Transcript Leadership Briefing Outline - Health and Human Services

Medicaid and CHIP
Health Information Exchange (HIE)
Advisory Committee
Meeting
October 6, 2010
Agenda
10:00 - 10:30
Welcome and Introductions
Approval of the Minutes
Meeting Schedule for 2011
10:30 – 12:00
Status Updates
• Statewide Health Information Exchange Plan
• Medicaid Electronic Health Record Incentive Program
12:00 - 1:00
Lunch
1:00 - 2:30
Medicaid Heath Information Technology Initiatives
• Medicaid Eligibility and Health Information Services
• Privacy and Opt Out Policy
• Health Information Exchange Pilot
• Electronic Prescribing
2:30 - 3:00
Additional Public Comment and Meeting Wrap-Up
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Statewide Health
Information Exchange Plan
Presenter
Stephen Palmer
Office of e-Health Coordination
October 6, 2010
Approach to Statewide HIE
Goal
Enable improvements in the quality and efficiency of the Texas health
care sector by establishing HIE infrastructure for the state.
Objective
Deliver private, secure, and reliable HIE services to all Texas patients
and providers through local HIE networks where the capacity exists and
through contracts administered from the state level where it does not.
Strategies
1. General state-level operations
2. Local HIE grant program
3. White-space coverage
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Strategy 1:
General State-Level Operations
1. Administer governance structure.
2. Identify core HIE services.
3. Establish and maintain required policies and standards for
local/regional HIEs.
4. Develop state-level shared services.
5. Develop and administer statewide evaluation plan to inform
sustainability planning.
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Strategy 2:
Local HIE Grant Program
1. Identify minimum criteria for applying/candidate local HIEs.
2. Develop Request for Application (RFA) for local HIE grant
program.
3. Accept and evaluation applications from local HIEs.
4. Award grants to qualifying local HIEs.
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Strategy 3:
White-Space Coverage
1. Develop Request for Proposal (RFP) to provide HIE services for
areas not served by a local HIE.
2. Accept and evaluate proposals.
3. Execute contract(s) with respondents to establish full HIE
coverage of white-space.
4. Monitor contracts to ensure delivery of core HIE services and
adherence to required policies and standards for local HIEs.
5. Monitor and evaluate impact to inform sustainability planning.
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Timeline: 2010 – 2013
2010
2011
2012
2013
•
•
•
•
Update THSA Governance Bylaws
Develop and Distribute RFA for Local HIE Grant Program and RFP for the White Space
Develop Required Policies and Standards for Local HIEs
Establish Interoperability and Other Technical Standards
• Award Local HIE Grants for Planning and Development
• Evaluate Proposals and Execute White-Space Contract(s)
• Develop, Implement, and Operate Shared State-Level Services
• Local HIEs Fully Operational
• White-Space HIE Fully Operational
• Evaluation of HIE Operations
• Sustainability Dialogue and Development of Sustainability Model
• Transition to Sustainability
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Budget
General State-Level Operations
$6.3 million
Local HIE Grant Program
• Proportional
• Base
$18 million
$1.5 million
White-Space Strategy*
$2 million
Total
$27.8 million
*It is anticipated that some of the proportional funding under the Local HIE
Grant Program will be dedicated to the White-Space Strategy if the local
HIEs do not claim all providers and hospitals.
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Texas Integration Strategy
TEXAS HEALTH SERVICES AUTHORITY (THSA)
Data elements
HIE Standards
Security/Privacy Policies
State-Level HIE Services
Record locator services
White space coverage
HEALTH & HUMAN SERVICES (HHSC)
Medicaid data
Regulatory issues
Population health
e-Health
Patients
Providers
Meaningful Use
REGIONAL EXTENSION CENTERS (RECs)
(Covers all of Texas)
Technical Consulting
Vendor selection
Provider interface
Provider support
HEALTH INFORMATION EXCHANGE (HIE)
Coalitions
Vendors
Community Records
Medicaid HIE
Workforce Development/Research Programs
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Statewide HIE Plan
Questions?
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Medicaid Health IT Plan and
Electronic Health Record (EHR)
Incentive Program
Presenter
Yvonne Sanchez, Sr. Policy Analyst
Medicaid and CHIP Division
October 6, 2010
Medicaid Health IT Plan Status
• August 30: Draft Medicaid Health IT Plan (MHP) provided to
Centers for Medicare & Medicaid Services (CMS) for informal
comments.
• September 28: CMS comments on draft Medicaid Health IT
plan received tentative timeframe:
• October 8: Respond to all comments
• October 18: Submit MHP, Implementation Advanced
Planning Document (IAPD), and contract change order for
management review
• October 25: Submit all documents to CMS for approval
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EHR Incentive Program
CMS Testing Schedules
• October 28:
Group 1 testing with CMS for the National Level Repository
(NLR) is scheduled to begin.
• January 2011:
• Group 1 states anticipate beginning EHR Incentive
Programs.
 Texas Medicaid is working toward participating
in Group 1.
• Group 2 states may begin NLR testing for an April
implementation date.
