-
MARYLAND DEPARTMENT OF HEALTH (MDH)
MMIS Modular Replacement Project4th Annual Business Opportunities & Entrepreneurial Training Summit
October 9, 2018
-
Welcome & Introductions
2
MDH Medicaid Summit – Welcome & Introductions
Presenters:
Craig SmallsAssistant Chief Information Officer
Office of Enterprise Technology (OET)
Dana DembrowDirector of Procurement
Office of Procurement and Support Services (OPASS)
John BohnsDirector of Special IT Project s and Procurement
Office of Enterprise Technology (OET)
-
MDH MMIS Modular Replacement (MMR) Project
Health & Human Services IT Project
$500 - $800 Million
Five – Ten Year Project
RFPs – CATS+ / eMMP – Multiple Awards
MBE Opportunities
3
MMIS Modular Replacement (MMR) Project
-
MMIS Modular Replacement (MMR) Project
Overview: MDH, Procurement, Medicaid
-
What is MDH?
MDH has four major Administrations - Public Health Services, Behavioral Health, Developmental Disabilities, and Medicaid/Operations. In addition, the department has 20 boards that license and regulate health care professionals; and various commissions that issue grants, and research and make recommendations on issues that affect Maryland’s health care delivery system. MDH has a budget of more than $12 billion to provide needed services to Maryland communities.MDH Website: https://health.maryland.gov/pages/about.aspx
• The Medicaid/Operations Administration is responsible for the Medicaid program and CHP, which features the department’s HealthChoice and Children’s Health Program along with other initiatives, including those that help people with the cost of prescription medications. Information about the Maryland Medicaid organization, programs, and many other services can be found on MDH website: https://mmcp.health.maryland.gov/Pages/home.aspx
• Medicaid is the nation’s largest health insurer, serving over 70 million Americans. As of 2016 Maryland’s Medicaid Program provides health care for over one million people, including 628,000 participants younger than 21.
• Statewide Medicaid spending was $10.2 billion in fiscal year 2016
5
MMIS Modular Replacement (MMR) Project
https://health.maryland.gov/pages/about.aspxhttps://mmcp.health.maryland.gov/Pages/home.aspx
-
MDH – Office of Procurement and Support Services (OPASS)
Dana Dembrow – Director of Procurement
• Role of OPASS
• Socio-economic Objective of State Procurement
• Where to find MDH procurement opportunities:
http://procurement.maryland.gov/
• MDH/OPASS website:
https://health.maryland.gov/opass/Pages/Home.aspx
• Contact OPASS: Naisadh [Nick] Desai (410) 767-5794
6
MMIS Modular Replacement (MMR) Project
http://procurement.maryland.gov/https://health.maryland.gov/opass/Pages/Home.aspxmailto:[email protected]
-
MDH - Medicaid
• $11 - Billion dollar a year program• 25% of Maryland’s Total Budget Expenditures
• Medicaid Reimbursements – 80% of MDH Budget
• Covers over 1.3 Million Maryland Citizens
• Over 75,000 Participating Providers (Physicians, Pharmacies, Hospitals, Behavioral Health, Nursing Homes, Dentists, Surgeons, etc.)
• Over 25 Million Claims Processed Annually
• Over 28 Million Managed Care Encounters Processed Annually
• https://mmcp.health.maryland.gov/Pages/home.aspx
7
MMIS Modular Replacement (MMR) Project
https://mmcp.health.maryland.gov/Pages/home.aspx
-
What is the MMIS?
8
MMIS Modular Replacement (MMR) Project
• The Medicaid Management Information System is the core system supporting all Medicaid operations including claims processing, member/provider management, and reporting.
• All Medicaid programs are federally required to operate, maintain, and routinely update the MMIS to remain compliant with regulation and law.
• Medicaid programs can choose to outsource their operations and the MMIS to an external vendor or manage their MMIS in-house. Maryland owns and operates its MMIS.
