1. HIPAA Progress in the State of California National Governors Association Burt Cohen, Acting Director Office of HIPAA Implementation Health & Human Services Agency April 3, 2003

2. Unique State and County Issues  HIPAA is written in the vocabulary of the private sector.  Governmental programs do not fit neatly into these concepts.  There will be problems – it’s not you!

3. And Then There’s Cost  Substantial public sector costs with little offsetting savings.  NGA has requested federal funding, but….  Compliance is required before all the rules are known.  Sanctions

4. The Scope Is Broader Than One Might Think  HIPAA doesn’t mean just Medicaid.  Governors must think of health broadly: mental health, developmental services, alcohol and drug services, veterans, AIDS programs, corrections, state employee health plans, other health services programs.  Trading partner, data content, or other impact to still more departments: SDI, Workers’ Compensation, Emergency Srvcs.

5. Some Issues on What’s Covered  Social Services – are Children’s Services a health plan; what about special services financed under Medicaid?  Corrections – Division of Health Services; some unique applications in Privacy; 33 institutions, 38 camps, 60 parole offices.  Youth Corrections – Not automated (yet).  Multiple institutions in Mental Health, Developmental Services, and Vets Affairs.

6. Coverage Issues (continued)  Mental Health – county funded but state operated hospitals.  Public Health – Cancer detection, breast and cervical cancer treatment, AIDS, Calif. children’s services/genetically handicapped persons program, CHDP (EPSDT), genetic disease, and family planning.  CalPERS – for its own health plans.  University of Calif. – provider and research.

7. In Case You Haven’t Noticed  Complex simultaneous changes to interfacing business practices and systems.  In an uncertain environment due to sequential rules, breadth and depth of changes.  And time marches on.

8. This Requires a Strategic Approach To Implementation  Perform a statewide assessment to see where and what the HIPAA impacts are.  Develop a common terminology so that comparisons can be made across programs and departments.  Build tools collaboratively to improve quality, save money, and promote standardization.

9. Strategic Approach (continued)  Identify leaders.  Require executive sponsorship and involvement.  Build a policy and administrative infrastructure both at the statewide and the departmental levels.  Reward initiative.

10. Some California Solutions  CalOHI Statutorily Established  Website  Statewide Work Group  Policy and Information Memos  Contracting Process  Schedules, Plans, Reports, Field Reviews  Advisory Group, Communication  Legislation, preemption

11. Beware of the Five Stages of HIPAA Shock  Denial  Stalling  Whining  Trying to pass it off  Panic

12. The Stages to HIPAA Results  Awareness  Commitment  Building a Team  Productivity  Communication

13. Five Standard Steps of a Project  Initiation (awareness)  Initial assessment (inventory)  Project plan  Detailed assessment (gap analysis)  Implementation (remediation) and testing