MMIS Upgrades and MITA 3.0

Transcription

1 MMIS Upgrades and MITA 3.0 Charles Lehman, Director of State Systems, CMCS Bill Schuh, Principal, CSG Government SoluEons Jacque Gombach, Business Development Manager, SoIware AG

2 The CMS PerspecEve Charles Lehman Director of State Systems, CMCS

3 Agenda Ø The State Self Assessment (SS- A) Process Ø The Gateway to 90% FFP Ø Ensuring Progress towards MITA Maturity Ø Timing of Eligibility and Enrollment Release Ø Next Steps

4 IntroducEon Ø The SS- A is the state s way to: ü Review strategic goals and objeceves. ü Measure the maturity of business, informaeon, and technical capabiliees. ü Develop target capabiliees that allow transformaeon of its State Medicaid Enterprise. ü Inform federal partners of the state s strategic plans.

5 Purpose Ø Provide a structured method for documeneng and analyzing a state s current Medicaid business enterprise. Ø Align SMA business areas to MITA business areas and business processes. Ø Enable the SMA to use defined levels of business maturity to help shape the future vision of its State Medicaid Enterprise. Ø Provide the foundaeon for a gap analysis that will support the state s transieon planning. Ø Facilitate the MITA Maturity Model Roadmap (MITA Roadmap) Ø Focus the APD to reflect current project funding requests and idenefy what is achievable.

6 Uses for the SS- A Ø Document state requirements Ø Prepare and review APD Ø Prepare RFP Ø Evaluate proposals Ø NegoEate contracts Ø Monitor Design, Development, and ImplementaEon (DDI) Ø Evaluate and approve new solueons

7 Overview of the SS- A

8 The Seven CondiEons and Standards Ø Modularity Ø Advance the MITA Maturity Level Ø Meet Industry Standards Ø Promote Sharing, Leverage and Reuse Ø Support Business Results Ø Meet Program ReporEng Requirements Ø Be Interoperable by supporeng seamless coordinaeon and integraeon

9 MITA Roadmap Ø A MITA Roadmap addresses goals and objeceves, as well as key aceviees and milestones, covering a 5- year outlook for proposed system solueons, as part of the APD process. Ø The SMA will update the MITA Roadmap document on an annual basis. Ø States should demonstrate how they plan to improve in MITA maturity over the 5- year period and their anecipated Eming for full MITA maturity. Ø States should ensure that they have a sequencing plan that considers cost, benefit, schedule, and risk. Ø States ensure that their BA conforms to COO and BPM distributed by CMS for specific business funceons, or idenefy divergences.

10 Maturity Levels Ø Level 1 Comply the mandatory changes but lack technical flexibility. Program changes are costly and Eme consuming to implement. Ø Level 2 Introduce elements of flexibility in program design and seleceon of technology driven by requirements to manage costs and implement new programs. Ø Level 3 Focus on adopeng naeonal standards, collaboraeng with other agencies in developing reusable business processes, and promoeng one- stop- shop solueons for providers and consumers. Agencies encourage intrastate data exchange. Ø Level 4 Benefit from widespread and secure access to clinical data and focuses on improvement of healthcare outcomes, empowering beneficiaries and provider stakeholders, measuring objeceves quanetaevely, and ensuring overall program improvement. Ø Level 5 Focus on fine tuning and opemizing program management, planning and evaluaeon since it has benefited from naeonal (and internaeonal) interoperability and previously noted improvements that maximize automaeon of rouene operaeons.

11 TransiEon Period for Compliance with the Seven CondiEons and Standards Ø New MMIS Ø MMIS Development already underway Ø MMIS in Maintenance and OperaEons

12 New MMIS Ø If you are planning a new MMIS you should begin that planning now using a SS- A. Ø The SS- A will be included in the IAPD.

13 New MMIS Currently in Development Ø You already have an Approved APD for 90% FFP. Ø Within 14 months of the effective date of the Final Rule you need to submit an IAPD detailing how you intend to meet the 7 Conditions and Standards.

14 MMIS in Maintenance and OperaEons Ø Within 38 Months of the effective date of the Final Rule you must submit an IAPD with plans to upgrade or modify systems to meet the 7 Conditions and Standards.

15 Monitoring Ø Front- end. APD Review and Prior Approval Processes. Ø Back- end. ü CerEficaEons of the Systems CapabiliEes ü Ongoing Performance Monitoring through data automaecally generated by the Systems.

16 Timing of Eligibility and Enrollment Release Ø Business Architecture based on the Final Rule is in the final stages of compleeon and should be issued shortly. Ø E & E Performance metrics will follow in a Federal Register NoEce for public comment.

