DRAFTDR
Leveraging Health Information Technology for
Health Insurance Exchange
Financial Management, Monitoring and Evaluation
Report 2
Patricia MacTaggart, MBA, MMA
The George Washington University
School of Public Health and Health Services
Department of Health Policy
February 10, 2013
Submitted to the State Health Access Data Assistance Center, University of Minnesota School of Public
Health, under subcontract to SHADAC. “Assessing State Administrative Data.” Funded by the U.S.
Department of Health and Human Services Assistant Secretary for Planning and Evaluation (ASPE)
(HHSP23320100024WI/HHSP23337001T)
DRAFT FOR STATE INPUT
Draft
Table of Contents
1.
2.
3.
4.
5.
6.
7.
Introduction ............................................................................................................... 3
Member, Qualified Health Plan and Health Insurance Exchange Financial Data
Elements….………………………………………………………………………………………………………….…….4
Member, Qualified Health Plan and Health Insurance Exchange Financial Data
Sources………………………………………………………………………………………………………………………6
Dashboard Capability for State Management and Reporting if Data Elements and IT
Infrastructure Included ………………………………………………………………………………………………6
Vendor and Contractor Language……………………………………….………………………………………8
Standards and Data Elements …..…………………………………………….….……………………….…...9
Process and Challenges……………………………………………………………………………….…………...10
Exhibit
Exhibit 1: Financial Questions for States that Align with Initial Core Questions…………………………….7
Attachments
A.
B.
C.
D.
E.
F.
Data Elements Needed for Financial Reporting ………………………………………………………..11
IT Interfaces to Data Sources for Financial and Cost Operations and Reporting. ……...12
Member…………………………………………………………………………………………………………………..14
Qualified Health Plan..................................................................................................19
Health Insurance Exchange………………………………………………………………………….……….....22
Checklist for Health Insurance Exchange Data for Financial Monitoring and
Reporting……………………………………………………………………………………………………………….…24
2
Leveraging Health Information Technology for
Health Insurance Exchange Financial
Management, Monitoring and Evaluation Report 2
1.
Introduction
States and Health Insurance Exchanges (HIXs) must: (1) address implementation and
operational costs; (2) manage expenditures for administrative functions, consumer education
and engagement, and payments to issuers, and (3) track and report on trends at the macro and
micro level. In order to manage the HIX in compliance with the Accountable Care Acti, as well
as monitor the results of the activities of the HIX, the involved Qualified Health Plans (QHPs)
and issuers, information technology (IT) support is required to address (1) adequate accounting
capability and protocols, policies and procedures; (2) identification of compliance issues, such
as medical loss ratio; (3) banking and wire transfer functions; (4) cash management and
payment authorization; (5) administrative budget and actual/variance reporting protocols, and
(6) internal financial controls and state/federal reporting.
One of the prerequisites for accurate reporting and analysis is the establishment of a solid
baseline, requiring the IT infrastructure, data sources and data specifications to be determined
as early in the process as possible. In addition, financial impacts have distinct, significant
federal and state implications, which demand documentation of initial and ongoing resource
requirements. The resource needs of the HIX have different cost impacts dependent on timing
as the federal government takes more responsibility for initial funding (100% for IT through a
grant process), while the state must deal with ongoing fiscal viability. Utilization of federal
dollars is a critical consideration for states.
Financial Data and Information Technology (IT) Essentials: This policy brief seeks to present
opportunities for states to learn from key leading states that are immensely varied in process
and policy, Minnesota, Oklahoma, Alabama, New York, Vermont and California the issues and
opportunities for efficient and effective collection and use of required Affordable Care Act
(ACA) HIX administrative and financial data for financial management and reporting. This
policy brief provides procurement and vendor language for consideration for financial
reporting elements, specific detailed functional specifications that addresses data definitions,
data structure, data sources and interface specifications, collection period (e.g. monthly,
quarterly, annual), and considerations related to interpreting the financial and cost information.
Mandated financial reporting requirements, new data sources (RS/Treasury Dept.) and newly
designed IT infrastructure create the parameters for discussion. The goal is to address these
3
components in requests for proposal (RFPs) and contract
specifications so that duplicative purchasing is avoided
and opportunities to standardize and leverage across
projects are maximized. This can be achieved through an
alignment of federal, standardized technology
infrastructure specifications, data definitions, privacy and
security (access, authorization and authentication)
requirements, and business rules.
States should consider aligning with
federal, standardized technology
infrastructure specifications, data
definitions, privacy and security
(access,
authorization
and
authentication) requirements, and
business rules.
HIXs must have the financial management infrastructure necessary to support the execution of
financial controls and audit function for all activities, receipts and expenditures, as well as
generate the appropriate reports. Enrollment and financial reports must be kept in synch and
all required reports to CMS must be sent in the format specified by the Centers for Medicare &
Medicaid Services (CMS). In addition, HIXs are subject to annual audits, oversight from the
Government Accountability Office (GAO), Department Treasury reporting requirements related
to data on individuals determined to be eligible for the premium tax credit, and reporting
requirements for specific information to employers. Each of these activities makes the
collection, retention, transmission and management of accurate financial and administrative
data critical.
This project is intended for states considering development and implementation of an ACA HIX.
It is intended as information only and as part of a larger project being conducted for the
Assistant Secretary of Planning and Evaluation (ASPE) by the SHADAC, in assessing the data
needs for monitoring and evaluation of the ACAii and by providing technical assistance to
leading states on the implementation of health reform, funded by the Robert Wood Johnson
Foundation (RWJF). The following report and recommendations represents a distillation of the
best current thinking by leading states in the development of Health Insurance Exchanges.
2.
Member, Qualified Health Plan and Health Insurance Exchange Financial
Data Elements
Financial Management and Data Collection:
Financial
management and data collection requirements for states under
the ACA relate to four specific areas: (1) appropriate use of
federal and state funds to support the verification of eligibility;
(2) rating, financial requirement determinations, and
management, including payment and oversight, of certification
of the qualified health plans (QHPs); (3) financial activities of the
Financial Management Data
Collection areas that States
need to address:
 Enrollees
 QHPs
 HIX
 Medicaid
4
Health Insurance Exchange (HIX) (annual operating costs and amounts lost to fraud, abuse and
waste), and (4) assurance of coordination and utilization of Medicaid funding through
Medicaid income eligibility.iii A state’s HIX must have a process for billing, collection, and
account management and financial controls and determine exception processing consistent
with federal regulations and guidance. The HIX must also have financial metrics (such as
variance from budget), a defined algorithm for plan ranking, claims acceptance and storage
capability, claims analytics and reporting tools, and a financial payment and reporting system.
These processes and capabilities produce data that can be utilized for reporting and
monitoring.
A state’s HIX must publish the costs and fees associated with operating the organization,
including the average cost of licensing, required regulatory fees and payments to operate the
Exchange, Exchange administrative costs, and an accounting of money lost to fraud, waste, and
abuse. Within the HIX system, the state must retain the data necessary to assure financial and
operations oversights of the Qualified Health Plans (QHP), including certification, carrier
management, user fee collection and management, enrollment and financial transactions. The
data collected for oversight will then be available for required reporting to the federal
government and to other stakeholders.
Financial Data Elements: Data elements that could be available for
the creation of a standardized reporting approach based on the
four key areas identified above are listed in Attachment A. For the
information to be available for operations, oversight and reporting,
the financial data must be (1) collected from identified data
sources, (2) leveraged where collected for other purposes (data
previously collected by regulatory agency), (3) appropriately linked
and defined, and (4) supported through an IT infrastructure where
the IT specifications accommodate the data requirements.
States need to consider
alignment of financial
data for federal reporting
for Federal Financial
Participation (FFP) with
financial data used for
ongoing monitoring and
other purposes..
Attachments B-D provide the core data elements that states may want to consider for financial
ongoing management and federal/state external reporting for monitoring and evaluation. The
attachments address (1) data content (elements and definitions), (2) format (structure, element
type, source) and (3) interfaces related to the individual enrolled into coverage through the HIX
(referred to as “member”), the QHPs, including Medicaid/CHIP managed care entities, and the
HIX. These data elements will need to be utilized by the HIX as well as the QHPs and potentially
their network providers.
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3.
Member, Qualified Health Plan and Health Insurance Exchange Financial
Data Sources
Financial Data Source Variables: Variables that affect state options in designing a financial
reporting/monitoring system include things like the internal back office administrative
infrastructure within the HIX, the availability of a state all payer claims data base, if there is or is
not a state tax system to use as a data source, what financial information is collected at the
QHP regulatory agency, and where Medicaid eligibility will be processed. States must
understand the structures, content, timelines and update periodicity of the data. For example,
how and by whom the HIX handles premium aggregation and billing, carrier payments,
eligibility and enrollment processing and reconciliation of employers, QHPs, and enrollees will
affect what data is collected and retained through internal IT systems rather than accessed
through interfaces with other IT systems.
Variables that affect financial data analysis that must be
considered include: (1) QHP and Medicaid use of managed care
(encounter data as a data source and limitations resulting from
sub-capitations where encounter data is not available); (2)
consistency in the use of Medicaid and QHP data sources
(Medicaid expenditures include both state and federal share but
not all data sources include both the state and federal share and
Medicaid, QHP and HIX expenditures include “administrative” and
managed care costs as well as “claims” costs but some payments made outside of the claims
processing system may not be included in the data source); (3) pre and post 2014 financial
