enrollemt workgroup
DESCRIPTION
TRANSCRIPT
HIT Policy Committee Enrollment Workgroup
Monday, June 14, 2010
12:00pm ET
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
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
Agenda
HIT Policy & Standards
CommitteesEnrollment Workgroup
Aneesh Chopra, ChairChief Technology Officer, OSTP
Sam Karp, Co-ChairCalifornia Healthcare Foundation
June 14, 2010
Workgroup Members
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
Chair: Aneesh Chopra, Federal CTO
Co-Chair: Sam Karp, California Healthcare Foundation
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.
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
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
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
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
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
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
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.
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
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
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
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
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
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
Agenda
State eHuman Services Efforts
HIT Policy CommitteeJune 14, 2010
J. Stephen FletcherChief Information Officer
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
Utah Health Info
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
cHIE
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
cHIE cont’d
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
Potential Issues w/HIE
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
Utah state eREP
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
Utah State eREP cont’d
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.
eREP Multiple Program Eligibility
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
Multiple Program Eligibility cont’d
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
eREP Sending Packets
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
Agenda
Social Interest Solutions
Testimony
HIT Policy Committee
Enrollment Workgroup Meeting
Washington, DC
June 14, 2010
©2010 SIS Confidential and Proprietary
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
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
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
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
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
Consumer Access
Consumer Access
• 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
ConsumerSelf-Assistance
Certified Community
Assistor
ProviderAssistor
Call CenterAssistor
Mail-In Paper Application
County Assistor
Outreach Provider Assistor
©2010 SIS Confidential and Proprietary
One-3-App Architecture
The One-e-App Architecture
Verification
Systems
Web
Service
State & County
Eligibility
Systems
Web
Service
USPS
Web
Service
Other Systems:
Kaiser, Utility, School,
City, Health Plan, . . .
Web
Service
Patient
Management
Systems
Web
Service
Clearinghouse
Systems
Web
Service
State
Medicaid
Systems
Web
Service
Authentication
Services
Workflow
Engine
Data Transformation
Services
Dispatcher
Services
System Integration
Engine
Data Validation
Service
Document
Management Service
Other Services
Information
Verification Service
Business
Intelligence
Enterprise Integration Portal
Enterprise Service Bus
. . . MITA architecture with services that can be
leveraged to augment legacy systems
©2010 SIS Confidential and Proprietary
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
More Programs . . .
• Food Stamps (SNAP)
• TANF (Temporary Aid to Needy
Families)
• Supplemental Nutrition for
Women, Infants and Children
(WIC)
• Earned Income Tax Credit
(EITC)
• Child Tax Credit
• Voter Registration
• Low Income Energy Programs
• Low Income Auto Insurance
• Employment Assistance (WIA)
(Coming Soon)
• Family Planning
• Cancer Detection and Treatment Programs
• General Assistance
• Drug and Alcohol Rehab Program
• Homeless Assistance
• Others
©2010 SIS Confidential and Proprietary
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
ACA Player Summary
ACA Player Summary
Federal Portal
•Information
•Routed to State Portal
State Portal
•Information
•Routed to Eligibility and Enrollment Systems
•Coverage Updates
•Consumer Portal
Medicaid
•Information
•Application Support in Medicaid System
•Exchange with Verification Systems
•Referral to Other Programs
•Coverage to Other Players
•Coverage Management
•Cost of Coverage
Social Services
•Information
•Application Support in Social Service System
•Exchange with Verification Systems
•Referral to Other Programs
•Coverage to Other Players
•Coverage ManagementState Exchange
•Information
