1. Human Services Department MMIS Replacement Project
PCC Change Request for Certification and Release of Funds
March 28, 2018

2. Medicaid Management Information System Replacement (MMISR) Project
Project Team
Medicaid Management Information System Replacement (MMISR) Project
Nancy Smith-Leslie, Director, Human Services Department (HSD) Medical Assistance Division (MAD)
Linda Gonzalez, Deputy Director, MAD
Sean Pearson, CIO, HSD
James Lilly, Health & Human Services (HHS) Project Director
Gary Rees, MMISR Project PM Lead

3. Project Stakeholders & Governance
MMISR Project Stakeholders
NM Human Services Department
HSD Office of Inspector General
NM Office of Attorney General
NM Department of Information Technology (DoIT)
Centers for Medicare and Medicaid Services (CMS)
HHS 2020 Steering Committee
HSD Fair Hearings Bureau
Indian Health Services
Medicaid Managed Care Organizations & Service Providers
NM Department of Finance and Administration

4. Project Stakeholders & Governance
MMISR Project Governance
Three entities provide formal project governance:
State project oversight by NM DoIT
Federal project oversight by CMS
Transactional oversight via embedded team members by Independent Verification & Validation service of CSG, Inc.

5. Overview & Background
MMISR project charter signed in 2014 with a forecast completion date in 2021 and APD approved in 2014.
MMISR replaces a system that annually processes 10 million transactions totaling $6 billion in medical care for 900,000 New Mexicans through 27,675 providers and 4 Managed Care Organizations (MCOs).
MMISR project creates a client-centric business solution that delivers services to New Mexico’s citizens as effectively and efficiently as possible.
MMISR is 90% funded by CMS and 10% funded by the New Mexico State General Fund (90/10 funding).
MMISR is the foundation for additional development within New Mexico’s Health & Human Services (HHS) enterprise.

6. Project Approach & Management Strategy
HSD Information Technology Division (ITD) formed a Project Management Office (PMO) to lead the project, in coordination with the MMISR business sponsor, MAD.
This State PMO will work within DoIT oversight through all phases of the project.
The project will develop and deploy a Medicaid Management Information System (MMIS) that can be certified by CMS.
CMS requires the deployment of a modular MMIS. The project will employ contactors to deploy five modules comprising the new MMIS.

7. Solution Details
SI contractor – Develop, Deploy & M&O for the SI platform. Oversight of integration and interoperability of all modules. Oversight of module contractors during project execution.
Data Services (DS) contractor – Data aggregation, Data Warehouse, Business Intelligence and State & federal reporting.
Quality Assurance (QA) contractor – Fraud and Abuse Detection, Audit and Hearing Coordination, Third-party Liability, and Recovery Audit Contractor.
Benefit Management Services (BMS) contractor – Provider enrollment, Provider & Member Management, Pharmacy Benefits Management, MCO Services, EHR, and Health Analytics.
Financial Services (FS) contractor – Claims Processing, Accounting, and Payments.
Consolidated Customer Service Center – Contact Center for Medicaid program and related NM HHS organizations.

8. Accomplishments & Status * See MMISR PCC supporting expenditures.xlsx
Contracted for PMO staff & artifacts (contract ended early)
Established State-led PMO
Completed MITA state self-assessment
Enhanced Automated System Program and Eligibility Network (ASPEN) system to meet current CMS standards for enrollment and real time eligibility
Received approval from CMS for SI, DS & QA RFPs
Executed contract with SI vendor
In negotiations with DS vendor
QA RFP issued
BMS and FS RFPs in development
Developing a Unified Portal for HHS customers and an associated Consolidated Customer Service Center with initial roll-out of internal- facing portal for HHS entities - completion by December 2018

9. Risks
An aggressive schedule may result in delayed deployment. HSD is transferring this risk by agreement with the module vendors to deploy or provide services in a compressed timeframe.
A highly complex undertaking with many stakeholders may be difficult to successfully manage. To mitigate this risk HSD has implemented a dedicated PMO for the project and will leverage the module vendors to coordinate activities.
Undocumented RFP and contract review timelines and requirements may pose delays to procurement activities for multiple MMISR modules.
Project resource estimating (staff levels) are incomplete. Lack of certainty on needed positions and time to fill positions may cause delays in the project.
The project does not have a finalized communications plan. Some stakeholder messaging may be incomplete resulting in partial commitments and participation in the project.

10. Justification for Change in Certification
This request is for the certification of $13.3 million, a portion of the $ million appropriated in SFY17. These funds will be used to transition the project to the implementation phase by undertaking the contract with the Integration Platform vendor and completing project planning efforts.
Amount Requested this Certification
$13,347,700.00
Amount Previously Certified
$37,089,900.00
Remaining Appropriation not Certified
$104,309,300.00
Total Appropriated Amount (include any new funds)
$153,857,000.00
Describe the high level proposed budget and this request.
Show the various funding sources used to support the proposed request (& total budget where applicable).
Include phasing options, if applicable- What are the viable options available to implement the solution? Include options for phased funding should limited funds be available.
Highlight cost savings and efficiencies, and ROI
Include prior/other funds if available
Show TCO

11. Questions