analyses that include children must address the inclusion/exclusion of CHIP financial data, and
(4) consistency in how the HIX defines and treats QHP and HIX administrative expenditures.
States need to establish a
hierarchy for financial
data sources based on
accuracy, timeliness and
efficiencies in order to
determine which data will
be used for purposes of
payment, financial
reporting and analysis.
Required Financial Data Sources: States are required to use a federal data hub and existing
State databases to the maximum extent feasible for income and financial reporting and
operations. Attachment B identifies potential financial data source interfaces for states to
consider and the data elements that can be obtained through the interfaces.
4.
Dashboard Capability for State Management and Reporting if Data
Elements and IT Infrastructure Included
For states, the “day one” functionalities are the priority. Included in that priority is the capacity to
manage, which requires the ability to transform data into actionable information in near real-time and
present it in an efficient, easily understandable “dashboard”. Health Insurance Exchanges must
6
collect and verify financial, eligibility and quality data on individuals, families, employers, QHPs
and issuersiv, which become data elements accessible for use in a dashboard.
There are multiple financial questions that can be answered with
these data elements. States should consider federal financial
reporting requirements, build off existing state financial
management and accountability tools, comply with all provisions
of the Affordable Care Act and federal grant terms, comply with
state specific auditing requirements, and support and monitor
Exchange consumer services, including premium payments,
subsidies and health plan payments. In addition to the federally
required financial information, alignment of financial
information with core enrollment, retention, premium subsidy
and QHP information will allow states to link activities and
utilization with costs.
Exhibit 1:
Financials related
to Individuals
Enrolled through
Health Insurance
Exchange
States should consider a
core, initial set of
standardized financial
questions for collection to
meet reporting and
management purposes
across states to assure
comparability and answer
critical “day one”
questions.
Financial Questions for States that Align with Initial Core Questions
Premium payment and tax credit cost for individuals that successfully enrolled
in private individual health insurance through the Health Insurance Exchange.
Premium payment and tax credit cost for individuals that successfully enrolled
in private group insurance through SHOP.
Number and cost of individuals that successfully enroll in Medicaid.
Number and cost of individuals that successfully enroll in CHIP.
Premium payment and tax credit cost for individual that successfully enrolled in
Basic Health Plan, if offered.
Number of individuals that successfully enrolled in a QHP, which QHP, and
Premium payments for those individuals.
Distribution of private market exchange members by actuarial value: Bronze,
Silver, Gold, Platinum, Catastrophic.
Distribution and costs of private market exchange members exchange members
by deductible level.
Cost information on use of navigator for applicants.
Cost information by characteristics of exchange members: age, gender,
geographic location.
How many people have their application rejected without their eligibility status
identified (e.g., information was missing at their application)?
Financials Related
to Retention and
Transitions
Premium and tax credit information on the people enrolling in the program in a
given month who are truly new to insurance affordability programs (i.e., they
did not churn or transfer)?
7
Exhibit 1: Financial Questions for States that Align with Initial Core Questions
between Programs
Premium Subsidy
Number and cost of individuals that receive a premium subsidy by various
subsidy levels.
Qualified Plans
Number of plans offered through Exchange and number of plans per level.
Number and premium cost of plans that offer only the essential benefits.
This is just the beginning of a list that each state will need to create to assure that the actual
reports that are required and/or desired are programmed into the system as an automated
function. The state will need the capacity to fully utilize the data from the systems and
conduct, interpret and report data analyses and results.
5.
Vendor and Contractor Language
The translation of the data elements and data source interface specifications into RFP and
contract language requires consideration of federal funding requirements, such as MITA and
the “Seven Conditions and Standards”, and privacy and security safeguards, including a
requirement that information systems containing tax return information comply with taxpayer
privacy and safeguards. Determining what is within scope and what is outside of scope of a
Health Insurance Exchange contract has initial cost implications and ongoing operational
consequences. In general, the Health Insurance Exchange must comply with ACA, particularly
Section 1561, Medicaid guidance and regulations related to reporting requirements, and core
requirements outlined in their approved Level 1 Exchange Establishment Grant.
Reports: RFPs and contracts must require a technology platform that can produce the financial
data and reports for relevant agencies and stakeholders which are needed to support
performance management, provide public transparency, evaluate progress, make
improvements, assure program integrity, allow for policy analysis, and comply with federal and
state reporting requirements (federal audit and oversight, quality control initiatives, (PERM),
and appropriate use of federal funding). The IT structure should guarantee that financial data
collected for operations and auditing is integrated into the reporting apparatus so it can be fully
utilized for oversight and evaluation.
Reporting capabilities must be able to connect and integrate data from multiple sources,
maximize automation, and assure personally-identifiable information is protected.
Considerations when determining report capabilities include: (1) the potential limitations by
vendors on the number of reports that can be requested (initial pricing will be dependent on
report requirements but limitations will add to ongoing costs), (2) the ability to integrate
8
encounter data (inclusion but separate identification within
reports), (3) the assurance of the integrity of the data, especially
with the conversation of data (such as ICD-9 to ICD-10), (4) the
capability to merge or associate data where appropriate
(individuals denied tax credits due to the eligibility for Medicaid
linked to individuals approved for Medicaid), (5) the capacity to
store and process external data, allow for querying by authorized
users, archive inactive files, and validate data for completeness,
(6) the specified response time requirements for ad-hoc or offcycle reports, and (7) the limitations on creating, supporting and
accepting interfaces with needed data sources.
States should consider
when integrating data
from multiple sources into
the IT infrastructure,
business processes and
quality performance
metrics interfaces with the
appropriate data sources
and the capacity to collect,
retain and integrate the
data with internal data
sources.
Identity Management-Individual, Provider, Entity: Accurate financial reporting is dependent
on the use of a standardized, common set of individual, provider and entity identifiers or a
standardized methodology to determine the required demographic data fields for matching.
This data could include but is not limited to name, date of birth, address and sex. In addition,
many current health care eligibility, claims, program integrity, financial management and/or
insurance systems do not have the capacity to capture, track and link an expansive set of
attributes across programs.
Health Insurance Exchanges need not create another identifier to
States should consider a
cross-walk to the HIE, Medicaid, etc. States can leverage the standardized, common set
EMPI or the algorithm that establishes the identity using multiple of individual, provider and
demographic attributes that have already been established for entity identifiers or a
Medicaid and/or the HIE. States can also build upon the required standardized methodology
provider level National Patient Identifier (NPI) using State/State for identity management.
Designated HIE provider directories. Re-using an already
established ID avoids cross-walk requirements and allows the state to utilize the validations
that have already been completed through the previous processes.
6.
Standards and Data Elements
For financial reporting, a starting place is the federal financial reporting definitions and
specifications already established for Medicaid reporting to CMS through the CMS-37 and CMS64. In addition, the Medicaid Statistical Information System (MSIS) data, which was designed
to provide CMS with a detailed national database of program information to support a broad
range of analytic and user needs, is already transmitted from states to the federal government,
has defined data specifications and cross-walk clarifications, includes eligibility and paid claims
9
personal information on Medicaid members and addresses payment and encounters. The CMS
specifications for MSIS definev terms, identify responsibilities, and describe the record layouts.
Established standards include the HIPAA 834 Transaction (Enrollment) Standards
(http://www/wpc-edi.com), race and ethnicity (OMB standards), preferred language (ISO 6391:2002), preliminary determination of cause of death (ICD-10-CM), and encounter diagnoses
(ICD-10-CM).
7.
Process and Challenges
Process: Documents created by the Office of the National Coordinator (ONC) and CMS CCIO
for states were reviewed, along with documents created by leading states for their HIX, HIE,
MMIS (MITA) and Medicaid eligibility expansions. Telephone interviews with states that were
further along in their process were completed in July to validate the translation of monitoring
strategy concepts into actualization and identify feasibility considerations and/or limitations.
Enhanced federal funding opportunities and requirements, policy guidance provided by CMS
regarding timeline flexibility and limitations, new IT development (service oriented
architecture, federal and state data verification functionality, business rules engine, business
intelligence and reporting) as well as expanding current efforts (identify management), and
state human, IT and financial resource constraints were considered. If Medicaid funding is
utilized, requirements necessitate compliance with the Seven Standards and Conditions and the
Medicaid Information Technology Framework (MITA). In addition, the activities must be
included in the State Medicaid Health IT Plan (SMHP), appropriate Advance Planning
Document(s) (APD(s)) must be submitted, and quarterly CMS-37 and CMS-64 reporting must be
adjusted. IT specifications must also be addressed in relationship to the state’s need for state
and provider infrastructure.
Challenges: Modularity, flexibility and standardization are even critical RFP and vendor contract
requirements as states need to specify vendor requirements in RFPs and contracts “now”; yet,
significant policy decisions at the federal and state level and guidance at the federal level is
currently in process. Future decisions in those area will affect “how” data is collected (sources,
location of the data sources and the interface requirements) but the “what” will remain. A checklist
for states to consider related to financial data follows in Attachment E.
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Attachment A: Data Elements Needed for Financial Reporting
Area
1. Verification
Eligibility:
Member
Information
of



