Chair: Mark Scrimshire
Scribe: Vanessa Candelora
This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."
Minutes Approved as Presented
Meeting Minutes from Discussion
|Decision Link(if not child)|
|Management||Review ANSI Anti-Trust Policy|
Call Structure & Name Changes
See Supporting section below!
|Today||Payer to Payer Enforcement Update|
New 9/16/2021 - CMS Enforcement Discretion
Specifically of interest to Da Vinci Community are updates in the FAQs reinforcing move to APIs and the use of Our FHIR APIs
Question. Will CMS enforce the payer-to-payer data exchange requirements on January 1, 2022 as finalized in the CMS Interoperability and Patient Access final rule?
Response. No. CMS is exercising its discretion in how it enforces the payer-to-payer data exchange provisions (85 FR 25564-25569) of the CMS Interoperability and Patient Access final rule (CMS-9115-F). As a matter of enforcement discretion, CMS will not take action to enforce compliance with these specific provisions until future rulemaking is finalized. CMS’s decision to exercise enforcement discretion for the payer-to-payer policy until future rulemaking is finalized does not affect any other existing regulatory requirements and implementation timelines finalized in the CMS Interoperability and Patient Access rule finalized on May 1, 2020.
CMS continues to encourage impacted payers that have already developed Fast Healthcare Interoperability Resources (FHIR)-based application programming interface (API) solutions to support payer-to-payer data exchange to continue to move forward with implementation and make this functionality available on January 1, 2022 in accordance with the CMS Interoperability and Patient Access final rule policies. However, for those impacted payers that are not capable of making the data available in a FHIR-based API format, we believe this enforcement discretion will alleviate industry tension regarding implementation; avoid the risk of discordant, non-standard data flowing between payers; provide time for data standards to mature further through constant development, testing, and reference implementations; and allow payers additional time to implement more sophisticated payer-to-payer data exchange solutions.
Discussions the last few days, two options:
Consent requirement for beyond minimum necessary data to be shared under OCR for TPO.
Bob and group of national payers working through who will manage the trust network around Payer to Payer exchange.
Will the Payer verification be solved under the trust framework? Yes, that is the intent. Ways to solve that now are reliant on payer to payer agreements... intend would be like how sequoia works - trust framework agreement that all sign up for.
Connectathon Read OUT
PDex: Whiteboard: https://miro.com/app/board/o9J_lxZlj_w=/
MIRO Board linked that captures the 30-40 Participants feedback - see attached!
Formulary: Switching to InsurancePlan from list to allow for many to many relationships between drugs and plans. Test Scripts updated and very useful - found some validation errors and formulary STU2. Capability statement. IBM Watson was there, Server exchange info - drug searches and compare plans. Another participant needed!
Call to Community: If you are implementing Formulary or PlanNet, please let us know if you're willing to come test with us! We are looking for more testers to meet HL7 Requirements for publication and balloting.
Plan-Net: see below.
Stage for people to review: https://build.fhir.org/ig/HL7/davinci-pdex-formulary/branches/stu-update-1.1/
Corey - gave update that he's not aware of any tickets or feedback from the review process, so plans to move forward with the request for publication at WGM next week. Pharmacy meeting on Tuesday Q3. Target for publication Sept 30 on track.
Learned from the Connectathon:
|New Implementer Support / Questions|
Daniel Venton to Everyone
Our legal analysis said, "All information retrieved, whether we have a use for it or not, must be stored and exposed on subsequent queries."
did not follow the comments on Consent and trust framework
can you pls elaborate on that
In a nutshell, "I'm a payer, I get a request from company X and I'd like Patient Y's chart." How do I know it really is company X, how can I trust that they really do have paitent Y's consent?
https://confluence.hl7.org/display/DVP/CMS+Final+Rule+Questions+and+Answers+log - See The last 3 questions on the page for the questions that Bob is describing right now on Payer to Payer to CMS and OCR.
Cancelled due to WGM. Next Call: 10/1
Adjourned at 12:45pm EST.
|PDex Companion Guides|
|CARIN CPCDS to US Core Mapping|
Latest draft CARIN CPCDS Mapping document: CARIN Mapping to FHIR interim 2020 0818 v2.xlsx
DRAFT - PDEX US Core Mapping from CPCDS source: ResourceMappingUSCoreCPCDS-2020-05-29-v26.xlsx
|PDex - US Core |
Source PowerPoint: PDEXandUSCoreRelationship.pptx
|Da Vinci is seeking answers to open questions and clarifications needed on the implementation and operational needs of the upcoming CMS Patient Directed API Rules.|
Find initial questions and corresponding answers shared from our colleagues at CMS here
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!
