State of Maine
Department of Health & Human Services (DHHS)
Office of MaineCare Services
State Medicaid Health Information Technology PlanVersion: Final May 12, 2011
(Approved May 2, 2011)
maine smhp table of contents
Page No.
INTRODUCTION AND EXECUTIVE SUMMARY ...... 1
Section A. “As-IS” HIT Landscape ...... 6
Section A. Part 1. State Level HIT Governance ...... 7
Part 1. Summary of State Level HIT Governance Findings. . .8
Section A. Part 2. Medicaid Information Technology Architecture
(MITA) ...... 8
A2a. MITA SS-A Approach ...... 9
A2b.Maine’s High-level Findings--Business Assessment ...... 9
A2c. Maine’s High-level Findings – Technical Assessment...... 10
Part 2. Summary of MITA Findings...... 11
Section A. Part 3. DHHS HIT/HIE Technology Assets...... 11
A3a. Medicaid Direct Support Assets...... 14
1) Maine’s Medicaid Management Information System (MMIS). 14
MIHMS Claims and Financial Management...... 15
MIHMS Provider Enrollment Portal ...... 16
MIHMS Information Management – Data
Warehouse/Decision Support System...... 16
Program Integrity–J-SURS...... 17
MIHMS Contact Manager...... 17
MIHMS Interface with AdvantageME ...... 18.
2)DHHS Technology Assets Related to Medicaid ...... 18
All-Payer Claims Database...... 18
Maine CDC Assets ...... 19
Integrated Public Health Information System (IPHIS).19 IMMPACT 2 – Immunization Information System. . . . . 20
Automated Survey Processing Environment (ASPEN).21
Part 3.Summary of DHHS HIT/HIE Technology Assets
Findings...... 21
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Page No.
Section A. Part 4. DHHS HIT/HIE Organizational Assets ...... 21
A4a.Office of MaineCare Services...... 21
1) OMS Administration Division...... 22
2)OMS Claims Division...... 22
3)OMS Customer Services Division...... 23
4)OMS Health Care Management Division...... 23
5)OMS Policy Division...... 24
6)Third Party Liability Division...... 24
A4b. DHHS Divisions Supporting MaineCare...... 24
1)Division of Licensing and Regulatory Services...... 24
2)Financial Management Services...... 25
3)Audit Division...... 25
A4c.Other DHHS Program Offices ...... 26
1)Office of Adult Mental Health Services ...... 26
2)Office of Adults with Cognitive and Physical Disability
Services ...... 26
3)Office of Child and Family Services...... 26
4)Office of Elder Services...... 26
5)Office of Integrated Access and Support ...... 26
6) Office of Substance Abuse...... 26
7)Maine Center for Disease Control and Prevention
(Maine CDC)...... 27
8)Office of Quality Improvement Services ...... 28
9)Office of Information Technology ...... 28
10)Quality and Health Information Organization Assets . . . . . 28
A4d. External Organizations ...... 28
1)OnPoint Health Data...... 28
2)Maine Quality Forum...... 29
3)Maine Health Data Organization ...... 29
4)Maine Health Management Coalition...... 29
Part 4. Summary of DHHS Organizational Assets ...... 30
Section A. Part 5. Maine EHR Adoption ...... 30
A5a.Survey of Maine Providers on EHR Use ...... 31
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Page No.
A5b.Medical Practices (Including Eligible Professionals) Survey . . . 32
1)Medical Practice EHR Adoption...... 33
2) Medical Practices’ Intent to Apply for Incentives...... 36
A5c.Acute Care Hospitals Survey ...... 37
1)Acute Care Hospitals EHR Adoption ...... 38
2)Intent to Apply for Incentives Among Acute Care
Hospitals...... 40
A5d.Dental Practice Survey ...... 40
1)Dental Practice EHR Adoption ...... 41
2)Intent to Apply for Incentives Among Dental Practices . . . . 43
Section A. Part 6. Parallel Initiatives ...... 44
A6a.Pharmacy Benefit Management ...... 44
A6b.CHIPRA...... 44
A6c.Federally Qualified Health Center Networks ...... 45
A6d.Managed Care / Accountable Care Planning and Procurement.46
A6e.Primary Care Case Management (PCCM) ...... 46
A6f.High Cost Chronic Care Management Initiative...... 46
A6g.Patient Centered Medical Home (PCMH) ...... 46
A6h.State Profile Tool Project – Long Term Services and
Supports System ...... 47
A6i.Dirigo Health Reform and DirigoChoice...... 47
A6j.DHHS Performance Metrics Dashboard ...... 47
A6k.Health Data Workgroup ...... 48
A6l.Department of Corrections EHR Capabilities ...... 49
A6m.Indian Health Center EHR Capabilities ...... 49
A6n.Veterans Administration EHR Capabilities ...... 49
A6o.Broadband Technology Opportunity Program...... 50
A6p.Telemedicine ...... 51
A6q.HIPAA2: 5010 / ICD-10...... 52
A6r.National Health Care Reform ...... 52
A6s.HITECH Extension for Behavioral Health Services
Act of 2010 (HR 5025)...... 54
A6t.EHR Incentives for Multi-Campus Hospitals Act of
2010 (HR 6072)...... 54
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Page No.