1. Certification of
Qualified Health
Plan (QHP)


2. Health Insurance
Exchange



3. Medicaid

Elements
Member/Taxpayer:
Identification,
Demographics/Household
Composition, Income and Eligibility and/or Enrollment Change of
Circumstances
Premium Tax Credit: total amount, amount of advance payments,
collection of advance payment overpayments (Billing/Collection)
Individual Coverage ( Period and Level), Premium (Cost Calculator) and
Cost Sharing
QHP: Identification, Geographic Area (QHP and Network), Financials,
(Licensing Costs/Regulatory Fees), Rating Practices (Use of Tobacco,
Family Tiers), Medical Loss Ratio, Financials by QHP Product
Claims: Payment Policies and Practices, Denials by Provider Type and Out
of Network Payments
Tax Credits by Individual: Accuracy, Receipt and Correctness of Tax
Credits, including Advance Payments
Expenditures and Administrative Costs, including Consumer Education
and Engagement, Payment to Issuers and Internal Operational Costs
(variance from budget)
Financial, Operations and Performance “Activities”, including Program
Integrity (monies lost to waste, fraud and abuse), accounting, financial
analysis and banking functionalities (banking functions will have data on
amount transferred, date transferred and to whom transferred)
All Federal Reporting Medicaid Data: T-MSIS and CMS Financial Reporting
(CMS-64 and CMS-37), including Encounter Data.
11
Attachment B: IT Interfaces to Data Sources for Financial and Cost Operations and
Reporting
Interfaces to
Data Sources
CMS Data Services Hub:
IRS/Treasury Dept.
CMS Data Services Hub:
Social Security
CMS Data Services Hub:
VA
Medicaid and CHIP
Eligibility Systems
MMIS – T-MSIS
Internal HIX: Member
and Navigator/
Authorized
Representative
Potential Data Elements Provided















