Medical Assistance Provider Incentive Repository (MAPIR) - 13 State Collaborative

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1 Medical Assistance Provider Incentive Repository (MAPIR) - 13 State Collaborative Category Contact Cross-Boundary Collaboration and Partnerships Sandy Patterson, Commonwealth of Pennsylvania Project Initiation August 2010 Project Completion June 2011

2 Executive Summary As part of the 2009 American Recovery and Reinvestment (ARRA) Act, the Health Information Technology for Economic and Clinical Health Act (HITECH Act) established incentive programs to promote the adoption and meaningful use of interoperable health information technology (HIT) and qualified electronic health records (EHRs), which research shows has the potential to improve health care outcomes for patients and efficiency of the health care system. Under this voluntary program, states can use federal funds provide incentive payments to physicians and hospitals who treat patients receiving Medical Assistance, meet certain eligibility criteria, use certified EHR systems, and use EHR software in a meaningful way. The incentive program began January 1, The Office of Medical Assistance Programs within Pennsylvania Department of Public Welfare led a multi-state collaborative with 12 additional states (Arkansas, Connecticut, Delaware, Florida, Georgia, Indiana, Kansas, Oregon, Massachusetts, Rhode Island, Vermont, and Wisconsin) to design, develop and implement a Medical Assistance Provider Incentive Repository (MAPIR) that would allow providers to apply for these incentive payments. MAPIR was developed in conjunction with HP Enterprise Services (HPES). The 13 states committed to putting aside the individual needs of their states in order to recognize a financial advantage, as well as to embrace the opportunity to discuss and develop best practices in the administration of the EHR incentive payment program and the use of the MAPIR application. MAPIR utilizes open source technology and is integrated with currently existing state Medicaid Management Information Systems (MMIS) leveraging state and federal investments. MAPIR allows eligible Medicaid providers to go to an existing state secured web portal, complete an application for the incentive payments and, if eligible, receive payments through the state s existing financial system. This collaborative effort and the technology used in developing the MAPIR application align perfectly with the Center of Medicare and Medicaid Services (CMS) Medicaid Information Technology Architecture, which encourages the use of open technology and reusable technical resources across state boundaries. The MAPIR Collaborative is one of the most successful state partnerships in the nation, with a formal governance structure, change management and release planning capabilities, and executive support from all member states and the CMS. Commonwealth of Pennsylvania Page 2

3 Description of the Business Problem and Solution In light of shrinking state budgets and the fact that the EHR incentive program is funded for a limited period of time ( ), Pennsylvania approached other states to determine their interest in sharing in the cost of design, development, and implementation of a system that would allow providers to apply for and receive EHR incentive payments. At the beginning, the motivation was purely financial; but as the MAPIR Collaborative continues to mature, it has become a valuable resource and partnership in Pennsylvania s administration of the EHR incentive program. The EHR incentive program contains specific rules for the processes of applying for and disbursing payments. The system solution needed to incorporate these rules for all states, while also allowing flexibility for individual states to leverage their MMIS investments for payment processing, including secured Internet access to MAPIR, provider identification through provider directories, and payment through financial systems. Additionally, when flexibility in the program was allowed, MAPIR needed to be able to be configured to accommodate individual state needs. MAPIR also needed to be able to incorporate each state s branding in the user interface and provide the ability to customize instructional information presented to the provider during the application process. When a provider decides to apply for an EHR incentive payment, he/she must first register at the CMS Registration and Attestation System (R&A). Once the provider has been validated by the R&A, the registration information is sent to the appropriate state. The provider then applies for the incentive payment with the state in which they are practicing. At certain intervals during the application process, states are required to send information to and receive information from the R&A prior to payment. Therefore, the MAPIR system needed to also interface with the CMS R&A before, during and after the provider application process. System Solution MAPIR is an Internet-based application that has both a provider-facing and administrative support component. It is designed to accommodate the unique aspects of a state and provide configurability and customization options in many areas. The application is configurable to allow the individual state to process state-specific requirements as permitted by the program regulations. MAPIR was developed according to Medicaid Information Technology Architecture (MITA) principles and uses open sources products. It relies on a secured MA provider portal, MA provider data, a financial system, and MA claims or encounter data sources to support the processing of incentive payment applications to eligible providers. MAPIR provides the following functionality: Commonwealth of Pennsylvania Page 3

