Medicaid and CHIP Health Information Exchange Advisory Committee Meeting

January 12, 2012

Agenda

Welcome• Approval of Committee Minutes• Committee Changes and Vacancies• Committee Schedule for 2012• Introduction of new Health Information Technology (IT) team members

State Legislative Activities and Federal Developments Update – Stephen Palmer

Statewide Health Information Exchange (HIE) Activities Update – Tony Gilman

Medicaid Project Updates:• 5010 Update – Joe Graves• Your Texas Medicaid Benefits Card / System – Noel Villarreal• Electronic Health Record (EHR) Incentive Program – Deb Norris and Kristen Leone• Health Information Exchange (HIE) Pilot and E-Prescribing – Jason Phipps

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Health IT Team Members

• Ramdas Menon, Health IT Director• Thomas Colvin, Project Manager• Deb Norris, Policy / Business Analyst• Jason Phipps, Project Manager• Noel Villarreal, Manager, Medicaid Benefits Card• Julia Alejandre, Communications• Sabrina Thomas, Administrative Assistant

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State Legislative Activities and Federal Developments

Stephen Palmer, Director

Office of e-Health Coordination

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State Legislative Activities and Federal Developments

State Legislative Activities

Update and discussion

Questions

Federal Developments

Update and discussion

Questions

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Statewide Health Information Exchange Activities

Tony Gilman, Executive Director

Texas Health Services Authority (THSA)

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Local HIE Grant Program

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• Quarterly Progress Reports

• Two HIE Business and Operational Plan Approved in September 2011.

• 14 HIEs submitted Business and Operational Plans: • Four HIEs have submitted plan amendments to address

weaknesses and deficiencies.

• Six HIEs developing plan amendment to address weaknesses and deficiencies.

• Three HIEs will either merge with another HIE or become part of White Space.

• One HIE will either continue or become part of the White Space.

• All HIEs are transitioning from planning to implementation in January 2012.

White Space Strategy

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Current Status

•Five Health Information Service Providers (HISPs) formally qualified in December 2011. •THSA White Space web page launched www.thsa.org/white-space.aspx •White Space Fact Sheet and Q&A posted.•Voucher registration form and HISP profile and pricing sheets added to web page.

Next Steps

•Soft communications campaign through THSA, state-level professional associations, Medicaid, and regional extension centers (RECs), to inform providers of White Space Strategy and voucher request and payment process.•Timeline: January 2012

General-State Level Operations

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Current Status

• Monthly Collaboration Council and Task Force Meetings

• Texas HIE Interoperability Guidance Published

• Technical Standards Review

• Enterprise Architecture Blueprint (EAB)

• EAB Lifecycle Management Plan

• Technical Implementation Specifications

• Privacy and Security White Papers Published

Next Steps

• Privacy and Security Guidance

• State-Level Trust Agreement

• Model Business Associate Agreement

• General Privacy and Security Guidelines and Procedures

• State-Level Shared Services

• THSA Web Site Redesign

5010 Update: ASC X12 Version 5010 and

NCPDP Version D.0 Implementation

Joe Graves, Team Lead

HHSC IT

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Introduction

• The Health Insurance Portability and Accountability Act (HIPAA) requires electronic standards for health care organizations

• CMS Rule January 2009

• HIPAA ASC X12 Version 5010

• NCPDP Version D.0

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5010 / D.0 Implementation Timeframe

• Original Date – January 1, 2012

• CMS published non-enforcement of standards for 90 days

• HHSC Implementation Dates:

• Managed Care Encounters – January 1, 2012

• Pharmacy Transactions – February 1, 2012

• Acute and Long-Term Care Transactions – April 1, 2012

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MEHIS System

• MEHIS System Eligibility – Already compliant with Version 5010.

• MEHIS Pharmacy History – Uses different NCPDP Standard (not D.0).

• No other areas impacted.

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5010 / D.0 Implementation

Your Texas MedicaidBenefits Card and System

Noel Villarreal, Project DirectorMedicaid and CHIP Division

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Project Status

• On June 29, 2011, Your Texas Benefits Medicaid Card became operational (previously known as the Medicaid ID card system).

• Release 1 implementation supports electronic eligibility verification and includes the following:

• Card production and distribution.

• Provider portal eligibility verification.

• Help Desk – Medicaid Eligibility and Health Information Services (MEHIS).

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Project Status

• Release 2.1, scheduled to release in January 2011, will include an initial basic version of the client portal that will enable clients to print a copy of their Medicaid ID cards.

• Subsequent 2.x releases are scheduled for completion in the first quarter of 2012 and will include the more robust applications associated with:

• Electronic health history.

• E-prescribing.