Internal HIX: Issuer and
QHP




Internal HIX:
Management
“Activities” and Costs
Internal HIX: SHOP
Coverage





Taxpayer Identification and Tax Credit: Payment, Amount, Date of Cessation (as
applicable), Advance Payments, and Exemption Status
Individual Identifier (Program Specific), Tax Information and Disability
Income and Disability
Individual, Provider and Entity Identification: Program Specific
Individual, Provider and Entity Identifier: Program Specific
Individual: Demographics (detail affected by age of system), Family Size and Income
(based on Medicaid Basis of Eligibility -MAGI and non-MAGI methodology), Household
Composition, Disability (if coded as basis of Medicaid eligibility)
Individual, Provider and Entity Identifier: Program Specific
Medicaid MCO/Health Plan Information: Co-payments, Cost Sharing, and Claims Payment
Policies/Practices (dependent on what is transferred from MCO to MMIS)
Claims Denials by Provider Type: MMIS for FFS and MMIS Encounter Data for MCOs
Medicaid/CHIP Member: appeals and outcomes (if in MMIS system)
Demographics, including Smoking Status if collected for rate calculations
Individual/Family, Taxpayer, Navigator and Authorized Representative: Identification
(program specific)
Individual Taxpayer/Family: Income (MAGI methodology), Period and Level of Coverage
by Individual by QHP, Payments (premium, cost sharing), Reported Change of
Circumstances Affecting Eligibility and/or Enrollment
Premium Tax Credit: Total Amount, Advanced Payments, Accuracy/Receipt/Correctness
(internal system)
Employer of Individual: Initial and at Time of Change, including Name and Date (if
required on application/redetermination)
Provider, Issuer and QHP by Issuer: Identification (program specific)
Issuers: Payments to Issuers through Banking and Wire Transfer Functions and
Payment Authorization Systems
QHP Coverage and Payment (if not collected by insurance/health plan regulatory
agency): Level of Coverage, Claims Payment Policies and Practices, Rating Practices,
Cost Sharing, Out of Network Payments, Enrollment/Disenrollment and Claims Denials
by Provider Type and Provider Network (provider and location)
QHP Quality and Financial Oversight (if not collected by insurance/health plan
regulatory agency): Medical Loss Ratio Coverage, Expenditures, Financials and Appeals
HIX Program Integrity Management “Activities”: Monies Lost to Waste, Fraud and Abuse
HIX Financial and Other Management “Activities”: Operations (administrative budget,
account management, billing and collection systems, and cost calculator infrastructure),
Performance (actual/variance reporting system) and Plan (claims acceptance and storage
capability) vi
HIX Internal Costs: Administrative, Consumer Education and Engagement Costs
Eligibility of Small Business and their Employees
Received Tax Credit and Payment Amount
12
Interfaces to
Data Sources
State Insurance and HP
Regulatory Agency
Potential Data Elements Provided

QHP: Entity Identification (program specific) Level of coverage, Licensing Costs and
Regulatory Fees, Financials, Expenditures and Cost Sharing by Plan within QHP Product,
Claims Payment Policies/Practices and Rating Practices (if reporting is a regulatory
requirement) and Enrollment/Disenrollment Data
Other State Specific
Systems: Illustrative


Veterans and Other Federal Matches (Public Assistance Reporting System (PARIS))
Individual, Provider and Entity: Identification (program specific for state tax, workman’s
compensation, Health Information Exchange (HIE), driver’s License:
E-Address through Provider and Entity Directory: Health Information Exchange

