Enrollemt workgroup

HIT Policy Committee
Enrollment Workgroup

Monday, June 14, 2010
12:00pm ET

Agenda Call to Order

1. Call to Order
– Judy Sparrow, Office of the National Coordinator for Health
Information Technology
2. Introduction of Workgroup Members
3. Overview of Workgroup Role & Charge
4. Introduction to Panel Presentations
5. Panel 1: Enrollment in 2014
6. Panel 2: State/Local eHuman Services Efforts
7. Break
8. Panel 3: Internet/Web Services /Consumer Data Platform
9. Workgroup Discussion
10. Public Comment
11. Adjourn

Agenda Intro of W G Members

1. Call to Order

– Aneesh Chopra, Chair
– Sam Karp, Co-Chair
7. Break
10. Public Comment
11. Adjourn

HIT Policy & Standards
Committees
Enrollment Workgroup
Aneesh Chopra, Chair
Chief Technology Officer, OSTP

Sam Karp, Co-Chair
California Healthcare Foundation

June 14, 2010

Workgroup Members
Chair: Aneesh Chopra, Federal CTO
Co-Chair: Sam Karp, California Healthcare Foundation
Members: Ex Officio/Federal:
• Cris Ross SureScripts Sharon Parrott, O/S, HHS
• James Borland Social Security Administration Nancy DeLew, CMS/HHS
• Jessica Shahin U.S. Department of Agriculture Penny Thompson, CMS/HHS
• Stacy Dean Center on Budget & Policy Priorities Henry Chao, CMS/HHS
• Steve Fletcher CIO, Utah Gary Glickman, OMB
• Reed V. Tuckson UnitedHealth Group John Galloway, OMB
• Ronan Rooney Curam David Hale, NIH
• Rob Restuccia Community Catalyst Paul Swanenberg, SSA
• Ruth Kennedy Louisiana Medicaid Department David Hansell, Administration for
• Ray Baxter Kaiser Permanente Children & Families, HHS
• Deborah Bachrach Consultant Julie Rushin, IRS
• Paul Egerman Businessman Farzad Mostashari, ONC
• Gopal Khanna CIO, Minnesota Doug Fridsma, ONC
• Bill Oates CIO, City of Boston Claudia Williams, ONC
• Anne Castro Blue Cross/Blue Shield South Carolina
• Oren Michels Mashery
• Wilfried Schobeiri InTake1
• Bryan Sivak CTO, Washington, DC
• Terri Shaw Children’s Partnership
• Sallie Milam West Virginia, Chief Privacy Officer
• Dave Molchany Deputy County Executive, Fairfax County

Section 1561 of Affordable Care Act

1561. HIT Enrollment, Standards and Protocols. Not
later than 180 days after the enactment, the Secretary,
in consultation with the HIT Policy and Standards
Committees, shall develop interoperable and secure
standards and protocols that facilitate enrollment in
Federal and State health and human services
programs through methods that include providing
individuals and authorized 3rd parties notification of
eligibility and verification of eligibility.

Draft Work Plan

• May: Initial Scoping
• June 14 – July 16: HIT Policy and Standards
Committee Workgroup: Inventory, candidate standards,
strategy to address gaps
• July 16 – August 27: Standards development, NIEM
process
• Sept 31: Finalize standards recommendations

Draft Workgroup Charge

• Inventory of standards in use, identification of gaps,
recommendations for candidate standards for federal
and state health and human service programs in
following areas:
– Electronic matching across state and Federal data
– Retrieval and submission of electronic documentation for
verification
– Reuse of eligibility information
– Capability for individuals to maintain eligibility information
online
– Notification of eligibility

Potential Deliverables

1. Inventory of standards-based data exchange in use
today to enroll in health and human services

2. Candidate standards for data elements and
messaging

3. Proposed process to fill in gaps to rapidly turn
"requirements" into working prototypes/live
implementations to deliver world class eligibility and
enrollment services

Potential Candidate Standards

• Core data elements
• Name, address, residence, income, citizenship, etc.