•Application Support for Private Insurance
•Determine If Medicaid Prior to Private Insurance
•Exchange with Verification Systems
•Referral to Other Programs
•Coverage to Other Players
•Coverage from Medicaid and State High Risk
•Billing and Collecting Employee
•Referral to Other Programs
•Coverage Management
•Cost of Coverage
Insurance Companies on the State Exchange
•Information
•Consumer Coverage Confirmation
•Track Changes in Consumer CoverageState High Risk Insurance
•Information
•Determine Medicaid Prior to High Risk Insurance
•Application Support for High Risk Insurance
•Exchange with Verification Systems
•Referral to Other Programs
•Coverage to Other Players
•Coverage Management
IRS
•Records Match
•Report No Coverage Consumer
•Long term, should incorporate the ability to apply through tax return
•Assess penalty to non-covered
©2010 SIS Confidential and Proprietary
ACA Players Must
Employ Electronic Matching to serve as evidence of eligibility in lieu of paper☐ Vital Records☐ Employment history☐ 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
ACA Players Must
©2010 SIS Confidential and Proprietary
ACA Player Summary
Federal Portal
•Information
•Routed to State Portal
State Portal
•Information
•Routed to Eligibility and Enrollment Systems
•Coverage Updates
•Consumer Portal
Medicaid
•Information
•Application Support in Medicaid System
•Exchange with Verification Systems
•Referral to Other Programs
•Coverage to Other Players
•Coverage Management
•Cost of Coverage
Social Services
•Information
•Application Support in Social Service System
•Exchange with Verification Systems
•Referral to Other Programs
•Coverage to Other Players
•Coverage ManagementState Exchange
•Information
•Application Support for Private Insurance
•Determine If Medicaid Prior to Private Insurance
•Exchange with Verification Systems
•Referral to Other Programs
•Coverage to Other Players
•Coverage from Medicaid and State High Risk
•Billing and Collecting Employee
•Referral to Other Programs
•Coverage Management
•Cost of Coverage
Insurance Companies on the State Exchange
•Information
•Consumer Coverage Confirmation
•Track Changes in Consumer CoverageState High Risk Insurance
•Information
•Determine Medicaid Prior to High Risk Insurance
•Application Support for High Risk Insurance
•Exchange with Verification Systems
•Referral to Other Programs
•Coverage to Other Players
•Coverage Management
IRS
•Records Match
•Report No Coverage Consumer
•Long term, should incorporate the ability to apply through tax return
•Assess penalty to non-covered
Patient Management and EHR
County and Community Safety Net ProgramsHealth Plans ACA Player Summary
©2010 SIS Confidential and Proprietary
Leverage, Leverage…
Adopt ExistingStandards with MinimalModifications
Augment Legacy Systems
Build on MITA Standard Architecture for High Re-use
Real-Time Verifications & Eligibility Determinations
Leverage Medicaid to Support Underpinnings for Insurance Exchange and Other Programs
Allow for new external
programs and services via
ESB
Consumer-
Centric ACA
Results!
©2010 SIS Confidential and Proprietary
Contact
Bobbie Wilbur
Co-Director
916-566-2643
Claudia Page
Co-Director
510-273-4641
www.socialinterest.org
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
Agenda
Electronic EligibilityProcesses in Louisiana
A State PerspectiveLouisiana Medicaid & CHIP
Eligibility Division
HIT Eligibility Workgroup MeetingJune 14, 2010
J. Ruth KennedyLa. Dept of Health & Hospitals
The Case for EligibilityAutomation 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
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!
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
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
Trolley
Files
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
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
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
4 photos LaChip
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
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
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, 1880-1944Head, Bank of England
Yikes!!
―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
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
Ruth KennedyLaCHIP Director & Medicaid Deputy DirectorLouisiana Department of Health & HospitalsP.O. Box 91030 Baton Rouge, LA 70821-9030Telephone: 225 342 3032Blackberry: 225 241 1437Fax: 225 342 9508E-Mail: [email protected]
www.lachip.org
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
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
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
Agenda
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.
Wes Rishel
Distinguished Analyst
14 June 2010
Washington DC (via telephone)
Enrollment Working Group Testimony
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.