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EHR Incentive Payments
Follow Up Items
1. Hospital CMS Certification Number (CCN): hospitals need to
validate their data in PECOS to ensure that it fits within the range of
eligible hospitals
• For acute care, last 4 digits of the CCNs range from 0001-0870 or 1300-1399.
• For children’s hospitals, last 4 digits of the CCNs range from 3300-3399.
2. Patient Volume Calculations: the following two options can to be
used for calculating Medicaid volume:
• Encounters 
• Patient panel

Medicaid Encounters
---------------------------- X 100
Total Encounters
Medicaid MCO Clients
+
All Unduplicated
Assigned to EP*
Medicaid Encounters
----------------------------------------------------------------------- X 100
Total MCO Clients
+
All Unduplicated
Assigned to EP*
Patient Encounters
* Who had at least 1 encounter in the year prior to the 90-day period
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EHR Incentive Payments
Discussion Question
What does the committee consider reasonable allowable costs and
documentation for the EHR incentive payment?
Allowable Costs
Documentation
Purchase or upgrade costs
1. Purchase Order
2. Contract
3. Software License
Initial implementation costs:
• Workflow design consultant
• System maintenance
• System modifications or interface development (if adhering to
standards?)
• Data conversion
• System supplies
• Hiring of temporary staff for transition to live system
By attestation; need to describe with some
specificity and provide evidence of cost if
audited.
Training
In-kind support
Ongoing operational costs:
• Internet access
• Licensing fees and other associated fees to EHR vendor
• Additional system modifications
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Medicaid Eligibility and
Health Information Services
(MEHIS)
Presenter
Noel Villarreal, MEHIS Director
Medicaid and CHIP Division
October 6, 2010
MEHIS
Update
•
MEHIS Vendor Contract Executed
•
•
Contract Start: September 1, 2010
Implementation Schedule
•
System Ready: May 2, 2011
•
Interfaces
•
Provider Access
•
Card Consolidation
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Implementation
Schedule
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Interfaces
• Claims Data
• Medicaid Management Information Systems (MMIS) vendor change
order in progress
• Immunization Data
• Initiated meetings with Department of State Health Services (DSHS) to
explore options
• Prescription Drug History
• Considering options – Medicaid only data vs. Surescripts data
• Texas Health Steps
• THSteps Periodicity Table
• THSteps Claims Data
• Exploring use of data feed for reminder letters
• Lab Data
• State Lab Data in HL7 Repository
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Provider Access
Methods to Access Data:
• MEHIS Portal
• Internet Access
• MEHIS Portlets
• Can be embedded into existing systems
• MEHIS Electronic Data Interfaces (EDI)
• Can be integrated from the providers back-end systems to directly
access MEHIS data
• MEHIS Point-of-Sale (POS) devices
• Basic Card Reader – card swipe enters text
• Stand-alone POS – limited functionality and compressed data
• Integrated POS – integrated into existing applications
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Card
Consolidation
•
•
•
HHSC evaluating feasibility of consolidating
multiple managed care cards into a single
MEHIS card
– Collected initial feedback from managed
care organizations (MCOs)
– Plan to meet with MCOs in October to
discuss technical and business operation
challenges
Key Considerations
– Program and plan data to be printed on
the card and card sleeve
– Updating data
– Card reissuance
– Data Interface
– Workgroup for Electronic Data
Interchange (WEDI) standards
Will provide progress at next committee
meeting
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Questions?
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Medicaid HIE Privacy
and Opt Out Policy
Presenter
LaDair Wright, Team Lead
Medicaid and CHIP Division
October 6, 2010
Executive Commissioner
Briefing and Directives
On August 13, 2010, presented options to the HHSC Executive
Commissioner on the consent policy model for the Medicaid HIE
pilot.
• Approved adopting a hybrid consent policy model.
• Directed that a paperless process be developed for clients to
make opt-out decisions that will have a minimal impact on
eligibility services.
• Approved utilizing a standard policy framework for all future HIE
initiatives by HHS agencies.
• Established the role of the Privacy and Security Workgroup in
reviewing agency proposals, using the framework as a guide.
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Process for Requesting
Medication History
• Medicaid provider in HIE organization obtains client’s consent and
sends request for medication history.
• HIEs attest to provider consent and forwards request to
SureScripts.
• SureScripts verifies client’s identity and forwards request for
medication history to Medicaid.
• Medicaid sends medication history to SureScripts if the client has
not opted out.
• SureScripts adds additional medication history from commercial
payers, cash pay, and over-the-counter drug purchases and
returns aggregated information to HIE and then to the provider.
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Notifying Clients About HIE
• Medicaid client stuffer
• Current clients to receive in December announcing
Medicaid’s HIE initiation and explaining opt-out option.
• New clients will receive the same stuffer in the next monthly
Medicaid ID letter following their enrollment.
• Interactive voice response (IVR) and website will be developed
to provide detailed information about Medicaid HIE activities and
opt-out mechanisms for clients.
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Benefits to Clients
Clients will receive information through IVR and website about the
benefits of participating in HIE, such as:
• Higher quality of care due to providers receiving more complete
health information.
• Safer and more secure health information transfers than
through paper.