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:
Attendees - 27
Intepro Solutions Rakesh Mathew Daniel Lilavois Patricia R Harbin Shalabh Gautam Kamaraj Kaliaperumal, Carefirst Bhanu Vemuri Narasimha Murthy Accenture Maggie Mellon Courtney Bland
Present Name Affiliation Onyx MITRE HealthLX MITRE Evernorth Mettle Solutions Rachel E. Foerster BCBST Tom Grannan Azuba Vanessa Candelora POCP, Da Vinci PMO Deepthi Reddy Mettle Solutions Allscripts Eric Sullivan Inovalon India Duncan Optum Availity Susan Lestina AHA Bob Bowman CAQH Thomas Kessler CMS Patrick Edwards Briana Barnes Scope Info Tech Kishore Metla Mettle Solutions John Donnelly Lorraine Doo CMS Melanie Jones CMS Rim Cothren Yolanda Villanova CMS Manoj Kumar BCBSFL MITRE Srinivas Konchada Centene Corporation Sheryl Turney Anthem Helina Gebremariam Mike Novales BCBSIL Ric Light Humana Ann Gallagher Optum Chris Klesges Mitre Adam Gronsky Health Fidelity CaseNet Anthem CMS eClinicalWorks Healow Interfaceware Mark Rucci Spectramedix Anthem Cindy Monarch BCBSM Michael Kim Jim Catan Accenture BCBSA Jia Chen Jeff Eastman Ernestine Cooper Jason Teeple CIGNA Mary Winter Tony Benson BCBS AL Independence BC Henry Archibong Inovalon HL7 Consultant Abdul Sattar Anirudh Choudhary Todd Biske ESI Darrell Woelk Doug Stoss Rick Lisseveld Aegis LakshminarayananSaravanan Laurie Burckhardt WPS Health Plan Kevin Lynch Inovalon Joseph Minieri MITRE Durwin Day BCBS IL Pamela West Ravi Thakkar Aetna UO Aetna Swati Nanda Aetna CVS Health Cyrus Kevin Fred Harmon Ready Computing Blue Cross NC Michael Ryan NCQA HealthSparq CVS/Aetna Dorothy Lee NCQA Khoa Nguyen Suma Addagadde BCBSNC Caitlyn Campi FL Blue Diane Bengtson Sean Mahoney MITRE Balaji Richard Lisseveld Shanna Hartman CMS Kevin Day Edifecs Sai Bagewadi Cognizant Kechia Scott Kerri Wing Krithika Kumar Accenture Don Zacharia Pamela Maklari Cognizant @David Bradsher BenMedica @DJ Gallagher @Follis @Nidhi @Emily Lozada Bruce Schreiber Ed Hafner WEDI / Change Healthcare Alberto S. Llanes FEHRM Danny Iacovou Kimberly Bradbury Prime Kranthi Pathca Sreeram vedururi Joel Hansen Milinda Perera WSO2 Nirmal Fernando WSO2 Viroopi Ujjawal Bhatnagar Jim McHugh Kenny Wang Alan Viars
Patricia R Harbin
Chris Johnson Anthony Omosule Accenture Google Cloud Healthcare Independent Health; X12 Scott M. Robertson David Clowers Ramandeep Dhanoa "Raman"
Present Name Affiliation Nancy Spector AMA Bruce Wilkinson BenMedica Avality Daniel Venton Optum BCBSAL Rob McClure MD Partners Ronald Wampler CVS Health Aetna Bryan Briegal ACP @Callie Phillips MCG ONC Surescripts NCPDP Anupam Thakur BCBSFL Jonathan Hutchins BCBST Anthem Sunitha Godavarthi Christopher Gracon Labcorp James Derrickson Intersystems Deb Conklin Medical Mutual of Ohio Cognizant Neetha Joseph Cognizant Kaiser Permanente MITRE Rutika Express Scripts Brody Brodock Allscripts Michael Brody CME Online Theressa Baumann BCBS AL Mona Chandrapal eClinicalWorks Optum Aakash Deliwala eClinicalWorks Mayo Epic Shaheer Stanley Nachimson Anthony Smith UNC Health Howard Cohen Minaei Behnaz FDA BCBSA Shilesh Nair gdit NewWave MaxMD BC Idaho Edward Castagna Altarum Andrea Kent CoverMyMeds Carrie Denny Kim Pham Celine Lefebvre AMA Edifecs Josh Lamb UPMC Keya Shah Casenet Gevity MITRE Mrugen Mehta eClinicalWorks Revathi Jayakumuar Supriya Bapi Bhera Matt Dyer Vyne Sree Vijetha Vegi C-HIT BCBSA Rich Bloch Lumedic Cigna Paul Knapp Ron Urwongse CAQH Anand Raghavan Ezequiel Morales Cigna Evernorth Frank McKinney Hanna ? Brett Rauschke Carolyn McKinney Clarissa Winchester BCBS AL JC HealthShare Exchange (HSX) River Wong Derrick Woolridge Beata Ferraiz Ed Donaldson Consultant with Humana Julie Burgoon Mark Neumuth Aetna Raj Sankuratri Aetna Dr. Cheryl D. Lohman Germantown, MD | Family Physician Barbara Valeno Eshaa Dhall eclinicalworks Angie Brandon Beatrice Thompson CVS Health Hema Srinivasa Kristin Ashby Aetna Nag Sanivarapu Abhishek Pandey Shailesh Prabhu Travis Hendrix Dr. First Zakir Guler Jason VanderJagt edifecs Erika Wagner Shamil Nizamov Michael Robinson Christopher Marchand Chris Busch Nathaniel Hosenpud Christopher Roedocker SKYGEN Jeff Brown MITRE Sid Nehal Amin Amit Cudykier C45214 Noah Lincoff Yukta Bellani Evernorth/Cigna Brian Schoonover Optum Tone Southerland OneRecord @Ram Optum Kat Sobel NCQA Phung Matthews Benji Graham @Grace Stambaugh Donnielle Williams Rob Brull Eric Liu, PharmD, MBA Chris Geisler Abhinav Garg Cindy Harber CBC Gevity Eric Heflin Rennil Cruz Avinash Kanal
Google Cloud Healthcare
Independent Health; X12
Scott M. Robertson
Ramandeep Dhanoa "Raman"