Archive for January 25, 2013

Another Data Leak Plagues Utah

Third party contractor Goold Health Systems, based in Maine, is behind a data leak in Utah, according to a report in the Salt Lake Tribune. Earlier this month, a Goold employee was having difficulty uploading a routine report onto a secure file server. Opting instead to save the data to an unsecured thumb drive, the data was later lost during the employee’s cross-country travel.

The Utah Department of Health is in the process of notifying 6,000 Medicaid enrollees that their personal information, inluding names, ages and prescription information, was exposed by the error. The missing data does not include patient birth dates, Social Security numbers or financial information.

“We believe the potential risk for identity theft is minimal. Further, we have no reason to believe the data were targeted by anyone to be used for malicious purposes,” said Utah Medicaid Director Michael Hales, in a statement.

The missing Medicaid data comes less than a year after a major breach of a Utah Department of Health server, which exposed hundreds of thousands of records containing Social Security numbers and other personally identifiable information. That breach, still under investigation, may result in fines for the state. According to a health department spokesperson, the state may seek restitution for this month’s data leak from Goold.

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Space Satellite Connects Rural Health Clinics to Broadband

To connect mobile health units in the hills of rural New England with broadband access, policymakers are looking up — all the way to space. In the next few months, roaming trailers that serve rural communities and ships that double as health clinics for Maine’s outer islands will be equipped with the gear necessary to draw broadband Internet from a satellite powered by Hughes Network Systems. The initiative is being led by the New England Telehealth Consortium, a federally funded group of health care providers dedicated in part to improving rural health care access. The consortium’s efforts also focus on building new broadband infrastructure, but the mobile units that serve many of the hard-to-reach communities in the area would never be able to plug into the grid. Instead, they’ll transmit data through the Hughes Spaceway 3 broadband satellite, floating 22,300 miles above the Earth. It will allow those providers to use remote monitoring, electronic health records and more in a way that they never could with their current technology.

“People will sometimes say: ‘Well, those are just going to be unserved areas,” says Tony Bardo, vice president for government solutions at Hughes. “With satellites, there are no unserved areas. We can serve wherever you can see the southern sky.”

The 10-year, $500,000 project — which got some start-up funding from the states — will serve mobile units reaching more than 400 sites and 2.5 million patients in Maine, New Hampshire and Vermont. And it could be the first of many, as rural connectivity is continually integrated into the health care reform conversation. In fact, the FCC announced last week that it would be setting some of its $400 million in recently announced rural health funding for satellite projects specifically.

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Iowa Plans Rapid Deployment of New Eligibility System

Come October, Iowa expects to have a new human services eligibility system online — less than a year out from starting the project.

The timeframe is ambitious, as eligibility system rollouts can often take years to fully implement. Just ask Texas, which spent eight years getting its project done. But as Iowa Department of Human Services Administrator Ann Wiebers explained, the rapid overhaul is a necessary step for the state to meet some of the requirements of the Affordable Care Act (ACA).

The ACA requires states to have online health insurance exchanges established by January 2014, so that citizens can purchase health coverage. But Wiebers said Iowa’s eligibility system wouldn’t be able to provide the real-time Medicaid determinations needed so that an exchange can work properly. Built in the late 1970s, the front end of the current system was installed in 1983 and isn’t easily upgraded.

“It is very difficult to change and it takes a significant amount of effort … and we knew that in order to do a seamless integration with the exchange that we had to replace it,” Wiebers said. “There was no discussion about trying to put a [new] front end onto the mainframe because it was so old.”

Iowa chose Accenture to handle the new eligibility system implementation. Debora Morris, managing director for integrated services for Accenture, said the age of the state’s current system isn’t necessarily a challenge for the company, but in order to meet Iowa’s Oct. 1 project deadline, the company had to forgo a phased implementation process.

Accenture will instead install the new system and have it running immediately. Then in the months and years to follow, they’ll add enhancements based on the state’s RFP as well as suggestions from workers using the system.

Morris added that the major challenge on Accenture’s part is working without final details from the federal government on the health benefit exchanges.

“We’re doing this at a time when the feds are still getting out some of the guidance to states and building out their federal exchange,” Morris said. “So there are a few unknowns out there that we’re working a little blind on.”

