MEDICAID TRANSFORMATION GRANT APPLICATION SECURE VERIFICATION OF CITIZENSHIP THROUGH AUTOMATION OF VITAL RECORDS

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1 MEDICAID TRANSFORMATION GRANT APPLICATION STATE: MASSACHUSETTS PROJECT TITLE: SECURE VERIFICATION OF CITIZENSHIP THROUGH AUTOMATION OF VITAL RECORDS NAME OF MEDICAID AGENCY: OFFICE OF MEDICAID, EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES CONTACT PERSONS: Medicaid/MassHealth: Don Novo, Director Member Policy and Implementation Unit Executive Office of Health and Human Services/MassHealth 600 Washington St., 5 th Floor Boston, MA Don.novo@state.ma.us (fax) Ken Maxwell, Director Eligibility Applications Development Executive Office of Health and Human Services/MassHealth 600 Washington St., 5 th Floor Boston, MA Ken.maxwell@state.ma.us (fax) Department of Public Health Center for Health Information, Statistics, Research and Evaluation (CHISRE) Registry of Vital Records and Statistics (RVRS): Stanley Nyberg, Registrar 150 Mount Vernon St. Dorchester, MA Stanley.nyberg@state.ma.us fax

2 ABSTRACT The Medicaid Transformation Grant provides a unique and valuable opportunity for Massachusetts Medicaid (MassHealth) to collaborate with the Massachusetts Registry of Vital Records and Statistics (RVRS) for the purpose of developing and implementing systems to improve and secure the citizenship verification process, providing significant benefits to both the agency and to MassHealth beneficiaries while reducing fraud and inefficiency. The primary goals of this project are to: Digitize what are currently primarily paper-based birth and death records Implement an electronic verification of vital events system (EVVE) Reduce fraud by obtaining citizenship information directly from the governmental source Reduce waste by rapidly identifying deceased individuals Digitizing Massachusetts vital records Currently, only a fraction of Massachusetts birth certificates are available for electronic certification or matching, primarily limited to individuals under the age of 21. The remaining birth records, and all death records, are certified manually from paper indexes and bound paper records. This project proposes to optically scan and enter into a database via optical character recognition (OCR) those records and data entry, from 1935 to present, which are currently paper-based. Implementing EVVE This project proposes to utilize existing, proven, technology developed by the National Association of Public Health Statistics and Information Systems (NAPHSIS) for instant verification of birth and death events. Extensively piloted, this system is active in six states and will ultimately allow for nationwide verification of vital records. This will allow MassHealth and other states Medicaid agencies to verify Massachusetts birth certificates. Reducing fraud Massachusetts is one of only a handful of open-record states. This means that any individual can obtain an official copy of a Massachusetts birth certificate. This, compounded by the fact that 351 cities and towns also issue certified copies in varying formats, makes identification of authentic documents difficult, and the system prone to fraud. Implementation of an electronic database and verification system will allow MassHealth and other state Medicaid agencies across the United States to confidently receive citizenship confirmation from Massachusetts birth certificates. Reducing waste Electronic records and verification will allow for rapid identification of deceased persons, allowing Medicaid agencies to quickly cease benefits when necessary. In addition, the ability to match birth and death records eventually nationwide will prevent fraudulent attempts to apply with birth records of deceased children and other individuals. In total, the project is estimated to total $3,950,

3 PROJECT NARRATIVE STATEMENT OF PROJECT NEED Due to the change in federal law, effective July 1, 2006 MassHealth first-time applicants and those applying for redetermination must provide documentation of United States citizenship. It is expected that a high percentage of such applicants will not possess a first-level document such as a U.S. passport, Certificate of Naturalization (DHS Form N-550 or N-570), or Certificate of U.S. Citizenship (DHS Form N-560 or N-561), and will seek to obtain a copy of their birth certificate. Because the Massachusetts Registry of Vital Records and Statistics (RVRS) does not currently have an automated system of verification, relies primarily on manual paper-based records and indexes for birth records prior to 1988, and is not adequately staffed for the estimated number of verifications expected, the MassHealth agency will inevitably experience a significant logjam in making health insurance available to Massachusetts low and moderate-income individuals and families. Issues: Approximately 700,000 existing MassHealth members will require citizenship verification in FY Approximately 200,000 new MassHealth applicants will require citizenship verification in FY2007 and annually thereafter, including Transitional Assistance applicants who automatically receive MassHealth coverage. Commonwealth Care, which will subsidize private health insurance to qualifying, non-medicaid eligible individuals under Massachusetts health care reform program, will also require verifications. Under current conditions, RVRS staff service approximately 110,000 customers annually without the addition of MassHealth and Commonwealth Care verifications. Turnaround time for birth certificate requests by mail is currently three to four weeks. RVRS does not have any systems in place for electronic verification of vital records. 1

