Stream: CARIN IG for Blue Button®
Topic: CMS LIS (Low Income Subsidy) Status
David Riddle (Nov 17 2021 at 13:13):
@Brendan Keeler had posed the following question here and I may have missed something, but it does not look like it ever got answered.
Does anyone know if the CMS LIS (Low Income Subsidy) status of a patient is available in BlueButton data? (1.0 or 2.0)?
I am struggling with the same question of how to convey the CMS LIS status of a patient (this includes what I understand to be the low income subsidy % - e.g., a percentage value of 25%, 50%, 75%, or 100%) via. FHIR/BlueButton data. Some have proposed using Coverage.class with a Coverage.class.type of class or subclass (Coverage Class Codes#class "Class" or subclass "SubClass"), Coverage.class.name = 'Low Income Subsidy' & Coverage.class.value = <LIS %> (e.g., 25%, 50%, 75% or 100%). However, this doesn't feel right, and it does not covey the 'Low Income Subsidy' concept via. a CodeableConcept.
Would extending the Coverage Class Codes (extensible) to include a 'lis' (LowIncomeSubsidy) code be an option? For example:
Coverage.class.type.coding.code = 'lis'
Coverage.class.type.coding.display = 'LowIncomeSubsidy'
Coverage.class.value = <LIS %> (e.g., 25%, 50%, 75% or 100%)
Corey Spears (Nov 17 2021 at 15:45):
This is not something explicitly included in Carin BB. There will have to be some discussion with the HL7 Financial Management workgroup as to the proper place to put it if we do make it explicit in the IG.
Would you mind entering a Jira ticket for the request so the team can review? (Or let me know if you can't or would prefer not to and I will do it for you.)
Note that if you do feel it is appropriate to place it in the Coverage.class, the slicing is open, so you could technically place it in there, but that of course would be undefined by the standard.
MaryKay McDaniel (Nov 23 2021 at 03:22):
HI all,
Could we have a bit more info please?
1)
Are you looking for the LIS Levels (which is what it looks like you are asking)? Level 1 - 100%, Level 2-75%, Level 3-50%, Level 4-25%.
OR is it the actual Copayment up to Out-of-Pocket Threshold amounts?
2)
This is eligibility information that happens up front before anyone is enrolled into a plan (...most the time). I don't ever recall seeing this type of eligibility information in paid claim data. Is there a reason you would expect to see it in these files?
3)
is there a need to get it on paid claim information and NOT enrollment information?
David Riddle (Dec 08 2021 at 15:11):
MaryKay McDaniel said:
HI all,
Could we have a bit more info please?
1)
Are you looking for the LIS Levels (which is what it looks like you are asking)? Level 1 - 100%, Level 2-75%, Level 3-50%, Level 4-25%.
OR is it the actual Copayment up to Out-of-Pocket Threshold amounts?
2)
This is eligibility information that happens up front before anyone is enrolled into a plan (...most the time). I don't ever recall seeing this type of eligibility information in paid claim data. Is there a reason you would expect to see it in these files?
3)
is there a need to get it on paid claim information and NOT enrollment information?
@MaryKay McDaniel ,
I am not sure about the original question from @Brendan Keeler posted here, but mine were more in the context of 'enrollment information' vs. 'paid claim information'.
I am trying to understand whether or not there is a recommended/acceptable mechanism for conveying both A) the fact that a beneficiary has Low Income Subsidy (LIS) and B) if so, their associated LIS level (Level 1 - 100%, Level 2-75%, Level 3-50%, Level 4-25%) via. the FHIR Coverage resource (or if not via. the Coverage resource, via. some other FHIR resource)? So without an extension, is there an 'approved' way via. FHIR to convey a beneficiaries LIS status and/or LIS level?
I apologize in advance if CARIN IG for Blue Button isn't the right Zulip STREAM for this question. I saw the question from @Brendan Keeler and 'piled on' w/o really thinking about how my question aligned with the CARIN IG for Blue Button.
Last updated: Apr 12 2022 at 19:14 UTC