13
Attachment C: Membervii viii ix x xi
Data Elements
Member
Management:
Individual
Identifier
Member
Management:
Date of Birth
Member
Management:
Date of Death
Data Definitions/ Codes
Data Source
Individual unique personal identification
number that is assigned by the State
(Master Individual Index: to standardize and
convert data between multiple systems state
should consider creating a Master Individual
Index for the HIX and public programs.
Format: Month, Day, Century, Year = Age
(Specifications required by Data Services Hub
will be the required specifications to assure
interoperability and avoid need for
conversion.)
Format: Month, Day, Century, Year
(Specifications required by Data Services Hub
will be the required specifications to assure
interoperability and avoid need for
conversion.)
Member
Management:
Address
 Street
 City
 State
 Zip Code
 County Code
Enrollment and
Eligibility
Management:
Income
Format:
(County Code will exist if application includes
County, individual is on another public
program that tracks county, or IT
infrastructure has programmed capability to
convert address and zip code through
mapping to county and convert county into
state established county code).
Member
Management:
Gender
Format: M = male F = female U = unknown
Eligibility
and
Enrollment
Management:
Citizenship
or
Immigration
Modified
Adjusted
Methodology
Gross
Income
State Established based on
name
on
Application/Enrollment
Form linked to coding
methodology of state.
Interfaces/
Dependencies
Linked to name and
“family”
defined
below.
Linked to other Public
Programs if possible.
Application/Enrollment
Form (primary source)
Data Services
Social Security
Vital Record & Passport
(secondary source)
Vital Records & State
Driver’s License (in
some states)
Data Services Hub:
Social Security
Notification by Employer
or Family/Interested Party
(primary source)
Vital Records
Death Certificate- Vital
Records (primary and/or
secondary source)
Application/Enrollment
Form (primary source)
Social
Security,
IRS/Treasury, State Tax
System, Unemployment,
Other Public Programs
(secondary source)
Application/Enrollment
Form (primary source)
Tax Return and Current
Paystubs (non-electronic
secondary source)
Application/Enrollment
Form (primary source)
State Public Program
System
Public Programs (WIC,
FS,
Medicaid/CHIP,
etc.)
State Driver’s License:
Dept.
of
Motor
Vehicles
Data Services Hub:
IRS/Treasury
Dept.
Unemployment,
Internal HIX
Gender = declared sex of individual
(Additional Issue: coding for unborn)
Citizen (Y/N)
Immigration Status: dependent on coding
from application/enrollment form
Hub:
Federal
Agencies
(secondary source)
Application/Enrollment
Form (primary source)
Data Services Hub
Federal
Agencies
(secondary source)
14
Data Elements
Status
Eligibility
and
Enrollment: Date
Individual
Enrollment
Eligibility
and
Enrollment:
Data Definitions/ Codes
Date Individual Enrolled = date individual
eligible for coverage through HIX = no earlier
than month of application = no later than
month of application approved
Format: 2 digit century, 2 digit year, 2 digit
month, 2 digit date
State specific definition
Incarceration
status
Data Source
Interfaces/
Dependencies
System generated when
approved
based
on
business rules (primary
source).
Internal HIX
Application/Enrollment if
on the Enrollment Form
(primary source)
Internal
HIX
and
Potential of other
State
systems
(dependent on state)
State
Dependent:
Criminal Justice System,
Medicaid
(secondary
source)
Member
Management:
Race/
Ethnicity
Eligibility and
Enrollment:
American
Indian/Native
American status
Ethnicity Options:
 Not of Hispanic, Latino/a, or Spanish
origin
 Mexican, Mexican American, Chicano
 Puerto Rican
 Cuban
 another Hispanic, Latino, Spanish origin
Application/Enrollment
Form (primary source)
Data Services Hub:
Social
Security,
IRS/TREASURY DEPT.
Social
Security,
IRS/Treasure
Dept.
Unemployment, State Tax
System, Other Public
Programs
(secondary
source)
Race Options:
 White
 Black or African American
 American Indian or Alaska Native
 Asian (Asian Indian, Chinese, Filipino,
Japanese, Korean, Vietnamese, Other
Asian)
 Native Hawaiian or Other Pacific Islander
(Native
Hawaiian,
Guamanian
or
Chamorro, Samoan or Other Pacific
Islander)
OMB Race/Ethnicity coded
Application/Enrollment if
on the Enrollment Form
(Consistent with Member Management: (primary source)
Race/Ethnicity but may have on application
Social
Security,
further information as to Tribe)
IRS/Treasury
Dept.,
Unemployment, State Tax
Data Services Hub:
Social
Security,
IRS/Treasury Dept.
Indian Nations
15
Data Elements
Eligibility
and
Enrollment
Management:
Individual
Risk
Score
Member
Management:
Smoking Status
Data Definitions/ Codes
Risk Score:
 Enrollment Date
 Disenrollment Date
Available if determination of individual risk
score is a part of process, collected and
retained as part of application/enrollment.
Current Smoker, Previous but not current,
Never, No Response
Data Source
System, Other Public
Programs, Tribal Records
(secondary source)
If established and retained
at HIX, it is available in the
system for linkage at
disenrollment.
System
must automate linkage
(primary source).
Application/Enrollment if
on the Enrollment Form
(primary source)
(No standardized coding)
Member
Management:
Interpreter
Services Required
Eligibility
and
Enrollment
Management:
Family
 Size
 Members
by
Age
Eligibility
and
Enrollment
Management:
Eligible
for
Publicly Funded
Program
Eligibility
and
Y for yes
N for no
Age = Data of Birth linked to individual linked
to family (Age will provide data source for
impact of insurance coverage for older
children).
 Medicare-Part A, B, C, D
 Medicare-Medicaid Full Dual
 QMBs, SLMBs, QIs and QDWIs
 Medicare Status Unknown
 Medicaid Only: Children, Pregnant
Women, Parents, New Adult Group,
Disabled by Medicaid category of
Disability, Elderly, Foster Care, HCBWS
Members by category of disability,
Breast and Cervical Cancer, Medicaid
Premium Subsidy
 CHIP
Individual receiving tax credit and amount
Internal HIX
QHPs, Issuers,
Medicaid
Internal HIX
QHP, Issuer, Medicaid
(secondary source)
Application/Enrollment if
on the Enrollment Form
(primary source)
Default – if no response indicated N for no
Size = MAGI Methodology
(Policy Dependent: if Pregnant Women, SSI
or CHIP child in household family size state
much determine how to handle)
Interfaces/
Dependencies
Federal & Other State
Agencies
(possible
secondary source)
Application/Enrollment
Form (primary source)
Tax Return
source)
(secondary
Application/Enrollment
Form (primary source)
Medicare and Medicaid
(secondary source)
Internal HIX
Potentially
Services Hub
Data
Internal HIX
Data Services Hub:
IRS/Treasury Dept.
Internal HIX
Data Services Hub:
CMS, Social Security
State
Medicaid
Eligibility System
HIX Computation (primary
Internal HIX
16
Data Elements
Enrollment
Management:
Tax
Credit
Amount
Eligibility
and
Enrollment
Management:
Enrollment into
Private Plan
Member
Management:
Premium
Tax
Credit
Eligibility
and
Enrollment
Management:
Employment
Status
 Insured/Uninsu
red status
 Employer:
initial and at
time of change
Eligibility
and
Enrollment
Management:
Exemption Status
Data Definitions/ Codes
Data Source
Interfaces/
Dependencies
source)
Bronze, Silver, Gold, Platinum, Catastrophic
Level by Individual
Tax Return (secondary
source)
HIX Computation (primary
source)
Data Services Hub:
IRS/Treasury Dept.
Internal HIX
Issuer/QHP
QHP Name by Individual


Amount $ per individual/family
Date of cessation as applicable
Insured through Employer: Y = Yes and name
issuer, name of employer and date of
employment by employed person
Employed at time of Application: F= Full
Time, P = Part Time, N = Not Employed
If F or P, then indicate I = Insured and
unstructured data element of name
Employed at time of Change: F= Full Time, P
= Part Time, N = Not Employed
If F or P, then indicate I = Insured and
unstructured data element of name
Exempt (Y or N) and if Y indicate
 R (Religious)
 F (Financial)
Member
Management:
Taxpayer
Identification No
(TIN)
TIN as reported to IRS
Member
Management:
Coverage

Issuer/QHP
(secondary
source)
HIX Computation (primary
source)
IRS/Treasury
Dept.
(secondary source)
HIX Computation (primary
source)
Other State Agencies:
Workman’s
Compensation, State Tax
New Hire Income & Health
Insurance Benefits

