MMIS Re-Bid of Fiscal Agent Services
Human Services Department
February 22, 2012
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Current Procurement Status
•
•
•
•
RFP Released January 28, 2011
Proposals received April 20, 2011
Proposals evaluated by DOH and HSD and a vendor selected
Contract has been negotiated but per State Purchasing
Division the identity of the vendor may not be disclosed until
the contract has been executed – desired effective date is
March 1, 2012.
• Next Step: Request PCC approval to move to Implementation Phase
to enable project start-up activities to commence pending TARC
approval of overall project requirements. This request is for $1.3
million of the overall transition/enhancement budget to permit the
start of transition and requirements analysis activities.
2
Procurement Background
• Medicaid State Fiscal Agent:
– Supports payment and operational services for
Medical Assistance Division
– Services range from direct service to hosting Omnicaid
payment application
• Contract has multiple services and functions
beyond IT operations
– Enroll non-institutional providers, process claims,
serve as enrollment broker for Medicaid recipients,
distribute forms and publications, etc..
3
RFP Objectives
• Open State Fiscal Agent services/professional
services to solicitation.
• Organize successful transition to new State Fiscal
Agent Contract to include:
– Transition of Medicaid Management
Information System (MMIS).
– Transition of MMIS Data Warehouse.
– Transition to supporting peripheral
systems/professional services (Pharmacy, etc.)
• Successful implementation of enhancements
4
RFP Management
• Medical Assistance Division appointed internal
staff manager as Procurement Manager.
• State Purchasing Department assigned
Procurement Analyst to oversee / guide process.
• Federal oversight included reviews by CMS Dallas
Regional Office and CMS Baltimore Central Office
• Evaluation committee included both Department
of Health and Human Services Department staff.
5
Procurement/Project Organization
Overall organization based on internal HSD staff with coordinating input from other agencies
Julie Weinberg
Executive Sponsor
PROJECT STEERING COMMITTEE
Mark Pitcock
Business Owner
HSD
Sean Pearson
Technical Sponsor
HSD CIO
Contractor Executive
Account Manager
Wayne Pendley
IT Project Manager
HSD
Contractor
Transition Phase
Manager
Roberta Duran
Business Owner
DOH
Robert Stevens
Business Owner
HSD
To be determined based on award of
contract.
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CMS Approvals for NM Medicaid
• CMS requires HSD to periodically open State Fiscal Agent contract to bid
• CMS approved funds to support Four Phases with federal match rate:
Federal
Match Rate
Purpose
75%
Support costs related to NM staff who will support
procurement.
75%
Support costs related to transition to new contract
operations (incumbent and non-incumbent
bidders were allowed to propose transition
activities and costs).
Enhancement
Phase
90%
Support costs related to remedy current system
issues or to improve functionality related to
upcoming health reform requirements.
Operations Phase
75%
Support costs related to Medicaid operational and
direct services for 7 years.
Category
Procurement
Phase
Transition Phase
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Procurement/Project Schedule
Period
Event
April 2010
Obtained PCC Certification of Project Initiation Phase
July 2010
Obtained CMS Approval of Estimated Project Funding
January 2011
Issued RFP
August 2011
Obtained PCC Certification of Planning Phase;
Selected Contractor
November 2011
Submitted APD Update and Contract to CMS
February 2012
Obtain PCC Certification of Implementation Phase
(initial $1.3 million to start transition/requirements);
March 2012
Contract signed; Transition and Enhancement Phases Begin
July 2012
Obtain TARC Approval of Replacement Systems;
Obtain PCC Approval of Remaining Project Budget
January 2013
New Contract Operations Begin
November 2013
Enhancement Phase Completed
March 2014
Project Closeout
December 2016
End of Base Contract
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Medicaid / IT Costs
• CMS approved costs related to Medicaid and IT:
– Medicaid includes administrative and program
– IT includes system enhancements
• Approval includes following for Transition, Enhancements and
Operations:
– Transition Phase
– Enhancements
– Medicaid Operations
[TBA after Procurement Award]
[TBA after Procurement Award]
[TBA after Procurement Award]
• This presentation focuses on initial transition and enhancement
activities.
