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DHHS defends New Hampshire Care Coordination pilot: privacy protections, SMART on FHIR interoperability and $4.285M spent
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Summary
DHHS staff told the Fiscal Committee the New Hampshire Care Coordination closed-loop referral system supports SMART on FHIR interoperability, uses per-referral consent and role-based authentication to protect client data, has more than 100 providers on the network, has spent $4,285,000 to date and has roughly $3.7M remaining for maintenance and provider growth.
Representative Erf pressed DHHS about interoperability and privacy for the New Hampshire Care Coordination closed-loop referral system, asking whether the state system is interoperable with other IT systems, whether external interfaces for managed-care organizations are on track, and how the system prevents unauthorized searching of client records.
David Weeters, DHHS chief operating officer, described multiple integration options: a discoverable SMART on FHIR integration that providers can consume, single-sign-on options, and deeper integrations at a providers request. "We are working with [managed-care organizations] and our contractor to complete the MCO integration," he said, adding that timelines depend on two-party discussions between the contractor and the MCOs.
On privacy, Weeters and other DHHS staff said the system is configured for per-referral consent and that role-based authentication prevents unrelated providers from searching for clients unless they are part of the referral chain and have consent. "Another provider on the network would not be able to search for that client and find information for them unless they first had a referral in the chain," a DHHS official said.
DHHS reported it has spent $4,285,000 on the contract since March 2024 for design, implementation, software licenses, testing and training, and that about $3.7 million remains primarily for maintenance, operations and provider growth. The department said it obtained CMS approval to fund 90% of design, development and implementation through Medicaid and that the state intended to continue base operations within the information services budget in future bienniums.
Committee members asked whether all patients (including Medicare and privately insured patients) could be on the network; DHHS said any client can be on the network but participation is opt-in and governed by the consent process. Members also asked whether the state required MCOs to use the state system; DHHS said the MCO contracts require use of the state's closed-loop referral system or interoperability with it, and that MCOs had expressed a preference for the state system but retain options to interoperate.
