2023-01-27 Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meeting

Single meeting on Fridays from 1:00-2:00 PM ET (reduced to 1 hour)

Join Zoom Meeting https://hl7-org.zoom.us/j/92482555863?pwd=TWQzVENNeStqeEpVTHdicGM2cGdMQT09 

CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P)

• Federal Register (published 12/13/22)
• Fact Sheet
• Comment period closes 3/13/2023

Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard Proposed Rule (CMS-0053-P)

• Federal Register (published on 12/21/22)
• Comments due 3/21/23

• SN: Proposed a Jan 2026 implementation date which is three years away (two years after final rule is published) - interesting that we are three years away from implementation. Certainly don't know what will be happening three years from now so hard to understand the right standard to be put in three years from now. 
• MS: If you read the PA rule, it's naming FHIR as a standard but recommending various IGs. This is a good thing because it allows the IGs to iterate to improve. The attachments rule (per conversations with PIE WG), was largely based on testimony that HL7 gave in 2016 which was largely based on X12 and CDA exchange. Discussion focused on whether this is the right direction. Hinted to CDex in preamble, but didn't call it out. Maybe we want to say that the industry has moved forward. Very interesting things going on here, which are worth paying attention to. One option is to provide feedback to either focus on just on claims, or recommend CDex to support attachments exchange. 
• SN: One other possible solution is to adopt the current X12 standard but allow, as an option, the use of CDex/FHIR standards. 
• There are Da Vinci member calls occurring twice per week, for Da Vinci members. If you are a Da Vinci member and interested in participating, please reach out to the Da Vinci PMO.

January Work Group Meeting & Connectathon Debrief

• Connectathon Track Report Outs: https://docs.google.com/document/d/1lc8BBaTRhSW_cAYwy7ZnqLsdvj__GvCD/edit?rtpof=true&sd=true

• Lots of discussions related to the NPRMs; Bob gave a number of presentations on the topic.
• There were 328 people who attended the Connectathon. 
• Some struggles with wifi connectivity. 
• PDex intended to have four subtracks
• No one came forward to test Formulary Bulk Data Exchange or Member Attribution Bulk Export
• Leading up to Connectathon, forked P2P repository - and created a subdirectory for the bundles and added additional documentation to fire up a HAPI server; all published in fork of repository
• Spent time drilling down into how to set up mTLS and created some documentation. 
• Successfully publish records to FAST National Directory reference implementation.
• Results revealed the need to add some mTLS endpoints to the bundle. 

FHIR-40239 - Getting issue details... STATUS

• After discussion with Bob about National Directory profiles, Mark modified examples (yesterday) to include adding a link to DCRP registration, and base URI for PDex. If you have base URI, you should be able to pull out the token endpoints from the security section of the capability statement. If this approach is acceptable, can close out a couple issue tickets.

FHIR-40236 - Getting issue details... STATUS

• Question about source format of certificate. 
• Want to be able to refer back to guidance that should be in National Directory so the National Directory IG  may add clarification. PDex IG can then be updated to reference tis. 

FHIR-38698 - Getting issue details... STATUS

Mark working on getting stuff moved over to HL7 GitHub repository. Lloyd noted that there is both an HL7 GitHub and FHIR GitHub repository. This stuff should go into the FHIR GitHub repository. 

FHIR-38697 - Getting issue details... STATUS

• MS: Discussions about how to operationalize this in the Trust Framework
• RW: Trust framework is a huge topics.
• IMS: n terms of endpoint resources, if you have a public certificate, there needs to be identity verification done by CA to determine you are representing the correct organization. Still a need to have a Trust Framework to verify certificate hasn't been revoked.
• Will discuss in next Core team meeting. Maybe we can then reserve second half of this meeting next week to try to close this out. 
• Direction at the moment is National Directory doesn't exist so need a work around to prove that this all works. Don't want to boil the ocean in terms of Trust Frameworks, but determine what we need to test this out until National Directory exists. 

After STU2 published, may be a need for STU update to include information about leveraging UDAP, etc. Still a bit to be ironed out. 

Will use the second half of next week to discuss the Trust Framework.

PDex IG Companion Guide List

PDex IG Companion Guide - Laboratory Reporting Resources

Find initial questions and corresponding answers shared from our colleagues at CMS here

• Links to Published IGs

• PDex STU 1.0.0
• Plan Net STU 1.0.0
• Formulary - STU 1.0.1

Implementer Resources

Da Vinci Implementer Support Page 

Implementers can take advantage of tools: See the Reference links on the Payer Data Exchange (PDex) page to access links for Reference Implementations, sandboxes, test scripts, and more!

Da Vinci PDex for Patient Access API Frequently Asked Questions (FAQs)

CMS Final Rule Questions and Answers log

ONC FAST National Healthcare Directory (including end points) solution page that includes links to everything (solution doc, Connectathon, HL7 workgroup, etc.): https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/National+Healthcare+Directory

For questions, reach out to us on Zulip:

• PDex: https://chat.fhir.org/#narrow/stream/235286-Da-Vinci.20PDex/topic/Implementers
• Plan Net: https://chat.fhir.org/#narrow/stream/229922-Da.2BVinci.2BPDex.2BPlan-Net
• Formulary: https://chat.fhir.org/#narrow/stream/197730-Da-Vinci.20PDex.20Drug.20Formulary

Formulary - Searching by DrugName.docx

Recording of Formulary Tickets for STU 1.1.0 Overview

Karen Barbeau

Diederik Muylwyk

IQVIA

Tulsi