From Iowa’s perspective, they’ve been prepping for quick turnaround of the eligibility system for a while. The state got its RFP out for the project last January and in December, they announced that Accenture was awarded a six-year base contract through 2018 with four one-year extension options. The total value of the contract over 10 years is approximately $77.7 million and includes software, hardware, maintenance and training.

Early Preparation

Weibers said that Iowa also spent the latter part of 2012 evaluating how its current eligibility mainframe connected to its separate Iowa Automated Benefits Calculation (ABC) System. She called ABC a “workhorse” that interfaces with more than 100 different subsystems. State personnel were identifying all those connections to make sure all functions were accounted for so Accenture had no surprises when starting the transition.

Given the short timeframe, Iowa is also supplementing its support staff in the Department of Human Services. In addition to hiring Accenture, the state has hired a project oversight, management and implementation contractor and a quality assurance and independent verification and validation contractor. Another “seven or eight” positions were also built into the project budget to augment state staff.

Wiebers added that the contractors hired have worked on other eligibility system projects in the past and are sharing lessons learned with the staff. Iowa is also in close contact with California and Idaho, who operate the same Accenture system and are willing to share their experiences.

“I think that we have done everything that we possibly can to mitigate any issues,” Wiebers said.

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Health Insurance Exchanges: Benefits, Challenges, Lessons

On Thursday, Jan. 10, Government Technology hosted its first TweetChat: Innovation in Focus – States and Health Insurance Exchanges.

The chat, held on Twitter using the hashtag #GTonHIX, included industry experts John Sweeney, IBM’s senior product manager for the Curam solution, and Dan Schuyler, director for Leavitt Partners’ health insurance exchange practice, to answer questions about state health insurance exchanges (HIX).

An HIX is a government-regulated, standardized marketplace for the purchase of health insurance, and the Obama administration mandates that each state have one. States may choose to create and run their own HIX, or they can opt out and have the federal government create their exchange for them.

States had to declare whether they were running their own exchange by Dec. 14, 2012. And according to the National Conference of State Legislatures, as of Jan. 4, 2013, 19 states, including the District of Columbia, submitted blueprints for HIXs to the U.S. Department of Health and Human Services, which must approve the plans. Under the mandate, all insurance exchanges must be fully operational by Jan. 1, 2014. 

As the deadline looms, states may have pressing questions about what needs to happen by 2014. Here are some of the discussion highlights:

1.    What are the benefits for both states and their citizens in building these exchanges?

2.    Are there any lessons learned from states that have implemented or are in the process of implementing an exchange?

3.    What are the technical challenges the states face in implementing HIXs?

4.    How different will the HIXs be across states?

5.    How can states maximize the cost benefits of implementing these HIXs?

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Utah’s Health Insurance Exchange in Limbo

Since the Affordable Care Act became law in 2010, states have known they would have a choice about whether to run their own health insurance exchanges or let the federal government do it for them. But with only eight months left before those online marketplaces are expected to open to the public, Utah hasn’t made up its mind.

Utah is one of several Republican-led states weighing an eleventh-hour decision about whether to set up a state-run exchange. But it is a special case because it is one of only two states, the other being Massachusetts, that already has a functioning insurance exchange. In both states, the exchange was the brainchild of a Republican governor eager to promote free market competition.  But once the concept became integral to the success of President Obama’s federal health law, Utah and many other Republican-dominated states resisted it.

The Obama administration has a strong interest in convincing red states to establish their own, tailor-made insurance exchanges keyed to their particular needs. To that end, the U.S. Department of Health and Human Services has vowed to give states as much leeway as possible. Utah is a test of that commitment.

As soon as the federal health law was enacted, Democratic governors jumped at the opportunity to set up their own exchanges, which are expected to serve 30 million Americans. Their states have received millions in federal grants to create the online marketplaces and call centers where individuals and small businesses will be able to choose between competing insurance plans that meet federal coverage standards.  Individuals also will be able to sign up for federal insurance premium tax credits and enroll in Medicaid through the exchanges.

GOP governors put off the decision on whether to launch state-run exchanges in hopes that either the Supreme Court would strike down the health law or Republican Mitt Romney — ironically, the Massachusetts governor who championed the exchange in that state — would become president and repeal it. Once those possibilities evaporated, most Republican governors decided to let Washington run their exchanges. A handful of states, some headed by Republicans and others by Democrats, elected to create joint state-federal exchanges.