4 RVRS birth records are available electronically only from 1988 to present. This subset may allow for electronic matching with MassHealth records, but for all birth records prior to 1988 and all death records, RVRS will be required to physically retrieve paper volumes of records. Measures to decrease fraud and waste include identification of deaths among the MassHealth population that is hindered by the manual system of death registration at RVRS, and its inability to reliably match births and deaths. Massachusetts birth certificates are predominantly open records, available to any individual, making the potential for fraudulent proof of citizenship unacceptably high. In addition, clients may present copies certified by individual cities and towns, all of which may be in a different format, making identification of authentic documents even more difficult. Proposed use of grant funds: Assist in the digitizing of Massachusetts vital records, including scanning, optical character recognition (OCR), and data entry for the creation of an electronic database. Assist in the customization of a Massachusetts electronic verification of vital events system (EVVE) to permit MassHealth staff to efficiently and securely verify citizenship of applicants and other state Medicaid agencies. Expected result: Timely verification at the point of application. Reduce delays in approval. Reduce fraud through notification of death and by obtaining verifications directly from source eliminating the inadvertent acceptance of fraudulent documents. 2

5 Medicaid beneficiaries throughout the United States who are born in Massachusetts are subject to the obstacles inherent in the Commonwealth s paper vital records system, the oldest system of vital records in the nation. Further, Medicaid agencies throughout the U.S. are currently subject to the unacceptably high potential for fraudulent Massachusetts birth certificates, which may result in clients being requested to obtain additional second-level proof of citizenship, and resultant delays in health coverage and services. The project proposes to utilize existing, proven, technology for verification of vital events. This system, Electronic Verification of Vital Events (EVVE), has been piloted and is actively being used in Missouri, Iowa, Minnesota, South Dakota, North Dakota, and Montana. The National Association for Public Health Statistics and Information Systems (NAPHSIS) has developed and implemented this electronic system that allows for participating states immediate confirmation of the information on a birth certificate presented by an applicant to a government office anywhere in the nation irrespective of the place or date of issuance. Authorized Federal and State agency users, via a single interface, can generate an electronic query to any participating vital records jurisdiction throughout the country to verify the contents of a paper birth certificate or to request an electronic certification (in lieu of the paper birth certificate). An electronic response from the participating vital records jurisdiction either verifies or denies the match with official state or jurisdiction records. The system will also flag positive responses where the person matched is now deceased. 1 PROJECT JUSTIFICATION Without a reliable and secure method to verify birth certificates of MassHealth applicants, the agency is faced with several inefficiencies and obstacles. Note that these obstacles will be faced by every state Medicaid agency servicing clients born in Massachusetts, which include: 1 Source: National Association of Public Health Statistics and Information Systems (NAPHSIS). 3

6 Potential delays of several weeks or months to verify citizenship via RVRS for applicants over the age of 21 (non-automated birth records). Inadequate ability for state Medicaid agencies to identify fraudulent birth certificates presented directly by applicants. Costs associated with lengthy application process. Costs associated with customer satisfaction related to obtaining certificates and delayed/rejected applications. If the state s vital records are scanned and automated, and Massachusetts participates in a national EVVE system, MassHealth (and other Medicaid agencies throughout the country) will benefit by: Instant and secure verification of Massachusetts births. Elimination of manual processing of birth certificate requests, substantially reducing delays in decisions. Elimination of document fraud by receiving secure verifications from the source. Rapid identification/verification of deceased clients. Elimination of fraudulent use of a deceased individual s birth information by an applicant. Reduce terminations of benefits of individuals for lack of timely verification. 4

7 PROJECT GOALS AND OUTCOMES Funds obtained through this grant will be used to achieve the following goals: Digitize all births and deaths housed at RVRS, from 1935 to present resulting in a secure, electronic, statewide database of over 10 million records. Customize and install the EVVE system for RVRS, providing MassHealth and other Medicaid agencies throughout the U.S. reliable and authentic proof of citizenship for clients born in Massachusetts. Utilize the EVVE system to eliminate deceased clients from Medicaid rolls, and identify potential fraudulent applicants attempting to use birth certificates of deceased persons. The outcome of this effort will be a means to confidently verify citizenship of MassHealth/Medicaid applicants, good customer service, rapid approval of benefits for individuals and families, and reduction of fraud and waste. The project will use proven technology, consistent with industry and state standards. The following is a brief overview of the technology being considered for this project. Digitization Technology Overview RVRS plans to engage a vendor to assist in the development and implementation of a digitizing system. The same vendor is also expected to provide the support /personnel towards converting the near 10 million records within a two year period. 5

