A section in the health reform law mandates development of interoperable and secure standards and protocols to facilitate electronic enrollment of individuals in federal and state health and human services programs.

The federal government may require that states, as a condition of receiving grant funds authorized in the law, incorporate these standards in their health information technology investments. Under Sec. 3021 of the law, the HIT Policy and HIT Standards Committees will aid the Department of Health and Human Services in developing the standards and protocols necessary to confirm individuals' eligibility for federal or state programs and enroll them.

Specific content and functions required for the electronic enrollment system include:

* Electronic matching against existing federal and state data, including vital records, employment history, enrollment systems, tax records, and other data determined appropriate by the Secretary of Health and Human Services to serve as evidence of eligibility and in lieu of paper-based documentation.

* Simplification and submission of electronic documentation, digitization of documents, and systems verification of eligibility.

* Reuse of stored eligibility information (including documentation) to assist with retention of eligible individuals.

* Capability for individuals to apply, recertify and manage their eligibility information online, including at home, at points of service, and other community-based locations.

* Ability to expand the enrollment system to integrate new programs, rules, and functionalities, to operate at increased volume, and to apply streamlined verification and eligibility processes to other federal and state programs, as appropriate.

* Notification of eligibility, recertification, and other needed communication regarding eligibility, which may include communication via email and cellular phones.

* Other functionalities necessary to provide eligible individuals with streamlined enrollment process.

--Joseph Goedert

 

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