MEDICAID IT FUNDING OPPORTUNITIES & RESPONSIBILITIES ELIGIBILITY, ENROLLMENT, EDUCATION & ENGAGEMENT Fully Utilizing Funding Opportunities and Efficiencies through Leveraging ARRA-HITECH and ACA Options Maximizing Enrollment 2011 State Meeting Eligibility and Enrollment Systems Transformation: Building on Lessons and Work in Maximizing Enrollment to Get Ready for 2014 Patricia MacTaggart May 19, 12:30 – 1:30
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MEDICAID IT FUNDING OPPORTUNITIES & RESPONSIBILITIES ELIGIBILITY, ENROLLMENT, EDUCATION & ENGAGEMENT Fully Utilizing Funding Opportunities and Efficiencies.
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MEDICAID IT FUNDING OPPORTUNITIES & RESPONSIBILITIES
ELIGIBILITY, ENROLLMENT, EDUCATION & ENGAGEMENT
Fully Utilizing Funding Opportunities and Efficiencies through
Leveraging ARRA-HITECH and ACA Options
Maximizing Enrollment 2011 State Meeting Eligibility and Enrollment Systems Transformation:
Building on Lessons and Work in Maximizing Enrollment to Get Ready for 2014
•Consumer Information strategies•Provider information strategies•F&A/Program integrity•Performance measures•Information Mgmt•Performance Mgmt•Grievance and appeals
Quality Oversight*
•Co-pays•Cost sharing•Caps/Limitations•Individual and Family•Plan of Care•Treatment Plan
•Eligibility:• Systems Funding: Design, development, installation or
enhancement (DDI) of a state eligibility determination & redetermination and/or enrollment system at 90% federal-10% state for DDI up to 2015 and 75% federal-25% state for ongoing operation.• Move to MAGI (Income and Household) (Modified Adjusted
Gross Income)
•Data on Performance: CHIPRA Quality Measures for Children, MU Measures, ACA Quality Measures for Adults, HCBS Measures for Waivers, PQRI Measures
Get the Data Once & Use It Multiple TimesDuplication of IT Systems Will No Longer Be Funded
• National Standards: Terminology & Approach (Medicare, SSA, IRS)
• Project Management: Accountability and Singular/Aligned Structure
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ELIGIBILITY AS CORE TO EVOLVING HEALTH INSURANCE EXCHANGE
•Authority: need to see State Authority
•Implementation is really July 2013• •Single Integrate Pathway • Easy for Individuals to Explore Health Coverage Options• Individuals can Quickly and Accurately Enroll into Coverage
• Financing Plan: matching governance• Exchange: 100% FFP for IT Infrastructure for
Insurance for those components• Medicaid: 90/10 authority have today
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ELIGIBILITY AS CORE TO EVOLVING HEALTH INSURANCE EXCHANGE
•Common systems and High Levels of Integration: No “Gap” in Coverage: Governance and Accounting
• Non-Dual Disabled May Not Be “Coded” Disabled
Medicaid138% FPL
Basic Health Plan139% to 200%
Tax Subsidy138% to 400%
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MITA: MEDICAID INFORMATION TECHNOLOGYArchitecture & Framework
• Member Management: Eligibility, Enrollment & Outreach & Consumer Communication & Information, Grievance/Appeal
• Provider Management: Enrollment, Communication & Information &
New Aged & Disabled Consumer Benefits & State Opportunities
•Dependent Adults up to 26 on Parent’s Plans even Married (2011)•No Pre-existing Condition Exclusions for Children (2011)• Prohibitions against Lifetime Benefit Caps & Rescissions (2011)•Preventive Care Coverage & No Cost-Sharing Medicare (2011)
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IMPLEMENTATIONConcepts Transformed Into Actions
• Financing Strategies:– Services and State Administration State Strategies– Cost Allocation
• Responsibility to Validate Value - Metrics for Success:– MU Measures for Ambulatory and Hospital– Clinical and Outcomes: Success Rate in Treatment– Productivity: Absenteeism and Presenteeism– Consumer Experience: CAHPS
• Cross Initiative Implementation Strategies:No Current IT Infrastructure Supports the Needs of Tomorrow:
What has to be done 2014 – What Gets Phased In
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Category DescriptionInterface State interfaces of a Health Information Exchange (HIE)--
(e.g., labs, registries, PH databases, emergency preparedness, etc.) needed for providers to reach MU.
Data Mgmt
Creation/enhancement of a Data Warehouse/Repository (cost allocated), for evaluation and data analysis for federal and state reporting, as well as external and internal management that complies with HIPPA Privacy and Security requirements related to authorization to data, access to data types and functions, role permissions, ability to further designate third parties, and security to prevent breaches.
Identity Mgmt
Development of a Master Patient Index (cost allocated).
HIT POTENTIALLY ELIGIBLE FOR MEDICAID FUNDING FOR CROSS INITIATIVE IMPLEMENTATION
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Category DescriptionProvider
MgmtProvider Help-Line/Dedicated E-mail Address/Call Center (hardware, software, staffing)
Operations Mgmt
System associated with the collection and verification of MU data from providers’ EHRs and Data Analysis, Oversight and Auditing and Reporting on EHR Adoption and MU as well as regular Medicaid oversight activities
Program Integrity
System and resource costs to develop, capture, and audit provider attestations for MU, including e-signature. Systems related to fraud and abuse prevention activities, such as interfaces with the Board of Medical Quality Assurance (BMQA) for licensing status.
HIT POTENTIALLY ELIGIBLE FOR MEDICAID FUNDING FOR CROSS INITIATIVE IMPLEMENTATION