1. Presented to: NJ Medicaid - DMAHS HIT Projects May 26, 2010 NJHIMSS - Healthcare Reform School

2. Agenda  Medicaid HIT Program Context  New Jersey Medicaid HIT Projects  The State Medicaid HIT Planning (SMHP) Project  NJ Perspective - Incentive Program and Meaningful Use  Key Events 2

3. HIT Program Goals  Improve Quality of Care/Patient Safety  Enhance Access to Patient Information  Reduce Costs ______________________________  Positive State Impact  Improved Children Care  Job Creation  Budget Neutral  Leveraging Non-profits 3

4. State Medicaid Responsibilities – 10 Mandated Actions Medicaid is “Ground Zero” 4 Source: Centers of Medicare and Medicaid Services – Letter dated 9/1/09 1.Develop NJ Roadmap for HIT adoption 2.Set specific performance goals for EHR adoption 3.Establish accountability for reporting clinical outcomes 4.Provide technical assistance/training to providers 5.Provide for stakeholder input and advocacy 6.Coordinate with other NJ HIT initiatives 7.Bring successful Transformation Grant initiatives to scale 8.Initiate NJ legislation to create HIE/EHR regulatory authorities 9.Ensure quality reporting processes 10.Manage Incentive Program in Concert with HIT Commission

5. New Jersey State Medicaid HIT Plan (SMHP) As-Is Landscape State of NJ Department Influencers NJ HIT Act 2007 HIT Commission Office for e-HIT NJ Health Information Network (NJHIN) NJAMHA Department of Human Services Department of Medical Assistance and Health Services State HIT Plan Department of Health and Senior Services Department of Banking & Insurance Department of Children & Families Health Care Facilities and Financing Authority (HCFFA) Project Governance Healthcare Industry Influencers NHIN HL7 HISPC HITSP WEDI Professional Associations Providers Other Payers Regional Extension Centers Community Health Information Exchanges Best Practices & Standards Federal Influencers ARRA Act HHS ONC CMS MITA HIPAA HRSA CHIPRA SAMHSA NIST AHRQ. FHA X.12 NCPDP IHE – Integrating Healthcare Enterprise Federal Financial Participation (FFP) Federal Statute Federal Policy Federal Guidelines HIT Workgroup – SMEs HIT Workgroup – SMEs Privacy & SecurityPrivacy & Security Project Management Office (PMO) Project Management Office (PMO) Change Management & Communication Change Management & Communication Risk/Issue Management Risk/Issue Management Regular Steering Committee Meetings Weekly Status Meetings Weekly Status Meetings Daily Team Meetings Daily Team Meetings HIT Vision Department of Labor Office of Information Technology (OIT) State Treasurer State Statute, Policy & Guidelines Best Practices & Standards Roadmap 5 Medicaid HIT Planning Project Stakeholders *MMIS/MITA Architecture Provider EHR Adoption Current State HIT Governance Structure Current HIE/HIT Initiatives Goals and Objectives *MITA / Enterprise Architecture Future State HIT Governance Structure Other future activities required Roadmap Gantt Methodologies Success Metrics *MITA As-Is / To-Be Landscape will be delivered from the MMIS project and included in the overall HIT Planning Deliverables 5

6. - 6 State Medicaid HIT Projects

7. In-flight Medicaid Projects 7 ProjectDescription ICD-10New data standard for medical diagnosis and inpatient Version 5010New version of the X12 standards for HIPAA transactions. Version D.0New version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier transactions. Version 3.0New NCPDP standard for Medicaid pharmacy subrogation CASSDevelopment of integrated Medicaid eligibility system. MITA AssessmentMMIS replacement Master Client IndexCoordinated internal structure for gathering and sharing information. Ties current isolated databases and systems into a coordinated system for easy information sharing. State HIEState health information exchange State EHRState electronic health record model SMHP – State Medicaid HIT plan

8. State Medicaid HIT Plan (SMHP)  A mandated Medicaid plan with clear targets and measurable outcomes for a statewide EHR incentive program  Content  Current Landscape Assessment (As-IS)  Vision of NJ HIT Future (To-Be 2014)  Specific actions to implement incentive payment program 8 Source: Centers of Medicare and Medicaid Services – Letter dated 9/1/09

