HIT Policy & Standards Committees HIT Policy & Standards Committees Enrollment WorkgroupEnrollment Workgroup

Aneesh Chopra, Chair

Chief Technology Officer, OSTP

Sam Karp, Co-Chair

California Healthcare Foundation

November 10, 2010

Workgroup Members

Members: Ex Officio/Federal:• Cris Ross Lab Hub Initiative Sharon Parrott, O/S, HHS• James Borland Social Security Administration Nancy DeLew, OCIIO/HHS• Jessica Shahin U.S. Department of Agriculture Penny Thompson, CMS/HHS• Stacy Dean Center on Budget & Policy Priorities Henry Chao, OCIIO/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 David Hansell, Administration for• Ruth Kennedy Louisiana Medicaid Department Children & Families, HHS• Ray Baxter Kaiser Permanente Julie Rushin, IRS• Deborah Bachrach Consultant Farzad Mostashari, ONC• Paul Egerman Businessman Doug Fridsma,

ONC• Gopal Khanna CIO, Minnesota Kristen Ratcliff, ONC• Bill Oates CIO, City of Boston Tom Schankweiler, OCIIO/HHS • Anne Castro Blue Cross/Blue Shield South Carolina• Oren MichelsMashery• Wilfried Schobeiri InTake1• Bryan Sivak CTO, Washington, DC• Terri Shaw Children’s Partnership• Eli Staub SEIU• 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

Agenda

Review work to date and path forward

Panel discussion on industry perspectives on implementation of initial Section 1561 standards

Lunch Break

Panel discussion on state perspectives on implementation of initial Section 1561 standards

Next Steps

Public Comment

Adjourn

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.

Workgroup Activity To Date

• June 14 – August 31: Eight public WG sessions, MANY Tiger Team meetings

• August 19: HIT Policy Committee accepts initial recommendations

• August 30: HIT Standards Committee accepts initial recommendations

• Sept 7: Initial recommendations transmitted from FACAs to ONC

• Sept 17: Secretary accepts standards with slight edits; standards published on ONC website at https://healthit.hhs.gov/aca/section1561

Operationalizing Sec. 1561 Standards

• Support CMS/OCIIO implementation of standards

• 3 of the 4 original Tiger Teams will continue work on the initial standards– Verification Interfaces: Focus on state and national verification

interfaces – Business Rules: Focus on standards for consistent expression of

business rules– Privacy and Security: Identifying the gaps in FIPs and address

additional security safeguards.

• ONC team will continue work on 10 core data elements, as well as complete new analysis on additional data elements (e.g., marital status, veterans status).

Operationalizing Sec. 1561 Standards

• A new Consumer Focused Tiger Team has been created to build upon Appendix A by suggesting approaches to improve consumer access, engagement, usability and customer service.

– Co-chairs: Terri Shaw and Brian Sivak

– Membership:

• Reed Tuckson United Healthcare• Anne Castro BCBS• Deborah Bachrach• Ray Baxter/Bob Arndt Kaiser Permanente• Stacy Dean Center on Budget & Policy Priorities• Ronan Rooney/Walt Sedlazek/

Hank Kehlbeck Curam Software• Eli Staub SEIU• Rob Restuccia/Sue Kaufman Community Catalyst• Wilfried Schobeiri Intake

Industry Perspectives on Implementation of Initial Section 1561 Standards

Panel Discussion – Core Data Elements

• Do your systems currently use any specific data standards-based approach to collect and share data with other State programs and/or agencies?– If so, what advantages and disadvantages have you found to

this approach?– What would it take to integrate the NIEM guidelines into your

data collection and data transmission approach?

Panel Discussion – Verification Interfaces

• Does your system currently use a real time, Web services approach to obtain verifications from Federal and/or State data sources?– If so, what are the benefits?

– If not, why not? What would it take to do so? Have you ever encountered a situation where a Web service would not be the preferred approach?

• Recommendation 2.2 recommends development of a reference software model for obtaining verification from Federal agencies and other State and National data sources.– How difficult would it be to connect your system to such a reference

software model? What challenges would you encounter?

– Would this be a preferred approach or would it be simpler to obtain verifications using existing methods?

Panel Discussion –Transmission of Eligibility and Enrollment Information

• Does your system currently use existing HIPAA standards to transmit eligibility and enrollment information to other entities?

• Do your systems incorporate any additional level of specificity, for example, use of CAQH CORE or other operating rules, to ensure consistent interpretation of information contained in the HIPAA standards?

Panel Discussion – Business Rules

• Do you currently express business rules outside of transaction systems?– What standard do you use for consistently expressing rules?– If so, what benefits have you seen from doing so? What challenges did

you encounter?– If not, what (if any) challenges has this presented? What strategies do

your systems currently employ to ensure the capacity and flexibility to change and/or modify rules as needed?

• How could eligibility determinations made from these business rules be presented to consumers in a more clear, concise and unambiguous manner?

• What challenges/opportunities are presented by the idea of a business rules repository as expressed in Recommendation 3.2?– Is additional standardization of business rules necessary to make this a

valuable resource?– What strategies would you suggest for contributing to and/or

maintaining such a resource?

Panel Discussion – Privacy & Security

• How, if at all, does the consumer interact with your system?– How difficult would it be to modify your system to offer consumer

access to and control over eligibility and enrollment information?

• What functions/standards do your systems currently contain, if any, to track and monitor third party access?

• What safeguard systems do your systems currently include?– Do you currently encrypt data in motion? If not, why not? What are the

challenges in doing so?– Do your systems currently have the capacity to generate and publish

audit logs? If not, why not? What are the challenges in incorporating this function?

– Do you have access control functions? If not, what are the challenges to incorporating this?

– Do your systems incorporate automatic log off functionality? If not, what are the challenges to incorporating this?

– Do your systems currently include any standards for ID assurance? If so, at what level? What are the challenges associated with this?

State Perspectives on the Implementation of Initial Section 1561 Standards

State Medicaid Panel Discussion

• Andrew Allison, KHPA, Kansas• Toby Douglas, DHCS, California Medicaid Director• Linda Skinner, Arizona Health Care Cost Containment

System (AHCCCS) • Ivan Handler, CIO, Department of Healthcare and

Family Services, Illinois

Next Steps

• November 16: Consumer Focused TT• November 17: Business Rules TT• November 18: Verification Interfaces TT• December 8: Full Enrollment WG• TBD: Privacy & Security TT