• Messaging
• Checking eligibility and enrollment
• Consumer matching across systems
• Retrieving and sending “packages” of verification information
including income, employment, citizenship
• Communicating enrollment information

• Privacy and security
• Secure transport
• Authentication

Standards Requirements

We need to conceptualize standards that might be useful
and work across a variety of use cases or architectures
which might include:
• Front end user-facing consumer portal to conduct initial
eligibility checks and obtain and forward verification
information
• Comprehensive eligibility system for Health and Human
Services programs
• State or Federal exchange portals

Draft Policy Principles

Do not make policy through standards
Standards and technologies must support and be in
service to our policy goals:
• Consumer at the center
• Make enrollment process less burdensome; simplify
eligibility process and make it seamless
• Enter/obtain information once, reuse for other purposes
• Make it easier for consumers to move between
programs
• Focus on 2014 world

Draft Standards Principles
• Keep it simple - Think big, but start small. Recommend standards as
minimal as required to support necessary policy objective/business need,
and then build as you go.
– Don’t rip and replace existing interfaces that are working (e.g., with SSA etc.).
– Advance adoption of common standards where proven through use (e.g.,
270/271).

• Don’t let “perfect” be the enemy of “good enough” Go for the 80
percent that everyone can agree on.
– Opportunity to standardize the core, shared data elements across programs.
– Cannot represent every desired data element.

• Keep the implementation cost as low as possible
– May be possible to designate a basic set of services and interfaces that can be
built once and used by or incorporated by states.
– Opportunity to accelerate move to web services.

• Do not try to create a one-size-fits-all standard that add burden or
complexity to the simple use cases
– Opportunity to describe data elements and messaging standards that would be
needed regardless of the architecture or precise business rules selected.

Agenda Overview of W G Role & Charge

1. Call to Order

– Sam Karp, Co-Chair
7. Break
10. Public Comment
11. Adjourn

Agenda Intro to Panel Presentations

1. Call to Order

7. Break
10. Public Comment
11. Adjourn

Agenda Penny Thompson - Panel 1

1. Call to Order

– Penny R. Thompson, Centers for Medicare & Medicaid
Services
7. Break
10. Public Comment
11. Adjourn

Agenda Alice W eiss - Panel 1

1. Call to Order

– Alice Weiss, National Academy for State Health Policy
7. Break
10. Public Comment
11. Adjourn

Agenda Discuss Panel 1

1. Call to Order

– Discussion
7. Break
10. Public Comment
11. Adjourn

Agenda Steve Fletcher - Panel 2

1. Call to Order

6. Panel 2: State/Local eHuman Services
Efforts
– Steve Fletcher, Chief Information Officer, Utah
7. Break
10. Public Comment
11. Adjourn

State eHuman Services
Efforts
June 14, 2010

J. Stephen Fletcher
Chief Information Officer

Utah Health Info

Utah Health Information Network
• UHIN is a State not-for-profit company
• UHIN is a broad-based coalition of nearly all the
hospitals, ambulatory surgery centers, national
laboratories, insurers, and approximately 90% of the
medical providers in Utah as well as the Utah State
government.
• All parties exchange data in a standard format using
standard codes
– Administrative costs savings
– Opens the door to improving patient care and safety

cHIE

Clinical Health Information
Exchange (cHIE)
• Statewide system makes more complete patient
information securely available to authorized
providers
• Gives providers the capacity to render more
informed care and patients have more control over
their information
• Provides the means to locate and view information
available from the health care entities that
participate in this community effort

cHIE cont’d

Clinical Health Information
Exchange (cHIE)
• 11 entities are exchanging data
• 9 Sites are actively pursuing a connection
• 13 Organizations are collaborating with UHIN
• 12 Electronic medical records vendors are
pursuing a connection with the exchange

Potential Issues w/HIE

Potential Issues with HIE
• Assumes that since these are government programs,
there is no option for the provider (clinicians and
facilities) to opt-out of participating in the HIE and no
option for the patient to decide to opt-out of their
information being involved in the HIE
• Accurate, unambiguous, non-duplicative provider
identification system provided by HIE
– Liability protection
– Lack resources
– Primary identity focus is on keeping the patient identities
unique and unambiguous, not the provider