Internal HIX
Internal HIX: Linked to
application date for
data of change.
Data Services Hub:
New Hire Income &
Health
Insurance
Benefits
Application/Enrollment
Form (primary source)
Data Services Hub:
IRS/Treasury Dept.
HIX Administrative and
IRS/Treasury (secondary
source)
Tax (primary course)
Internal HIX
HIX Administrative, State
Tax
and
Medicaid
(secondary source)
Period of Coverage: Date range with
open and end date by individual
Level of coverage: by individual
Data Services Hub:
IRS/Treasury Dept.
HIX
Administrative
(primary source)
Issuer/QHP,
State
Insurance
/Regulatory
Agency dependent on
state (secondary source)
Data Services Hub:
IRS/ Treasury Dept.
Internal HIX and
MMIS
Internal HIX
Issuer/QHP and
Other State Agencies:
Potentially the State
Insurance/Regulatory
17
Data Elements
Data Definitions/ Codes
Member
Management:
Premium
Member specific
pricing
Premium by individual by period of coverage
Member
Management:
Cost sharing
QHP by individual:
 Copayments by service by amount
 Deductible by coverage year by individual
by family by total amount
Member
Management/
Program
Integrity:
Advanced
Payments
Eligibility
and
Enrollment
Management:
Insurance status
at
time
of
enrollment
Linkage of individual to family for family
deductibles
By coverage year, by quarter advanced
payment rolling to a total annual advanced
payment
Link to total eligible tax credit to determine
number who took advanced payments and
number of individuals overpaid during year.
Link
to
collections/repayments
of
overpayments to determine “lost monies”
due to advanced payments
By individual:
 Insured at time of enrollment
 Uninsured at time of enrollment
 If uninsured, date of last insurance
coverage
 If uninsured, last coverage source by
private/Medicaid/CHIP and by health
plan
Data Source
HIX Calculation (primary
source)
Issuer/QHP,
State
Insurance
/Regulatory
Agency (secondary source)
HIX
Administrative
(primary source)
QHP/Issuer
source)
(secondary
IRS/TREASURY
(primary source)
DEPT.
HIX
Administrative(primary
source)
Application/Enrollment
Form (primary source)
Medicaid
and
Application
(primary source)
CHIP
Forms
Interfaces/
Dependencies
Internal HIX
Issuer/QHP and
Other State Agencies:
Potentially
State
Insurance/Regulatory
HIX Internal
QHP/Issuer (secondary
source)
HIX Internal
Data
Hub:
IRS/Treasury Dept.
HIX Internal
Medicaid and CHIP
Eligibility Systems
HIX
Administrative
(secondary source)
Link HIX enrollment to last coverage to
address churn, seamless transitions, gaps in
coverage and long-term departures.
18
Attachment D: Qualified Health Planxii xiii xiv xv xvi
Data
Elements
QHP Product
Issuer
Identification
QHP Product
Identification
of Plan within
QHP Product
Payer
Member
QHP
for
for
Plan
Management:
Coverage/
Benefits
by
Plan
within
QHP Products
Data Definitions/ Codes
Issuer identifier = Issuer Name: Federal HIX
standard alignment
Issuer Address: Federal HIX standard alignment
and/or Health Insurance Regulatory Agency
alignment
Plan = product of issuer by
 Name & Type: Exchange HMO, Exchange
point of service (POS), Exchange PPO,
Medicaid, Medicare Advantage
 Geographic Area: county
 Level:
Bronze, Silver, Gold, Platinum,
Catastrophic, Dental Only
 Indication if “benchmark” plan: no standard
code
 Other: State specific, such as potentially
Division of Insurance (DOI) Rating
Information and Tiers
 Medicaid
 CHIP
 Medicare
 Employer/Group
 Individual HIX
Data Source
Health
Insurance
Regulatory
Agency
(primary source)
HIX Internal
HIX
Administrative
(secondary source)
Health
Insurance
Regulatory
Agency
(primary source)
Health
Insurance
Regulatory System
HIX Internal
HIX
Administrative
(secondary source)
All
Payer
Claims
Database (APCD)
State Data Analytics
Contractor (SDAC)
Health
Insurance
Regulatory
Agency
(primary source)
HIX
Administrative,
Medicaid
and
CHIP
(secondary source)
The package of benefits that an issuer offers Health
Insurance
that is reported to state regulators in an Regulatory
Agency
insurance filing.
(primary source)
Services Definition = Medicaid definition of
services, while package of services included are
defined by state option of “benchmark”
comparison. For example, hospitalization –
inpatient hospital payments as defined by CMS
64.
Interfaces/
Dependencies
Health
Insurance
Regulatory System
HIX
Administrative,
Medicaid/CHIP/All Payer
Claims (APCD), Issuer
(secondary source)
Health
Insurance
Regulatory System
HIX Internal &
Medicaid/CHIP/All
Payer Claims Database
(APCD)
Health
Insurance
Regulatory Data Base
HIX Internal
Medicaid/CHIP/All
Payer Claims Database
(APCD)
Issuer Data Base
Need to cross walk
ambulatory patient services
to Medicaid Services for
inclusion/exclusion
and
determine for comparison
role
of
rebates
in
determining comparisons
related to pharmaceutical.
10 Minimum Categories (use CMS 37/64
coding):
ambulatory patient services;
emergency services; hospitalization; maternity
and newborn care; mental health and substance
use disorder services, including behavioral
health treatment;
prescription drugs;
rehabilitative and habilitative services and
devices; laboratory services; preventive and Issue:
Medicaid service
19
Data
Elements
Data Definitions/ Codes
Data Source
wellness services and chronic disease more
management; and pediatric services, including segmentation
oral and vision care.
Interfaces/
Dependencies
discreet
By Category of Service: Limits (funding and life Issue: Encounter data (if
time.
required – but mandatory
for Medicaid – use coding
Prescription Drugs: formulary and limitations
for CMS 37/64 and/or MSIS
and include adjudication
May include optional benefits available for an and encounter payment
additional premium as well as benefits that are history information)
legally considered riders but are not optional for