• Traditionally, the MMIS has been one large-scale monolithic system. Recent federal regulation requires states to design new MMIS systems in a modular fashion.
-
What is CMS?
• Federal partner providing oversight and funding
• CMS Funding:• 90% for planning, design, development and installation• 75% for maintenance and operations• 50% for training/licenses/staff
• Major Initiatives:• Medicaid Information Technology Architecture State Self-
Assessment version 3.0 (MITA SS-A 3.0)
• Medicaid Management Information System (MMIS) Modularity
• Maryland’s Total Human-services Information NetworK (MD THINK)
9
MMIS Modular Replacement (MMR) Project
-
What is MITA?• MITA – Medicaid IT Architecture – is a CMS initiative
that fosters an integrated business and information technology (IT) transformation across the Medicaid enterprise in an effort to improve the administration and operation of the Medicaid program. (see link)
• Version 3.0 updates version 2.0 published in 2006 and takes into account the availability of new technologies, such as cloud computing, and new legislative requirements
• Helps states in the preparation of the (required) State Self Assessment and Advanced Planning Documents which are used by states to obtain federal financial participation for the costs of IT systems.
• Provides a structured assessment of “as is” capabilities and “to be” targets to plan for replacement of the MMIS.
10
MMIS Modular Replacement (MMR) Project
-
MMIS Modular Replacement (MMR) Project for Maryland
• Two Key Objectives
• Technology, Efficiency, & Quality. Reconstruct the current monolithic, decades-old MMIS into a modern, modular system
• Compliance & Leverage. Remain compliant with CMS regulations, leveraging specially targeted federal funding
• Sense of Scale
• Transaction Volume. Medicaid will process $110B in claims over the next 10 years
• System Investment. Medicaid is expecting to invest $500M+ over next 10 years to execute the projects and roadmap for the MMIS Modular Replacement (MMR) Project
11
MMIS Modular Replacement (MMR) Project
-
MMIS Module Replacement Project
Medicaid: Service & System Architecture
-
13
Service & Data Integration to MMIS
MMIS Module Replacement Project
Planning & Control
Transaction Management
Stakeholder Management
MMIS
Annapolis Data Center
Medicaid Management
Information System (MMIS)
Member Data• HBE (MHBE)• CARES (DHS)
Provider Data• eMedicaid• ePREP
Claims Data• EDITPS• Pharmacy POS• Beacon (BH ASO)• Scion (Dental ASO)• MCOs• eCMS (Kidney Disease
Program)• eCMS (Breast and
Cervical Cancer)• DDA• LTSS
Financial Data• FMIS• Pharmacy POS (Drug
Rebate)
Program Integrity• SURS (OIG)• FPI• LTSS
Prior Authorization• Telligen• Long Term Services and
Support (LTSS)• Pharmacy POS• Beacon (BH ASO)• Scion (Dental ASO)• OHS (MMIS)
Data Analytics• Hilltop (UMBC)
Case Management• Long Term Services and
Support (LTSS)• HealthChoice CRM
Annapolis Data
Center
-
MMIS Modular Replacement (MMR) Project
Medicaid: MMIS Replacement Program Development Roadmap
-
Program Development RoadmapMMIS Modular Replacement (MMR) Project
15
Module T1: Customer Relationship Management (CRM)
Module T2: Pharmacy Claims Processing
Module T3: National Correct Coding Initiative (NCCI)
Module T4: Long Term Services & Support (LTSS)
Module T5: Provider Re-Enrollment (ePrep)
Module T6: Surveillance Utilization Review System (SURS)
Module RM1: Project Management Office (PMO)
Module RM2: Independent Verification & Validation (IV&V)
Module RM3: System Engineering, Architecture, and Integration
Module G1: State Project Management/SMEs
Module G2: Internal/Organic System Integration
Module T7: MD THINK: Enterprise Service Bus (ESB) Integration
Module T8: MD Think: Member Eligibility Integration
Module T9: MD THINK: Customer Portal Integration
Module T10: Core MMIS
Module T11:Electronic Data Interchange Transaction Processing
System (EDITPS)
Module T12:Data Warehouse (DW) / Decision Support System
(DSS)
Module T13: Provider Management
Module T14: Financial Management
Key
Modules (Systems)
Project Support (People)
T-Modules Technical Solution/SaaS
RM-Modules Risk Management
G-Modules Governance
Phase 1
tbd
tbd
Oct-19
Sep-19
Sep-21Dec-20
N/A
N/A
Dec-19
Sep-20
Nov-28
N/A
tbd
tbd
tbd
tbd
tbd
tbd
tbd
tbd
tbd
Oct-17
tbd
Mar-19
08022018_v1.4
Pre-Procurement
Procurement
DDI
Agile DDI
Base Operations
Option Years
Pause
tbd
tbd
Program Development Roadmap
20212016 2017 2018 2019 2020 2022 2023 2024 2025 2026 2028
Feb-16
2027Est. Publish
Date
Est.