Utah state eREP

State of Utah eREP: Front End
Eligibility Check
• eREP has a Rules Engine that cascades all information
entered and suggests the optimal program according to
eligibility rules
• Data linking is done through web services links
– Link to common shared customer information across
several state applications
– Use common standards for linking to certain Federal data
sources such as Social Security, PARIS match, IRS,
National New Hire
– Mostly use Mainframe standards, use web services where
available
– Currently in the process of changing financial transactions
to web services

Utah State eREP cont’d

State of Utah eREP: Front End
Eligibility Check (continued)
• Programs Included
– CHIP and various related programs for adults
– All Medicaid and cost sharing programs including
several optional and waiver programs
– TANF/FEP and Refugee financial programs
– Several State optional financial programs
– Food stamps
– Child care assistance

eREP Multiple Program Eligibility

State of Utah eREP: Multiple
Program Eligibility
• Interfaces used to obtain electronic verification
information:
– All available Federal and State electronic match data,
including the complete array of Social Security information
such as BENDEX, SDX, Wire Third Party, SOLQ, SVES,
Prison Match, Death Match.
– IRS data including BEERS and the 1099 information
provided on matching clients.
– State/Federal consortiums such as PARIS match for civil
service and veterans benefits, as well as the National New
Hire Registry for TANF/FEP.

Multiple Program Eligibility cont’d

State of Utah eREP: Multiple
Program Eligibility (continued)
• Standards Used
– Mainframe file transfer protocols established by the
Federal partner (NDM transactions)
• Data Elements for Consumer Entry
– On-line application which creates an imaged document real
time
– State worker manually inputs the information from the
imaged application into eREP
• Consumer Authentication
– Consumer verifies through electronic signature
– Consumer then participates in immediate interview with no
appointment necessary

eREP Sending Packets

State of Utah eREP: Sending
Packets
• Business Rules are maintained at the program
level
– All business rules are applied centrally at the
application level, allowing the cascading process
to select any and all appropriate programs
• Standards used for messaging are IBM
Websphere MQ and JMS

Agenda Bobbie W ilbur - Panel 2

1. Call to Order

Efforts
– Bobbie Wilbur, Social Interest Solutions
7. Break
10. Public Comment
11. Adjourn

Social Interest Solutions
Testimony
Enrollment Workgroup Meeting
Washington, DC
June 14, 2010

Social Interest Solutions
• Independent, mission-driven non-profit organization
• Systems development, implementation, maintenance and
enhancement
• Integrated eligibility and case management systems and other
solutions to support consumers
• Support a range of state, county and city jurisdictions
• Handle a range of public and private programs
• One-e-App is the SIS signature product for eligibility and
enrollment in programs

©2010 SIS Confidential and Proprietary

The One-e-App Approach
• Web-based system
• Consumer-centric channels via:
– Self-service
– Call center
– Assisted application support
• Offers a secure single point of entry
• Provides simultaneous preliminary and/or final eligibility
determination across multiple public and private programs


More on the approach . . .

• Verifies applicant information via automated verification, scan,
fax and e-mail and stores and manages verifications for
submission to other systems and for future re-use
• Supports telephonic and a variety of electronic signatures
• Provides a consumer “home page” to allow for self-management
of new applications, change in circumstances (modify), renewals
(re-certification) for all programs
• Provides consumer (and assistors) communication and
notification via e-mail, text messaging and paper
• Integrated across a range of public and private systems


What Makes One-e-App Work
• Careful, deliberate and complete gathering of consumer
information
• Real-time information verification through system and process
integration
• Searching enrollment systems for existing or prior benefit
coverages
• Real-time eligibility determination or routing
• Augmenting the capabilities of existing legacy systems
• Configurable client administration
• Never accepting “it can’t be done”


Standards and Integration

• Innovative system integration using a range of tools from “mash
ups” to complex web services
• Translators that provide for data exchange across a continuum
from HL7 to X12 to XML to . . .
• Utilizing existing standards including:
– ADA
– HIPAA (Privacy and Trading Data (Transactional)
– MITA
– US Postal Standards
• Augmenting the capabilities of existing legacy systems


Consumer Access
Consumer Access

Outreach Certified
Consumer Provider Community Provider Call Center Mail-In Paper County
Self-Assistance Assistor Assistor Assistor Assistor Application Assistor