17 Next Steps Ø Stay Tuned for updates. Ø Begin planning for your SS-A. Ø Ask for guidance from us. Ø Submit an APD.

18 MITA 3.0 and the State Self- Assessment (SS- A) Bill Schuh, Principal Director of Healthcare and Human Services CSG Government SoluEons (217)

19 Overview of Changes Ø The MITA Framework incorporates updates and new guidance on several legislaeve inieaeves and direceves available 10/2011 ü HIPAA, ICD- 10, 5010, NCPDP, CHIPRA, ARRA, HITECH ü Affordable Care Act Medicaid Program; Federal Funding for Medicaid Eligibility DeterminaEon and Enrollment AcEviEes (90/10 Rule) Enhanced Funding Requirements: Seven CondiEons and Standards Guidance for Exchange and Medicaid InformaEon Technology Systems ü Not released in -me for inclusion: Eligibility Changes Final Rule

20 Overview of Changes Ø Revised business process model to include current business procedures and rules ü Local, regional, and naeonal informaeon exchanges Electronic Health Records (EHR) EHR IncenEve Program RegistraEon and AjestaEon System Health InformaEon Exchanges Health Insurance Exchanges ü Division of financial aceviees from operaeonal aceviees ü Withheld: Member Eligibility and Enrollment as well as Member Management (8 business processes and capability matrices)

21 Overview of Changes Ø Expansion of current informa<on data standards guidance for Health Care and Health Insurance industries Ø AddiEon of current technological advancements such as business rules engines, cloud compueng, enterprise architecture, and performance monitoring Ø Expansion of technical services and technical standards guidance for Enterprise Architecture Ø Guidance for State Self- Assessment, APD Process and MITA Roadmap ü May con-nue SS- A planning ac-vi-es and proceed to conduct SS- A without Eligibility & Enrollment content

22 Business Architecture 3.0 Ø New content to reflect federal inieaeves, programs, and legislaeon that influence the MITA Framework Ø Expansion of the Concept of Opera<ons for the State Medicaid Enterprise Ø ModificaEon of the Maturity Model Matrix Ø Expansion of Business Process Model to ten (10) business areas and eighty (80) business processes Ø Expansion of Business Capability Matrix to include Level 4 and 5 definieons Ø Guidance for Performance Monitoring MITA 3.0 does not include Eligibility & Enrollment for Member and Member Management business processes (8 business processes withheld)

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24 InformaEon Architecture 3.0 Ø Inclusion of Summary of Components Ø Inclusion of Data Management Strategy (DMS) Ø Expansion of the Conceptual Data Model (CDM) Ø Expansion of the Logical Data Model (LDM) Ø Industry standards are idenefied as structured data standards or vocabulary data standards Ø AddiEon of Informa<on Capability Matrix (ICM)

25 Technical Architecture 3.0 Ø Enhanced detail and guidance on how the federal inieaeves and other similar legislaeon change the Medicaid Enterprise Ø Enhanced Technical Management Strategy to include business rules engines, cloud compueng, enterprise architecture, and performance monitoring Ø Enhanced Business Services and Technical Services Ø Inclusion of Applica<on Architecture Ø Expansion of Technology Standards to align with Seven CondiEons and Standards Ø AddiEon of Technical Capability Matrix (TCM)

26 State Self- Assessment 3.0 Ø New Companion Guide with relevant informaeon for conduceng the SS- A Ø Guidance on assessing As- Is and To- Be capabili<es Ø Guidance on suppor<ng evidence references Ø InformaEon on other uses for SS- A results Ø Guidance on MITA Roadmap, Concept of Opera<ons, Business Process Models, and APD Overview Ø Tools such as profiles and scorecard templates Ø Appendix with Seven Condi<ons and Standards Maturity Model and Capability Matrix

27 New to MITA Framework 3.0 Ø Expansion of acronyms and abbrevia<ons Ø AddiEon of glossary of MITA terms Ø AddiEon of MITA At- A- Glance summary Ø AddiEon of Quick Reference Guide for topics of interest Ø AddiEon of Crosswalk from 2.01 to 3.0 business process models Ø Incorporated plain language guidelines from the Plain WriEng Act of 2010

28 Next Steps Ø Review Framework 3.0 Ø Complete State Self- Assessment within 12 months of complete 3.0 publicaeon ü Date will be determined by release of Eligibility and Enrollment arefacts Ø Establish plan for annual updates

29 Making MITA Real Jacque Gombach Business Development Manager SoIware AG

30 Change Agent Framework for MITA Reuse of common elements Monitor, Alert (Real-time) (BAM) Outcome Repeat Legacy App

31 ObjecEons Ø Too Complicated too many business processes and interaceons ü Take one business process at a Eme Ø ExtracEng business rules from legacy system is difficult ü Tools exist to accomplish Ø TheoreEcal and experimental ü Now proven and tested. The state of the art has evolved.