Medicaid HIPAA-Compliant Concept Model A Demonstration of the MHCCM Sheila Frank, HCFA May 7, 2001

Background HCFA and State Medicaid management literally have spent decades encouraging creative, divergent solutions to similar issues. Our first order of business was to break down the fiefdoms within and between Medicaid Agencies.

Purpose of MHCCM Show How the Transaction Standards Will Affect Medicaid Business Practices Illustrate the Commonalities That Medicaid Agencies Historically Have Downplayed First step

Model of a generalized Medicaid business enterprise including all of its typical data exchange partners. Allows us to show the Medicaid Enterprise in a comprehensive way; ALL of its functions and connections, not just those affected by HIPAA. Simplistic and colorful representation MHCCM

Orientation MHCCM Uses Web Architecture Images Are Presented by a Browser (Microsoft IE) Microsoft Personal Server Controls Process Images Are Created in PowerPoint, Activated by Front Page, Stored in Files Information Stored in an Access Database

Model Operational Environment Personal Web Server 4.0 Internet Explorer 5.5 Windows 95, 98, 2000, Me Office 97, 2000 (Access, Word, Excel, PowerPoint)

Browser Personal Server Image Files Action Data Base MHCCM Architecture

Uses of the MHCCM Prepare awareness and outreach presentations Illustrate the impact of each Final Rule Unify business and technical staff Provide graphical representation of all Medicaid Enterprise functions

Uses of the MHCCM Provide an organized, documented collection of all Medicaid Enterprise business functions and processes Help to develop –Strategic plan –Project plan –Implementation plan –Gap Analysis

Uses of the MHCCM Help in mapping data elements into standard transactions Validate transaction crosswalk activity Monitor the actual implementation - quality control Identify processes affected by a future fully compliant system Help in documenting HIPAA compliance