9. SMHP Project Timeline Source: P-APD Draft Submission to CMS March 2010 We are Here! 9

10. SMHP Stakeholder Context 10 Landscape Stakeholder Strategy Stakeholder Analysis Communication Plan Education Awareness Messaging Various stakeholders will play key roles in the SMHP project. We will use different tools to manage stakeholder participation. Example mechanisms to reach out to stakeholders include site visits, surveys, focus groups, reporting, newsletters, etc. Campaign Plan

11. Key Events and Milestones Key SMHP Project Events/Milestones Actual & Estimated Timeframes P-APD for SMHP – Submitted to CMSMarch 2010 Project Kickoff and Launch Event(s)April 14, 2010 Stakeholder Analysis PlanMarch 2010 Landscape Assessment (as-is view)June 2010 Vision and Roadmap (to-be view)July/August 2010 SMHP – The PlanSeptember 2010 I-APDOctober 2010 11

12. - 12 EHR Incentive Program - NJ Perspective

13. Notable Differences Between the Medicare & Medicaid EHR Incentive Programs MedicareMedicaid Feds will implement (will be an option nationally)Voluntary for States to implement (may not be an option in every State) Fee schedule reductions begin in 2015 for providers that are not Meaningful Users No Medicaid fee schedule reductions Must be a meaningful user in Year 1Adopt/Implement/Upgrade option for 1 st participation year Maximum incentive is $44,000 for EPsMaximum incentive is $63,750 for EPs MU definition will be common for MedicareStates can adopt a more rigorous definition (based on common definition) Medicare Advantage EPs have special eligibility accommodations Medicaid managed care providers must meet regular eligibility requirements Last year an EP may initiate program is 2014; Last payment in program is 2016. Payment adjustments begin in 2015 Last year an EP may initiate program is 2016; Last payment in program is 2021 Only physicians, subsection (d) hospitals and CAHs5 types of EPs, acute care hospitals, children’s hospitals 13

14. New Jersey Perspectives  The State expects to add no new meaningful use criteria  The incentive program is new to everyone – the “how-to” needs to be determined in collaboration  We need communication both ways with many stakeholders to make this happen (collaborate – collaborate – collaborate)  A communication plan is essential  An “incentive after the incentive” may be implemented  The State is on your team to maximize incentive funds you receive  Leverage State funding (investment) for your benefit  Many questions to be answered – the State has a plan & has implemented a PMO structure in support of these initiatives 14

15. New Jersey Medicaid’s Approach  Promote Interoperability through:  Development of a Master Client Index (MCI)  Continuity of Care Document (CCD)  Leveraging the existing MMIS and web portal applications  Claims history view  Convening Stakeholders  Achieve consensus  Collaborative approach  Develop a governance model  Safeguard privacy and security  Leverage Federal Funding  Transformation Grant Multi-State Collaborative  CMS planning and implementation  ONC training and awareness  Provider incentive program  ONC HIE funding 15

16. Medicaid EHR Road Map Stage I – Secure Federal funding Stage II – MMIS planning and replacement Stage III – Develop a plan (SMHP) Stage IV – Offer claims-based Medicaid EHR  EPSDT Case Management  Integrate with Immunization and Lead Registry Stage V –Develop a Medicaid EHR System  Clinical Decision Support (CDS)  e-Prescribing  CCD/CCR Stage VI - Integrate with the New Jersey Health Information Exchange 16

17. - 17 Contacts

18. Key Events  Standing Up Medicaid HIT PMO – 5/14  New Jersey Hospital Focus Group – 5/18  Launching Survey and Conduct of Workgroups Touching 1000+ NJ Based Physicians (May/June)  New Jersey Medicaid HIT Launch – 6/15  Landscape Assessment for NJ HIT – June/July  Multi-State HIT Collaboration – TBD (tentative July)  MMIS 2010 Conference – Making Medicaid Information Sustainable - August 15th -19th  NJ Medicaid and North Highland – Joint Paper/Presentation - SMHP Lessons Learned – An “Embedded Reporters” approach. 18

19. - 19 Contacts

20. Questions? Michele Romeo, CIO NJ Medicaid 609-588-2815 Michele.Romeo@dhs.state.nj.us The North Highland Company Marty Lupinetti, Public Sector Lead 609-792-3896 Martin.Lupinetti@northhighland.com