• On-line explanation of benefits verification.

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2012 Roadmap

JAN FEB MAR APR MAY

IVR Enhancements

Opt-Out Transition

Client Portal (v1)

Provider Portal – Claims History

View Medicaid eligibilityView THSteps reminders

Request Card ReplacementPrint card image

Change Opt-Out Election Health History SummaryCheck-ins

Visits (Claims/Encounter History)Diagnosis

Detail views Prescription Drug HistoryImmunization History

ReportsProvider Portal (Enh) – Rx, Imm, Rpts

View Claims/Encounter HistoryView Prescription Drug History

View Immunization HistoryView Alerts

Client Portal – Health History

Help Desk Portal

IVR Enhancements

Data Access Portlet AccessElectronic Data Interface

e-Prescribing

Lab Data

IVR Enhancements

All release dates subject to change.Last Updated: 01-02-2012 18

5010 Impacts

• The N5010 standard applies to X12 transactions from a MEHIS perspective.

• The MEHIS system has two X12 transaction sets which both revolve around the X12 270/271 Eligibility Inquiry/Response transactions:

• Texas Medicaid & Healthcare Partnership (TMHP)– MEHIS submits interactive X12 270 Eligibility Inquiries to TMHP to verify client

eligibility. – This inquiry transaction already conforms with the 5010 standard. – The 271 Eligibility Response received from TMHP also conforms with 5010 as

implemented. – No anticipated impacts to this interface.

• SureScripts– MEHIS submits interactive X12 270 Eligibility Inquiries to SureScripts in

support of the ePrescribing tool. – MEHIS is implementing the latest version of the e-prescribing system that

already supports the 5010 standard with SureScripts. – No anticipated impacts after implementation.

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5010 Impacts

• Area of possible impact: If there are new requirements regarding the minimum set of client and provider data that is captured and submitted within the Eligibility Inquiry transaction. • Not likely as this is specific to program policies or business rules,

and not necessarily requirements of the 5010 standard.

• There are no other interfaces in MEHIS that use X12; therefore, no impact with the current implementation.

• Other transactions supported by MEHIS are batch files, HL-7, and NCPDP SCRIPT 8. • These should not be impacted by the 5010 standard as none of

these are candidates for the X12 specifications.

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Your Texas Medicaid Benefits Card

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Medicaid EHRIncentive Program

Deb Norris, Business/Policy Analyst, Medicaid/CHIP DivisionKristen Leone, Texas Project Manager, CGI

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Hospitals

$186,691,71582%

EligibleProfessionals

$40,934,62418%

Status Updateas of December 22, 2011

• EHR incentives paid total $227.6 million

• 175 hospitals• 1,967 eligible professionals

• 504 eligible professionals (EPs) from federally qualified health centers (FQHC) and rural health clinics (RHC) have enrolled

• 410 EPs have been paid from 115 FQHC/RHCs

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Provider Enrollment Statusas of December 22, 2011

Registration

Step

Number

of EPsNumber of Hospitals Total

CMS Registrations 4,689 263 4,952

Texas EHR Incentive Enrollment:

Not Started 1,498 36 1,534

In Process 678 2 680

Payment Pending 355 46 2,214

Paid 1,967 175 2,142

Cancelled or

Not Eligible193 4 197

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Centers for Medicare & Medicaid Services (CMS) Registration by

Provider Type

Medicaid EHR Incentive Program: Payments by State

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Meaningful Use Attestation

• Meaningful Use attestation portal for eligible hospitals in January 2012.

• EPs begin attestation for meaningful use (payment year 2) in April 2012.

• Meaningful use audit strategy under development based on guidance from CMS.• HHSC will contract with outside audit vendor.

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Medicaid EHR Incentive Program

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HIE Pilot and E-Prescribing

Jason Phipps, Project Manager

Medicaid and CHIP Division

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HIE Pilot

Background:

• Two organizations are participating in the exchange of Medicaid medication history data – Sandlot and Texas Health Resources.

• Pilot is limited to medication history.

• Phase 2 will provide real-time connectivity between HHSC and two local HIEs.

Status:

• Phase 1 completed in November 2011.

• Phase 2 design finalized in December 2011.• Currently resolving design dependencies and investigating

possible efficiencies.• Implementation to begin in February 2012.

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HIE Pilot

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E-Prescribing

Status:

• Connectivity to Surescripts certified December 12, 2011.

• Service went live December 21, 2011, in a “soft” rollout.

• Eligibility checks, medication history, formulary.

• Very few issues to troubleshoot.

• Marketing / Communications underway soon.

• Now planning long-term maintenance and usability improvements.

Medicaid HIEAdvisory Committee

Public

Comment

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