4 File exchanges with the CMS Registration & Attestation (R&A) system to record such functions as eligibility determination, payment history, sanction inquiry and cost report and attestation data for hospitals eligible for both Medicare and Medicaid payments Provider information from the MMIS or a designated system is used for validating against R&A data Integration of MAPIR into an established provider portal that allows authorized providers to register, view, and confirm R&A registration information Contact information, including an additional address and phone number, is collected and used for provider notifications. Providers attest to adopting, implementing, upgrading EHR technology in order to obtain their initial incentive payment. To obtain additional incentive payments, the provider must attest that they are utilizing their EHR in a meaningful way. All of these attestations are captured via the online application process Different response flows to enable accurate collection of patient volume information based on provider responses (such as individual, group, and panel) Providers and state users can upload supporting documentation to be maintained with the application Calculation of patient volume percentages and payment amounts in accordance with the final rule A web service to the Office of National Coordinator (ONC) Certified HIT Product List (CHPL) to verify the use of a certified EHR technology State-specific data, such as summarized claim data and hospital cost reports, can be loaded and viewed within MAPIR by the internal state users for validation against provider submitted data Financial transactions, including adjustments, are created in MAPIR to be sent to the MMIS or designated financial system for payment MAPIR accepts payment information, such as payment transaction number and payment date, returned from the MMIS or designated financial system and returns this information to the R&A Application status information is viewable to providers after submission via the portal Context sensitive help is available to providers through the use of hover bubbles Validation edits verify accurate data entry of information submitted by providers and users State users may enter appeals tracking information into MAPIR through a user interface MAPIR introductory splash pages provide state-specific instructions and guidance A customizable online questionnaire may be configured by a state to collect HIT data from the provider prior to their application submission Multiple daily and weekly reports and extracts are generated from MAPIR to assist with application processing and inventory tracking Automated s are sent to providers as they proceed through the application process; all provider correspondence is sent electronically. Commonwealth of Pennsylvania Page 4

5 State users can add notes to each application to track actions taken in support of the application eligibility determination The MAPIR system solution began design of the initial release in August 2010 and Pennsylvania was the first implementation of the solution in June All but 2 states within the collaborative were implemented by December Since June 2011, there have been 5 releases of software to meet the continued progression of the EHR Incentive program. The MAPIR application is guided by a formal governance structure comprised of representatives from each participating state and HPES. The purpose of this governance structure is to guide the ongoing development and deployment of the application and to ensure the core design meets the requirements necessary to facilitate incentive payments to providers for the implementation and continued use of an EHR in accordance with the provisions outlined in the federal regulations. The MAPIR governance structure comprises the following: Steering Committee State representatives who are responsible for making highlevel decisions on the development of the core application and funding required to do so. PA Project Team Pennsylvania team that has taken the lead in analyzing the business requirements, organizing the collaborative meetings and acting as the leader in providing final approval of HP core system deliverables on behalf of the participating states Technical Review Team State representatives, who review implementation deliverables presented by HPES, and make recommendations for approval/ disapproval, and identify core issues that need to be addressed by HPES or the Steering Committee MAPIR Development Team HPES team that designs, develops, and tests the core MAPIR application for deployment to individual states HPES State Deployment/ Integration Team HPES state team members that integrate the Core MAPIR into their existing state MMIS and business operations Commonwealth of Pennsylvania Page 5

6 The MAPIR Collaborative Governance Structure Benefits The concept of multiple states coming together and jointly designing and implementing a highly customizable, open source system is a notable advancement in the government arena. This is not a system that was solely developed by a vendor and sold to multiple states, it is a system that was developed via a partnership of 13 states and a single vendor. This concept of developing open systems that are able to be used in multiple states is an example of the goals of the Medicaid Information Technology Architecture mandated by CMS. As a result of this genuine collaboration, the members of the MAPIR multi-state collaborative have seen the following benefits: The MAPIR governance structure allows all collaborative members to provide oversight and input in the ongoing development of the application. The shared knowledge, best practices and experience of participants from 13 Medicaid programs enhances the system development process. The collaborative provides a forum for representatives from the various state Medicaid programs to discuss operational issues and incentive program implementation strategies. Commonwealth of Pennsylvania Page 6

7 Program management required to manage interdependencies with the R&A is shared across the participating states and HPES. Member states collaborate to make sure that MAPIR meets statutory and regulatory requirements and is implemented in a manner that minimizes the potential for fraud, waste, and abuse. Further collaboration around operational procedures and processes has reduced overall effort for states One joint Implementation Advance Planning Document (IAPD) was submitted to CMS by the multi-state collaborative for enhanced funding of the core MAPIR development and ongoing enhancements, reducing each state s administrative burden. A cohesive voice of 13 state agencies influences the future direction of the program. Significant savings have been achieved because one core system has been developed and used by many states. Costs are distributed among participating states, thereby significantly reducing each state s cost. The $3.6 million cost of the initial implementation was split equally among the 13 states for a total cost per state of $276,923. Since the EHR incentive program is funded 90% by the federal government, the savings to pay for one system solution across 13 states saved the federal government approximately $38.9 million. Each state spent $27,682 in state funds for the initial system solution. Enhancement of the product continues to be split across 13 states and savings continue to be realized. States can leverage their existing MMIS infrastructure, further reducing costs. Due to the fact that the MAPIR application utilizes service oriented architecture (SOA) and used federal funding for the development cost, any state can obtain the MAPIR system and operate the system at no additional cost. Pennsylvania Governor Tom Corbett stated in a letter to the National Governor s Association regarding the MAPIR solution, In a time when government is frequently criticized for poor financial management and wasteful spending, MAPIR is an example to the contrary. The members of the MAPIR Collaborative and HPES have been committed to the project success from the beginning. Throughout the process, each entity has truly approached this with an open mind and willingness to compromise. The individual states changed their approach from me to us. Commonwealth of Pennsylvania Page 7

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