Wednesday, June 22nd, 2011 - 6:48
Wednesday, June 22, 2011 - 06:46
A federal data hub will verify information provided by individuals to get covered through insurance exchanges.
Of vital interest to the states as they continue to plan for exchanges is the Data Services Hub described in the new CMS guidance issued in May 2011. This federally operated hub will verify citizenship, immigration status, and tax information with the Social Security Administration (SSA), the Department of Homeland Security (DHS), and the Internal Revenue Service (IRS). The federal government’s HIT Policy Committee concluded that the development of a federal data service for verifying consumer-provided information would be an efficient and cost-effective approach to delivering these services. This Data Services Hub will deliver information to the states for exchanges, Medicaid, and CHIP. The idea is to reduce costs and improve reliability by organizing a single set of interfaces that would otherwise require multiple point-to-point interfaces and redundancies.
HHS is pushing for a streamlined, secure, and interactive consumer experience in enrolling in the exchange and selecting a health plan, one that is fully automated and provides real-time adjudication while protecting privacy and personally identifiable information. IT projects undertaken by states in support of ACA must also comply with all relevant HIPAA standards, including those for protection of confidential health information.
All this means that states can “plug and play” into the federal government’s data hub and not be as burdened by a having to make all of the income and eligibility determinations themselves. In effect, a person could enter some very basic information into a web portal such as name, Social Security number, address, etc, and the data hub would determine the person’s income, and with that, whether they are eligible for Medicaid, an advance premium tax credit under the Exchange, and if the latter, what the amount of that tax credit would be. The IRS tax credit premium contribution for people headed to the exchange could be sent directly to the health plan that the person selects, and the person would be billed for the household’s own contribution.
The federal government’s goal is for individuals to be able to go to a web portal, enter a few pieces of protected information, and get a determination about what program they are eligible for, and get enrolled, within 15 to 20 minutes. The next step would be to choose a health plan, and the goal is to permit the vast majority of applicants to make this plan selection in the same online session covering enrollment.
HHS realizes that some applicants will need customer service and online support. The idea is to enable individuals to access education and online assistance and connect with a customer service or caseworker representative through online chat or by calling a toll-free customer service line. In some cases, of course, there will be discrepancies between information supplied by the applicant and that returned by the third-party data sources, and this will require more in-depth interactions, either by phone or in-person. In some cases, there will be a need for paper adjudication.
Building this hub in time for the Exchange implementation deadline is a daunting but important task. It will be an important test of the goal of using 21st Century technology for health reform implementation.