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Key Transition Phase Activities
• Develop Master Transition/Enhancement
Work Plan
• Develop Staffing and Training Work Plan
• Develop Client/Provider Outreach and
Communication Plan
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Enhancements
• Enhancements cover changes to meet federal
mandates, increase efficiency, and improve service to
clients and providers
• Implementation cost of enhancements approved by
CMS is matched with 90 percent federal funds
• RFP included 7 required and 6 optional
enhancements
• Based on contract negotiations, HSD plans to
purchase 11 enhancements
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Disposition of RFP-Required
Enhancements
Enhancement
ICD-10
Remediation
Disposition
Purchased
Purpose
Meet national deadline to convert to new ICD-10 diagnosis
and surgical procedure codes
MARS Replacement Deleted
Replace the legacy Management and Administrative
Reporting System with a data warehouse-based system
HIPAA 270/271
Purchased
Implement eligibility verification inquiry and response
transactions to comply with HIPAA standards
HIPAA 276/277
Purchased
Implement claim status inquiry and response transactions to
comply with HIPAA standards
HIPAA 820
Purchased
HIPAA 834
Purchased
Client Eligibility
Span Dates on the
Web Portal
Incorporated into
new replacement
Web Portal
enhancement
Implement premium payment transactions for Managed
Care Organizations to comply with HIPAA standards
Implement benefit enrollment and maintenance
transactions for Managed Care Organizations to comply with
HIPAA standards
Allow providers to inquire on a span of dates when checking
client eligibility instead of a single date of service
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Disposition of RFP-Defined
Optional Enhancements
Enhancement
Web-based Direct Data
Entry
Web-based Provider
Enrollment
Client Web Portal
Electronic Billing of Other
Carriers
Disposition
Incorporated in new
Web portal
enhancement
Incorporated in new
Web portal
enhancement
Incorporated in new
Web portal
enhancement
Purpose
Allow providers to submit claims electronically via
the Web portal
Allow providers to submit enrollment applications
via the Web portal
Give clients new self-service options via a Web
portal
Purchased
Replace current paper billing of other insurance
carriers with electronic billing
Automated Processing and
Posting of Third Party
Liability Payments
Deleted
Accept electronic payment transactions from
insurance carriers and use the information to post
payments and adjust claims
NCPDP 3.0
Purchased
Implement the new National Council of
Prescription Drug Programs (NCPDP) subrogation
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Additional Enhancements
Enhancement
Disposition
Purpose
New Web Portal
Purchased
Replace the current Web portal with a new portal that
meets the RFP’s enhancement requirements (client
eligibility span dates, client-facing capabilities, webbased provider enrollment, and direct data entry of
claims)
New Fraud and Abuse
Detection System (FADS)
Purchased
Replace the current FADS with a new system with
enhanced case management and tracking capability
New Pharmacy Benefits
Management System (PBMS)
Purchased
Replace the current PBMS with a new system platform
for ease of maintenance and reduced ongoing costs
Add Workflow Component
to Electronic Document
Management System
(EDMS)
Purchased
The Workflow component will automate many
document handling processes, improve the timeliness
and quality of services, and provide enhanced tracking
and reporting for fiscal agent activities
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Final Enhancement List
• ICD-10 Remediation
• HIPAA 270/271, 276/277, 820, and 834 (four
enhancements)
• Electronic Billing of Other Carriers
• NCPDP 3.0 Subrogation
• New Web Portal
• New Fraud and Abuse Detection System
• New Pharmacy Benefits Management System
• Add Workflow Component to EDMS
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Key Enhancement Sub-deliverables
•
•
•
•
Requirements Analysis Document
Detailed Design Document
Acceptance Test Results
Implementation
These sub-deliverables also represent payment
milestones for most of the 11 enhancements.
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Procurement/Project Funding
•No formal funding request required in this phase.
•Discussion limited to public record of approved CMS funds.
•Final funding will be determined after procurement award.
Area
Initiation
Planning
Activity
o Acquire state and
federal approvals.
o Issue RFP.
o Review Proposals.
o Select Winning Proposal.
o Initiate Contracting
Process.
o Obtain State and Federal
Approvals.
Implementation and Closeout
o
o
o
o
o
Sign contract.
Initiate transition activities.
Initiate project activities.
Perform IV&V on projects.
Finalize transition to new contract.
Contracted
Services
$0
$0
$1.5 million
(previously approved for IV&V)
$1.3 million (current request)
HSD
Personnel
$0
$0
$0
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Summary
• The Medicaid State Fiscal Agent procurement is still
in progress but a contract has been negotiated with
the selected vendor.
• The Department requests approval to move from the
Planning Phase to the Implementation Phase in order
to begin requirements analysis and transition
activities.
• Certification of remaining project funds will be
requested at the July PCC meeting, following
TARC review and approval.
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