GOVERNMENT OF THE DISTRICT OF COLUMBIA Department of Health Care Finance Open Government Report 2014 Introduction The Department of Health Care Finance (DHCF) is the agency responsible for the administration of the Medicaid, CHIP, Alliance Health Care and other programs. The mission of DHCF is to improve health outcomes by providing access to comprehensive, cost-effective, and quality health care services for D.C residents. To institutionalize a culture of transparent and open government, accountability, and to expand opportunities for resident participation and collaboration, this Report describes how the Department of Health Care Finance has and will continue to develop and enhance transparency, public participation, and collaboration. In accordance with Mayor’s Order 2014-170, this report addresses the following topics: 1) Transparency Below is a description of the steps DHCF has taken or plans to take to be more transparent in the areas of: covered Medicaid services in DC; how to apply for Medicaid in the District; the program policies for Medicaid and CHIP; grants and cooperative agreements to DHCF; FOIA activities; and access to meetings and data. A. Medicaid Covered Services Offered by DHCF in the District of Columbia DHCF is the single state agency responsible for the administration of services covered under title XIX (Medicaid) and Title XXI (Child Health Insurance Program, or CHIP) of the Social Security Act, as amended. Covered Medicaid services fall into two categories: mandatory and optional services. While the mandatory services are the same across all states and jurisdictions, the optional services are independently determined by each jurisdiction. The DHCF website (http://dhcf.dc.gov/service/medicaid) contains descriptive information of the Medicaid services covered by the Medicaid program in the District of Columbia and how to apply for Medicaid in the District of Columbia (http://dhcf.dc.gov/page/medical-assistance-programs-informationand-eligibility). DHCF intends to also provide a link to the CMS website that will allow DC residents to identify and compare the services offered by Medicaid agencies in other jurisdictions to those offered by DC (http://www.medicaid.gov/stateresource-center/medicaid-state-plan-amendments/medicaid-state-planamendments.html). B. Medicaid and CHIP Program Policies DHCF Open Government Report 2014 Page 1 of 6 DHCF maintains on its website an electronic copy of the Medicaid State Plan (http://dhcf.dc.gov/page/dhcf-medicaid-regulations) that contains all of the policies for the Medicaid program. A Medicaid State Plan is an agreement between a state (or other jurisdiction, like the District) and the Federal government describing how the jurisdiction administers its Medicaid program. In DC, CHIP is accomplished through a Medicaid expansion and a copy of the CHIP Plan and Amendments is available on the Federal Website (http://medicaid.gov/Medicaid-CHIP-Program-Information/ByTopics/Childrens-Health-Insurance-Program-CHIP/CHIP-State-ProgramInformation.html?filterBy=District of Columbia). The Plans provide an assurance that a jurisdiction will abide by Federal rules and may claim Federal matching funds for its program activities. The State Plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are currently approved for that jurisdiction. Changes to the State Plan are done through the State Plan Amendment (SPA) Process and must be ultimately approved by the Centers for Medicare and Medicaid Services (CMS). Before DHCF submits a SPA to CMS, DHCF publishes the proposed SPA in the District Register to allow for comments by affected parties (http://www.dcregs.dc.gov/). Copies of local rule-making that support the State Plan Amendments are also published in the District Register for public comment before approval. Transmittals are documents that provide guidance to the enrolled providers or services to Medicaid beneficiaries. DHCF shares copies of our Transmittals on our website (http://dhcf.dc.gov/page/2014-dhcf-medicaidupdates) so they are accessible to all providers and consumers of services, as well as the general public. DHCF intends to provide a link on our website to the CMS website where providers and consumers can compare policy documents from other Medicaid State Agencies in other jurisdictions (http://medicaid.gov/Medicaid-CHIPProgram-Information/By-State/By-State.html) to the District’s policy documents. C. Medicaid Grants and Cooperative Agreements DHCF has been the recipient of several federal grants and cooperative agreements over the past five years in the areas of health information exchange, health information technology, health insurance exchange planning and health care reform. DHCF announces the award of these through press releases coordinated through the Executive Office of the Mayor (EOM). For some of the grants and cooperative agreements, funds were included to pay for information dissemination activities to let the public know what activities transpired or were being planned in the grant or cooperative agreement. Activities such as the HIE Stakeholder Summit (September 