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MMIS Re-Bid of Fiscal Agent Services

MMIS Re-Bid of Fiscal Agent Services. Human Services Department February 22, 2012. Current Procurement Status. RFP Released January 28, 2011 Proposals received April 20, 2011 Proposals evaluated by DOH and HSD and a vendor selected

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MMIS Re-Bid of Fiscal Agent Services

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  1. MMIS Re-Bid of Fiscal Agent Services Human Services Department February 22, 2012

  2. 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.

  3. 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..

  4. 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

  5. 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.

  6. Procurement/Project Organization Overall organization based on internal HSD staff with coordinating input from other agencies To be determined based on award of contract.

  7. 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:

  8. Procurement/Project Schedule

  9. 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 [TBA after Procurement Award] • Enhancements [TBA after Procurement Award] • Medicaid Operations [TBA after Procurement Award] • This presentation focuses on initial transition and enhancement activities.

  10. Key Transition Phase Activities • Develop Master Transition/Enhancement Work Plan • Develop Staffing and Training Work Plan • Develop Client/Provider Outreach and Communication Plan

  11. 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

  12. Disposition of RFP-Required Enhancements

  13. Disposition of RFP-Defined Optional Enhancements

  14. Additional Enhancements

  15. 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

  16. 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.

  17. 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.

  18. 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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