Author: Tom Entrikin | Posted: 5. April 2012 07:07
The Centers for Medicare and Medicaid Services (CMS) issued the Medicaid Information Technology Architecture (MITA) Framework, Version 3.0, on March 28. MITA 3.0, the most important MITA update since 2006, takes into account legislation enacted in 2009-2010 such as the Health Information Technology for Economic and Clinical Health Act (HITECH), the Children’s Health Insurance Program Reauthorization Act (CHIPRA), and the Affordable Care Act (ACA); CMS regulations on enhanced Medicaid FFP for eligibility determination systems that went into effect on April 19, 2011; other recent CMS policy issuances; and emerging technologies such as cloud computing not covered in earlier CMS guidance. It includes new sections for state Medicaid agencies on MITA Self Assessments and development of Advance Planning Documents (APDs) required for enhanced funding. It does not reflect CMS regulations finalized on March 23, 2012 about Medicaid eligibility changes that will be effective in January 2014 under the ACA but CMS has said that additional materials will be forthcoming on that as well. State Medicaid agencies’ MITA Self Assessments under the new guidelines will be due 12 months after those additional materials come out. CMS also released, on March 21, updated standards for the adoption of operating rules for eligibility determinations under health plans and health care claims status transactions, based on section 1104 of the ACA, which amended administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Those standards apply to health plans that are covered entities under HIPAA, including state Medicaid programs. To promote administrative simplicity and efficiency in automated transactions among covered entities, they require standardized electronic formats, certain minimum content for eligibility transactions, and certain performance metrics for eligibility and claims status transactions. State Medicaid agencies must perform new HIPAA gap analyses this year to get ready for the January 1, 2013 compliance date specified in the March 21 issuance.
