1. Aneesh Chopra, Chair Chief Technology Officer (CTO), Office of Science and Technology Policy (OSTP) Sam Karp, Co-Chair California Healthcare Foundation June 30, 2010 HIT Policy & Standards Committees Enrollment Workgroup

2. Workgroup Members Members: Ex Officio/Federal: Cris RossSureScriptsSharon Parrott, O/S, HHS James BorlandSocial Security AdministrationNancy DeLew, HHS Jessica ShahinU.S. Department of AgriculturePenny Thompson, CMS/HHS Stacy DeanCenter on Budget & Policy PrioritiesHenry Chao, CMS/HHS Steve FletcherChief Information Office (CIO), UtahGary Glickman, OMB Reed V. TucksonUnitedHealth Group John Galloway, OMB Ronan RooneyCuramDavid Hale, NIH Rob RestucciaCommunity CatalystPaul Swanenberg, SSA Ruth KennedyLouisiana Medicaid DepartmentDavid Hansell, Administration for Ray BaxterKaiser PermanenteChildren & Families, HHS Deborah BachrachConsultantJulie Rushin, IRS Paul EgermanBusinessmanFarzad Mostashari, ONC Gopal KhannaCIO, Minnesota Doug Fridsma, ONC Bill OatesCIO, City of Boston Claudia Williams, ONC Anne CastroBlue Cross/Blue Shield South Carolina Oren MichelsMashery Wilfried SchobeiriInTake1 Bryan SivakCTO, Washington, DC Terri ShawChildren’s Partnership Elizabeth RoyalService Employees International Union (SEIU) 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. 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.

4. Enrollment Workgroup Charge Inventory of standards in use, identification of gap, recommendations for candidate standards for federal and state health and human service programs in following areas: –Electronic matching across state and Federal data –Retrieval and submission of electronic documentation for verification –Reuse of eligibility information –Capability for individuals to maintain eligibility information online –Notification of eligibility

5. Potential Deliverables 1.Inventory of standards-based data exchange in use today to enroll in health and human services 2.Candidate standards for data elements and messaging 3.Proposed process to fill in gaps to rapidly turn "requirements" into working prototypes/live implementations to deliver world class eligibility and enrollment services

6. Potential Candidate Standards Core data elements Name, address, residence, income, citizenship, etc. Messaging Checking eligibility and enrollment Consumer matching across systems Retrieving and sending “packages” of verification information including income, employment, citizenship Communicating enrollment information Privacy and security Secure transport Authentication

7. Standards Requirements We need to conceptualize standards that might be useful and work across a variety of use cases or architectures which might include: Front end user-facing consumer portal* to conduct initial eligibility checks and obtain and forward verification information Comprehensive eligibility system for Health and Human Services programs State or Federal exchange portals *online, mail and telephone based systems

8. Draft Policy Principles - Reprise Standards and technologies must support and be in service to our policy goals: Consumer at the center Make enrollment process less burdensome; simplify eligibility process and make it seamless Enter/obtain information once, reuse for other purposes Make it easier for consumers to move between programs Focus on 2014 world

9. Draft Standards Principles - Reprise Keep it simple - Think big, but start small. Recommend standards as minimal as required to support necessary policy objective/business need, and then build as you go. –Don’t rip and replace existing interfaces that are working (e.g., with SSA etc.) –Advance adoption of common standards where proven through use (e.g., 270/271). Don’t let “perfect” be the enemy of “good enough” Go for the 80 percent that everyone can agree on. –Opportunity to standardize the core, shared data elements across programs. –Cannot represent every desired data element. Keep the implementation cost as low as possible –May be possible to designate a basic set of services and interfaces that can be built once and used by or incorporated by states. –Opportunity to accelerate move to web services Do not try to create a one-size-fits-all standard that add burden or complexity to the simple use cases –Opportunity to describe data elements and messaging standards that would be needed regardless of the architecture or precise business rules selected.

10. Base Use Case – Draft – Under Discussion Consumer-facing web portal that allows applicants to: »Identify available services for which they might be eligible »Conduct initial screening and enrollment checks »Retrieve electronic verification information from outside sources »Determine eligibility or forward eligibility “packet” (screening information and verification information) to programs for final determination »Store and re-use eligibility information

11. This Base Use Case Supports Several Eligibility and Enrollment Scenarios in 2014 – Draft Under Discussion Makes recommendations more flexible, durable and useful »Scenario One: Exchange portal Screening, verification and eligibility for 2014 Modified Adjusted Gross Income (MAGI)-eligible group: Medicaid, Children’s Health Insurance Program (CHIP) and exchange Send/receive applicant information “packets” with Medicaid »Scenario Two: Medicaid/Temporary Assistance for Needy Families (TANF) TANF/ Supplemental Nutrition Assistance Program (SNAP) portal Screening, verification and eligibility for residual Medicaid, TANF, and SNAP. Send/receive applicant information “packets” with exchange Re-use eligibility information to screen for other programs »Scenario Three: Combined portal All of Medicaid, CHIP, Exchange; other combinations

12. Send eligibility info to other programs (human services, etc.) Obtain Verification Info: Electronically verify identity, residency, citizenship, household size, income, etc. Check Current Enrollment: Check other systems for existing coverage; first match using single identifier, probabilistic formula, or other method; then obtain enrollment info Initial Screening : Applicant provides basic demographic info Determine Eligibility: Method will depend on system capabilities. IRS DHS State systems IEVS DMV VR 2 3 Medicaid MAGI, MA, Exchange, State systems 1 5 Program makes eligibility decision 4 Portal makes eligibility decision 4b Portal sends eligibility packet to program 4a Enrollment Notification to Portal SSA Send enrollment information to plans 6