Enrollment Workgroup 06-28-10


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Enrollment Workgroup 06-28-10

  1. 1. HIT Policy Committee Enrollment Workgroup Monday, June 28, 2010 11:00am ET
  2. 2. Agenda Call to Order 1. Call to Order – Judy Sparrow, Office of the National Coordinator for Health Information Technology 2. Key Takeaways from First Meeting 3. Discuss Base Use Case 4. Agree on Areas of Focus & Timeline for Standards Work 5. Public Comment 6. Adjourn
  3. 3. HIT Policy & Standards Committee Enrollment Workgroup Aneesh Chopra, Chair Chief Technology Officer, OSTP Sam Karp, Co-Chair California Healthcare Foundation June 28, 2010
  4. 4. 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, 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 • Elizabeth Royal SEIU • Sallie Milam West Virginia, Chief Privacy Officer • Dave Molchany Deputy County Executive, Fairfax County
  5. 5. Agenda » Key takeaways from first meeting » Discuss base use case » Agree on areas of focus for standards work » Review timeline for workgroup effort » Discuss agenda for 7/2 3
  6. 6. Key Takeaways from First Meeting 4
  7. 7. Policy Principles - Reprise 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 • Don’t make policy through standards 5
  8. 8. Standards Principles - Reprise • 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. 6
  9. 9. Base Use Case Consumer-facing web portal that allows applicants to: » Identify available services for which they might be eligible » Conduct initial screening and enrollment checks » Retrieve electronic verification information from outside sources » Determine eligibility or forward eligibility “packet” (screening information and verification information) to programs for final determination » Store and re-use eligibility information 7
  10. 10. This Base Use Case Supports Several Eligibility and Enrollment Scenarios in 2014 Makes recommendations more flexible, durable and useful » Scenario One: Exchange portal • Screening, verification and eligibility for 2014 MAGI-eligible group: Medicaid, CHIP and exchange • Send/receive applicant information “packets” with Medicaid » Scenario Two: Medicaid/TANF/SNAP portal • Screening, verification and eligibility for residual Medicaid, TANF, and SNAP. • Send/receive applicant information “packets” with exchange • Re-use eligibility information to screen for other programs » Scenario Three: Combined portal • All of Medicaid, CHIP, Exchange; other combinations 8
  11. 11. Medicaid MAGI, MA, Exchange, State systems Diagram Check Current 1 2 Enrollment: Initial Check other systems 3 for existing coverage; first Obtain Screening: Applicant match using single identifier, Verification Info: IEVS provides basic probabilistic formula, or Electronically verify other method; then obtain identity, residency, VR demographic info enrollment info citizenship, household size, income, IRS DMV etc. SSA DHS 4b Portal makes State eligibility decision Determine 4 systems Eligibility: Portal Method 4a sends will depend Enrollment eligibility on system 5 packet to capabilities. Notification program Send eligibility info to to Portal other programs Program (human services, etc.) makes eligibility decision 6 Send enrollment information to plans 9
  12. 12. Areas of Focus for Standards Work » The diagram points to areas where standards are needed • Services descriptions • Data elements • Verification interfaces 10
  13. 13. Services Descriptions What Standards Needed – Clear “prototype” definitions of services and protocols. Certain cases where widely used technical standards can be specified: e.g., HIPAA transaction standards 270/271 for some types of messaging » Initial screening based on consumer-input information » Identify if applicant already enrolled (Medicaid, exchange, etc.) » Obtain and message back electronic verification information » Share eligibility “packet” with programs » Maintain eligibility information for re-use Cross-cutting services/standards » Consumer match across systems » Authentication/consent » Messaging/envelope » Encryption 11
  14. 14. Data Elements What standards needed – Define core data elements for eligibility determination, map different definitions for these core elements across programs » Focus on defining and mapping data elements that will need to be shared at key handoffs, for instance between an exchange portal and a Medicaid/SNAP/TANF portal – represented by the black core intersection of intersections » Keep definition at general level if data element has not yet been clearly defined Other Programs Exchange 1. Intersection of intersections 2. Shared data elements 3. New data elements Remaining Medicaid 4. Everything else 12 (TANF/SNAP)
  15. 15. Verification Interfaces What standards needed – Widely used verification interfaces can serve as de facto standards. Define requirements for modernizing interfaces » Identify and analyze widely used verification interfaces for income, residency, employment, citizenship, etc. • How widely used? • For what information (e.g., residence, income, etc)? • How does interface work? Batch? Real-time? • What standards used? • What information is messaged back? • Limitations on how info can be used/reused? » Define requirements for modernizing interfaces; examine existing models » Real-time data availability through web services » Consumer mediated model » Data storage and re-use 13
  16. 16. Timeline for Workgroup Effort Standards Focus Date Verification interfaces July 2 Data elements July 15 TBD July 19 Services descriptions July 30 Services descriptions (cont.) Aug 12 TBD Aug 17 Recommendations for building working Aug 31 prototypes In person meeting: Summary Sep 9 14 Recommendations
  17. 17. Proposed Agenda for 7/2 » Assess key verification interfaces » Inventory/analysis » Proposed Speaker: DHS (e-verify, SAVE) » Opportunities to modernize verification interfaces and approach » Proposed Speaker: VA Blue button » Requirements/Principles » Discussion 15
  18. 18. Reminders • Please spread word on opportunity to comment through FACA blog post, until July 1: http://healthit.hhs.gov/blog/faca/index.php/2010/06/21/enr ollment-workgroup-solicits-your-help-with-information- on-moving-government-into-the-21st-century/ • Next meeting is July 2h from 11 am to 1 pm EDT 16
  19. 19. Discussion
  20. 20. Adjourn Meeting Adjourned