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

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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

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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

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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).

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MMISR Project Objectives & Benefits

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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

MMISR Project Objectives & Benefits (cont.)

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• 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

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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

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Project Risks

Risk

Competing HSD and State Priorities Contracting Experienced and Qualified Vendors

Mitigation

Provide HSD Executive Steering Committee with necessary facts for governance decisions over HSD projects to confirm objectives are met and project is successful.

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

Project Governance

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MMIS Replacement Project MMIS Replacement - Schedule Overview 10

Q1 Q2 Q3 Q4 PMO RFP Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

MMIS PMO Start

Planning

Integrator RFP Issued

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Requirements

Requirements Review Detailed Design Review

Design Development Testing

Test Review Operational Readiness Review MMIS Certified by CMS

Implementation

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Request

• HSD requesting PCC Approval to Initiate this Project • Funding certification will be requested at Planning PCC (March 2014)

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Thank you…

Questions?