa Hulbert, Utah Medicaid (telephone) Laura Cole, Kentucky (telephone) Perry Yastrof, Arizona (telephone) Sue Miller, New Jersey Theresa Carns, Mississippi Kathleen Cota, MTG Manager Minnesota Sandeep Kapoor, CTO Kentucky Kimberly Ortiz, Chief Office of Medi-Cal Payment Systems California Sam Walker, MMIS DC LaRah Payne, MTG DC Patti Campbell, Idaho Donna Larson, Idaho Charles Gallia, Oregon Beth Nagel, Michigan
State by State Update : Arizona ) : Arizona has been developing its MTG over the summer and is intending to send out an RFP for HEI. Through the HIE, the state intends to develop of health record data base and a web portal which will have an application providers will use to access the health record. The states’ goal is to “raise all boats”. They intend to form a corporation that will be the owner of the statewide information portal. Arizona has submitted first quarter report to CMS. Texas: Texas’ MTF is for a Foster Care Health Passport with a claims based health summary. The goal is to establish a continuity of care standard so there can be an exchange with EHRs and EMRs and will issue an RFP to develop the standards Idaho: Idaho has applied for a second round MTG. They have been working with a health planning commission and are hoping for funding to participate in HIE, including pharmacy. Oregon: Oregon has applied for a second round MTF. One of the components is a HIE. Michigan : applied for MTF that includes an HIE. The state has already analyzed and has funded planning and implementation grants in 7 of 9 areas. The MTG addresses for provider certification. They are also working on MMIS replacement. NC: NC has filed for a round two MTF but specifics were not provided at this time Alabama: Alabama issued a RFP and has finalized its first vendor selection (ACS). Alabama’s quarterly report is on the web at www.medicaid.alabama.gov . Go to site, look for transformation grant for quality and then look for CMS report. They have applied for a second grant As a part of their first MTG, there will be a HIE and health record, an electronic clinical support tool with EMR, integration with current EMR –systems and they have added a feature, which is interoperability with another state agency. The agency is the Dept of Senior Services with a focus on HCBS. They plan to be up by March 08
Missour i : Missouri has applied for 2nd round and seeks to expand into HCBWS and integrate with patient outreach. The state seeks to have a single point of entry for seniors. They are working on verbal communication, integrating optometric and dental in to pre-certification program; direct care; training; bringing lab into electronic report and into cyber access tool; and EPSDT integrated within 3 week into the cyber access tool Mississippi : Mississippi intends to create a system for hospitals and nursing home to exchange information in the case of emergencies. In the state’s second MTG round, they have focused on EHR and e-prescribing. California : California submitted a MTG for e-prescribing to include Medicaid histories and formulary to point of care at physician offices using the UTAH EPRM tool. California is also doing a re-procurement of their MMIS. California is encountering an issue with fees with vendors for safety net providers with e-prescribing related to hidden costs are in different funding models. Although some have EHRs that have an e-prescribing tool that they are using and they want to bring data to point of care, but they will not turn on data to point of care because they will be charged fees. Although the state is still trying to determine who is charging the fees as some are paying one time costs and some do fees some are facing fees, Medi-Cal is currently paying switch company but on the other end, the center is also being charged by their integrator or vendor. Minnesota: Minnesota has just answered bidders’ questions and hope to award within the next two weeks for their MTG 1. They are creating web based tools for select providers and select consumers to create a communication between provider and team for individuals needing intensive primary care. They will pay $50 to physicians to work with difficult, complex consumers. This tool will allow the state to do performance measures and to trigger payment with a PA algorithm without involvement of professionals. MTG 2 has been submitted and through it the state proposed to work with private sector and health care stakeholders in a public/private non-profit super highway using a public utility approach for administrative and clinical data. The state is working to solidify the public/private parameters.