Utah’s Republican Governor Gary Herbert asked Washington right after the elections to accept his existing state exchange as compliant with the federal health law — pretty much as is.  In response, Utah received “conditional” approval from the U.S. Department of Health and Human Services last week. But the conditions include changes to Utah’s exchange that state officials say the governor may not be prepared to make.

That leaves Utah’s decision about whether to run an exchange up in the air. But even if the governor were in full agreement with Washington, he would need final approval from the state legislature, which meets January 28.

So far, Utah lawmakers have been solidly against a state-run exchange. In fact, a law was enacted in 2010 preventing the state from seeking any federal money for the project.  And despite the governor’s recent request for the flexibility to convert its existing exchange into a health law-compliant exchange, many in the legislature still oppose the idea.

One influential lawmaker, however, has an alternative. Republican Representative Jim Dunnigan, the  chair of Utah’s Health System Reform Task Force, says it’s clear the federal government isn’t going to give Utah the leeway it needs to run its own exchange. Instead, the state should maintain its existing small business exchange and let the federal government build a new site for consumers.

One thing working in Utah’s favor, at least from Herbert’s point of view, is that the state’s existing exchange has been a success. It includes 140 health insurance plans and has sold coverage to 326 small businesses employing 7,890 individuals. The site uses what it calls a “defined contribution” approach that allows employers to decide how much they want to contribute to their employees’ health insurance and then select a list of policies employees can choose from.

Of the companies served by the exchange, 67 percent had no prior coverage for their employees, and 92 percent renewed their policies after the first year. The exchange is working with 789 insurance brokers across the state to expand the number of businesses it serves, according to the governor’s office.

But the site has its critics. Unlike the one in Massachusetts, the Utah exchange — now called Avenue H — does not vet insurance policies or negotiate for the lowest prices. Built in 2009, the website was designed to let all insurance carriers offer their policies to small businesses as a way to promote competition.

As a result, critics say, many small businesses that have visited the site find the policies too expensive and look elsewhere. Utah has about 60,000 businesses with fewer than 500 employees, according to the U.S. Small Business Administration. Covering 326 businesses after two years of operation is hardly an achievement, they add.

So far, Avenue H does not offer comparison shopping for individuals, but Herbert says the state always planned to extend the service to consumers. In fact, the plan also envisioned a tool that would allow people to pull together funding from various sources —which could include federal tax credits — to purchase their policies.

Since November, Herbert and the Obama administration have been swapping letters about whether Avenue H will pass muster under the health law.  If Washington agrees to approve Avenue H in its current form, Herbert has said he would join three other Republican-led states, Idaho, Nevada and New Mexico, in creating a state-run exchange.

“I want the Utah exchange to survive and thrive as we originally envisioned it,” Herbert wrote to President Obama ;ast month. “In fact, I hope it becomes a model for other states to use as a platform for their own versions regarding health care reform.” In subsequent letters, Herbert outlined his plans for expanding Avenue H to serve individuals and larger businesses.

HHS Secretary Kathleen Sebelius promptly replied to his letter, promising that her staff would work with the state to expand its existing exchange. Herbert thanked her, but made it clear what the state would and would not do to comply with the health law. Within days, Sebelius gave the Utah exchange a conditional stamp of approval. The state is expected to give HHS more details on its plans on February 1.

The problem for Utah is that the agency’s approval came with a long to-do list. “That wasn’t what we wanted to hear,” says the governor’s exchange chief, Patty Conner. “We wanted to hear that they would approve the exchange that we have. I think we have a different definition of flexible.”

Conner says she and her staff are committed to dramatically expanding Avenue H according to their own plans, not the check lists and timelines forwarded by HHS. She says she’s confident the site will be ready to receive consumers by October 1, and will provide most of the services outlined in the federal health law. She intends to use a seamless software patch to link Avenue H to federal premium credits and Medicaid forms.

Behind the scenes, officials in the governor’s office say they’re mystified by Washington’s approval letter. “Utah’s position on our state health exchange has not changed and it will not change,” wrote deputy staff chief Ally Isom in an official response. “Of course we’ll review the HHS announcement and determine if the conditions are acceptable or reasonable for our state exchange — and that includes sitting down with legislators — but there is nothing about Utah’s path that changes as a result of today’s announcement.”

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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