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Supporting State HIE Needs through MITA and CONNECT

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.

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Supporting State HIE Needs through MITA and CONNECT

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  1. WEDNESDAY, 10:30 – 10:50AM Supporting State HIE Needsthrough 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

  2. MITA – Transforming the Medicaid Business Transaction Processing Beneficiary Service Population Health INTERIM LONG-TERM AS IS • Enrollment simplified • Administration Automated • Pro-active fraud detection • Enabled decision-making • Improved ability to safeguard the health of beneficiaries • Enrollment complexities • Administrative burden • Retroactive fraud detection • Decision-making hampered • Ability to safeguard the health of beneficiaries constrained • Multi-Agency Enrollment • Administration Transformed • Reduction in Fraud • Decision Making Focus • Communities collaborate to safeguard population and public health HIMSS 2010

  3. 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

  4. 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

  5. Collaborators in Effort CMSO Owner of MITA Initiative • MITA TAC • Collaborators in Open Source Service Development • CAQH • Establishing Operating Rules for Administrative Transactions • FHA • Sponsor of MITA CONNECT Initiative • NHIN • Nationwide Exchange Framework • CONNECT • Open Source HIE Reference Implementation HIMSS 2010

  6. 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 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* Discovery and Lessons Learned Sep 2009 MITA-Based MMIS Operations Management Contractor Management Program Management Oct 2009 9 19 26 Program Integrity Management Care Management Business Relationship Management Nov 2009 2 4 4 Member Management Provider Management 8 7 MITA Gateway Jan 2010 CAQH CORE II Adapter NHIN Eligibility Adapter Authorization Service Authorization Service Eligibility Adapter Feb 2010 PM EMR EMR HIMSS 2010

  7. Solution that Works for Everybody • Hub for State HIE • Network of network • Statewide service provider • Medicaid • State HHS services • CHIP • Foster Care • SNAP, TANF • Public Health • Interaction with Federal health systems • VA • DoD • CMS • Medicare • Interaction with Commercial Payers HIMSS 2010

  8. Mapping Future Activities • MMIS 2009 • Only MITA resources demonstrated • Inquire Member Eligibility (IME) business service and supporting MITA technical services and infrastructure demonstrated • 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 HIMSS 2010

  9. 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. Thank You

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