HIT Policy Committee Enrollment Workgroup

Monday, June 28, 2010

11:00am ET

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

Agenda

HIT Policy & Standards Committee

Enrollment Workgroup

Aneesh Chopra, ChairChief Technology Officer, OSTP

Sam Karp, Co-ChairCalifornia Healthcare Foundation

June 28, 2010

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

Workgroup Members

Chair: Aneesh Chopra, Federal CTO

Co-Chair: Sam Karp, California Healthcare Foundation

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

Key Takeaways from First Meeting

4

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

Policy Principles - Reprise

5

• 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.

Standards Principles - Reprise

6

7

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

Base Use Case

8

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

This Base Use Case Supports Several Eligibility and

Enrollment Scenarios in 2014

9

Send eligibility info to

other programs

(human services, etc.)

Obtain

Verification Info: Electronically verify

identity, residency,

citizenship, household

size, income,

etc.

Check Current

Enrollment:

Check other systems

for existing coverage; first

match using single identifier,

probabilistic formula, or

other method; then obtain

enrollment info

Initial

Screening:

Applicant

provides basic

demographic info

Determine

Eligibility: Method

will depend

on system

capabilities.

IRS

DHS

State

systems

IEVS

DMV

VR

23

Medicaid MAGI, MA,

Exchange, State systems

1

5

Program

makes

eligibility

decision

4

Portal

makes

eligibility

decision

4b

Portal

sends

eligibility

packet to

program

4a

Enrollment

Notification

to Portal

SSA

Send enrollment

information to plans

6

Diagram

10

» The diagram points to areas where standards are needed

• Services descriptions

• Data elements

• Verification interfaces

Areas of Focus for Standards Work

11

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

Services Descriptions

12

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

Data Elements

Exchange

Remaining Medicaid

(TANF/SNAP)

Other Programs

1. Intersection of intersections

2. Shared data elements

3. New data elements

4. Everything else

13

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

Verification Interfaces

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

prototypesAug 31

In person meeting: Summary

RecommendationsSep 9

Timeline for Workgroup Effort

14

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

• 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

Reminders

16

Discussion

Adjourn

Meeting Adjourned