August 2011David JenkinsAdministration for Children and Families

ACF Interoperability Human Services 2.0 Overview

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• Creating a Health and Human Service Creating a Health and Human Service System in which services are planned, System in which services are planned, coordinated, delivered, monitored, and coordinated, delivered, monitored, and evaluated in an integrated, efficient evaluated in an integrated, efficient manner, maximizing positive outcomes manner, maximizing positive outcomes for children, families, and communities. for children, families, and communities.

• Technology now allows new systems and Technology now allows new systems and approaches to connect across approaches to connect across conventional barriers and silos.conventional barriers and silos.

Interoperability: Interoperability: An Operational DefinitionAn Operational Definition

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Build Interoperability Capacity within ACF Build Interoperability Capacity within ACF Create a Long-term ‘To Be’ Vision and RoadmapCreate a Long-term ‘To Be’ Vision and Roadmap Build Repository of Interoperability Practices and Build Repository of Interoperability Practices and

Activities Activities Develop Interoperability Plans for Every Program Develop Interoperability Plans for Every Program

and Service Officeand Service Office Develop National Human Services Interoperability Develop National Human Services Interoperability

Architecture (NHSIA) and PilotsArchitecture (NHSIA) and Pilots Establish and Provide Leadership for the Human Establish and Provide Leadership for the Human

Services Domain for National Information Exchange Services Domain for National Information Exchange Model (NIEM)Model (NIEM)

Initiate Programs and Build Toolkit to Support Linkages Initiate Programs and Build Toolkit to Support Linkages between Human Services and Health/ACA initiativesbetween Human Services and Health/ACA initiatives

ACF Strategic Initiatives - ACF Strategic Initiatives - Interoperability Interoperability

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• Affordable Care Act – Requirements for Affordable Care Act – Requirements for Health Insurance Exchange by 2013Health Insurance Exchange by 2013

• Federal Agency CollaborationFederal Agency Collaboration

• National Human Services Information National Human Services Information ArchitectureArchitecture

• Human Services Domain for NIEM – Human Services Domain for NIEM – (National Information Exchange Model)(National Information Exchange Model)

• Confidentiality GuidanceConfidentiality Guidance

Opportunities for Opportunities for InteroperabilityInteroperability

• ACA 1561 Recommendations - Health and Human Services Linkages

• Executive Order 13563 – Administrative simplification

• Joint Letters – ACF, CMS, CCIIO, USDA (FNS)

• Enhanced Funding: 7 Conditions and Standards to receive 90% match

• NHSIA• NIEM• Confidentiality

Guidance • A-87 Cost Allocation

Exception

CommunicationsCommunications and Resources and Resources

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* From Centers for Medicare & Medicaid Services. Enhanced Funding Requirements: Seven Conditions and Standards

1.1. Modularity Standard – Use of a modular flexible Modularity Standard – Use of a modular flexible approach to systems development.approach to systems development.

2.2. MITA Condition – Align to and advance increasing MITA Condition – Align to and advance increasing MITA maturity.MITA maturity.

3.3. Industry Standards Condition – Align and Industry Standards Condition – Align and incorporate industry standards (including HIPAA).incorporate industry standards (including HIPAA).

4.4. Leverage Condition – Promote sharing, leverage and Leverage Condition – Promote sharing, leverage and reuse of Medicaid technologies.reuse of Medicaid technologies.

5.5. Business Results Condition – Systems support Business Results Condition – Systems support results (i.e. timely processing of claims).results (i.e. timely processing of claims).

6.6. Reporting Condition – Solutions produce data that Reporting Condition – Solutions produce data that contribute to program evaluation, improvement, contribute to program evaluation, improvement, and accountability.and accountability.

7.7. INTEROPERABILITY CONDITION INTEROPERABILITY CONDITION

CMS Enhanced funding for CMS Enhanced funding for Eligibility: Eligibility:

7 Conditions and Standards7 Conditions and Standards

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* From Centers for Medicare & Medicaid Services. Enhanced Funding Requirements: Seven Conditions and Standards

• Systems must ensure seamless coordination Systems must ensure seamless coordination and integration with the Exchange, and and integration with the Exchange, and allow interoperability with HIX, public health allow interoperability with HIX, public health agencies, human services programs, and agencies, human services programs, and community organizations providing outreach community organizations providing outreach and enrollment assistance services. and enrollment assistance services.

• …”…”CMS expects a key outcome of the CMS expects a key outcome of the government’s technology investments will government’s technology investments will be a much higher degree of interaction and be a much higher degree of interaction and interoperability…”interoperability…”

7. Interoperability Condition7. Interoperability Condition

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Overview

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NHSIA: National Human Services Interoperability Architecture

Challenge – Develop a national architecture to enable information exchange across currently siloed federal, state, local and private human service information systems.

Project Tasks1. Analyze existing human service programs and IT

architecture2. Define required capabilities to share information3. Define a to-be architecture in migrating to interoperable

systems

Outcome and Desired Impact Outcome: A national architecture to guide federal, state, and local governments

and private institutions and vendors in improving information sharing across human service programs and systems.

Impact: Improved effectiveness and efficiency in providing human services.

National Human Services Interoperability National Human Services Interoperability Architecture Architecture

NHSIA Project ObjectivesNHSIA Project Objectives

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NHSIA will be described from multiple viewpoints. Each viewpoint serves a different purpose and is useful to different stakeholders.

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NHSIA - Architecture FrameworkNHSIA - Architecture Framework

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• Enable, encourage, and reward information sharing and portability.Enable, encourage, and reward information sharing and portability.

• Develop a consumer oriented environment (e.g., no wrong door).Develop a consumer oriented environment (e.g., no wrong door).

