Ok so this is worded a bit different from a post I made around 2 years ago but when you read the article here, this is the first “baby step” in that direction and you have to start somewhere. As you read through you will see the notations and comments made where they state how difficult it is to determine eligibility with some states, so what do you need, a working model that shows how it is done, in other words some new algorithms.
The next level up from here is to create laws that are digital and algorithm centric as we need this to be able to understand what we are doing and how the software and algorithms will work.
I have been hinting around for something like this for a long time as it’s the only way to get a visual to enable everyone to be able to wrap their heads around it. All of these new tools being discussed are at the base, just some new algorithms. BD
White House Task Force on Unfair Business Practices - A Department of Algorithms To Allow Enforcement Would Be Nice…
Life is one big algorithm it seems anymore and since the insurers use and rely on them heavily we need them too. BD
Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution
A Health and Human Services Department panel backed a plan to build a federal database of business rules that states could use to help determine the eligibility of consumers for Medicaid and other federal health insurance programs.
The collection of program eligibility rules in a single location would enable states to compare their enrollment processes with other states’ and find instances where systems could be re-used or merged.
One business rule that applies to Medicaid eligibility is that an insurance seeker’s income level must be under a certain threshold of the federal poverty line, Chopra said. Currently, the majority of business rules are not easily known or accessible.
“It’s hard to understand how some states determine eligibility,” he said.
The committee also pushed for the creation of a federal reference verification tool, or sample application, for states to use so they don’t have to design and create their own. The software would contain standards for states to verify an individual’s eligibility information from federal agencies.