Kentucky: Kentucky implemented a new MMIS about a month and half ago DC : DC submitted MTG 1 and is looking at a hybrid model with a repository for DC government agencies and record locator for private entity health information exchange between Medicaid, Dept. of Health agencies, 6 health centers, selected government agencies, and three hospitals initially. DC is in the design phase. New Jersey: NJ has and MTG 1 and applied for a MTG 2. New Jersey had previously combined lead and immunization registries with the MTG 1 combining immunization information with Medicaid claims records. The intent in MTG 2 is to go out to other children records in order to have complete children’s records West Virginia: nothing to report New Mexico : NM is working on two separate MTGs - e-prescribing and an electronic health record with partial progress on each. Unanticipated issues include what is included in a basic model for EHR; reviewing the Montana/ACS system but do not find it ready for physicians in a usable format; finding contradictory information on how much information for MH and Family Planning, AID diagnosis (was going to use NY approach but concerned about privacy law); e-prescribing is a little complex. In addition, determining who pays for the transaction cost is also a little more complex. Nebraska : Nebraska participated as a listener as they are interested in the topic but do not have a MTG
HRSA Overview by Johanna Barraza Cannon HRSA is provider focused. 30% of community centers (FHQCs, RH, and MCH) revenue comes from Medicaid HRSA was part of the review team for the MTG and is now looking for opportunities to partner. Johanna is point of contact with HRSA for HIT adoption by safety net providers There were HRSA grants last year for EHR adoption and another $20M this year; priority is for centers that network. West VA network is one of HRSA shining stars as they have implemented, continue to work with Medicaid, and improved care. New Mexico network is working with Utah and Florida on EHR. CA has a number of models, including practice management systems, EHRs, and EMRs. Safety net providers have come together as networks. HRSA would like to partner HRSA grantees with MTG efforts and will provide states with names of HRSA grantees as soon as they are available. HRSS is doing some TA on guidance on how to spend money with innovation grantees (e-prescribing and health information grantees). HRSA is also doing case studies. They have a portal on the AHRQ web site with private communities where participants can talk about vendors and tools to use. Each community is currently password protected and private; going “public” for tools with some sections. If a state is working with a TA Center for HRSA grantees, the state may benefit from the TA, including web-ex conference calls and information on the portal. HRSA is also working to get HIT to address health disparities, improve quality, etc and address public domain (West VA is using a public domain HIS system. TA includes “peer to peer” – network of health centers that are advanced who can help others – and paid consultants. First HRSA all grantee meeting will be held 11/5 – 11/7 in Crystal City. Participants need to send Johanna e-mail if want to attend. There is no fee to attend but registration is limited. HIT Conference: 500 invited to conference, including MCH agencies, Ryan White agencies and Health Centers who have come together (CHCs and FQHCs) Johanna’s slides will be distributed by NASMD on the web
Feedback/Questions from States on HRSA Overview : Alabama would like to work with HRSA. Alabama’s Medicaid Medical Director has joined the Alabama Primary Care Association and Alabama would like to work together to use MITA and FQHC involvement If most FQHCs are going to use VISTA or one or two other software packages and you are creating interfaces; are those interfaces public domain. When purchasing proprietary using HRSA funding, it doesn’t turn into open source. Modifications on IHS system will be shared and incorporated on both VISTA and IHS systems with some leveraging on an informal basis. Jim Kutz – SAMSHA: License requires availability. Medsphere used VISTA but they changed it. I-Care, which is the HIS chronic disease management tool will work with specific models. Arizona asked if any states are writing interfaces with specific EMRs. Georgia has designated 5 interfaces; Missouri 0 but requires HL7 data standard used in Cyber tool). Missouri is overlaying MMIS HRSA: NY has let vendors know that if they are working with community centers they need to have certain functional specifications related to reporting and population health Arizona: suggested joint meetings with HRSA grantees Question to Rick Friedman/CMS regarding the use of MITA 90-10 and 75-25 to link with FQHCs The rules for MMIS in MITA are the same rules. If a state is providing software that FQHC can use to tap into in the web – yes – remember cost allocation. There is different match rate for different activities and states should work with RO to create the boundaries. No MMIS dollars can be used for equipment for providers at providers’ locations. Suggestion: don’t use MTF for things that can be used under regular MITA