Section A. Part 7. HIE Initiatives ...... 54
A7a.HIN Statewide Demonstration Project...... 54
A7b.Regional Extension Center Grant Recipient...... 55 A7c. Geographic Reach of HIN...... 55
A7d.Electronic Clinical Laboratory Ordering and Results Delivery.55
A7e.Electronic Public Health Reporting...... 56
A7f.Prescription Fill Status / Medication Fill History...... 56
Section A. Part 8. Privacy and Security ...... 56
A8a.Impact of HITECH Act on Privacy and Security...... 56
A8b.Privacy and Security Rules in Maine ...... 57
SECTION B – HIT “TO BE” LANDSCAPE ...... 58
Section B. Part 1. Vision
B1a.HIT Visions...... 58
B1b.Process to Create the MaineCare HIT Vision...... 60
Section B. Part 2. 2016 Five Year Plan ...... 62
B2a. Governance ...... 62
B2b.Privacy and Security...... 66
B2c.Communication, Education and Outreach ...... 68
B2d.HIT Initiative Coordination ...... 72
B2e.Infrastructure and Systems...... 74
SECTION C – ACTIVITIES NECESSARY TO ADMINISTER AND
OVERSEE THE EHR INCENTIVE PROGRAM ...... 76
Section C. Part 1. Program Registration and Eligibility ...... 81
C1a.Registration ...... 81
1) Help Desk Functions and Tools...... 83
C1b.Determine Eligibility...... 84
C1c.Switch EP or EH between Program and/or State Process Flow.86
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Page No.
Section C. Part 2. Payment ...... 88
C2a.Submit Payment Request and Attestation...... 90
C2b.Verify Eligibility Sub-Process ...... 92
C2c.Adjudicate Payment ...... 94
C2d.Manage Recoupment ...... 96
Section C. Part 3. Appeals ...... 98
Section C. Part 4. Reporting...... 101
C4a. Submit Annual CMS Report...... 103
C4b. Submit Quarterly HHS Report ...... 105
Section C.Part 5. Communication, Education and Outreach ...... 106
C5a.Manage Provider Inquiries...... 108
C5b.Deliver Provider Education, Training and Technical
Assistance...... 109
C5c. Deliver Provider Communications...... 110
Section C. Part 6. State Oversight ...... 111
C6a.Develop Rules ...... 114
C6b.Maintain SMHP ...... 115
1) Revise HIT Landscape Assessment...... 116
2) Revise Vision...... 117
3)Revise Meaningful Use Sustainability Plan ...... 118
4)Revise HIT Roadmap...... 119
C6c.Submit IAPD...... 120
C6d.Track and Report FFP for the Administration of Program. . . . 121
C6e.Manage FFP for Provider Payments...... 122
SECTION D: STATE AUDIT STRATEGY ...... 123
Section D. Part 1. Audit Eligibility Determinations...... 126
.
Section D. Part 2. Audit AIU of Certified EHR Technology...... 128
Section D. Part 3. Audit Meaningful Use...... 130
Section D. Part 4. Audit Incentive Payment ...... 131
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Page No.
Section E. Gap analysis and roadmap...... 133
Section E. Part 1. Gap Analysis ...... 133
E1a.Key Questions ...... 133
E1b.Approach and Activities for the Development of the
State’s. HIT...... 134 E1c. Gap Analysis Findings...... 134
E1d.Gap Analysis Findings – What Works ...... 135
E1e.Gap Analysis Findings – Gaps and Recommendations. . . .138
Section E.Part 2. State’s HIT Roadmap ...... 144
E2a.State’s EHR Incentive Program Implementation Plan...... 144
E2b.State’s Long-Term HIT Vision Roadmap...... 147
CONCLUSION ...... 150
LIST OF APPENDICES ...... 151
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