• Match Birth Record
• Apply, Modify, Renew Applications
• Submit Applications Electronically
• Submit Verification Documents
Electronically
• Select Medical Home or Provider
• Look Up Eligibility Status
• Manage Outreach, Notifications, Case
• Access Data Mart
• Other Features


The One-e-App Architecture
One-3-App Architecture

. . . MITA architecture with services that can be
Enterprise Integration Portal leveraged to augment legacy systems
Authentication Data Transformation Data Validation Information
Services Services Service Verification Service
Workflow Dispatcher Document Business
Engine Services Management Service Intelligence
System Integration
Other Services
Engine
Enterprise Service Bus

Web Web Web Web Web Web Web
Service Service Service Service Service Service Service

Verification State & County USPS Patient Clearinghouse State Other Systems:
Systems Eligibility Management Systems Medicaid Kaiser, Utility, School,
Systems Systems Systems City, Health Plan, . . .


Enrollment Across Programs
• Health Programs:
– Medicaid
– SCHIP
– EPSDT
– Medicare Cost Sharing
– County Indigent Care Programs
– County, Clinic and Hospital Sliding Fee Programs
– Hospital Charity Care Programs
– County Expansion or Access Programs
– Kaiser Permanente Child Health Plan and Kaiser Bridge
– CaliforniaKids
– Express Lane Eligibility (school lunch / MC linkage)
– Pharmacy Discount Programs


More Programs . . .

• Food Stamps (SNAP) • Low Income Auto Insurance
• TANF (Temporary Aid to Needy • Employment Assistance (WIA)
Families) (Coming Soon)
• Supplemental Nutrition for • Family Planning
Women, Infants and Children • Cancer Detection and Treatment
(WIC) Programs
• Earned Income Tax Credit • General Assistance
(EITC) • Drug and Alcohol Rehab
Program
• Child Tax Credit
• Homeless Assistance
• Voter Registration • Others
• Low Income Energy Programs


Reach
• Arizona: Health-e-Arizona
• Indiana: Ind-e-App
• Maryland: Health-e-Link and Healthy Maryland (Coming Soon!)
• California:
– One-e-App
• 15 California Counties
• City of Los Angeles
• Los Angeles Unified School District
– Health-e-App – Statewide
• Kaiser Permanente Child Health Plan
• PG&E CARE Program
• CaliforniaKids
• Pharmaceutical Patient Assistance Programs (Coming Soon)


ACA Player Summary ACA Player Summary

Federal Portal State Portal
•Information •Information
•Routed to State Portal •Routed to Eligibility and Enrollment Systems
Medicaid •Coverage Updates
•Information •Consumer Portal
•Application Support in Medicaid System Social Services
•Exchange with Verification Systems
•Information
•Referral to Other Programs
•Application Support in Social Service System
•Coverage to Other Players
•Coverage Management
•Cost of Coverage
State Exchange •Coverage Management
•Information
•Application Support for Private Insurance Insurance Companies on the State
•Determine If Medicaid Prior to Private Insurance Exchange
•Information
•Coverage to Other Players •Consumer Coverage Confirmation
State High Risk Insurance Risk
•Coverage from Medicaid and State High •Track Changes in Consumer Coverage
•Billing and Collecting Employee
•Information
•Referral to Medicaid Prior to High Risk Insurance
•Determine Other Programs
IRS
•Coverage ManagementHigh Risk Insurance
•Application Support for •Records Match
•Cost of Coverage
•Exchange with Verification Systems •Report No Coverage Consumer
•Referral to Other Programs •Long term, should incorporate the ability to apply through
•Coverage to Other Players tax return
•Assess penalty to non-covered


ACA Players Must
Employ Electronic Matching to serve as evidence of eligibility in lieu of paper
☐ Vital Records
☐ Employment history ACA Players Must

☐ Enrollment system
☐ Tax records
☐ Other

Simplify verification and submission of documents
☐ Digitization of documents
☐ System verification

Reuse of stored eligibility information to assist with retention of eligible individuals

Provide Online access for individuals to:
☐ Apply
☐ Recertify
☐ Manage eligibility information