General Discussion : Arizona: States need documentation of fields/ standards and all interfaces must be in the public domain. When pulling data from hospitals, need to decide between file or data transfers. Consistency would be desirable. Where there are standards, want to have them so bi-transfer is interoperable. Where standards don’t exist, need to be one way transfer. DC: DC plans interfaces with community clinic through e-clinics and with three existing hospitals MN: MN RFP says what is developed by state or under state contract is owned by state. Standard for MN is owned. For MN MTF 2, if the state can pull off a statewide public private entity to build the highway, the plan is to have a fee for use. Encourage states to go to highest level of collaboration they can get to. Kentucky: For MTF1, it has been hard to get everyone to table. California: The project interfaces to EHRs, but the state’s challenge was that it didn’t plan to write and pay for interfaces with providers/vendors and the state wants to get data into the providers’ hands at the point of care. The devil is in the details. Arizona : Safety net providers don’t have technical ability and/or funding in all cases so need Medicaid to write interfaces to get them into the system. Share ware to reduce the cost of the next states. Technical group needs to look at how to avoid getting charged for the same interface over and over again and how to not create interfaces over and over again. Kentucky: For MTF1, it has been hard to get everyone to table. California: The project interfaces to EHRs, but the state’s challenge was that it didn’t plan to write and pay for interfaces with providers/vendors and the state wants to get data into the providers’ hands at the point of care. The devil is in the details. Arizona : Safety net providers don’t have technical ability and/or funding in all cases so need Medicaid to write interfaces to get them into the system. Share ware to reduce the cost of the next states. Technical group needs to look at how to avoid getting charged for the same interface over and over again and how to not create interfaces over and over again. SAMSHA: HL7 Continuity of Care specifications is on its way to be an ANSI standard. By 2009 CCHIT will require CCR. If there are future standards, they need to be included in contacts. Look to pharmacy paradigm with the requirement of the interface back into the state private but with specifications designed by state. DC: asked questions regarding who pays for interfaces and how a state/agency can assure that they have to only pay for them once
Collaboration Agreement : There are two materials related to the Multi State Collaboration: the agreement itself with the purpose and objective and the organization chart of collaboration Organization : The Steering Committee will set the agenda for the year. The chair is Tony Rodgers, Arizona, and the vice chair is Carol Herrmann-Steckel. NASMD will be administrator There are 6 workgroups: HIE: Chair - Perry Yastro (Arizona) Provider Adoption/ Deployment: Chairs -Kim and Paul (Alabama) Clinical Decision Support: Data Structure: Sandeep Kapoor (Kentucky) EHR: Kimberly Ortiz (California) Legal/Patient Consent: LaRah Payne (DC) Technical Support will be provided through consultants. NASMD would bring in TA support consultants (paid/free/other states) and the Steering Committee will facilitate the technical support needs. The budget will come from the contributions to NASMD from states for the collaboration. States have the option to put in $10,000 or other in kind contributions. NASMD will seek additional funding through other grants, including AHRQ TA grant. NASMD has receiving 11 letters of support and have $150,000 in the bank ($50,000 from Arizona and $10,000 for rest). A couple of foundations are also talking to NASMD (Commonwealth and RWJF) regarding facilitation of information between states. Learning groups will be open any state would wants to participate. Web-sight will be available shortly for documents and the Multi State Collaboration use web conferencing for some meetings. APHA is moving 2 years into Verizon building downtown DC that is already set up for web casting and has a class room set up on bottom floor. In the interim, NASMD will be looking at facilities at the universities. There will be set up 6 list serves for workgroups. The Collaboration will be a place for partners such as HRSA to talk to states.
Questions on Organization : Where would provider change management be address? Provider Adoption and Deployment Workgroup The ability to open meetings to non-payer members is important so they can get the goods for free without paying; however, if free for some, will every state choose not to pay so there won’t be money to do anything? Only paid member states can be on the Steering Committee; however there is such a critical need for all to participate that alternatives need to be considered, such as charging for meetings/presentations. The Collaboration may want to look at registration fees in order to get more involvement. An example to review is the Medical Directors Collaborative where only paid members vote but nonpaying participate (consistent with APHSA). May need to amend charter. Can a state use MTF grant dollars to pay the fee for the Collaboration? Can a state overrun its grant to pay the Collaboration fee? MTF is one source of funding. Rick/CMS indicated that overruns for any reason would not be appreciated. Administrative match is available. If a state put money in their grant request for this and it was approved. it is not a problem. States can use grant funds as needed – but overruns different issue. Alabama is using regular administration money. Dennis said ok with MTF funds or Medicaid administrative. A bigger problem facing some states is how to pay the $10,000 in the state accounting system . NASMD is working on technicalities of “paying”. A state should simply tell NASMD that they want to be part of collaboration and NASMD will work on good faith until the state can get the technical process to work out. How are individual states structured for the Medicaid Transformation Grant? What is the organizational structure? MN team for MITA and MTG are the same team. Kentucky is approaching it as a public/private e-health corporation with Medicaid participating, state employee, etc. Alabama is making it a part of the entire Medicaid agency – all hands on deck and viewing it as not a project but a transformation of how they manage Medicaid.