Contract
Award
Mandates and Creating an Infrastructure for Success
Birth of the Enterprise
N/A
N/A
Apr-19Nov-18
N/A
N/A
Jan-19
Nov-19
N/A
CORE MMIS
External Modules
Phase 2
Phase 3
Phase 4
tbd
tbd
-
Planned Initiatives
• Project Management Support Office – TORFP development
• IV&V – In procurement
• Systems Engineering/Integration (SI)
• Customer Relationship/Case Management – Salesforce develop
• Pharmacy Point Of Sale – proposal evaluation
• National Correct Coding Initiative – RFP development
• Surveillance and Utilization Review System (SURS)
• MD Think Integration
• Core MMIS / EDITPS – Multiple
• Data Warehouse/Decision Support System – RFP development
• Provider Management
• Financial Management
16
MMIS Modular Replacement (MMR) Project
-
Project Support for MMR Project
Project Management Office (PMO)
• Day to Day Project Oversight
• Project Management Guidelines and Standards
• Procurement Support
17
MMIS Modular Replacement (MMR) Project
STATUS
Procurement: CATS+ - Publish Jan 2019
Staffing: Key Personnel (4), Non-Key (8), Add’l via work order
Min Quals: Company –experience provide staff with MITA
Key Personnel – MITA experience, PMP
Current contract (Cognosante) ends 5/31/20
Expected Contract Award: – Oct 2019
-
Project Support
Independent Validation and Verification (IV&V)
• State Due Diligence
• Federal Compliance / Reporting
• Assess Project Health
18
MMIS Modular Replacement (MMR) Project
STATUS
Procurement: CATS+ - Publish Jan 2019
Staffing: Key Personnel (1), Non-Key (6)
Min Quals: Company –IV&V for CMS certifiable component
Key Personnel – experience leading IV&V team, PMP
Expected Contract Award: – Sep 2019
-
Project Support
System Engineering / Integration (SI)
• Engineering
• Data/Technical Standards and Strategies
• Interoperability
19
MMIS Modular Replacement (MMR) Project
STATUS
Procurement: CATS+ Publish Dec 2020
Staffing: Key Personnel (tbd), Non-Key (tbd), via work order
Min Quals: Key Personnel – Systems engineering/integration
Expected Contract Award: – Sep 2021
-
Project Modules
Customer Relationship / Case Management
• Workflow management
• Member Care Management
• CRM solution
• Document Management
20
MMIS Modular Replacement (MMR) Project
STATUS
Procurement: CATS+ RFR
Staffing: Procure Salesforce administrator/developers as needed
Min Quals: Salesforce administration /development experience
Expected Contract Award: – tbd
-
Project Modules
Pharmacy Claims Processing
• Pharmacy Point of Sale electronic Claims Processing System (POSECMS) and operations
• Prospective Drug Utilization Review
• E-Prescribing
21
MMIS Modular Replacement (MMR) Project
STATUS
Procurement: Published – Oct 2017 / Closed Mar 2018
Solution: Services Contract
Status: Proposal Evaluation Period
Expected Contract Award: – Jun 2019
-
Project Modules
National Correct Coding Initiative
• Rules engine based solution
• Implement NCCI edits on MMIS claims
22
MMIS Modular Replacement (MMR) Project
STATUS