Expand enrollment systems to:
☐ Integrate new programs
☐ Integrate new rules
☐ Integrate new functionalities
☐ Operate at increased volumes
☐ Apply the streamlined eligibility and verification processes to other Federal and State programs

Notify parties of eligibility, recertification and other needed communication by:
☐ Email
☐ Cell Phone (e.g., text messaging, Apps)
☐ Other

Provide other functionalities to streamline the enrollment process

ACA Player Summary
Health Plans ACA Player Summary

County and Community Safety Net Programs

Federal Portal State Portal
•Information •Information
•Routed to State Portal •Routed to Eligibility and Enrollment Systems
Medicaid •Coverage Updates
•Information •Consumer Portal
•Application Support in Medicaid System Social Services
•Information
•Application Support in Social Service System
•Cost of Coverage
State Exchange •Coverage Management
•Information
•Application Support for Private Insurance Insurance Companies on the State
•Determine If Medicaid Prior to Private Insurance Exchange
•Information
•Coverage to Other Players •Consumer Coverage Confirmation
State High Risk Insurance Risk
•Coverage from Medicaid and State High •Track Changes in Consumer Coverage
•Billing and Collecting Employee
•Information
•Referral to Medicaid Prior to High Risk Insurance
•Determine Other Programs
IRS
•Coverage ManagementHigh Risk Insurance
•Application Support for •Records Match
•Cost of Coverage
•Exchange with Verification Systems •Report No Coverage Consumer
•Referral to Other Programs •Long term, should incorporate the ability to apply through
•Coverage to Other Players tax return
•Assess penalty to non-covered

PatientSIS Confidential and Proprietary
©2010 Management and EHR

Leverage, Leverage…

Leverage Consumer-
Medicaid to
Real-Time Support
Centric ACA
Verifications & Underpinnings Results!
Eligibility for Insurance
Build on MITA Determinations Exchange and
Standard Other
Architecture for Programs
High Re-use
Augment
Legacy
Systems

Allow for new external
Adopt Existing
Standards with Minimal programs and services via
Modifications ESB


Contact
Bobbie Wilbur
Co-Director
916-566-2643
bwilbur@socialinterest.org

Claudia Page
Co-Director
510-273-4641
cpage@socialinterest.org

www.socialinterest.org


Agenda Ruth Kennedy - Panel 2

1. Call to Order

Efforts
– Ruth Kennedy, Louisiana Medicaid
7. Break
10. Public Comment
11. Adjourn

Electronic Eligibility
Processes in Louisiana

A State Perspective
Louisiana Medicaid & CHIP
Eligibility Division

HIT Eligibility Workgroup Meeting
June 14, 2010

J. Ruth Kennedy
La. Dept of Health & Hospitals

The Case for Eligibility
Automation in Louisiana
 Genuine desire to reduce number of
uninsured, increase enrollment & access
 Accelerate (faster) enrollment and
maximization of retention
 Advances in technology presented new
opportunities
 Severe state budget shortfalls
 Eligibility workloads spiraling out of control
 We believed it was possible to do so without
compromising program integrity

Starting Assumptions

 Important differences in eligibility
for public health coverage and TANF/SNAP
 Less need for income preciseness

 Underlying philosophy and goals

 Automated processes will increase enrollment
and retention of eligible individuals
 Integrating IT into eligibility business processes
is a heavy lift— about more than standards!

Electronic Case Records
(ECR)= Transformative
 Totally paperless, web-based eligibility
case records
 Includes images of all incoming and
outgoing documents
 All eligibility employees in state can
create, add to and access the ECR
 Now institutionalized—conversion was
completed in July, 2005

Why Convert to Electronic
Eligibility Case Records?
 Major savings
Labor and rental costs
 Postage, filing systems, paper, printing
costs, toner
 Immediate accessibility to
documents and data
 better customer service
 makes paperless eligibility business
processes practical

Ex Parte Renewals Using SNAP
Data Since 2001
 High level of confidence in SNAP income data
 Match with DSS system identifies & flags
children due for renewal with active SNAP case
 Caseworkers still play major role in decision
making
 Income in SNAP system for Medicaid/CHIP
income unit members is cross walked
 ~ 2/3 of Medicaid children in active SNAP case
 Has resulted in dramatic reduction in procedural
(paperwork) closures

