NASMD MultiState Collaboration for Medicaid Transformation

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NASMD Multi-State Collaboration for Medicaid
Transformation Third Meeting August 16, 2007 D
RAFT
MINUTES
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Attendees Martha Roherty, NASMD Greg Hunt, NA
SMD Tony Rogers, Arizona (chair) Carol Herrmann-
Steckel, Alabama Commissioner (vice chair)
Kim Davis-Allen, Alabama MTG Director
Paul Brannan, MMIS Coordinator/Privacy Officer
Alabama Sanchez, Texas (telephone) Lisa Hulbert,
Utah Medicaid (telephone) Laura Cole, Kentucky (
telephone) Perry Yastrof, Arizona (telephone) Su
e Miller, New Jersey Theresa Carns, Mississippi
Kathleen Cota, MTG Manager Minnesota Sandeep Ka
poor, CTO Kentucky Kimberly Ortiz, Chief Office o
f Medi-Cal Payment Systems California
Sam Walker, MMIS DC LaRah Payne, MTG DC Patti Ca
mpbell, Idaho Donna Larson, Idaho Charles Gallia
, Oregon Beth Nagel, Michigan
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State by State Update Arizona) Arizona ha
s been developing its MTG over the summer and is
intending to send out an RFP for HEI. Through
the HIE, the state intends to develop of health
record data base and a web portal which will have
an application providers will use to access the
health record. The states goal is to raise all
boats. They intend to form a corporation that
will be the owner of the statewide information
portal. Arizona has submitted first quarter
report to CMS. Texas Texas MTF is for a Foster
Care Health Passport with a claims based health
summary. The goal is to establish a continuity
of care standard so there can be an exchange with
EHRs and EMRs and will issue an RFP to develop
the standards Idaho Idaho has applied for a sec
ond round MTG. They have been working with a
health planning commission and are hoping for
funding to participate in HIE, including
pharmacy. Oregon Oregon has applied for a sec
ond round MTF. One of the components is a HIE.
Michigan applied for MTF that includes an HIE.
The state has already analyzed and has funded
planning and implementation grants in 7 of 9
areas. The MTG addresses for provider
certification. They are also working on MMIS
replacement. NC NC has filed for a round two MT
F but specifics were not provided at this time
Alabama Alabama issued a RFP and has finalized
its first vendor selection (ACS). Alabamas
quarterly report is on the web at
www.medicaid.alabama.gov. Go to site, look for
transformation grant for quality and then look
for CMS report. They have applied for a second
grant As a part of their first MTG, there will
be a HIE and health record, an electronic
clinical support tool with EMR, integration with
current EMR systems and they have added a
feature, which is interoperability with another
state agency. The agency is the Dept of Senior
Services with a focus on HCBS. They plan to be
up by March 08
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Missouri Missouri has applied for 2nd round
and seeks to expand into HCBWS and integrate with
patient outreach. The state seeks to have a
single point of entry for seniors. They are
working on verbal communication, integrating
optometric and dental in to pre-certification
program direct care training bringing lab
into electronic report and into cyber access
tool and EPSDT integrated within 3 week into
the cyber access tool Mississippi Mississippi
intends to create a system for hospitals and
nursing home to exchange information in the case
of emergencies. In the states second MTG round,
they have focused on EHR and e-prescribing.
California California submitted a MTG for
e-prescribing to include Medicaid histories and
formulary to point of care at physician offices
using the UTAH EPRM tool. California is also
doing a re-procurement of their MMIS. California
is encountering an issue with fees with vendors
for safety net providers with e-prescribing
related to hidden costs are in different funding
models. Although some have EHRs that have an
e-prescribing tool that they are using and they
want to bring data to point of care, but they
will not turn on data to point of care because
they will be charged fees. Although the state is
still trying to determine who is charging the
fees as some are paying one time costs and
some do fees some are facing fees, Medi-Cal is
currently paying switch company but on the other
end, the center is also being charged by their
integrator or vendor. Minnesota Minnesota has
just answered bidders questions and hope to
award within the next two weeks for their MTG 1.
