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. HIT Policy & Standards Committee
Enrollment Workgroup
Aneesh Chopra, Chair
Chief Technology Officer, OSTP
Sam Karp, Co-Chair
California Healthcare Foundation
June 28, 2010
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. 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
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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
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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.
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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
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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
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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
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12. Areas of Focus for Standards Work
» The diagram points to areas where standards are needed
• Services descriptions
• Data elements
• Verification interfaces
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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. 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
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(TANF/SNAP)
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
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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. 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
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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
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