Can We Built a Better
Mousetrap?
 Federal regs (42CFR 435.9160)
mandate periodic redetermination ―at
least every 12 months‖
 In the 21st Century, is there a better
way to do so for low risk cases?
 Intensive data mining to determine
case characteristics
 Extensive testing and
refining prior to
implementation

Web-Based Applications

 We believe electronic signature is
critically important
 Focus groups indicate families
appreciate the option
 Eliminates the need for scanning;
data electronically goes to ECR
 Continuous improvement in
functionality

Express Lane Eligibility(ELE)

 CHIPRA option to use
eligibility decisions by
other agencies
 Electronic eligibility
data from SNAP
agency
 Over 14,000 children
< age 19 have been
automatically enrolled

Some Lessons From the ELE
Bleeding Edge

 Simplification isn’t simple!
 Data matching isn’t ―magic‖ or totally
clean
 ―Automatic‖ is relative
 Human intervention is still
important

Beware the
Watchman!!
―The government are very keen on
amassing statistics. They collect them,
add them, raise them to the Nth power,
take the cube root and prepare
wonderful diagrams.

But you must never forget that every one
of these figures comes in the first
instance from the village watchman, who
just puts down what he . . . pleases.”
--Sir Josiah Stamp, 1880-1944
Head, Bank of England

Yikes!!

―Organizational Change‖ is
Essential to Maximize IT
 Even more important than
technology
 Caseworkers ―open‖ and
―close‖ the door
 Requires fundamental change
in approach to eligibility
 Major changes in expectations
of caseworkers and managers
 It’s about winning hearts &
minds

Louisiana’s Eligibility HIT
Wish List for HHS

 Enhanced FFP for ―standalone‖
Medicaid/CHIP eligibility systems
 Data standards
 Reporting requirements
 Dissemination of information about
state HIT eligibility innovations and
―lessons learned‖
 ELE-type eligibility processes for
adults as well as children

Never doubt that a small group of thoughtful,
caring people can change the world Indeed, it is
the only thing that ever has !— Dr. Margaret Mead

Ruth Kennedy
LaCHIP Director & Medicaid Deputy Director
Louisiana Department of Health & Hospitals
P.O. Box 91030
Baton Rouge, LA 70821-9030
Telephone: 225 342 3032
Blackberry: 225 241 1437
Fax: 225 342 9508
E-Mail: ruth.kennedy@la.gov
www.lachip.org


1. Call to Order

Efforts
– Discussion
7. Break
10. Public Comment
11. Adjourn

Agenda W es Rishel - Panel 3

1. Call to Order
7. Break

8. Panel 3: Internet/Web Services /Consumer
Data Platform
– Wes Rishel, Gartner
10. Public Comment
11. Adjourn

Enrollment Working Group
Testimony

Wes Rishel
Distinguished Analyst
14 June 2010
Washington DC (via telephone)

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© 2010 Gartner, Inc. and/or its affiliates. All rights reserved.

Why is interoperability so darn hard?
An Interoperability Joke:
Mrs. Johnson brings little Johnny in for his first day of school.
After meeting the teacher in a group of moms, she pulls the teacher
aside and says:

Johnny is very sensitive, So, if he misbehaves,
don’t hit him.

Hit the kid next to him.

That will scare him and he will straighten up.

Things To Consider Standardizing
• Core data elements
• Name, address, residence, income, citizenship, etc.
• Codes and structure (e.g., citizenship and ethnicity)
• Signature: Electronic and/or digital; applicant, third-party data source
• Data Formats
• Business Functions
• Checking eligibility and enrollment
• Consumer matching across systems
• Retrieving and sending “packages” of verification information including income,
employment, citizenship
• Communicating enrollment information
• Privacy and security
• Auditing and other provisions for detecting, investigating and proving fraud
• Secure transport
• Authentication
• Identity vetting
• Package integrity

Impedance Matching:
The Interoperability Metaphor
Source Receiving
Computer or Computer or
Organization Organization

• The maximum high-fidelity data transfer occurs when the
representation of data and the process are the same in
both systems/organizations
• The maximum interoperability is probably << half the total
understanding of semantics and process at either end

