In order to offer viable electronic marketplaces by 2014 to help people purchase health insurance, states must set up common integrated IT systems capable of sharing client eligibility and enrollment records across multiple health and human services programs, federal health IT executives say.
In doing so, states will focus on the core functions of a health insurance exchange, said Henry Chao, chief information officer of the Office of Consumer Information and Insurance Oversight (OCIIO) in the Health and Human Services Department.
Those include eligibility, enrollment, administration of premium tax credits and simplifying cost-sharing, said Chao, whose office was created by the health reform law to help establish the state health insurance exchanges.
At the same time HHS will need to generate massive support in the next three ears from many public and private organizations for its ambitious plan to be successful.
"This is a signal for a set of expectations that many people have talked about for a long time," Chao said at a Nov. 4 meeting of the enrollment panel of the Health IT Policy Committee. To get there, the Centers for Medicare and Medicaid Services has said it will help states revamp or introduce new IT systems, services and ways of doing business for determining eligibility for state Medicaid as well as the Children's Insurance Program.
"We want to set the expectation that the system will work as a coherent whole," said Penny Thompson, deputy director for the Center for Medicaid, CHIP and Survey and Certification.
On Nov. 3, CMS released a notice of proposed rulemaking to dramatically boost funding available to all states to streamline and upgrade their Medicaid eligibility computer systems, which will provide data and calculations for the state health insurance exchanges.
CMS and OCIIO will also provide technical guidance to help states design, develop, and establish new or improved IT systems for the health insurance exchanges, Medicaid and CHIP. More detailed technical descriptions for deploying standards will help states reduce variations in the standards when they apply them, Chao said.
On Oct. 29, HHS announced that it will fund "early innovator" grants for up to five state insurance exchange IT models that all states will be able to use.
State IT systems are expected to support the synchronization of Medicaid, CHIP and the insurance exchanges as well as between the exchanges and private health plans, Thompson said. To validate customer information, the state exchanges will use federal verification services used by the Internal Revenue Service and other agencies.
Planners intend that all customers should have the same "rich and positive" experience of using the exchanges regardless of whether their health coverage is a public or private plan. "We anticipate that people will enter this system of coverage not necessarily knowing which particular program they will be eligible for," Thompson said.
"The level of service we're looking at is as good or better as what people expect with transactions and interactions with the service and retail industry," she added.