They are creating web based tools for select
providers and select consumers to create a
communication between provider and team for
individuals needing intensive primary care. They
will pay 50 to physicians to work with
difficult, complex consumers. This tool will
allow the state to do performance measures and to
trigger payment with a PA algorithm without
involvement of professionals. MTG 2 has been subm
itted and through it the state proposed to work
with private sector and health care stakeholders
in a public/private non-profit super highway
using a public utility approach for
administrative and clinical data. The state is
working to solidify the public/private parameters.
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Kentucky Kentucky implemented a new MMIS about a
month and half ago DC DC submitted MTG 1 and i
s looking at a hybrid model with a repository for
DC government agencies and record locator for
private entity health information exchange
between Medicaid, Dept. of Health agencies, 6
health centers, selected government agencies, and
three hospitals initially. DC is in the design
phase. New Jersey NJ has and MTG 1 and applied f
or a MTG 2. New Jersey had previously combined
lead and immunization registries with the MTG 1
combining immunization information with Medicaid
claims records. The intent in MTG 2 is to go out
to other children records in order to have
complete childrens records West Virginia nothi
ng to report New Mexico NM is working on two s
eparate MTGs - e-prescribing and an electronic
health record with partial progress on each.
Unanticipated issues include what is included in
a basic model for EHR reviewing the Montana/ACS
system but do not find it ready for physicians in
a usable format finding contradictory
information on how much information for MH and
Family Planning, AID diagnosis (was going to use
NY approach but concerned about privacy law)
e-prescribing is a little complex. In addition,
determining who pays for the transaction cost is
also a little more complex. Nebraska Nebraska
participated as a listener as they are interested
in the topic but do not have a MTG
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HRSA Overview by Johanna Barraza Cannon
HRSA is provider focused. 30 of community
centers (FHQCs, RH, and MCH) revenue comes from
Medicaid HRSA was part of the review team for the
MTG and is now looking for opportunities to
partner. Johanna is point of contact with HRSA
for HIT adoption by safety net providers
There were HRSA grants last year for EHR adoption
and another 20M this year priority is for
centers that network. West VA network is one of
HRSA shining stars as they have implemented,
continue to work with Medicaid, and improved
care. New Mexico network is working with Utah
and Florida on EHR. CA has a number of models,
including practice management systems, EHRs, and
EMRs. Safety net providers have come together as
networks. HRSA would like to partner HRSA
grantees with MTG efforts and will provide states
with names of HRSA grantees as soon as they are
available. HRSS is doing some TA on guidance on h
ow to spend money with innovation grantees
(e-prescribing and health information grantees).
HRSA is also doing case studies. They have a
portal on the AHRQ web site with private
communities where participants can talk about
vendors and tools to use. Each community is
currently password protected and private going
public for tools with some sections. If a
state is working with a TA Center for HRSA
grantees, the state may benefit from the TA,
including web-ex conference calls and information
on the portal. HRSA is also working to get HIT
to address health disparities, improve quality,
etc and address public domain (West VA is using a
public domain HIS system. TA includes peer to
peer network of health centers that are
advanced who can help others and paid
consultants. First HRSA all grantee meeting will
be held 11/5 11/7 in Crystal City.
Participants need to send Johanna e-mail if want
to attend. There is no fee to attend but
registration is limited. HIT Conference 500
invited to conference, including MCH agencies,
Ryan White agencies and Health Centers who have
come together (CHCs and FQHCs)
Johannas slides will be distributed by NASMD on
the web
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Feedback/Questions from States on HRSA Overview
Alabama would like to work with HRSA. Alabamas
Medicaid Medical Director has joined the Alabama
Primary Care Association and Alabama would like
to work together to use MITA and FQHC involvement
If most FQHCs are going to use VISTA or one or t
wo other software packages and you are creating
interfaces are those interfaces public domain.