• Faster treatment through faster and easier record sharing
among providers.
• Avoid unnecessary tests being ordered by different providers.
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Benefits to Medicaid
• More patient participation generally leads to higher quality of
care.
• Provides patient choice with less legal risk than no consent.
• Less costly to administer and more sustainable than other
models.
• Less complexity of education and technology effort than other
models.
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Client Consent
• System will allow for clients to change their mind on the opt-out
option.
• Mechanisms will be established to allow clients to revoke their
initial decision at any time.
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Medicaid Health Information
Exchange (HIE) Pilot
Presenter
Yvonne Sanchez, Sr. Policy Analyst
Medicaid and CHIP Division
October 6, 2010
HIE Pilot
Status
• Initially, the HIE pilot will be limited to the exchange of medication
history.
• Offers to participate in the pilot project will be extended to six
identified organizations that are operational.
• Data exchange will utilize the network connection between the
Pharmacy Claims and Rebate Administrator (PCRA) and the
e-prescribing network.
• Pilot project will begin when PCRA transition is completed and
e-prescribing support is enabled.
• Target date for implementation: December 2010.
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Executive Commissioner
Briefing and Directive
On September 30, 2010, the HHSC Executive Commissioner
approved two recommendations on proceeding with the Medicaid
HIE pilot:
• The client consent policy will move forward with the opt-out
consent process as planned.
• The implementation of the medication history data exchange will
be implemented in two phases:
1. Implement the non-standardized batch file with
participating HIE organizations, if they chose to accept the
flat file option.
2. Proceed with the interoperable exchange through the
SureScripts network as soon as practicable after the PCRA
contract has fully transitioned to Affiliated Computer
Services, Inc. (ACS).
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Approved Consent Policy Model
The Medicaid HIE pilot project will utilize a hybrid consent policy
model:
• Medicaid providers must obtain a client’s signed consent to
request and receive their medication history from Medicaid.
• Medicaid will release clients’ medication history to requesting
Medicaid providers unless the client has chosen to opt-out of
participation in HIE.
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HIE Pilot
Phase One
• This phase would operate on a temporary basis until the PCRA
transition is complete and the new vendor is ready to begin the
data exchange for the HIE pilot and electronic prescribing.
• The batch files would be generated using the file format created
for medication claims data exchanged with the STAR Health
program for the Foster Care Health Passport.
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HIE Pilot
Phase Two
• To support the Medicaid pilot, SureScripts will expand its
delivery of real-time medication history that is currently delivered
to acute care facilities.
• Dependent upon Texas Medicaid pharmacy systems becoming
certified on the SureScripts network to support e-prescribing.
• Participating HIE organizations would be responsible for
certifying their systems with SureScripts.
• Medicaid will use grant funds to pay for the initial subscription
fees for participating HIEs.
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HIE Pilot
Tentative Timeframe
• October 2010: Notify field staff of Medicaid HIE plans.
• October - December 2010: Develop and test preliminary batch
medication history exchange using flat files (Phase 1).
• December 2010:
• Mail stuffers to current clients informing them of Medicaid HIE
plans and opt-out process; begin accepting opt-out decisions.
• Begin batch data exchange with HIEs.
• January 2011:
• Mail stuffers to new clients with monthly Medicaid ID letters.
• Submit mandated report to the Legislature.
• February 2011: Begin medication history exchange with
participating HIEs using an interoperable exchange through the
SureScripts network (Phase 2).
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Electronic Prescribing
Presenter
Ivy Bela, Project Manager
Medicaid and CHIP Division
October 6, 2010
e-Prescribing
Federal Regulations
Controlled Substances:
• The Drug Enforcement Administration (DEA) has lifted the
restriction of not allowing e-prescribing of controlled substances.
• State restrictions on Schedule II drugs: Office e-Health
Coordination and the Medicaid/CHIP Division is working with the
Department of Public Safety and Texas State Board of Pharmacy.
Brand Medically Necessary Prescriptions:
• An electronic solution has been approved by CMS that allows a
prescriber to require a brand named drug be dispensed by the
pharmacy when a generic is available.
• In the electronic prescription, the prescriber indicates the Dispense
as Written and then adds the words “brand medically necessary”
at the beginning of the notes field.
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e-Prescribing
Status Update
Design and Development:
• Business requirements and functional design approved.
• February 2011 is the go live date.
• Same opt-out policy approved by the Executive Commissioner
for the HIE Policy is being recommended by the Privacy and
Security Committee for e-prescribing.
New 2009 Statewide Adoption Rates:
• Percentage of eligible prescriptions routed electronically has
increased in the last year from 3 percent to 10 percent.
• Percentage of physicians in Texas routing prescriptions
electronically has increased in the last year from 10 percent to
15 percent.
Source: SureScripts
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HIE Advisory Committee
Public
Testimony
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HIE Advisory Committee
Meeting Wrap-Up
• Public Comments
• Review of Action Items for Next Meeting
• Next Meeting: December 1, 2010
This presentation is available at:
http://www.hhsc.state.tx.us/about_hhsc/AdvisoryCommittees/HIE.shtml
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