Objectives/Purpose (See Charter ) Front runner states documenting for states following behind Common set of Medicaid specific EHR functionality, data standards and definitions for master beneficiary index, master provider index, record locator, and Medicaid electronic health record data architecture Jointly develop/shared RFP documents Joint training Joint ventures Working in concert with CMS with federal on issues going forward Establish a Medicaid EHR/HIE steering group composed of state Medicaid Directors to coordinate and encourage continuing development and deployment of EHR/HIE Seek other grant and other funding sources to support this collaboration Questions on Objectives/Purpose Does the Collaborative want CMS interface/participation? Because this is an area where there is not a disagreement with CMS, and the group wants to be effective partner, CMS involvement is appreciated and guidance helpful. Is the Collaboration’s focus MTG or HIE and HIT or HIE/HIT as a subset of MTG? It is a “learning collaborative” that include MTGs for HIE/HIT, including e-prescribing) as long as it is Medicaid, it is included. Transformation Grant Survey The purpose of the survey was to determine what states were looking to learn through the collaborative. 14 states responded to the survey and the majority were interested in joining workgroups on HIE and EHRs. Most states report need for overview of HIE options and data exchange standards. States also want patient and beneficiary consents, data exchange permission and requests for non-disclosure of information, legal document development and provider participation development. (See NASMD slides) Additional areas for TA: overview of EHR-systems and software options; web-based EHR data architecture, data standards and database design; provider adoption and deployment strategies and incentives. There is also interest in an orientation to web-based clinical decision supports and web-based order entry. In addition, there is interest in an overview on e-prescribing, developing requirements and integrating with HIE and EHRs
MTG Round 2 Jean Shield, CMS, indicated 2nd round will not be announced for several weeks Plans Proposed State to state exchange of information via website; newsletter; listserv Leadership Development (through presentations by Collaboration leaders) includes: overview to non-tech types; managing system transformation; leveraging system transformation; public/private partnerships; evaluation implementation (multi –state in addition to single state – under consideration) Speed up process through having meetings closer together and providing information between meetings to members, including use of workgroups. Also the Collaborative is looking for low-hanging fruit (white papers, small joint efforts, joining other existing collaborations, survey of states). A web-conference with steering committee will be scheduled for between now and November 15-16. General Discussion Regarding Plans Need to bridge gap between technical and Medicaid Directors. Need to address multi-year health care projects (not IT projects), ROI for CMS and states – the goal is to reduce the failure points, provides state staff with a real-world view of the issues they are facing with consultants provided just in time, and work with NGA State Alliance for e-Health. Need for technical assistance on procurement and to identify opportunities to joint venture to procurement. Multi-state purchasing is an option and already approved by CMS. Some states currently doing it do in pharmacy so should be able to similar in MTG. A multi-state opportunity for vendors to present to group so they won’t do the state individual is of interest.
NGA State Alliance Workgroup on Data Exchange and Communications in Medicaid, PH, and State Employees: Tony Rodgers The group is addressing: leadership and governance; consumers; financial stability of models; approach and structure, and regulatory barriers for state participation Medicaid/SCHIP/PH and exchange of data between states. Tony is looking for recommendations to the Governors. Final recommendations are due in January so participants should get to Tony before then. Action Steps: Each state is to send their quarterly CMS reports to Martha and she will post them. Remember to check list serve as that is where things are posted. Send information on who needs to be on the list serve from each state A Steering Committee web-conference will be scheduled for between now and November 15-16. NASMD will send out e-mails to schedule and will need names and e-mail addresses for appropriate contacts in order to get meetings set up. The Steering Committee, regarding Consultant Technical Assistance, will get a list of vendors who attended the MMIS conference and get a list of vendors/consultants that people are aware of and do a broadcast request for interest. At the next Steering Committee, decisions on how to proceed with consultants to do this kind of activity will be made. NASMD will send an e-mail for subject matter experts from states within group that could provide TA Kentucky will try to ask questions of Gardner on behalf of group and report back. Rick Friedman will provide CMS subject matters experts to Tony/Martha. Any state interested in working with SAMSHA on what it would take to exchange data between Medicaid, substance use programs and mental health should like Jim Krenz know directly. The Steering Committee will work with the ERISA Industry Group regarding lessons learned from the NC PCCM model. Next Face-to-Face Steering Committee : November 15 in conjunction with fall NASMD meeting, Washington, DC Next Steering Committee Meeting October – date to be determined Initial Work Group Meetings Organizational Meetings – September by phone Initial Substantive Meeting – End of September to early October