8 The following are the standard requirements that RVRS is using to select an industry vendor for the digitizing of vital records. RVRS requires the ability to capture, store, manage, retrieve, and preserve MA RVRS paper vital event records. RVRS has developed an RFI Digitizing Vital Records to begin the process of vendor selection, subject to this project s grant funding. a. The solution will allow RVRS to capture and store images and index information from paper vital record volumes b. Scanning solution will need to be able to handle documents of varying sizes (minimum 6.25x8.5 and 9.5x8.5 ) and will not damage paper documents in the process. c. Will be able to provide a secure environment that will meet RVRS business processes and MA laws and regulation regarding vital records and electronic record storage. d. Provide a solution for RVRS to securely retrieve documents for printing. e. Provide storage of image/data in a secure environment. f. Provide RVRS better management of its paper environment. g. Where applicable use Optical Character Recognition technology or other technology to reduce time needed to perform data entry. The solution must provide a software interface for RVRS future vital information processing software application or other software applications (e.g. NAPHSIS Electronic Verification of Vital Events) that would need to either store or retrieve RVRS vital event records. a. Currently RVRS is in the process of developing a new vital records processing system. The electronic records management system will provide the means for RVRS to access the older records image and data. 6

9 b. The solution has to be flexible enough to provide a standard method in which other software applications may access the data contained within the records management system in a secure manner. The solution must provide the ability to input additional data for each record beyond basic image and indexing information. The additional data will at the minimum be the fields needed to provide verifications and birth and death matching of records. a. Data fields will need to be defined but the information contained in the paper certificates if in electronic format will allow RVRS to in a timely and efficient manner verify information from outside agencies that need birth and death information. b. RVRS will need to meet new business requirements concerning identification information. Having data contained in an electronic format will allow RVRS to match and prevent vital records to be used in a fraudulent manner. EVVE Technology Overview (from RVRS would be customizing the EVVE application for usage in Massachusetts. Currently the EVVE application is being used in other state by NAPHSIS. The EVVE system supports remote message-based verifications and certifications of birth and death records with each of the jurisdictions. The message-based approach provides the following advantages over online, dial-up verifications accessing jurisdiction vital records databases directly: (1) it minimizes opportunities for any network security breach and reduces the threat of an opportunity for users outside of the jurisdiction s vital records office to 'browse' records in the jurisdiction s vital records database; (2) federal and state agency authorized requesters need to learn a simple modification to their own entry 7

10 screen in order to request a verification or certification from any jurisdiction; and (3) jurisdictions will not lose revenue essential to running the vital records operation. All transaction requests will be logged so that any unusual activities can be traced back to the originating requesting agency. Federal and State agencies communicate with the EVVE system via an extensible markup language XML message called a Vital Event Transaction (VET). The federal and/or state agency generates a request to be sent to the EVVE hub using the VET format. The EVVE hub routes the request to the jurisdiction where the event took place. In each jurisdiction participating in the EVVE system, software is installed that receives the routed message, interprets the information contained within it, runs the request against whatever automated search system the jurisdiction maintains, constructs a response to the message, and returns the response to the EVVE hub which forwards the response to the Federal or State agency in the VET format. ESTIMATE OF IMPACT TO BENEFICIARIES The project will benefit MassHealth/Medicaid beneficiaries in two significant ways: Obtain benefits without delay, and Protect personal information. MassHealth currently serves approximately 1 million clients, and anticipates an annual new member application pool of 200,000. Projections taking in account adjustments of Massachusetts-born clients requiring citizenship verification via a birth certificate, estimate 50,000 potential clients will be serviced by RVRS monthly. Until new systems are in place, MassHealth applicants will apply for birth certificates via mail or counter service. Because additional funds and staffing have not been made available to RVRS at this time, our clients will inevitably encounter additional burdens of effort, travel, delay, and cost that 8

