1. Cactus Enhancements Project
Date: November 13, 2018
Presenters: Terry Reusser – NMDOH CIO
Janice Gonzales, MD PHD FHB Kim Price - Project Manager
Certification Phase: Initiation
1190 S. St. Francis Drive • Santa Fe, NM • Phone: • Fax: • nmhealth.org

2. Background Information
The New Mexico Department of Health (DOH), Public Health Division (PHD) is charged with providing health care services in New Mexico to women, youth and children who have chronic medical problems and disabilities or who do not qualify for Medicaid or other insurance. This project focuses on improving PHD’s ability to provide access to health care services for the State’s neediest populations by enhancing its case management system (CACTUS) to couple with Human Services Department’s (HSD) enterprise Medicaid Management Information System-Replacement (MMIS-R) to enhance the current electronic information exchange for clients resulting in improved access to care, provision of services, outreach and provider billing.
In 2016, PHD launched CACTUS, a case management information system for multiple PHD programs including Children’s Medical Services (PHD-CMS), Families FIRST (Families and Infants Receive Services and Training) and other programs.
PHD bills Managed Care Organizations for services as part of its revenue stream.
PHD has an established relationship with HSD for PHD-CMS client enrollment and authorization activities as well as provider billing and payment services in the Medicaid system.
PHD enrolls over 800 CMS providers to provide services for the program in the Medicaid system
DOH will receive a Federal 90/10 match through a GSA with HSD.

3. Funding Request and Sources:
For this Initiation Certification, we are requesting $XXX,XXX
For FY19-20, C2 funds were granted by the legislature in the amount of $XXX,XXX for this project with a Federal 90/10 match rate through HSD

4. Business Objectives
Maintain fiscal relationship with HSD/Medicaid to guarantee a mechanism to reimburse providers for services rendered to CMS clients through MMIS-R Enhance business staff productivity by providing digital access to document artifacts
Add enhancements to the current system to support bi-directional exchange of CMS eligible clients, prior authorizations and third party liability information with MMIS-R
Maintain access to Medicaid system to monitor provider enrollment, claims, billing errors and authorizations
Streamline provider enrollment into the Medicaid system to include opportunity to enroll as a DOH/CMS provider through provider portal.
Provide the capability of PHD-CMS to transmit claims to MCOs or through a clearinghouse
Increase the number of clients reached by utilizing eligibility reports or lists received via the secure electronic transfer of data between the state Human Services Department and the Families FIRST program.

5. Technical Objectives
Interface with MMIS-R to improve bi-directional automation of information exchanges of client, eligibility, prior authorizations and TPL. Define requirements to modify and increase functionality of the CACTUS application and test enhancements to the application to insure proper functionality
Interface with MMIS-R to enroll providers as DOH CMS specific providers and to manage provider agreements.
Eliminate paper and manual processing by enhancing system to send and receive HIPAA compliant claims transactions to bill managed care organizations or send through a clearing house, to save staff time
Interface with MMIS-R to streamline validation of Medicaid clients.
Improve client outreach by interfacing with MMIS-R to streamline pregnancy related referrals of Medicaid clients.

6. Tentative Schedule

7. Project Organization

8. Questions?