When purchasing proprietary using HRSA funding,
it doesnt turn into open source. Modifications
on IHS system will be shared and incorporated on
both VISTA and IHS systems with some leveraging
on an informal basis. Jim Kutz SAMSHA License
requires availability. Medsphere used VISTA but
they changed it. I-Care, which is the HIS
chronic disease management tool will work with
specific models. Arizona asked if any states are
writing interfaces with specific EMRs. Georgia
has designated 5 interfaces Missouri 0 but
requires HL7 data standard used in Cyber tool).
Missouri is overlaying MMIS HRSA NY has let ven
dors know that if they are working with community
centers they need to have certain functional
specifications related to reporting and
population health Arizona suggested joint meet
ings with HRSA grantees Question to Rick Friedman
/CMS regarding the use of MITA 90-10 and 75-25 to
link with FQHCs The rules for MMIS in MITA are th
e same rules. If a state is providing software
that FQHC can use to tap into in the web yes
remember cost allocation. There is different
match rate for different activities and states
should work with RO to create the boundaries. No
MMIS dollars can be used for equipment for
providers at providers locations. Suggestion
dont use MTF for things that can be used under
regular MITA
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General Discussion Arizona States need documen
tation of fields/ standards and all interfaces
must be in the public domain. When pulling data
from hospitals, need to decide between file or
data transfers. Consistency would be desirable.
Where there are standards, want to have them so
bi-transfer is interoperable. Where standards
dont exist, need to be one way transfer.
DC DC plans interfaces with community clinic
through e-clinics and with three existing
hospitals MN MN RFP says what is developed by s
tate or under state contract is owned by state.
Standard for MN is owned. For MN MTF 2, if the
state can pull off a statewide public private
entity to build the highway, the plan is to have
a fee for use. Encourage states to go to highest
level of collaboration they can get to.
Kentucky For MTF1, it has been hard to get
everyone to table. California The project inter
faces to EHRs, but the states challenge was that
it didnt plan to write and pay for interfaces
with providers/vendors and the state wants to get
data into the providers hands at the point of
care. The devil is in the details.
Arizona Safety net providers dont have
technical ability and/or funding in all cases so
need Medicaid to write interfaces to get them
into the system. Share ware to reduce the cost
of the next states. Technical group needs to look
at how to avoid getting charged for the same
interface over and over again and how to not
create interfaces over and over again.
Kentucky For MTF1, it has been hard to get
everyone to table. California The project inter
faces to EHRs, but the states challenge was that
it didnt plan to write and pay for interfaces
with providers/vendors and the state wants to get
data into the providers hands at the point of
care. The devil is in the details.
Arizona Safety net providers dont have
technical ability and/or funding in all cases so
need Medicaid to write interfaces to get them
into the system. Share ware to reduce the cost
of the next states. Technical group needs to look
at how to avoid getting charged for the same
interface over and over again and how to not
create interfaces over and over again.
SAMSHA HL7 Continuity of Care specifications is
on its way to be an ANSI standard. By 2009 CCHIT
will require CCR. If there are future standards,
they need to be included in contacts. Look to
pharmacy paradigm with the requirement of the
interface back into the state private but with
specifications designed by state.
