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2009 NAMPI Conference

. KY Background. Medicaid is the primary payer source for health care in KentuckyCovers nearly half of all births in the Commonwealth per yearProvides health coverage to 1 out of every 3 children, and 1 out of every 7 seniors over age 65Provides coverage to approximately 740,000 enrollees, repres

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2009 NAMPI Conference

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    1. 2009 NAMPI Conference CMS Systems Certification: Kentucky�s Recent Experience

    2. KY Background

    3. KY Background 39,955 enrolled providers (as of 3/24/09) FY09 Budget = $5.54 billion FY10 Budget = $5.7 billion (projected)

    4. Certification Background MMIS Certification Modernization

    5. Certification Background Process unchanged for the past 25 years Begins 6 + months after commencement of operations MMIS defined as claims processing engine and 6+ subsystems Basis of Review--State Medicaid Manual (SMM) Part 11 requirements Reviewers rely on �checklists� covering 6 - 8 subsystems

    6. Medicaid Enterprise Certification Toolkit

    7. Certification Review Transformation

    8. Tools in the Toolkit

    9. Old Checklist Format

    10. Sample New Checklist

    11. 20 New Certification checklists

    12. SDLC and the Toolkit

    13. Certification Overview

    14. KY Procurement Lifecycle

    15. KY MMIS Project Timeline

    16. KY Certification Approach

    17. Coordination of Effort

    18. KY Documentation Points

    19. KY Site Visit Logistics

    20. KY Program Integrity Preparation Review the MITA assessment Verify the requirements related to PI Review the Implementation APD Verify the requirements have been met Review the RFP and proposal Verify the requirements related to PI Certification Toolkit Verify the requirements related to PI

    21. KY Program Integrity Preparation Assigned reviewers (two) to verify the checklist documentation An SME and a person not as familiar with PI Checked each answer on the checklist/protocol Does it adequately answer the question? Did we attach enough documentation? Does it illustrate functionality from �Go-Live�? Etc.

    22. KY Program Integrity Preparation Reviewer walkthrough of the system Reviewers performed a functional walkthrough of the system Does the system function according to the documentation provided? Do the screen prints match the system? Do all of the reports work correctly? Etc. Does the system match the APD, MITA assessment, RFP etc? (this should only be a cursory check at this point in the process)

    23. KY Program Integrity Preparation Prepared Staff Assigned an �interviewer� Performed mock interviews with staff Job function Processes used Describe reports used Demonstrate use of the system Select random reports to generate Ensured staff understood the checklist Reassured staff Prepared Business Partners

    24. Other Items Review the last PI Audit (ensure any deficiencies have been addressed) Address defects (a large number of defects could indicate issues) Change orders (a large number of outstanding change orders could indicate issues) TPL Action Plan (up-to-date?) Suspended/Denied Claims (higher than before?) Reporting (who, what, when, where) MSIS Files (up-to-date?)

    25. CMS Certification

    26. Questions and Comments

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