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
Impedance Matching:The Interoperability Metaphor
• 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
Source Computer orOrganization
Receiving Computer orOrganization
OlderSystem
Highly "Informatical"
Systems
1001 0100 0100
1011 1110 0101
1001 0100 0100
1011 1110 0101
Incremental Interoperability:Variable Impedance Matching
1001 0100 0100
1011 1110 0101
1001 0100 0100
1011 1110 0101
*
*More Structure or Less;Not All or None
*
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 informaticallevels
• Make interface negotiation a part of the infrastructure
Vision: Putting the Consumer in ChargeControl v. Transparency; Source Authenticity
Source’s Seal of Authenticity
Trusted Data Bank
Consumer Account
Data Set
Data Set
Data Set
Policies and Compliance RulesConsumer
• Creates and signs data sets
• Edits self-signed data sets
• Establishes identity relationships with other data sources
• Authorizes one-time and ongoing transfers
• View all data sets (with few limitations)
• Deletes self-signed and selected other data sets
• Creates externally attached comments on other-sourced data sets
• Authorizes services of 3rd party advocates
Data User
• Establishes identity relationship with consumer
• Retrieves authorized data
• Edits self-signed data sets
• Validates seals of authenticity
• Provides history and status updates as signed data sets
• Maintains valid seal of authenticity (for verifying authorization and audit logs)
3rd Party Data Source
• Establishes identity relationships consumer
• Provides signed authorized data
• Maintains valid seal of authenticity
Trusted Data Bank
• Provides APIs and user interface for stakeholders
• Continually meets compliance requirements for security and privacy
• Provides forensic-quality logs
• Warrants to hand off data to other trusted data banks
Invention Quote
Invention, it must be humbly admitted, does not consist in creating out of void, but out of chaos.
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
Agenda
IRS - FAFSA
Internal Revenue Service (IRS)
Free Application For Federal Student Aid (FAFSA)
June 14, 2010
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.
Project Overview- Background
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.
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.
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
IRS FSA-D Input Screen
IRS FSA-D Data Elements to User
User Returns to on-line FAFSA
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)
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.
Questions and Comments
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
Agenda
CHIPRA Citizenship Match
CHIPRA Citizenship MatchWith SSA (SCHIP)
StateMEDICAID & CHIP Agencies within
Existing-Approved Network
SSAProvides Name, SSN, DOB and
Citizenship Matching
StateMEDICAID or CHIP Agencies outside
Approved Network
MEDICAID & CHIP Agency
2
3
4
1
2
1
Diagram 1
SCHIP
•Provides name, SSN, DOB andcitizenship matching
•Uses an existing and approved telecommunications network in place between SSA and all states-File Transfer Management System (FTMS)
•Uses an existing batch query in place with all states – State Verifications and Exchange System (SVES)
•Part of existing data exchange agreement between STATES and SSA (CMPPA & IEA) for MEDICAID and CHIP
Affordable Care Act – 90 Day Requirement
Affordable Care ActCitizenship Match with SSA
90 Day Requirement (SCHIP)
Diagram 2
SCHIP (90 Day)
•To meet 90 day (06/21/10) requirement-use CHIPRA SCHIP Query
•Use existing FTMS & SVES Network/Query
•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) agreements would not meet 90 day criteria
State•Opting In
•HRP within Umbrella of
DHS/STC
State•Opting Out
•Opting In but HRP outside of DHS/STC
1
2
SSAProvides Name, SSN, DOB and
Citizenship Matching
Affordable Care Act - HRP
Affordable Care ActCitizenship Match with SSA
States Administering Own High Risk Pool (HRP)
Diagram 3
SCHIP (06/21/10 – 12/31/13)
•Use CHIPRA SCHIP Query
•Use existing FTMS & SVES Network/Query
•Modify existing information exchange agreements (IEA) with States within umbrella of DHS/STC
•Create new agreements/security approvals for HRPs outside of existing/approved DHS/STC umbrella
State•Opting In
•HRP within Umbrella of
DHS/STC
State•Opting In
•HRP outside of DHS/STC
1
2
SSAProvides Name, SSN, DOB and
Citizenship Matching
HRP
2 3
1
4
Affordable Care Act – State Fallback
Affordable Care ActCitizenship Match with SSAStates Opting Out-Fallback
Diagram 4
(NFC)
Administering Opt Out States HRPs
1
2SSA
Provides Name, SSN, DOB and
Citizenship Matching
SCHIP (06/21/10 – 12/31/13)
•Use CHIPRA SCHIP Query
•Operate within approved FTMS network using SVES based query
•Create new CMPPA/IEA agreements
ASSUMPTIONS:1. Queries will not be routed
through PA DPW2. NFC approved site will administer
all opt out states3. FTMS approved network technology
will be used4. Administered through 12/31/13
Multiple SourcesInput for
Enrollment Process
3
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
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
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 Discussion10. Public Comment
11. Adjourn
Agenda
Adjourn
Meeting Adjourned