11 could be almost entirely eliminated if a reliable and secure system is in place. In addition, each certified copy that is issued on paper poses additional security and identity risk for applicants that must obtain and present these documents. Further, if Massachusetts participates in EVVE, the benefit will extend beyond the Commonwealth s borders, and ultimately benefit every Medicaid beneficiary born in Massachusetts, regardless of their state of residence. DESCRIPTION OF MAGNITUDE OF THE TRANSFORMATION/SYSTEM CHANGE The result of this project will transform the citizenship verification process for Massachusetts-born Medicaid applicants from a complex, time-consuming, paper-based, and fraud-prone procedure to a secure, efficient, and timely electronic procedure. The project will allow MassHealth applicants, proving citizenship via birth certificates, to receive approvals weeks sooner than currently possible. Electronic verification of vital events will prevent fraud by allowing MassHealth to be 100 percent confident of the authenticity of the birth certificate information. Currently, Massachusetts paper certificates may be issued to any individual that requests them, making them prone to fraud and identity theft. Built upon current standards, the system will be completely auditable and easily managed, making this a long-term solution translatable to other Medicaid and governmental agencies. By utilizing a nationally central EVVE system, Massachusetts will join the six other states successfully, securely, and instantaneously exchanging vital records verifications. 9

12 DESCRIPTION OF THE SUSTAINABILITY OF THE PROJECT RVRS projects a two-year period for digitizing 10 million records. Massachusetts will fund and RVRS will remain responsible for maintaining both the manual and electronic systems of verification until the conversion process is completed. The long-term sustainability is favorable, as the need for intensive clerical staffing will eventually decrease due to automation of records and will shift to systems support functions. It is therefore anticipated that the long term staffing and systems support needs will be minimal and will be funded by state appropriation. This project will also take advantage of existing IT infrastructure within the state and nationally. Massachusetts Executive Office of Health and Human Services has developed the architectural framework and implemented the infrastructure to support interagency data sharing, such as that proposed between DPH and MassHealth. Maintenance and support of the national component of EVVE will be performed by NAPHSIS. RVRS staff will maintain its interfaces to that system. EVALUATION PLAN MassHealth will comply with section 1903(z)(3)(C) by providing an annual report that will include uses of grant payments, assessment of quality improvements, and estimates of any cost savings. RVRS has already determined in order to manually verify the records needed by MassHealth clients, they will require approximately $1.18 million in the initial year with subsequent years costing $250,000 annually. Cost of development and maintenance is expected to compare favorably, especially when viewed as a long-term solution and will be easily measured for evaluation. After completion of the conversion, the on-going cost of verification is expected to decrease substantially for this agency of the Commonwealth. Although MassHealth benefits only indirectly from these cost reductions, it expects to realize improvement efficiencies. Expected measurable efficiencies include quality of processing, 10

13 timeliness of processing, and reduction of labor hours for applications and verifications. Standard reporting will be developed on the progress of changes as compared to current baselines and will be incorporated into the annual report. DESCRIPTION OF PROJECT IMPLEMENTATION READINESS RVRS is already in the process of developing secure web-base vital records applications. The components funded by this grant would be integrated into existing and new RVRS systems. In July 2006, MassHealth and RVRS began to meet to assess the methods and feasibility of obtaining vital records information for citizenship verification purposes. In these meetings RVRS was able to confirm that birth data from 1988 is available electronically to match with a MassHealth applicant database. Application modifications or development would still be needed in order for MassHealth to use the vital records data. Limited death data is available dating back to 1969, but is not certification quality. All other record information is in paper format. It is currently estimated that MassHealth would need citizenship verification of approximately 50,000 new applications and re-determinations monthly. RVRS has obtained cost information for digitizing records in order to make the data available electronically from 1935 to present (approximately 10 million records). In 1998 RVRS also had a study performed by American Management Systems (AMS, Inc.) for the cost of converting 22 million records in a four to five year period. While RVRS does not currently have funding to convert records, they are preparing an RFI for the conversion of records to an electronic format in order to get a further estimate of the cost. In addition RVRS would expect to take advantage of the development of the national Electronic Verification of Vital Events (EVVE) software as it is being implemented in other states. MassHealth and other state Medicaid agencies would be able to verify vital record information using this national standard. 11

14 This grant submission is based on these estimates and the work involved in getting records into a format usable by MassHealth. Proposed tasks and timelines are as follows: Date October 2006 November 2006 November 2006 January 2007 February 2007 September 2008 January 2007-March 2007 March 2007 December 2007 January 2008 May 2008 June 2008 September 2008 Task RVRS - Vital Records Digitizing RFI RFR / Vendor Selection Development project plan for electronic verification/ Modifications of existing software. (customization of national standard EVVE application) Start of Digitizing (Vendor) Implementation / training completed Digitizing/data entry begins (ongoing) EVVE/MA Planning / Design EVVE/MA construction EVVE/MA testing ( est. 1/3 of needed records would have been digitized) EVVE/MA Implementation BUDGET Estimated budget total: $3,950, FY 07: $1,911, FY 08: $2,039,

15 Total estimated funding requirements for each year: 13