1. HIT Policy & Standards Committees Enrollment Workgroup Aneesh Chopra, Chair Chief Technology Officer, OSTP Sam Karp, Co-Chair California Healthcare Foundation November 10, 2010

2. Workgroup Members Members: Ex Officio/Federal: Cris RossLab Hub InitiativeSharon Parrott, O/S, HHS James BorlandSocial Security AdministrationNancy DeLew, OCIIO/HHS Jessica ShahinU.S. Department of AgriculturePenny Thompson, CMS/HHS Stacy DeanCenter on Budget & Policy PrioritiesHenry Chao, OCIIO/HHS Steve FletcherCIO, UtahGary Glickman, OMB Reed V. TucksonUnitedHealth Group John Galloway, OMB Ronan RooneyCuramDavid Hale, NIH Rob RestucciaCommunity CatalystDavid Hansell, Administration for Ruth KennedyLouisiana Medicaid DepartmentChildren & Families, HHS Ray BaxterKaiser PermanenteJulie Rushin, IRS Deborah BachrachConsultantFarzad Mostashari, ONC Paul EgermanBusinessmanDoug Fridsma, ONC Gopal KhannaCIO, MinnesotaKristen Ratcliff, ONC Bill OatesCIO, City of BostonTom Schankweiler, OCIIO/HHS Anne CastroBlue Cross/Blue Shield South Carolina Oren MichelsMashery Wilfried SchobeiriInTake1 Bryan SivakCTO, Washington, DC Terri ShawChildren’s Partnership Eli StaubSEIU Sallie MilamWest Virginia, Chief Privacy Officer Dave MolchanyDeputy County Executive, Fairfax County Chair: Aneesh Chopra, Federal CTO Co-Chair: Sam Karp, California Healthcare Foundation

3. Agenda  Review work to date and path forward  Panel discussion on industry perspectives on implementation of initial Section 1561 standards  Lunch Break  Panel discussion on state perspectives on implementation of initial Section 1561 standards  Next Steps  Public Comment  Adjourn

4. Section 1561 of Affordable Care Act §1561. HIT Enrollment, Standards and Protocols. Not later than 180 days after the enactment, the Secretary, in consultation with the HIT Policy and Standards Committees, shall develop interoperable and secure standards and protocols that facilitate enrollment in Federal and State health and human services programs through methods that include providing individuals and authorized 3 rd parties notification of eligibility and verification of eligibility.

5. Workgroup Activity To Date June 14 – August 31: Eight public WG sessions, MANY Tiger Team meetings August 19: HIT Policy Committee accepts initial recommendations August 30: HIT Standards Committee accepts initial recommendations Sept 7: Initial recommendations transmitted from FACAs to ONC Sept 17: Secretary accepts standards with slight edits; standards published on ONC website at https://healthit.hhs.gov/aca/section1561 https://healthit.hhs.gov/aca/section1561

6. Operationalizing Sec. 1561 Standards Support CMS/OCIIO implementation of standards 3 of the 4 original Tiger Teams will continue work on the initial standards –Verification Interfaces: Focus on state and national verification interfaces –Business Rules: Focus on standards for consistent expression of business rules –Privacy and Security: Identifying the gaps in FIPs and address additional security safeguards. ONC team will continue work on 10 core data elements, as well as complete new analysis on additional data elements (e.g., marital status, veterans status).

7. Operationalizing Sec. 1561 Standards A new Consumer Focused Tiger Team has been created to build upon Appendix A by suggesting approaches to improve consumer access, engagement, usability and customer service. –Co-chairs: Terri Shaw and Brian Sivak –Membership: Reed TucksonUnited Healthcare Anne CastroBCBS Deborah Bachrach Ray Baxter/Bob ArndtKaiser Permanente Stacy DeanCenter on Budget & Policy Priorities Ronan Rooney/Walt Sedlazek/ Hank KehlbeckCuram Software Eli StaubSEIU Rob Restuccia/Sue KaufmanCommunity Catalyst Wilfried SchobeiriIntake

8. Industry Perspectives on Implementation of Initial Section 1561 Standards

9. Panel Discussion – Core Data Elements Do your systems currently use any specific data standards-based approach to collect and share data with other State programs and/or agencies? –If so, what advantages and disadvantages have you found to this approach? –What would it take to integrate the NIEM guidelines into your data collection and data transmission approach?

10. Panel Discussion – Verification Interfaces Does your system currently use a real time, Web services approach to obtain verifications from Federal and/or State data sources? –If so, what are the benefits? –If not, why not? What would it take to do so? Have you ever encountered a situation where a Web service would not be the preferred approach? Recommendation 2.2 recommends development of a reference software model for obtaining verification from Federal agencies and other State and National data sources. –How difficult would it be to connect your system to such a reference software model? What challenges would you encounter? –Would this be a preferred approach or would it be simpler to obtain verifications using existing methods?

11. Panel Discussion – Transmission of Eligibility and Enrollment Information Does your system currently use existing HIPAA standards to transmit eligibility and enrollment information to other entities? Do your systems incorporate any additional level of specificity, for example, use of CAQH CORE or other operating rules, to ensure consistent interpretation of information contained in the HIPAA standards?

12. Panel Discussion – Business Rules Do you currently express business rules outside of transaction systems? –What standard do you use for consistently expressing rules? –If so, what benefits have you seen from doing so? What challenges did you encounter? –If not, what (if any) challenges has this presented? What strategies do your systems currently employ to ensure the capacity and flexibility to change and/or modify rules as needed? How could eligibility determinations made from these business rules be presented to consumers in a more clear, concise and unambiguous manner? What challenges/opportunities are presented by the idea of a business rules repository as expressed in Recommendation 3.2? –Is additional standardization of business rules necessary to make this a valuable resource? –What strategies would you suggest for contributing to and/or maintaining such a resource?

13. Panel Discussion – Privacy & Security How, if at all, does the consumer interact with your system? –How difficult would it be to modify your system to offer consumer access to and control over eligibility and enrollment information? What functions/standards do your systems currently contain, if any, to track and monitor third party access? What safeguard systems do your systems currently include? –Do you currently encrypt data in motion? If not, why not? What are the challenges in doing so? –Do your systems currently have the capacity to generate and publish audit logs? If not, why not? What are the challenges in incorporating this function? –Do you have access control functions? If not, what are the challenges to incorporating this? –Do your systems incorporate automatic log off functionality? If not, what are the challenges to incorporating this? –Do your systems currently include any standards for ID assurance? If so, at what level? What are the challenges associated with this?

14. State Perspectives on the Implementation of Initial Section 1561 Standards

15. State Medicaid Panel Discussion Andrew Allison, KHPA, Kansas Toby Douglas, DHCS, California Medicaid Director Linda Skinner, Arizona Health Care Cost Containment System (AHCCCS) Ivan Handler, CIO, Department of Healthcare and Family Services, Illinois

16. Next Steps November 16: Consumer Focused TT November 17: Business Rules TT November 18: Verification Interfaces TT December 8: Full Enrollment WG TBD: Privacy & Security TT