Incremental Interoperability:
Variable Impedance Matching
Highly "Informatical"
Systems

* 1001 0100 0100
1011 1110 0101

1001 0100 0100
1011 1110 0101

*

1001 0100 0100

*More Structure or Less; 1011 1110 0101

Older Not All or None
System

Preventing FIS:
Frozen Interface Syndrome

• Make incremental interoperability
a fundamental business premise
- Variable structure
- Require mappable code
upgrades
- Flexible utterances
• Use business incentives to drive
upgrades to system informatical
levels
• Make interface negotiation a part
of the infrastructure

Vision: Putting the Consumer in Charge
Control v. Transparency; Source Authenticity
Consumer Policies and Compliance Rules Data User
• Creates and signs data sets • Establishes identity
Trusted Data Bank relationship with consumer
• Edits self-signed data sets
• Establishes identity
Consumer Account • Retrieves authorized data
relationships with other data • Edits self-signed data sets
sources Data Set • Validates seals of authenticity
• Authorizes one-time and • Provides history and status
ongoing transfers Data Set
updates as signed data sets
• View all data sets (with few Data Set • Maintains valid seal of
limitations) authenticity (for verifying
• Deletes self-signed and authorization and audit logs)
selected other data sets
• Creates externally attached 3rd Party Data Source
comments on other-sourced Trusted Data Bank
data sets • Establishes identity
• Provides APIs and user relationships consumer
• Authorizes services of 3rd party interface for stakeholders
advocates • Provides signed authorized
• Continually meets compliance data
requirements for security and
privacy • Maintains valid seal of
authenticity
• Provides forensic-quality logs
• Warrants to hand off data to
Source’s Seal of other trusted data banks
Authenticity

Invention Quote

Invention, it must be humbly
admitted, does not consist in
creating out of void, but out of
chaos.

Agenda Julie Rushin - Panel 3

1. Call to Order
7. Break

Data Platform
– Julie A. Rushin, Deputy CIO, IRS
10. Public Comment
11. Adjourn

IRS - FAFSA

Internal Revenue Service (IRS)
Free Application For Federal Student Aid (FAFSA)

June 14, 2010

Project Overview- Background

 Federal Student Aid (FSA) mandated through the American
Recovery and Reinvestment Act to simplify the Free
Application for Federal Student Aid (FAFSA) process

 IRS and FSA data exchange discussions begin (December
2007)

 Decision made to allow students and parents access to IRS
tax data needed to complete the FAFSA (March 2009)

 The IRS solution, the Federal Student Aid-Datashare (FSA-D)
application, successfully deployed January 28, 2010.

FSA-D Interface with Dept. Of Ed.
 FSA-D is accessible from within the FAFSA
application process only.
 FSA-D has no direct interface with the Department of
Education.
 FSA-D has external interfaces to taxpayer (and 3rd
party) web browsers and IRS programs.
 Data is transferred to and from the Department of
Education through an 128 bit SSL encrypted HTTP
Post via the taxpayer’s browser.

Modernized Production Systems and Services

 FSA-D interacts with production programming
to retrieve information from the Individual
Return Transaction File (IRTF).
 FSA-D logs messages to the Security Audit
and Analysis System (SAAS) which
implements a data warehousing solution to
provide on-line analytical processing of audit
trail data.

Department of Ed Process

 ED Applicant (Student or Parent) initiates the on-line process for Free
Application For Student Aid (FAFSA)
 Includes application for a PIN (if not previously secured)
 User provides SSN, Name, DOB, Address and selects a challenge
question to activate the PIN
 User information validated through Social Security Administration (SSA)
 User- or ED-created PIN provided to user instantly, via email or through
postal service
 PIN considered conditional until validated by SSA and can only be used
to sign the FAFSA (SSA validation completed within one to three days)

 Applicant completes the applicable FAFSA On The Web (FOTW) Input
Screens
 User’s SSN, DOB, Name and PIN collected

 Link to IRS FSA-D is displayed

IRS FSA-D Data Elements to User

Current Statistics
 Statistics from 1/28/2010 through 6/10/2010

 612,279 users requested access
 324,018 users successfully authenticated (52.9 %
of volume)
 303,118 users transferred tax information to
FAFSA (49.5% of volume)

