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