DC asked questions regarding who pays for
interfaces and how a state/agency can assure that
they have to only pay for them once
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Collaboration Agreement There are two materials
related to the Multi State Collaboration the
agreement itself with the purpose and objective
and the organization chart of collaboration
Organization The Steering Committee will set
the agenda for the year. The chair is Tony
Rodgers, Arizona, and the vice chair is Carol
Herrmann-Steckel. NASMD will be administrator
There are 6 workgroups HIE Chair - Perry
Yastro (Arizona) Provider Adoption/ Deployment
Chairs -Kim and Paul (Alabama)
Clinical Decision Support Data Structure Sande
ep Kapoor (Kentucky) EHR Kimberly Ortiz (Califo
rnia) Legal/Patient Consent LaRah Payne (DC)
Technical Support will be provided through cons
ultants. NASMD would bring in TA support
consultants (paid/free/other states) and the
Steering Committee will facilitate the technical
support needs. The budget will come from the
contributions to NASMD from states for the
collaboration. States have the option to put in
10,000 or other in kind contributions. NASMD
will seek additional funding through other
grants, including AHRQ TA grant. NASMD has
receiving 11 letters of support and have 150,000
in the bank (50,000 from Arizona and 10,000 for
rest). A couple of foundations are also talking
to NASMD (Commonwealth and RWJF) regarding
facilitation of information between states.
Learning groups will be open any state would
wants to participate. Web-sight will be
available shortly for documents and the Multi
State Collaboration use web conferencing for some
meetings. APHA is moving 2 years into Verizon
building downtown DC that is already set up for
web casting and has a class room set up on bottom
floor. In the interim, NASMD will be looking at
facilities at the universities. There will be
set up 6 list serves for workgroups. The
Collaboration will be a place for partners such
as HRSA to talk to states.
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Questions on Organization Where would provider c
hange management be address? Provider Adoption
and Deployment Workgroup The ability to open meet
ings to non-payer members is important so they
can get the goods for free without paying
however, if free for some, will every state
choose not to pay so there wont be money to do
anything? Only paid member states can be on the
Steering Committee however there is such a
critical need for all to participate that
alternatives need to be considered, such as
charging for meetings/presentations. The
Collaboration may want to look at registration
fees in order to get more involvement. An
example to review is the Medical Directors
Collaborative where only paid members vote but
nonpaying participate (consistent with APHSA).
May need to amend charter. Can a state use MTF gr
ant dollars to pay the fee for the Collaboration?
Can a state overrun its grant to pay the
Collaboration fee? MTF is one source of funding.
Rick/CMS indicated that overruns for any reason
would not be appreciated. Administrative match
is available. If a state put money in their
grant request for this and it was approved. it is
not a problem. States can use grant funds as
needed but overruns different issue. Alabama is
using regular administration money. Dennis said
ok with MTF funds or Medicaid administrative.
A bigger problem facing some states is how to pay
the 10,000 in the state accounting system.
NASMD is working on technicalities of paying.
A state should simply tell NASMD that they want
to be part of collaboration and NASMD will work
on good faith until the state can get the
technical process to work out.
How are individual states structured for the
Medicaid Transformation Grant? What is the
organizational structure? MN team for MITA and
MTG are the same team. Kentucky is approaching
it as a public/private e-health corporation with
Medicaid participating, state employee, etc.
Alabama is making it a part of the entire
Medicaid agency all hands on deck and viewing
it as not a project but a transformation of how
they manage Medicaid.
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Objectives/Purpose (See Charter)
Front runner states documenting for states
following behind Common set of Medicaid specific
EHR functionality, data standards and definitions
for master beneficiary index, master provider
index, record locator, and Medicaid electronic
health record data architecture
Jointly develop/shared RFP documents
Joint training Joint ventures Working in concert
with CMS with federal on issues going forward
Establish a Medicaid EHR/HIE steering group
composed of state Medicaid Directors to
coordinate and encourage continuing development
and deployment of EHR/HIE Seek other grant and ot
her funding sources to support this
collaboration Questions on Objectives/Purpose Do
es the Collaborative want CMS interface/participat
ion? Because this is an area where there is not a
disagreement with CMS, and the group wants to be
effective partner, CMS involvement is appreciated
and guidance helpful. Is the Collaborations focu
s MTG or HIE and HIT or HIE/HIT as a subset of
MTG? It is a learning collaborative that
include MTGs for HIE/HIT, including
e-prescribing) as long as it is Medicaid, it is
included. Transformation Grant Survey The purpo
se of the survey was to determine what states
were looking to learn through the collaborative.
