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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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supporting state hie needs through mita and connect

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

mita transforming the medicaid business
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

mita framework provides the basic dna for medicaid hie
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

mita connect providing an hie platform for mita
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

collaborators in effort
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

discovery and lessons learned

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

solution that works for everybody
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

mapping future activities
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

thank you

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