consumers (‘‘mandatory riders’’), if those Need to determine “dental”
benefits are part of the most commonly definition in commercial
purchased set of benefits within the product by and cross-walk to Medicaid
enrollment) and a particular cost sharing option definition.
(not including premium rates or premium
quotes).
Care
Management:
Treatment
Limitations by
plan
within
QHP Product
Need to define for reporting and comparison
issues such as supplemental payments, DSH,
Medical Education.
Quantitative Limits Based on:
 frequency of treatment
 days of coverage
 other similar limits on the scope and
duration of treatment, such as physical
therapy to 10 visits/year
Operations
Management:
Claims Denial
by
Provider
Type by plan
within
QHP
Product
Claims Denial by Provider Type by plan within
QHP Product
Contract
Management:
Cost Sharing by
plan
within
QHP Product
Cost Sharing by plan within QHP Product
 Copayments by services
 Deductible by services
 Out-of-Network Payment by services
Issuer/QHP and Health
Insurance
Regulatory
(primary source)
Health
Insurance
Regulatory
&
Issuer/QHP Data Bases
HIX Administrative and
Medicaid/CHIP/All Payer
(secondary source)
HIX Administrative Data
(primary source)
HIX Internal and
Medicaid/CHIP/All
Payer Claims Database
Issuer/QHP Data Base
HIX Internal
Medicaid/CHIP/All Payer
Claims Database
and
Potentially State Data
Analytics
Contractor
(secondary source)
HIX Administrative Data,
QHP/Issuer Data Base and
Health
Insurance
Regulatory
(primary
source)
Medicaid/CHIP/All Payer
Claims
Database
(secondary source)
Medicaid
(MSIS)/
CHIP/All Payer Claims
Database
Issuer/QHP Data Base
HIX Internal
Medicaid/CHIP/All
Payer Claims Database
and Potentially State
Regulatory
(state
dependent)
20
Data
Elements
Eligibility and
Enrollment:
Provider Appeals
Data Definitions/ Codes
Provider Appeals by Provider Type
 Provider Type (CMS 64-37 or Medicare)
 Appeal Category: State Determined
Data Source
State Provider
(primary source)
Appeals
HIX
Administrative
(secondary source)
Performance
Management:
QHP Network
Providers
Operations
Management:
Small
Business
Health
Options
Program
(SHOP)
By Network Provider:
 Credentialing
 Name
 Primary Location
 If Multiple Location: Each Location
 Services: CMS 37/64 Data Definition
 Key Contact Personnel
 Essential Community Providers (ECPs) Status
 Specialty
 NPI
Optional: Link to Geographic Information
System to validate locations and adequacy
Employer:
 Name/ID
 Number of Employees
 Receiving tax credit or not receiving tax
credit
 Did -Did not previously offer health
insurance benefits
 Defined Financial Contribution
 If defined benefit plan: name and if open to
employees by employer
 Premium Tax Credits
QHP/Issuer
source)
(primary
Department of Insurance
and/or
Health
Plan
Regulatory
Agency
(primary source)
HIX
Administrative(secondary
source)
QHP/Issuer
source)
Interfaces/
Dependencies
State Provider Appeals
System
(may
be
Medicaid or other
system)
HIX Internal
HIE Master Provider
Director
Other State Agencies:
Insurance/Health Plan
Regulatory Agency
QHP/Issuer Provider
Enrollment System
(primary
HIE Master Provider
Director
Department of Insurance
and/or
Health
Plan
Regulatory
Agency
(primary source)
Other State Agencies:
Insurance/Health Plan
Regulatory Agency
HIX
Administrative(secondary
source)
QHP/Issuer Provider
Enrollment System
Group Market Issuers
 Name
 By Employer, Covered Lives
21
Attachment E: Health Insurance Exchangexvii xviii xix xx xxi
Data Elements
Data Definitions/ Codes
Operations
Management:
Validation of
Tax
Credits,
including
advance payments:
 Accuracy
 Receipt
 Correctness
Eligibility
and
Enrollment
Management:
Number of people
who used “Assister”
and cost
Validation of Tax Credits (Final)
 Accuracy/Correctness (number correctly
calculated first time – number
adjustments made per reporting year)
 Receipt (audit system validation of
payment issue – see financial
management)
Validation of Tax Credit Advance Payments:
 Accuracy/Correctness
 number correctly calculated first
time
 number collections made at end of
year and amount of variance from
advance and actual
 number of additional payments
made beyond advance payments
and variance)
 Receipt (audit system validation of
payment issue – see financial
management)
Number of people who used “Assister”:
 Navigator and cost
 Broker and cost
 Neither/None: accessed HIX through web
Eligibility
and Error Rate = of initial determination, % error
Enrollment: Accuracy identified during audit review and $ value of
of initial decisions error cases
based on audit reviews
“Initial” data from initial determination.
Operations
Management:
Tax
Audit review data: from audit (unknown
whether data source will be electronic)
Tax Credits to Employers:
 Employer ID
Data Source
Interfaces/
Dependencies
HIX
Internal
Administrative
HIX
(primary source)
IRS (secondary source)
Data only available if
asked on application-self
reported and retained in
HIX
Administrative
(primary).
If navigator system tracks
navigator by member and
“broker” interface reports
by member, it might be
possible to calculate this
information.
State
specific.
HIX Calculation (state
specific) of audit change
versus initial if audit
review data available
electronically and linked.
(primary)
Data Hub: IRS/
Treasury Dept.
HIX Internal
Possibly Navigator
IT and “Broker”
interface.
(See
data
source
comment).
HIX Internal
HIX Audit Review
System.
HIX
Administrative HIX Internal
(primary source)
22
Data Elements
Data Definitions/ Codes
Credits to Employers
Operations
Management:
Charged
by
Exchange
Operations
Management:
Expenditures
Administrative
Functions
Fees
the
for
Program
Integrity
Management:
Monies
Lost
to
Waste, Fraud and
Abuse
Financial
Management:
Payments to Issuers
Received
Grant:
Federal



