Harmonizing & Standardizing Behavioral Health Claims, Data Collection and reporting Requirements

1. Harmonizing & Standardizing Behavioral Health Claims, Data Collection and reporting Requirements Xpio Health, LLC Thad Dickson, CEO thad@xpiohealth.com

2. Xpio Health • Behavioral Healthcare and Medicaid System specific technology consulting firm • Meaningful Use technical and regulatory expertise in Medicaid program across 15 states and multiple EHR’s including CA. • EHR Technical Support for the small counties in CA under CiMH contract • Expert Panel for Washington State HCA on Medicaid MU rollout

3. Definitions • Harmonize – “Looking for the prevention or elimination of differences in the technical content of standards having the same scope.” Harmonization looks at differences • between process standard, and sets bounds to the degree of their variation. • Standardize – “Standardization means creating uniform business processes across various divisions or locations. The expected results are processes that consistently meet their cost and performance objectives using a • well-defined practice.

4. MITA 3.0 Definition • The Medicaid Information Technology Architecture (MITA) is an initiative of the Center for Medicaid & State Operations (CMSO), and is aligned with the National Health Infrastructure Initiative (NHII).

5. Behavioral HIT Landscape

6. Change Agents in the HIT Landscape • ARRA, HITECH, HIPAA, and ACA • Primary Care and Behavioral Health Integration • HL7 Behavioral Health Continuity of Care Document • Managed care, case rates, capitation, and evolving financial models • Accountable Care Organizations and PCMH • HIE, PHR’s, EHR’s, and patient engagement • Privacy and Security • Meaningful Use Stage 1, 2, 3 • ICD-10 • DSM 5

7. Existing Challenges

8. “As Is” condition – Business Process Challenges for Counties • EHR’s are complex, and when “bent” to meet unique standards or requirements, often “break.” Extensive internal testing and payer testing environments are needed. Also consider root cause of complexity. • Requirements need to be harmonized and standardized. Common frameworks should be pre-negotiated by sending and receiving parties before systems are developed. • HIPAA and HL7 compliant and ACA standards and constructs need to be included. Cross walk engines baked in to handle ICD 10, DSM 5, SNOMED. New system should avoid being constructed around old rules.

9. “As Is” condition – Business, Application, and Technical Architecture • Manual Processes • Siloed Programs • Batch file interfaces • Partially adopted standard data model • Fragmented stores • Legacy systems • Encapsulated subroutines • Standalone applications

10. “As Is” condition

11. “As Is” condition

13. MITA Maturity Model

14. “Business needs and objectives inform and drive technical design” MITA BPM

15. MITA 3.0 Construct

16. What is MITA?

17. MITA Goals and Objectives

18. MITA Artifacts

19. HL7 Community Based Collaborative Care

20. Community Based Collaborative Care Mission The Community Based Collaborative Care (CBCC) Work Group facilitates development and use of HL7 standards that support and integrate the provision of HHS (health and human services) in community and non-acute care residential settings. We engage experts and other stakeholders to identify, clarify, and validate (by consensus) information system requirements with an emphasis on privacy protection.

21. Community Based Collaborative Care

22. Community Based Collaborative Care

23. Opportunities for California • Align technology with current MITA 3.0 standards • Integrate Behavioral Health into the core infrastructure • Create a system that is harmonized with ACA, Behavioral Health and Primary Care Integration constructs, Patient Centered Care, the BH CCD Framework, HIPAA, HL7, Meaningful Use Stage 1, 2 and 3 • Support exchange, interoperability, and payment models with efficient reimbursement, along with robust auditability. • Create a national role model for State and County collaboration

24. Questions / Discussion