1. 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

2. MMIS Components and Functions
MMIS Replacement Project
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
Mark

3. MMIS Components and Functions (cont.)
MMIS Replacement Project
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
Mark

4. Background & Business Problem
MMIS Replacement Project
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).
Mark

5. MMISR Project Objectives & Benefits
MMIS Replacement Project
MMISR Project Objectives & Benefits
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.
Mark

6. MMISR Project Objectives & Benefits (cont.)
MMIS Replacement Project
MMISR Project Objectives & Benefits (cont.)
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
Sean / Chuck

7. MMIS Replacement Project
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
Mark

8. MMIS Replacement Project
Project Risks
Risk
Mitigation
Competing HSD and State Priorities
Provide HSD Executive Steering Committee with necessary facts for governance decisions over HSD projects to confirm objectives are met and project is successful.
Contracting Experienced and Qualified Vendors
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
Chuck

9. MMIS Replacement Project
Project Governance
Chuck

10. MMIS Replacement - Schedule Overview
MMIS Replacement Project 10
MMIS Replacement - Schedule Overview
2013
2014
2015
2016
2017
2018
2019
2020
Q1 Q2 Q3 Q4
Q1 Q2 Q3 Q4
Q1 Q2 Q3 Q4
Q1 Q2 Q3 Q4
Q1 Q2 Q3 Q4
Q1 Q2 Q3 Q4
Q1 Q2 Q3 Q4
Q1 Q2 Q3 Q4
Planning
PMO RFP
MMIS PMO
Start
Integrator
RFP Issued
Requirements
Requirements
Review
Design
Detailed Design
Review
Development
Chuck
Testing
Test
Review
Implementation
Operational Readiness Review
MMIS Certified by CMS

11. MMIS Replacement Project
Request
HSD requesting PCC Approval to Initiate this Project
Funding certification will be requested at Planning PCC (March 2014)

12. MMIS Replacement Project
Thank you…
Questions?