2014) provided an opportunity to share accomplishments and future plans of the cooperative agreement at a local Summit conducted by DHCF at no charge to the participants. D. Freedom of Information and FOIAXpress Reading Room Activities DHCF is committed to a transparent and open form of government. The agency makes certain records available online through its website (www.dhcf.dc.gov), including public employee salary information, fiscal year budget, policy statements, and numerous frequently requested public records. In addition, publically released documents can be accessed via the DC Government’s Freedom of Information Act (FOIA) Reading Room (https://foia-dc.gov/palMain.aspx). For records that are not available online the public is invited to submit a FOIA request through the DC government Public FOIA Portal (https://foia-dc.gov/palMain.aspx). DHCF complies with all the legal requirements of FOIA. When the FOIA Officer receives a FOIA request he informs the requestor that it has been received and that the agency has 15 business days to respond. The request is then evaluated to ensure that it is seeking information that falls within FOIA’s disclosure requirements. It is important to note that FOIA only applies to documents already in existence; no new records are to be created in response to a FOIA request. The request is then funneled to the appropriate agency representative to collect the necessary documentation. If the documents requested exist they are collected and evaluated to determine if they fall within any of the statutorily listed exemptions, such as trade secrets, personal information that would constitute an invasion of privacy, investigatory records compiled for law enforcement purposes, etc. (see D.C. Municipal Regulations Title I, 1-406 (2014)). If the documents do not fall within any exemption then they are sent to the requestor, either electronically or through the U.S. postal service. DHCF is committed to open and transparent government. It will continue to strive to provide the public with access to relevant information concerning the agency’s operations. E. Open Meeting Act Activities DHCF DHCF has one advisory board (DC HIE Advisory Board) whose members are appointed and sworn in through the Mayor’s Office of Boards and Commissions. DHCF also has two advisory committees (the Medical Care Advisory Committee and the Pharmacy and Therapeutics Committee), and an advisory council (Ombudsman Advisory Council) whose members are appointed by the State Medicaid Director, or by their designee. These groups provide advice to the agency in a number of areas: Health Information Exchange, Medical Care Services, Pharmacy and Therapeutics, and Insurance Advocacy. Notices of the meetings are posted in advance and the meetings are open to the public. Open Government Report 2014 Page 3 of 6 DHCF is exploring the technology and logistics requirements that would be necessary in order to webcast the advisory board meetings and archive the past meetings for public consumption. F. Access to Medicaid Data 2) As a covered entity under HIPAA, DHCF has a mandated responsibility to protect the privacy and security of beneficiary information. However DHCF can provide aggregate and de-identified data to interested parties. The Division of Analytics and Policy Research (DAPR), within the Health Care Policy and Research Administration (HCPRA) at DHCF, regularly produces data snapshots on recent analyses of costs and utilization of Medicaid services among beneficiaries in the District of Columbia. Snapshots recently posted to the DHCF website have covered a variety of topics, including insurance coverage levels among children in the District; the effect of the Medicaid expansion on Medicaid Managed Care enrollment; and the cost of Mental Health Rehabilitation Services (MHRS). By sharing these snapshots on the DHCF website, the agency seeks to engage the public interest in timely health care policy issues, and provide a transparent view of the work DHCF conducts to serve Medicaid beneficiaries of the District of Columbia. DHCF is working closely with the Office of the City Administrator (OCA) and the Office of the Chief Technology Officer (OCTO) to identify a significant number of datasets that OCA and OCTO expect to publish online later this year. If no dataset from DHCF is selected to be included in this 2014 release, we will continue to work with OCA and OCTO to identify datasets appropriate to publish in 2015. In the future, requirements for open data reporting will be provided by the DHCF Chief Data Officer. Public Engagement and Participation To enhance or expand opportunities for the public to participate in agency decisionmaking, DHCF has taken the following steps: For the SPA-related documents and Transmittals that were previously discussed under Transparency, DHCF currently uses the District Register’s public comment process to provide for public engagement, participation and input on the approval process for these policy documents. URL: http://lims.dccouncil.us/ DHCF publishes on its website (http://dhcf.dc.gov/) advance notices of public