Tax Credit Range
Previously provided health insurance
Did not previously provided health
insurance
 QHP by Employer
 Fees charged QHP by the Exchange for
User/Licensing
 Amount/month Assessment/subscriber
fee included in premium/month
Administrative Functions by:
 Management of SHOP
 Management of QHP
 Internal management of HIX
 Enrollment and Education activities
 Program Integrity
 Marketing
 Financial Activities
 IT/Systems Activities
 Quality Oversight
No standardized categories or definitions –
one way to address is “cost centers” and/or
consider reporting by staff and contractor
categories
Audit Recoveries by category:
 Waste, including billing errors
 Fraud and Abuse

Premium Payments
 Level 1 Grant
 2nd Level 1 Grant
 Level 2 Grant
Data Source
Interfaces/
Dependencies
State
Regulatory
State Regulatory Authority Dept.
and
Department
of
Revenue
(secondary State Department
source)
of Revenue/Taxes
HIX
Administrative HIX Internal
(primary source)
HIX
Administrative
(primary source)
HIX Internal
HIX
Administrative
(primary source)
HIX Internal
HIX Administrative
 Banking and Wire
Transfer Systems
 Cash
Management
Systems
 Payment Systems:
 Accounting Systems:
Billing, Collection, and
Account
Management
Systems.
HIX
Administrative
(primary source) but may
not be electronic or in
system
HIX Internal
HIX Internal
tracked
electronically)
23
(if
Attachment F: Checklist for HIX Data for Financial Monitoring and Reporting
Elements
 Does the state understand the HIX financial data requirements related to the activities of the
Health Insurance Exchange?
 Has the state identified the availability of needed financial data sources, including federal sources,
state sources, health plans, etc.? How will the state access these data sources? What is provided
by the federal Data Services Hub vs. state sources? Has the state started dialogue with all
entities, especially non-health sources, such as state Departments of Revenue?
 Does the state require the HIX vendor to obtain the required data elements related to the
financial activities of the Health Insurance Exchange?
 Is the HIX vendor required to leverage data collected for other purposes (audit trail information as
a data source for reporting) for purposes of financial monitoring and reporting?
 Do the HIX vendor requirements align with federal, standardized technology infrastructure
specifications, data definitions, privacy and security (access, authorization and authentication)
requirements, and business rules?
 Does the state define which financial data elements are linked and require the HIX vendor to
appropriately link them?
 Do the HIX IT infrastructure specifications accommodate the financial data requirements?
 Has the state included in the QHP contract requirements those financial data elements that will
need to be utilized by the QHPs, and potentially their network providers, as well as the HIX?
 Has the state addressed which data source is the primary data “truth” in the event there is
conflicting data?
 Has state specified to the HIX vendor the required data source interfaces and data elements and
specifications for each data source?
 Has the state defined for the HIX vendor which data sources are to be used for what and when in
order to assure access to whichever data source provides the most efficient, accurate and timely
data elements when there is more than one option available to the state?
 Has the state addressed in the HIX vendor contract how the HIX vendor must integrate other data
into the IT infrastructure, business processes and quality performance metrics, including,
interfaces with the appropriate data sources and capacity to collect, retain and integrate the data
with internal data sources?
 In translating the financial data elements and data source interface specifications into RFP and
contract language, has the state clearly defined what is within scope and what is outside of scope
of an HIX contract related to financial data elements and interfaces?
 Does the state require a technology platform that can produce the financial data and reports
which are needed and support reporting capabilities that connect and integrate data from
multiple sources?
 Does the state require the HIX vendor to respond in a stated amount of time to ad-hoc or offcycle reports?
 Will the state require the HIX vendor to leverage the EMPI or the algorithm that establish the
identity using multiple demographic attributes that have already been established for Medicaid
and/or the HIE?
 Has the state specified to the HIX vendor modularity, flexibility and standardization requirements? Has
the state gained assurances from the vendor that they can accommodate changing guidelines and
standards?
 Has the state reused standard contract language relative to working with vendors and federal
government, etc. to expedite processes and mitigate risk/cost?
24
i
ACA, Public Law 111-148 § 1313
Blewett, Lynn A., Pari McGarraugh and Karen Soderberg. “Draft Preliminary Report: Data Needs for Evaluation of the
Affordable Care Act.” State Health Access Data Assistance Center (SHADAC), University of Minnesota, School of Public
Health. Submitted to the U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation
(ASPE) July 21, 2012. (Solicitation Number 11-233-SOL-00530)
iii iii Blewett, Lynn A., Pari McGarraugh and Karen Soderberg. “Draft Preliminary Report: Data Needs for Evaluation of the
Affordable Care Act.” State Health Access Data Assistance Center (SHADAC), University of Minnesota, School of Public
Health. Submitted to the U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation
(ASPE) July 21, 2012. (Solicitation Number 11-233-SOL-00530)
iv Federal Exchange Program System Data Services Hub Statement of Work,
http://www.nescies.org/sites/www.nescies.org/files/HHS%20-%20Hub%20Statement%20of%20Work%20.pdf
v http://www.cms.hhs.gov/MSIS/
vi Draft Part 1 Chapter 4 business Process Model 3.0, MITA, http://www.cms.gov/Research-Statistics-Data-andSystems/Computer-Data-and-Systems/MedicaidInfoTechArch/index.html?redirect=/MedicaidInfoTechArch/, reviewed
7/15/12
vii
Bipartisan Policy Center (June 2012) Challenges and Strategies for Accurately Matching Patients to Their Health Care
Data. Washington, D.C.: Bipartisan Policy Center. Retrieved from
http://bipartisanpolicy.org/sites/default/files/BPC%20HIT%20Issue%20Brief%20on%20Patient%20Matching.pdf
viii viiiReducing Health Disparities with Improved Data Collection: New Refined Data Standards for Race, Ethnicity, Sex,
Primary Language, and Disability Status,
http://minorityhealth.hhs.gov/templates/content.aspx?lvl=2&lvlid=208&id=9227#Race
ix Minnesota RFP, Minnesota Department of Commerce Health Benefit Exchange,
http://mn.gov/commerce/insurance/images/ExchOutreachRFP2-12.pdf, reviewed 7/21/12
x CALIFORNIA OCIO OFFICE, DRAFT FOR DISCUSSION, VERSION 14, DECEMBER 7, 2010 Health Care One Stop,
Transforming California Health Care Interoperability – Interfaces – Information The Time to Start is Now, IT Infrastructure
Operational Roadmap to meet Federal Mandates and Fully Utilized Federal Options, George Washington University for
CA CIO Office, 12/07/2010,
xi Massachusetts Health Insurance Exchange Contract,
xii Bipartisan Policy Center (June 2012) Challenges and Strategies for Accurately Matching Patients to Their Health Care
Data. Washington, D.C.: Bipartisan Policy Center. Retrieved from
http://bipartisanpolicy.org/sites/default/files/BPC%20HIT%20Issue%20Brief%20on%20Patient%20Matching.pdf
xiii xiiiReducing Health Disparities with Improved Data Collection: New Refined Data Standards for Race, Ethnicity, Sex,
Primary Language, and Disability Status,
http://minorityhealth.hhs.gov/templates/content.aspx?lvl=2&lvlid=208&id=9227#Race
xiv Minnesota RFP, Minnesota Department of Commerce Health Benefit Exchange,
http://mn.gov/commerce/insurance/images/ExchOutreachRFP2-12.pdf, reviewed 7/21/12
xv Health Care One Stop, Transforming California Health Care Interoperability – Interfaces – Information The Time to Start
is Now, IT Infrastructure Operational Roadmap to meet Federal Mandates and Fully Utilized Federal Options, George
Washington University for CA CIO Office, 12/07/2010,
xvi Massachusetts Health Insurance Exchange Contract,
xvii Bipartisan Policy Center (June 2012) Challenges and Strategies for Accurately Matching Patients to Their Health Care
Data. Washington, D.C.: Bipartisan Policy Center. Retrieved from
http://bipartisanpolicy.org/sites/default/files/BPC%20HIT%20Issue%20Brief%20on%20Patient%20Matching.pdf
xviii xviiiReducing Health Disparities with Improved Data Collection: New Refined Data Standards for Race, Ethnicity, Sex,
Primary Language, and Disability Status,
http://minorityhealth.hhs.gov/templates/content.aspx?lvl=2&lvlid=208&id=9227#Race
xix Minnesota RFP, Minnesota Department of Commerce Health Benefit Exchange,
http://mn.gov/commerce/insurance/images/ExchOutreachRFP2-12.pdf, reviewed 7/21/12
xx CALIFORNIA OCIO OFFICE, DRAFT FOR DISCUSSION, VERSION 14, DECEMBER 7, 2010 Health Care One Stop,
ii
Transforming California Health Care Interoperability – Interfaces – Information The Time to Start is Now, IT
Infrastructure Operational Roadmap to meet Federal Mandates and Fully Utilized Federal Options, George
Washington University for CA CIO Office, 12/07/2010,
xxi
Massachusetts Health Insurance Exchange Contract,
25