HIE Request for Information

March 26, 2013

Information Exchange Workgroup

Micky Tripathi

Agenda

• Review HIE RFI Response Framework• Workgroup discussion

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Tentative IE Workgroup TimelineDate TopicMarch 26th 9:30-11:30 am ET HIE RFI – payment, ineligibles

March 28th 9:00 – 11:00 am ET HIE RFI – states, infrastructure , labs/CLIA

Wednesday, April 3rd, 10:00 am – 3:00 pm ET

HITPC Meeting - recommendations from workgroup

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HIE RFI Response Framework

• Topics– Payment policy– Ineligibles (with a focus on standards)– States– Labs/CLIA– Infrastructure

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Potential Levers

• Regulation• Payment• Certification• State Action• Reporting and Public Reporting

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Payment Policy RFI Questions

1. What changes in payment policy would have the most impact on HIE?

2. Which programs are having the greatest impact on HIE? Are there any aspects of the design or implementation of these programs that are limiting their potential impact on encouraging care coordination and quality improvement across settings of care and among organizations that are market competitors?

3. To what extent do current CMS payment policies encourage or impede electronic information exchange across health care provider organizations, particularly those that may be market competitors?

8. How can the new authorities under the ACA for CMS test, evaluate, and scale innovative payment and service delivery models best accelerate standards- based electronic HIE across treating providers?

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Payment Policy• Payment levers

– Requirements to participate– Incentive payments– Avoidance of disincentive– Federal purchasing requirements– Care coordination payment

• Potential Levers to discuss– CMS Conditions of Participation for hospitals or Requirements for SNFs/NFs to

get reimbursement– Require or encourage HIE among providers for ACOs in the Medicare Shared

Savings Program – New CMMI care and payment models – require HIE strategy for applications

and actual progress for participants– HIE requirements and expectations in new models to integrate care delivery

for Medicare and Medicaid beneficiaries, aka, dual eligibles7

Potential Levers

• Regulation• Payment• Certification• State Action• Reporting and Public Reporting

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Ineligibles RFI Questions

4. What CMS and ONC policies and programs would most impact post acute, long term care providers (institutional and HCBS) and behavioral health providers‘ exchange of health information with other treating providers?

5. How could CMS and states use existing authorities to better support electronic and interoperable HIE among Medicare and Medicaid providers, including post acute, long-term care, and behavioral health providers?

6. How can CMS leverage regulatory requirements for acceptable quality in the operation of health care entities, such as conditions of participation for hospitals or requirements for SNFs, NFs, and home health to support and accelerate electronic, interoperable health information exchange?

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Ineligibles

• What approaches can be taken to promote standards adoption for MU ineligible providers?

• Potential Levers to Discuss– Alignment of MDS and OASIS with standards– CMS Conditions of Participation for hospitals or Requirements

for SNFs/NFs to get reimbursement– Certification– HIE requirements and expectations in new models to integrate

care delivery for Medicare and Medicaid beneficiaries, aka, dual eligibles

– States10

Next Steps

• Next call we will address states, infrastructure and labs/CLIA

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