WEDNESDAY, 10:30 – 10:50AM
Supporting State HIE Needs
through MITA and CONNECT
Bill Branch, Chief Architect, Medicaid Information
Technology Architecture (MITA)
Laura Megas, MITA-CONNECT Lead (Contractor), Federal Health Architecture,
Office of the National Coordinator for Health IT
1
MITA – Transforming the Medicaid Business
Transaction
Processing
Beneficiary
Service
Population
Health
INTERIM
AS IS
LONG-TERM
•
Enrollment complexities
•
Enrollment simplified
•
•
Administrative burden
•
•
Retroactive fraud
detection
Administration
Automated
Multi-Agency
Enrollment
•
Pro-active fraud
detection
Administration
Transformed
•
Reduction in Fraud
•
Decision Making Focus
•
Communities
collaborate to safeguard
population and public
health
•
•
HIMSS 2010
Decision-making
hampered
Ability to safeguard the
health of beneficiaries
constrained
•
•
•
Enabled decisionmaking
Improved ability to
safeguard the health of
beneficiaries
2
MITA Framework Provides the Basic
“DNA” for Medicaid HIE
• Emphasis on Interoperability
• Emphasis on Service-Oriented Architecture
– What do we want to achieve and then ask
what technology will enable that goal?
• Looking for shared business processes across
state agencies
– Child Welfare
– WIC
– Vital Statistics
– Dept of Aging
HIMSS 2010
3
MITA-CONNECT: Providing an HIE platform for MITA
• Standards First
• Commonality and Differences
Co-Exist
• Business Driven Design
• Built-in Security and Privacy
• Collaborative Approach
Makes It All Work
HIMSS 2010
4
Collaborators in Effort
HIMSS 2010
CMSO
Owner of MITA Initiative
MITA TAC
Collaborators in Open
Source Service Development
FHA
Sponsor of MITA
CONNECT Initiative
NHIN
Nationwide Exchange
Framework
CAQH
Establishing Operating Rules for
Administrative Transactions
CONNECT
Open Source HIE Reference
Implementation
5
Discovery and Lessons Learned
Sep 2009
Oct 2009
Nov 2009
Identified initial MITA business process
• Medicaid Eligibility Verification (Member Management)
Reviewed, qualified existing standards
• HIPAA, HITSP, CORE
Identified & vetted “advancement opportunities” for NHIN
• Exchanging trusted identities
• Medicaid services directory
MITA-Based MMIS
Operations
Management
9
19
26
Program
Integrity
Management
Contractor
Management
Program
Management
Care
Management
2
4
Member
Management
Business
Relationship
Management
4
Provider
Management
8
7
MITA Gateway
Jan 2010
Feb 2010
HIMSS 2010
Leveraged open source CONNECT
• MITA workgroup developed service adapters, incorporated into
CONNECT baseline
• Provides NHIN connectivity support for existing eligibility
standards
• Provides MITA Gateway audit log and authorization services
• Supports integration within Medicaid environment and with
external systems
• Testing and demonstrating with HIO and MITA MMIS*
CAQH CORE II
Adapter
NHIN Eligibility
Adapter
Authorization
Service
Authorization
Service
Eligibility
Adapter
EMR
PM
EMR
6
Solution that Works for Everybody
» Hub for State HIE
• Network of network
• Statewide service provider
• Medicaid
• State HHS services
• CHIP
• Foster Care
• SNAP, TANF
» Interaction with Federal
health systems
• VA
• DoD
• CMS
• Medicare
» Interaction with
Commercial Payers
• Public Health
HIMSS 2010
7
Mapping Future Activities
•
MMIS 2009
–
Only MITA resources demonstrated
–
Inquire Member Eligibility (IME) business service
and supporting MITA technical services and
infrastructure demonstrated
–
•
HIMSS 2010
•
–
Used recommended MITA standard and CAQH
CORE Phase 2 connectivity and content standards
HIMSS 2010
–
MITA , CONNECT and NHIN resources
demonstrated
–
IME business service, MITA technical services,
CONNECT adapters and Gateways, and NHIN
infrastructure demonstrated
–
Used recommended MITA standard , CAQH CORE
Phase 2 connectivity and content standard, NHIN
standards and CONNECT services
MMIS 2010 plans
HIMSS 2010 + additional administrative
transactions
•
Prior Authorization
•
Claim Status
–
Exchange beneficiary health information
between the Medicaid MMIS and Nodes
on the NHIN using CONNECT
–
Incorporates the exchange and use of
clinical data into administrative business
logic - MITA level 4
–
Will use recommended MITA standard,
CAQH CORE Phase 2 connectivity and
content standard, NHIN standards and
CONNECT services
•
Multi-State demonstration
•
TRANSFORM project
8
Thank You
The participation of any company or organization in the NHIN and CONNECT area within the HIMSS Interoperability showcase
does not represent an endorsement by the Office of the National Coordinator for Health Information Technology, the Federal
Health Architecture or the Department of Health and Human Services.
9
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Supporting State HIE Needs through MITA and CONNECT