In a town hall meeting at the HIMSS conference in Orlando on Feb. 21, officials of the Centers for Medicare and Medicaid Services (CMS) described the flurry of systems and administrative changes the agency is undertaking to carry out the provisions of the HITECH Act and the Accountable Care Act (ACA).
"We have found that among the ACA mandates, about 20 percent require large changes in CMS systems," said Tony Trenkle, acting CMS chief information officer and director of the Office of Information Services.
Trenkle said his organization has launched a modernization strategy to replace aging legacy applications while maintaining existing services, and a second iteration of its modernization strategy will be made public in a few months.
Among CMS' challenges is absorbing the Office of Consumer Information and Insurance Oversight (OCIIO), which was recently transferred from the Department of Health and Human Services (HHS) to the Centers for Medicare and Medicaid Services and renamed the Center for Consumer Information and Insurance Oversight (CCIIO). Among other things, it will oversee the establishment of state-level heath insurance exchanges.
Elizabeth Holland, director of the HIT Initiatives Group in the Office of e-Health Standards, gave a progress report on the EHR incentive program. She said the Medicare program is preparing to launch attestation in April and begin meaningful use payments in May. More than 21,000 providers have initiated the registration process, she added. The CMS web site has added 114 frequently asked questions and a listserv to help organizations understand the process. Audience members asked Holland and Trenkle about the possibility of delaying Stage 2 of meaningful use requirements. Holland said CMS has been listening to provider concerns about the timeline for Stage 2 and many alternatives have been suggested. "At this point, no decision has been made," she said. "Stay tuned."
From one perspective, health reform means the Medicaid program must continue to work with state partners to upgrade their systems, but on the other hand, the changes are so large that it will require rethinking the approach to partnerships to foster greater collaboration, said Penny Thompson, deputy center director in the Center for Medicaid, Children's Health Insurance Program (CHIP), and Survey & Certification.
Thompson noted that by 2019 Medicaid and CHIP are expected to become the second largest source of coverage for the under-65 population. As people enter the health insurance exchanges, it is expected that as many as half will end up in Medicaid or CHIP.
CMS is helping states develop overarching enrollment programs for health insurance exchanges and Medicaid so that consumers will all enter through the same portal and then be routed to the best program to serve them. Seven states that won "early adopter" grants are starting to work on creating those exchanges.
"This creates a new paradigm," Thompson said. "We have to see it not as a safety net but as a full partner in assuring coverage for all. It has to be a system of coverage and care, where to be eligible means to be enrolled. Increased enrollment is how we are going to get to improvements in coverage and outcomes."