Procurement: RFP - Publish Mar 2019
Solution: - Software as a Service(SaaS)
Min Quals: NCCI Claims Editing implement/operate
Expected Contract Award: – Sep 2020
-
Project Modules
Surveillance and Utilization Review (SURS)
• Fraud and Abuse detection
• Fraud waste, abuse reports for Medicaid, Program Integrity, Federal and State Agencies
23
MMIS Modular Replacement (MMR) Project
STATUS
Procurement: RFP - Publish Nov 2018
Solution: - Software as a Service(SaaS)
Preferred Qualifications: Project Mgr – SURS experience,PMP
Expected Contract Award: – Apr 2019
-
MMIS Modular Replacement (MMR) Project
Next Steps
-
Next Steps
• Meet with CMS to discuss approach
• Submit Implementation Advance Planning Document (I-APD) to CMS – Approval for Federal Funding
• Work with DoIT to establish a Major IT Development Project – DoIT Oversight
• Begin strategic engagement with individual agencies
• Module Certification Process Implementation
• Procure:
• IV&V
• PMO
• SI
• NCCI
25
MMIS Modular Replacement (MMR) Project
-
26
To Be System Context Diagram• MMIS Modular Replacement (MMR) Project
-
MDH Contacts & Important Links
27
MMIS Modular Replacement (MMR) Project
For more information send questions to:
MITA (Medical Information Technology Architecture) CMS Information
https://www.medicaid.gov/medicaid/data-and-systems/mita/index.html
MECL (Medicaid Enterprise Certification Life Cycle)
https://www.medicaid.gov/medicaid/data-and-systems/mect/index.html
MDH Procurement Opportunities:
eMarylandMarketPlace (eMM):
https://emaryland.buyspeed.com/bso/login.jsp
https://health.maryland.gov/procumnt/Pages/Procopps.aspx
CATS+:
https://doit.maryland.gov/contracts/Pages/CATSPlusTORFPStatus.aspx
https://www.medicaid.gov/medicaid/data-and-systems/mita/index.htmlhttps://www.medicaid.gov/medicaid/data-and-systems/mect/index.htmlhttps://emaryland.buyspeed.com/bso/login.jsphttps://health.maryland.gov/procumnt/Pages/Procopps.aspxhttps://doit.maryland.gov/contracts/Pages/CATSPlusTORFPStatus.aspx
-
MMIS Modular Replacement (MMR) Project
Appendices
-
Appendix A - Acronyms
Acronyms Definition Acronyms Definition
CIO Chief Information Officer MHBE Maryland Health Benefit Exchange
CMS Centers for Medicare and Medicaid ServicesMITA SS-A
3.0
Medicaid Information Technology Architecture
State Self-Assessment version 3.0
DBM Maryland Department of Budget and Management MMIS Medicaid Management Information System
DoIT Maryland Department of Information Technology NCCI National Correct Coding Initiative
DSS Decision Support System OSOP Office of Systems, Operations, and Pharmacy
DW Data Warehouse PCP Primary Care Physician
FFP Federal Financial Participation PM Project Manager
IV&V Independent Validation and Verification PMO Project Management Office
MD THINKMaryland’s Total Human-services Information
NetworkPOS Point of Sale
MDH Maryland Department of Health SI System Integration
MECL Medicaid Enterprise Certification Lifecycle
29
MMIS Modular Replacement (MMR) Project