Transcript Leadership Briefing Outline - Health and Human Services

Medicaid and CHIP
Health Information Exchange
Advisory Committee Meeting
January 12, 2012
Agenda
Welcome
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Approval of Committee Minutes
Committee Changes and Vacancies
Committee Schedule for 2012
Introduction of new Health Information Technology (IT) team members
State Legislative Activities and Federal Developments Update – Stephen Palmer
Statewide Health Information Exchange (HIE) Activities Update – Tony Gilman
Medicaid Project Updates:
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5010 Update – Joe Graves
Your Texas Medicaid Benefits Card / System – Noel Villarreal
Electronic Health Record (EHR) Incentive Program – Deb Norris and Kristen Leone
Health Information Exchange (HIE) Pilot and E-Prescribing – Jason Phipps
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Health IT Team Members
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Ramdas Menon, Health IT Director
Thomas Colvin, Project Manager
Deb Norris, Policy / Business Analyst
Jason Phipps, Project Manager
Noel Villarreal, Manager, Medicaid Benefits Card
Julia Alejandre, Communications
Sabrina Thomas, Administrative Assistant
3
State Legislative Activities and
Federal Developments
Stephen Palmer, Director
Office of e-Health Coordination
4
State Legislative Activities
and Federal Developments
State Legislative Activities

