Compliance Factors in REALD & SOGI Data Reporting

REALD & SOGI and APAC discussion group Session 4 Compliance with REALD & SOGI data reporting June 11, 2024

Acronyms APAC All Payer All Claims program; within Health Policy & Analysis in OHA CMS Centers for Medicare & Medicaid Services E & I Equity and Inclusion Division in OHA HSRI Human Services Research Institute (APAC s vendor) OHA Oregon Health Authority OMB Office of Management and Budget; determines federal standards on race, ethnicity, language and other items REALD Race Ethnicity (and) Language and Disability SOGI Sexual Orientation and Gender Identity TAG (APAC s) Technical Advisory Group 2

What are the goals of these discussions? Enhanced planning for reporters from deeper consideration of laws, rules, collection devices and reporting REALD and SOGI questions and potential answers And then Data collection, storage and possibly use Files sent to APAC 3

Compliance factors insurer reporting 1. Who Head of household completes for each member Ideally, persons of a certain age would respond for themselves, but we recognize the difficulty in doing this Information should not be extracted from EHR as purpose is to go directly to the source 2. What Are questions being asked as required? As a survey, it is essential that questions be phrased as indicated, options as required and no cross-validation for data quality 4

Compliance factors insurer reporting continued 3. When This an annual survey submitted to APAC quarterly First survey within thirty days of enrollment For CCO enrollment, the first survey is covered by ONE but subsequent years must be sent to the members Anyone who is non-responsive should receive at least two follow up reminders to complete the survey Next annual survey will be one year from date previous response received 4. If data of poor quality, work with E & I to strengthen data 5

Compliance factors 1. Who Are all subscribers receiving the request to submit data? This includes accommodating any disability and providing alternate languages (E & I can help plan) 2. What Are questions being asked as required? 3. When An annual survey submitted to APAC quarterly Anyone who is non-responsive should receive two follow up reminders to complete the survey Next annual survey sent on time 4. Using E & I subject matter expertise to improve poor response rate or poor-quality reporting 6

Compliance activities APAC exclusively If requests are not being sent, a civil penalty through APAC is a possibility If sending is documented but members largely non- responsive, APAC will ask the reporters to work with E & I to determine if there is better communication (messaging) to introduce the survey Potential of civil penalty if messaging is problematic and not updated after suggestions from E & I Otherwise, reporter is compliant even though data quality is poor 7

Compliant, but weak data This will be a journey If data received from members with a high level of not answering , reporter is still compliant There is no expectation that the reporter presses members for more information This means the expected activity to improve data quality in claims is very different than REALD & SOGI Expect a need for broad activity to strengthen members trust in submitting data Messaging from E & I (and APAC) Messaging from reporter Alternative paths to reporting 8

Resources more to be developed APAC REALD & SOGI Implementation page is active Implementation plan Draft Appendix J Discussion schedule and recordings of meetings REALD and SOGI page for E & I Proposed rules for REALD & SOGI Presentation by E & I for January 2024 TAG meeting Draft Appendix J presented to March 2024 TAG meeting Fields and values still under review in E & I rulemaking; updates will be required Basic structure, length, reference lists useful in planning now 9

Questions, comments or concerns to share today? Comments, etc. at any time to APAC.admin@odhsoha.Oregon.gov 10