meetings of: the Medical Care Advisory Committee (MCAC), DC HIE Advisory Board, and the Pharmacy and Therapeutics Committee, and the Ombudsman’s Advisory Council. Minutes are taken at these meetings and can, in most instances, be made available to the public, on request. The MCAC holds a standing monthly meeting to share DHCF program initiatives and to obtain public and stakeholder input. DHCF maintains both 3) Facebook and Twitter accounts and links to them through the DHCF website for social media interactions. DHCF also participates in the “Ask the Director” program to answer questions from the public posted to the website. For the existing committees and advisory boards, suggestions for additional stakeholders often come from the current stakeholders or externally from individuals who self-refer after learning about the group. Additional participation can also come in the form of ad-hoc working groups or tasks forces that are augmented by participants who are not formally on the full board or committee. Collaboration DHCF has taken or plans to take the following steps to enhance or expand cooperation among departments, other governmental agencies, the public, and nonprofit and private entities to fulfill our mission: A. Intergovernmental Collaboration DHCF DHCF works with DHS and the DCHBX on a multi-year project to design and deploy a new integrated eligibility system for health and human services programs. The system is called the DC ACCESS SYSTEM or DCAS. During the first phase of the project, DHCF, DHS and DCHBX developed the needed functionality to automate and streamline eligibility for Medicaid and the DC Health Benefits Exchange in compliance with the Affordable Care Act and to build the health benefits website, DC Healthlink. DHCF and DHS continue to work together to automate and streamline eligibility for all remaining health and human services programs. DHCF has several intergovernmental collaborations with sister agencies for the purpose of improving the delivery of services to Medicaid beneficiaries to ultimately improve health care outcomes and/or the quality of life. Current collaborations include DOH, DOC, DYRS, DBH, DCOA, CFSA, OSSE, DCPS, DDS, and DDOE on public health or health care delivery projects. DHCF has collaborated with DOH on health information technology (IT) projects that enable the improved collection of health care information for public health purposes. The collaboration involved joint participation on an advisory board and providing a sub-grant from DHCF to DOH to pay for health IT upgrades to DOH systems. DHCF is collaborating with DBH on a Medicaid health homes project to improve the services delivered to Medicaid beneficiaries with severe mental illness (SMI). This collaboration involved the drafting a Medicaid Health Homes State Plan Amendment to finance the services. DHCF, DDS, DCOA, DBH and DHS also successfully collaborated on a planning grant to the US. Administration for Community Living (ACL) to develop a No Wrong Door, streamlined referral and eligibility system for individuals seeking access to long-term care services and supports. The focus Open Government Report 2014 Page 5 of 6 of the grant is to strengthen the services offered by the ADRC and to build upon the functionality of DCAS. B. Private Sector Provider Collaboration DHCF used federal funding from an Office of the National Coordinator (ONC) cooperative agreement to fund sub-grants for six District hospitals to participate in a regional project for an electronic Encounter Notification System (ENS) which alerts physicians when their patients transition to a different health care setting. DHCF is exploring private sector collaborations with evolving Accountable Care Organizations (ACOs) and ACO-like entities to improve the capabilities of these organizations to do care coordination, which will allow more effective utilization of scarce health care resources. Some of these collaborations are not just intra-District but may involve regional collaborations with providers in Maryland locations. DHCF will also explore ways to inform the public of these collaborations and how the collaborations can positively affect the health outcomes of consumer members and beneficiaries. C. Academic Collaboration DHCF is collaborating with George Washington University (GWU) on a federally funded grant GWU received to evaluate the use of mobile technologies and integrated care systems. This collaboration will involve data sharing and analysis of linked data to determine the impact of technology on selected health outcomes. Another public sector agency will be involved in this collaboration as well. DHCF will be examining new tools in data collaboration to help improve the timely communication of progress in the analysis of the data and the accurate interpretation of research implications. Conclusion DHCF intends to update this Open Government Report annually to include new and emerging initiatives that demonstrate transparency, engagement, and collaboration in the agency and that would be of interest to our stakeholders and to the public at large.