Update and discussion

Questions
Federal Developments

Update and discussion

Questions
5
Statewide Health Information
Exchange Activities
Tony Gilman, Executive Director
Texas Health Services Authority (THSA)
6
Local HIE Grant Program
• Quarterly Progress Reports
• Two HIE Business and Operational Plan Approved in
September 2011.
• 14 HIEs submitted Business and Operational Plans:
• Four HIEs have submitted plan amendments to address
weaknesses and deficiencies.
• Six HIEs developing plan amendment to address weaknesses
and deficiencies.
• Three HIEs will either merge with another HIE or become part
of White Space.
• One HIE will either continue or become part of the White
Space.
• All HIEs are transitioning from planning to implementation
in January 2012.
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White Space Strategy
Current Status
Next Steps
• Five Health Information Service
Providers (HISPs) formally
qualified in December 2011.
• THSA White Space web page
launched www.thsa.org/whitespace.aspx
• White Space Fact Sheet and Q&A
posted.
• Voucher registration form and
HISP profile and pricing sheets
added to web page.
• Soft communications campaign
through THSA, state-level
professional associations,
Medicaid, and regional
extension centers (RECs), to
inform providers of White
Space Strategy and voucher
request and payment process.
• Timeline: January 2012
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General-State Level
Operations
Current Status
Next Steps
• Monthly Collaboration Council
and Task Force Meetings
• Texas HIE Interoperability
Guidance Published
• Privacy and Security
Guidance
• State-Level Trust Agreement
• Technical Standards Review
• Model Business Associate
Agreement
• Enterprise Architecture
Blueprint (EAB)
• General Privacy and Security
Guidelines and Procedures
• EAB Lifecycle Management
Plan
• State-Level Shared Services
• THSA Web Site Redesign
• Technical Implementation
Specifications
• Privacy and Security White
Papers Published
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5010 Update:
ASC X12 Version 5010 and
NCPDP Version D.0 Implementation
Joe Graves, Team Lead
HHSC IT
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Introduction
• The Health Insurance Portability and Accountability
Act (HIPAA) requires electronic standards for health
care organizations
• CMS Rule January 2009
• HIPAA ASC X12 Version 5010
• NCPDP Version D.0
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5010 / D.0 Implementation
Timeframe
• Original Date – January 1, 2012
• CMS published non-enforcement of standards for
90 days
• HHSC Implementation Dates:
• Managed Care Encounters – January 1, 2012
• Pharmacy Transactions – February 1, 2012
• Acute and Long-Term Care Transactions – April 1, 2012
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MEHIS System
• MEHIS System Eligibility – Already compliant with
Version 5010.
• MEHIS Pharmacy History – Uses different NCPDP
Standard (not D.0).
• No other areas impacted.
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5010 / D.0 Implementation
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Your Texas Medicaid
Benefits Card and System
Noel Villarreal, Project Director
Medicaid and CHIP Division
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Project Status
• On June 29, 2011, Your Texas Benefits Medicaid Card became
operational (previously known as the Medicaid ID card system).
• Release 1 implementation supports electronic eligibility
verification and includes the following:
• Card production and distribution.
• Provider portal eligibility verification.
• Help Desk – Medicaid Eligibility and Health Information
Services (MEHIS).
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Project Status
• Release 2.1, scheduled to release in January 2011, will include
an initial basic version of the client portal that will enable clients to
print a copy of their Medicaid ID cards.
• Subsequent 2.x releases are scheduled for completion in the first
quarter of 2012 and will include the more robust applications
associated with:
• Electronic health history.
• E-prescribing.
• On-line explanation of benefits verification.
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2012 Roadmap
JAN
FEB
MAR
APR
MAY
IVR Enhancements
Opt-Out Transition
Client Portal (v1)
View Medicaid eligibility
View THSteps reminders
Request Card Replacement
Print card image
Change Opt-Out Election
Provider Portal – Claims History
Health History Summary
Check-ins
Visits (Claims/Encounter History)
Diagnosis
Detail views
Provider Portal (Enh) – Rx, Imm, Rpts
Client Portal – Health History
Prescription Drug History
Immunization History
Reports
View Claims/Encounter History
View Prescription Drug History
View Immunization History
View Alerts
Help Desk Portal
Data Access
IVR Enhancements
e-Prescribing
Portlet Access
Electronic Data Interface
Lab Data
IVR Enhancements
Last Updated: 01-02-2012
All release dates subject to change.
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5010 Impacts
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The N5010 standard applies to X12 transactions from a MEHIS
perspective.
The MEHIS system has two X12 transaction sets which both revolve
around the X12 270/271 Eligibility Inquiry/Response transactions:
• Texas Medicaid & Healthcare Partnership (TMHP)
– MEHIS submits interactive X12 270 Eligibility Inquiries to TMHP to verify client
eligibility.
– This inquiry transaction already conforms with the 5010 standard.
– The 271 Eligibility Response received from TMHP also conforms with 5010 as
implemented.
– No anticipated impacts to this interface.
• SureScripts
– MEHIS submits interactive X12 270 Eligibility Inquiries to SureScripts in
support of the ePrescribing tool.
– MEHIS is implementing the latest version of the e-prescribing system that
already supports the 5010 standard with SureScripts.
– No anticipated impacts after implementation.
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5010 Impacts
• Area of possible impact: If there are new requirements
regarding the minimum set of client and provider data that is
captured and submitted within the Eligibility Inquiry transaction.
• Not likely as this is specific to program policies or business rules,
and not necessarily requirements of the 5010 standard.
• There are no other interfaces in MEHIS that use X12; therefore,
no impact with the current implementation.
• Other transactions supported by MEHIS are batch files, HL-7,
and NCPDP SCRIPT 8.
• These should not be impacted by the 5010 standard as none of
these are candidates for the X12 specifications.
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Your Texas Medicaid
Benefits Card
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Medicaid EHR
Incentive Program
Deb Norris, Business/Policy Analyst, Medicaid/CHIP Division
Kristen Leone, Texas Project Manager, CGI
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Status Update
as of December 22, 2011
• EHR incentives paid total
$227.6 million
• 175 hospitals
• 1,967 eligible professionals
• 504 eligible professionals
(EPs) from federally qualified
health centers (FQHC) and
rural health clinics (RHC)
have enrolled
Eligible
Professionals
$40,934,624
18%
Hospitals
$186,691,715
82%
• 410 EPs have been paid
from 115 FQHC/RHCs
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Provider Enrollment Status
as of December 22, 2011
Centers for Medicare & Medicaid
Services (CMS) Registration by
Provider Type
Physician
Assistant
2%
Certified
Hospitals Nurse
Midwife
5%
1%
CMS Registrations
Dentist
7%
Nurse
Practitioner
15%
Physician
70%
Registration
Step
Number
of EPs
Number of
Hospitals
Total
4,689
263
4,952
Texas EHR Incentive Enrollment:
Not Started
1,498
36
1,534
In Process
678
2
680
Payment Pending
355
46
2,214
1,967
175
2,142
193
4
197
Paid
Cancelled or
Not Eligible
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Medicaid EHR Incentive
Program: Payments by State
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Meaningful Use Attestation
• Meaningful Use attestation portal for eligible hospitals in
January 2012.
• EPs begin attestation for meaningful use (payment year 2)
in April 2012.
• Meaningful use audit strategy under development based
on guidance from CMS.
• HHSC will contract with outside audit vendor.
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Medicaid EHR
Incentive Program
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HIE Pilot and E-Prescribing
Jason Phipps, Project Manager
Medicaid and CHIP Division
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HIE Pilot
Background:
• Two organizations are participating in the exchange of Medicaid
medication history data – Sandlot and Texas Health Resources.
• Pilot is limited to medication history.
• Phase 2 will provide real-time connectivity between HHSC and
two local HIEs.
Status:
• Phase 1 completed in November 2011.
• Phase 2 design finalized in December 2011.
• Currently resolving design dependencies and investigating
possible efficiencies.
• Implementation to begin in February 2012.
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HIE Pilot
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E-Prescribing
Status:
• Connectivity to Surescripts certified December 12, 2011.
• Service went live December 21, 2011, in a “soft” rollout.
• Eligibility checks, medication history, formulary.
• Very few issues to troubleshoot.
• Marketing / Communications underway soon.
• Now planning long-term maintenance and usability
improvements.
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Medicaid HIE
Advisory Committee
Public
Comment
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