Change Request: Medicaid Management Information System Enhancements Project 2012 - 2014

1. Change Request: Medicaid Management Information System Enhancements Project 2012 - 2014 Presented toProject Certification Committee December 19, 2012 Presenters: Mark Pitcock, Deputy Director, HSD/MAD Linda Gonzales, Systems Bureau Chief, HSD/MAD Wayne Pendley, Medicaid IT Project Manager, HSD/ITD

2. Background • Medicaid State Fiscal Agent: • Supports payment and operational services for Medical Assistance Division • Services range from direct service to hosting OmniCaid payment application • State Fiscal Agent contract provides many services and functions beyond IT operations • Enroll providers, process claims, enroll Medicaid recipients in managed care plans, distribute forms and publications, etc..

3. 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:

4. 2010 RFP Objectives • Open State Fiscal Agent services/professional services to solicitation • Organize successful transition to new State Fiscal Agent contract including: • Transition of Medicaid Management Information System (MMIS) • Transition of MMIS Data Warehouse • Transition to supporting peripheral systems/professional services (Pharmacy, etc.) • Successful implementation of MMIS enhancements.

5. Procurement/Project Schedule

6. Procurement/Project Organization Overall organization based on internal HSD staff with coordinating input from other agencies

7. Medicaid / IT Costs • CMS approved costs related to Medicaid and IT: • Medicaid includes administrative and program • IT includes system enhancements • CMS approvals for Transition, Enhancements and Operations: • Transition Work $ 623 K • Enhancements $ 12,062 K • IV&V Enhancements $ 792 K • Medicaid Operations $ 95,404 K • This PCC Project includes all costs except Operations.

8. 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 purchased11 enhancements in the March 2012 contract • Two CMS-required “HIPAA Operating Rules” plus one for Centennial Care brings enhancement total to 14.

9. Disposition of RFP-Required Enhancements

10. Disposition of RFP-Defined Optional Enhancements

11. Additional Enhancements

12. Changes Since Last PCC Certification • CMS delayed the mandated ICD-10 deadline by one year – until October 1, 2014 • HIPAA Operating Rules required for eligibility and claim status by January 1, 2013 • Penalties of up to $1.5 million for non-compliance • HIPAA Operating Rules required for Electronic Funds Transfer and Electronic Remittance Advice (EFT/ERA) by January 1, 2014 • Requires an assessment of current MMIS and translator capabilities • Centennial Care DDI work estimated at $ 997 K • PPACA and Centennial Care require major changes in the MMIS • Today’s funding request accounts for these changes

13. Final Enhancement List • ICD-10 Remediation • HIPAA 270/271, 276/277, 820, & 834 (four enhancements) • Electronic Billing of Other Carriers • New Web Portal • New Fraud and Abuse Detection System • New Pharmacy Benefits Management System • Add Workflow Component to EDMS • NCPDP 3.0 Subrogation (optional) • HIPAA Operating Rules (Phase 1 + Phase 2 Assessment) • Centennial Care DDI

14. Key Deliverables for Each Enhancement • Requirements Analysis Document • Detailed Design Document • Acceptance Test Results • Implementation These Deliverables also represent payment milestones for most of the 14 enhancements.

15. Procurement/Project Funding • 11 MMIS Enhancements in March 2012 contract • 2 added for CMS-required HIPPA Operating Rules • 1 added for Centennial Care • These 3 new enhancements require a 3.3% increase in APDU budget ($3.5M over $106.6M approved)

16. Summary • HSD requests renaming of this HSD project from “MMIS Re-Bid RFP” to “MMIS Enhancements” to better communicate the remaining work • Current baseline costs for Contract Transition + MMIS Enhancements + IV&V total: $13,477,226 • PCC has previously certified $2.8 M for requirements analysis, IV&V and contract transition work. • HSD requests certification of remaining $10,677,226 to complete DDI work on these 14 MMIS Enhancements.