maryland department of health (mdh) mmis modular replacement...

MARYLAND DEPARTMENT OF HEALTH (MDH)

MMIS Modular Replacement Project4th Annual Business Opportunities & Entrepreneurial Training Summit

October 9, 2018

Welcome & Introductions

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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

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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

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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

[email protected]

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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

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https://mmcp.health.maryland.gov/Pages/home.aspx

What is the MMIS?

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• 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)

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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.

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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

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MMIS Module Replacement Project

Medicaid: Service & System Architecture

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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


Medicaid: MMIS Replacement Program Development Roadmap

Program Development RoadmapMMIS Modular Replacement (MMR) Project

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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

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Project Support for MMR Project

Project Management Office (PMO)

• Day to Day Project Oversight

• Project Management Guidelines and Standards

• Procurement Support

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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

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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

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STATUS

Procurement: CATS+ Publish Dec 2020

Staffing: Key Personnel (tbd), Non-Key (tbd), via work order

Min Quals: Key Personnel – Systems engineering/integration


Project Modules

Customer Relationship / Case Management

• Workflow management

• Member Care Management

• CRM solution

• Document Management

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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

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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

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STATUS

Procurement: RFP - Publish Mar 2019

Solution: - Software as a Service(SaaS)

Min Quals: NCCI Claims Editing implement/operate


Project Modules

Surveillance and Utilization Review (SURS)

• Fraud and Abuse detection

• Fraud waste, abuse reports for Medicaid, Program Integrity, Federal and State Agencies

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STATUS

Procurement: RFP - Publish Nov 2018

Solution: - Software as a Service(SaaS)

Preferred Qualifications: Project Mgr – SURS experience,PMP

Expected Contract Award: – Apr 2019


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

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To Be System Context Diagram• MMIS Modular Replacement (MMR) Project

MDH Contacts & Important Links

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For more information send questions to:

[email protected]

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


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

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