14 states responded to the survey and the
majority were interested in joining workgroups on
HIE and EHRs. Most states report need for
overview of HIE options and data exchange
standards. States also want patient and
beneficiary consents, data exchange permission
and requests for non-disclosure of information,
legal document development and provider
participation development. (See NASMD slides)
Additional areas for TA overview of EHR-systems
and software options web-based EHR data
architecture, data standards and database design
provider adoption and deployment strategies and
incentives. There is also interest in an
orientation to web-based clinical decision
supports and web-based order entry. In addition,
there is interest in an overview on
e-prescribing, developing requirements and
integrating with HIE and EHRs
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MTG Round 2 Jean Shield, CMS, indicated 2nd round
will not be announced for several weeks
Plans Proposed State to state exchange of informa
tion via website newsletter listserv
Leadership Development (through presentations by
Collaboration leaders) includes
overview to non-tech types managing system tra
nsformation leveraging system transformation
public/private partnerships evaluation impleme
ntation (multi state in addition to single
state under consideration) Speed up process thr
ough having meetings closer together and
providing information between meetings to
members, including use of workgroups. Also the
Collaborative is looking for low-hanging fruit
(white papers, small joint efforts, joining other
existing collaborations, survey of states). A
web-conference with steering committee will be
scheduled for between now and November 15-16.
General Discussion Regarding Plans
Need to bridge gap between technical and Medicaid
Directors. Need to address multi-year health
care projects (not IT projects), ROI for CMS and
states the goal is to reduce the failure
points, provides state staff with a real-world
view of the issues they are facing with
consultants provided just in time, and work with
NGA State Alliance for e-Health.
Need for technical assistance on procurement and
to identify opportunities to joint venture to
procurement. Multi-state purchasing is an option
and already approved by CMS. Some states
currently doing it do in pharmacy so should be
able to similar in MTG. A multi-state
opportunity for vendors to present to group so
they wont do the state individual is of interest.
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NGA State Alliance Workgroup on Data Exchange and
Communications in Medicaid, PH, and State
Employees Tony Rodgers The group is addressing
leadership and governance consumers financial
stability of models approach and structure, and
regulatory barriers for state participation
Medicaid/SCHIP/PH and exchange of data between
states. Tony is looking for recommendations to
the Governors. Final recommendations are due in
January so participants should get to Tony before
then. Action Steps Each state is to send their
quarterly CMS reports to Martha and she will
post them. Remember to check list serve as that i
s where things are posted. Send information on
who needs to be on the list serve from each
state A Steering Committee web-conference will be
scheduled for between now and November 15-16.
NASMD will send out e-mails to schedule and will
need names and e-mail addresses for appropriate
contacts in order to get meetings set up.
The Steering Committee, regarding Consultant
Technical Assistance, will get a list of vendors
who attended the MMIS conference and get a list
of vendors/consultants that people are aware of
and do a broadcast request for interest. At the
next Steering Committee, decisions on how to
proceed with consultants to do this kind of
activity will be made. NASMD will send an e-mail
for subject matter experts from states within
group that could provide TA Kentucky will try to
ask questions of Gardner on behalf of group and
report back. Rick Friedman will provide CMS
subject matters experts to Tony/Martha.
Any state interested in working with SAMSHA on
what it would take to exchange data between
Medicaid, substance use programs and mental
health should like Jim Krenz know directly.
The Steering Committee will work with the ERISA
Industry Group regarding lessons learned from the
NC PCCM model. Next Face-to-Face Steering Commit
tee November 15 in conjunction with fall NASMD
meeting, Washington, DC Next Steering Committee
Meeting October date to be determined Initial
Work Group Meetings Organizational Meetings Se
ptember by phone Initial Substantive Meeting En
d of September to early October