MMIS - New Mexico Department of Information Technology

Report
Human Services Department
MMIS Replacement (MMISR) Project
An HSD initiative to replace the Medicaid Management Information System
(MMIS)
December 18, 2013
Mark Pitcock, Deputy Director, MAD
Sean Pearson, CIO
Chuck Boudreaux, IT Project Manager
MMIS Replacement Project
2
MMIS Components and Functions
• OmniCaid Claims Engine
• Maintains recipient eligibility and provider enrollment data
• Enrolls recipients in managed care
• Pays fee-for-service claims and managed care capitations
• Processes managed care encounter data
• Pharmacy Benefits Management System
• Processes drug claims and encounters
• Fraud and Abuse Detection System
• Plan of Care Management System
• Supports payment of services for waiver recipients who self-direct
MMIS Replacement Project
3
MMIS Components and Functions (cont.)
• Supporting Systems
• Data Warehouse (Sybase)
• Business Intelligence (Cognos)
• Web Portal (provider- and recipient-facing components)
• Electronic Documents Management System (DocFinity)
• Scanning and image capture
• Optical Character Recognition (claims data capture)
• Online report retrieval
• Customer Relationship Management
• Call center support
MMIS Replacement Project
4
Background & Business Problem
• Current MMIS has been operating on a mainframe since 2002 and is
supported by a contracted vendor.
• MMIS contract includes a fiscal agent component that supports managed care
enrollment, claim payment, customer service, and other administrative functions.
• Contract costs are approximately $22.5 million annually for ongoing operations,
most of which are matched at 75% by CMS.
• The current system does not meet the Centers for Medicare and
Medicaid Services (CMS) Seven Conditions and Standards that
became MMIS requirements in April 2011.
• CMS requires each state to align with the Medicaid Information
Technology Architecture (MITA 3.0) and increase its “MITA maturity”
over time.
• Current vendor contract cannot be extended past 12/31/2019 (base
through 12/31/2016 plus three one-year options).
MMIS Replacement Project
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MMISR Project Objectives & Benefits
• Comply with CMS Seven Conditions and Standards
• HSD must submit an Implementation Advance Planning
Document for remediation or replacement of the MMIS by June
2014 or lose the 75% match for MMIS operations.
• Potential loss of $4.4 million in federal funds for the vendor
contract.
• Potential loss of $450,000 in federal funds for HSD
personnel.
• Inability to request 90% funding for future enhancements,
including federal mandates.
MMIS Replacement Project
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MMISR Project Objectives & Benefits
(cont.)
• Replace current MMIS to a cost effective system
• Leverage HSD Technology Investments
• Leverage a Shared PMO (CSES / MMIS)
• Assure compliance with state, federal, and new Medicaid
standards
MMIS Replacement Project
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Planning Approach
• Perform a State Self-Assessment (SS-A) per CMS
requirements
• Determine best option of:
• Status Quo / No Replacement
• Not a viable option due to loss of federal funding
• Upgrade Current System
• Develop a separate Solution in-house
• Transfer an MMIS solution that meets the Seven Conditions and
Standards and HSD requirements
• Possible cost/time savings if the selection is a transfer
system
MMIS Replacement Project
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Project Risks
Risk
Mitigation
Competing HSD and
State Priorities
Provide HSD Executive Steering Committee with
necessary facts for governance decisions over HSD
projects to confirm objectives are met and project is
successful.
Contracting
Experienced and
Qualified Vendors
Contract with experienced & qualified vendors with track
record of similar successful projects completed in recent
past.
More to come during the Planning Phase of this project
MMIS Replacement Project
Project Governance
9
10
MMIS Replacement Project
MMIS Replacement - Schedule Overview
Q1 Q2 Q3 Q4
PMO
RFP
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
MMIS PMO
Start
Q1 Q2 Q3 Q4
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Q1 Q2 Q3 Q4
Integrator
RFP Issued
Planning
Requirements
Requirements
Review
Detailed Design
Review
Design
Development
Testing
Test
Review
Operational Readiness Review
Implementation
MMIS Certified by CMS
MMIS Replacement Project
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Request
• HSD requesting PCC Approval to Initiate this Project
• Funding certification will be requested at Planning
PCC (March 2014)
MMIS Replacement Project
Thank you…
Questions?
12

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