Planned Enhancements
 *Changes to the FAFSA question numbers
 Change the design to display the FAFSA form question numbers that
correspond to the version of the form being completed by the applicant.
 *Return Correlation ID of all FSA-D Users
 Improves the user experience by enabling ED to return users exiting
the FSA-D to the appropriate section of the FAFSA.
 *Spanish language version
 Mirror the features and functionality of the English language FSA-D.
 Non-editable date of birth field
 Enhance the Security and Privacy of the FSA-D application by
changing the Date of Birth field on the Authentication Page from an
editable to a non-editable field (Requested by Privacy)

*Denotes Department of Education (ED) request.

Agenda Paul Swanenburg - Panel 3

1. Call to Order
7. Break

Data Platform
– Paul Swanenburg, Social Security Administration
10. Public Comment
11. Adjourn

CHIPRA Citizenship Match
With SSA (SCHIP)

CHIPRA Citizenship Match

SCHIP
State
1
•Provides name, SSN, DOB and MEDICAID & CHIP SSA
citizenship matching Agencies within
Provides Name,
Existing-Approved
•Uses an existing and approved 2 SSN, DOB and
Network
Citizenship
telecommunications network in Matching
place between SSA and all
states-File Transfer Management
System (FTMS) 2
3
•Uses an existing batch query in
place with all states – State
Verifications and Exchange State
System (SVES) MEDICAID or CHIP
1 Agencies outside
•Part of existing data exchange Approved Network
agreement between STATES and
MEDICAID 4
SSA (CMPPA & IEA) for MEDICAID & CHIP
and CHIP Agency
Diagram 1

Affordable Care Act
Citizenship Match with SSA
90 Day Requirement (SCHIP)

SCHIP (90 Day) Affordable Care Act – 90 Day Requirement

•To meet 90 day (06/21/10)
requirement-use CHIPRA SCHIP
Query State 1 SSA
•Opting In Provides Name,
•Use existing FTMS & SVES •HRP within SSN, DOB and
Network/Query Umbrella of Citizenship
2
DHS/STC Matching
•Modify existing information
exchange agreements (IEA) with
States
•Opt out States using HHS
contractor and States requiring
new Computer Matching and
Privacy Protection Act (CMPPA) State
agreements would not meet 90 •Opting Out
day criteria •Opting In but HRP
outside of DHS/STC

Diagram 2

Affordable Care Act
States Administering Own High Risk Pool (HRP)
Affordable Care Act - HRP

SCHIP (06/21/10 – 12/31/13)
•Use CHIPRA SCHIP Query
State 1 SSA
•Use existing FTMS & SVES •Opting In Provides Name,
Network/Query •HRP within SSN, DOB and
Umbrella of Citizenship
•Modify existing information DHS/STC
2
Matching
exchange agreements (IEA) with
States within umbrella of
DHS/STC
2 3
•Create new agreements/security
approvals for HRPs outside of
existing/approved DHS/STC
umbrella State
•Opting In
•HRP outside of
1
DHS/STC
4

HRP
Diagram 3

Affordable Care Act
States Opting Out-Fallback

SCHIP (06/21/10 – 12/31/13)
Affordable Care Act – State Fallback

•Use CHIPRA SCHIP Query
•Operate within approved FTMS Multiple
network using SVES based query Sources
Input for
•Create new CMPPA/IEA Enrollment Process
agreements

1

SSA
2
ASSUMPTIONS: Provides Name,
(NFC) SSN, DOB and
1. Queries will not be routed Citizenship
through PA DPW Administering Opt 3 Matching
2. NFC approved site will administer Out States HRPs
all opt out states
3. FTMS approved network technology
will be used
4. Administered through 12/31/13 Diagram 4

Agenda Bryan Sivak - Panel 3

1. Call to Order
7. Break

Data Platform
– Bryan Sivak, CIO, Government of D.C.
10. Public Comment
11. Adjourn


1. Call to Order
7. Break

Data Platform
– Discussion
10. Public Comment
11. Adjourn

Agenda W G Discussion

1. Call to Order
7. Break

10. Public Comment
11. Adjourn

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