• Provide an integrated environment for case workers.Provide an integrated environment for case workers.

• Leverage Medicaid IT Architecture (MITA) and behavioral health Leverage Medicaid IT Architecture (MITA) and behavioral health business processes – extend to include human services in general.business processes – extend to include human services in general.

• Use APD process to encourage NHSIA-compliance.Use APD process to encourage NHSIA-compliance.

• Use a Service-Oriented Architecture (SOA) model to encourage Use a Service-Oriented Architecture (SOA) model to encourage service reuse, flexible applications, and incremental deployment. service reuse, flexible applications, and incremental deployment.

• Allow for cloud computing. Allow for cloud computing.

• Use of common confidentiality/privacy agreements.Use of common confidentiality/privacy agreements.

• Use National Information Exchange Model (NIEM) standards as the Use National Information Exchange Model (NIEM) standards as the basis for information exchange.basis for information exchange.

Overview Viewpoint Artifact: Overview Viewpoint Artifact:

NHSIA Key Concepts – NHSIA Key Concepts – RequirementsRequirements

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• Integrated Eligibility DeterminationIntegrated Eligibility Determination VerificationsVerifications Pre Benefit PARIS checkPre Benefit PARIS check

• Integrated Case ManagementIntegrated Case Management Confidentiality and PrivacyConfidentiality and Privacy

OMB Partnership Fund Pilot OMB Partnership Fund Pilot ProposalsProposals

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*from NIEM.gov

• The National Information Exchange Model (NIEM) is a The National Information Exchange Model (NIEM) is a Federal, State, Local and Tribal interagency initiative Federal, State, Local and Tribal interagency initiative providing a foundation for seamless information exchange. providing a foundation for seamless information exchange. NIEM is a framework to:NIEM is a framework to:

• Bring stakeholders and Communities of Interest together to Bring stakeholders and Communities of Interest together to identify information sharing requirements in day-to-day identify information sharing requirements in day-to-day operational and emergency situations;operational and emergency situations;

• Develop standards, a common lexicon and an on-line Develop standards, a common lexicon and an on-line repository of information exchange package documents to repository of information exchange package documents to support information sharing;support information sharing;

• Provide technical tools to support development, discovery, Provide technical tools to support development, discovery, dissemination and re-use of exchange documents; anddissemination and re-use of exchange documents; and

• Provide training, technical assistance and implementation Provide training, technical assistance and implementation support services for enterprise-wide information exchange.support services for enterprise-wide information exchange.

What is NIEM?What is NIEM?

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• NIEM Launched in 2005 by U.S. Department NIEM Launched in 2005 by U.S. Department of Homeland Security and the U.S. of Homeland Security and the U.S. Department of Justice. Department of Justice.

• In 2011, the U.S. Department of Health and In 2011, the U.S. Department of Health and Human Services joined as a full partner.Human Services joined as a full partner.

• HHS Role includes the Stewardship of two HHS Role includes the Stewardship of two Domains:Domains: Health @ Office of the National Coordinator (ONC)Health @ Office of the National Coordinator (ONC) Human Services @ Administration for Children & Human Services @ Administration for Children &

Families (ACF)Families (ACF)

NIEM Brief TimelineNIEM Brief Timeline

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Refugee AssistanceChild Care

Community Services

Elder Services

Youth in Transition

Children, Youth and Families Domain

Juvenile JusticeCourts

Child WelfareChild Support

Emergency Financial AssistanceHomeless

Mental HealthEnergy AssistanceSubstance Abuse Programs

VASNAPEducation

Scope of Human Services Scope of Human Services DomainDomain

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Family/Child/PersonFamily/Child/Person

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• Improve services and save lives through improved Improve services and save lives through improved communication across silos.communication across silos.

• Common language reduces development costs for Common language reduces development costs for agencies and vendors—dollars that can be used instead agencies and vendors—dollars that can be used instead for service provision.for service provision.

Imagine:Imagine:• Child protective workers receiving educational Child protective workers receiving educational

attendance records in real-time for the children in attendance records in real-time for the children in their caseloads their caseloads

• Sharing information quickly between foster care and Sharing information quickly between foster care and supportive housing to secure newly available housing supportive housing to secure newly available housing for at-risk familiesfor at-risk families

• So much more…So much more…

Why is NIEM Important to State and Why is NIEM Important to State and Local Human Service Systems?Local Human Service Systems?

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• Share information AND protect Share information AND protect confidentiality and privacy rightsconfidentiality and privacy rights

• Confidentiality and Privacy can no longer Confidentiality and Privacy can no longer be a roadblock to information sharingbe a roadblock to information sharing STOP Sign, then proceed down the STOP Sign, then proceed down the

appropriate pathappropriate path Client-centric approachClient-centric approach Defining “need to know” and “minimum Defining “need to know” and “minimum

necessary” standardsnecessary” standards

Practical Solutions to Practical Solutions to Confidentiality and PrivacyConfidentiality and Privacy

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• 4Q 2011 availability4Q 2011 availability

• Federal GuidanceFederal Guidance

• Assistance to understand state and local laws Assistance to understand state and local laws regarding confidentiality and privacyregarding confidentiality and privacy

• Index of “Best Practices” for sharing of information Index of “Best Practices” for sharing of information

• Models to facilitate information sharingModels to facilitate information sharing Comprehensive Authorizations/Consent FormsComprehensive Authorizations/Consent Forms State legislationState legislation Court OrdersCourt Orders Memorandums of Understanding (MOU)Memorandums of Understanding (MOU) Organizational DesignOrganizational Design

Toolkit for Information SharingToolkit for Information Sharing