MMIS Modernization Update

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2 MMIS Modernization Update Project name assigned Illinois Michigan Program Alliance for Core Technology MaaS (MMIS as a Service) is the acronym we are using in reference to the new MMIS until an Illinois specific branding name is chosen. Cognosante is re-engaged to provide planning and IV&V services MMIS Expert Services contract is pending final state CPO/Federal approval Governance structure for joint state project management getting closer to being final HIT IAPD-U and MMIS PAPD-U are expected to be approved mid-april Feds indicate implementation work for EHR/PIP and Provider Enrollment can begin when federal approval is obtained DDI (Design, Development, Implementation) for Core MMIS can also begin Illinois to visit Michigan April rd to discuss project administrative items such as Statements of Work, Service Level Agreements, Infrastructure as a Service cloud strategy, and preparation for kick-off of EHR/PIP and Provider Enrollment. 2

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4 Background - Illinois Illinois has established the following requirements for a new MMIS. The replacement MMIS: must already exist and be federally certified in at least one Medicaid environment; will be based upon the Medicaid Information Technology Architecture (MITA) framework approach mandated by the Centers for Medicare and Medicaid Services (CMS); will have reached a MITA maturity level 2 or above for all Medicaid business processes; must also meet the seven standards and conditions promulgated by CMS in its April, 2011 directive; must be fully Health Information Portability and Accountability Act (HIPAA) compliant and remain compliant with all Federal requirements as a condition of the contract. will support a self-administered Medicaid business model, where in the Department will retain control over its administrative and fiscal functions. will include a rules engine to facilitate the configuration of logical processes within the system, which will allow for easier modifications. 4

5 Background Michigan MMIS Community Health Automated Medicaid Processing System (CHAMPS) New Web-Based, Rules-Driven, Real-Time Adjudication Medicaid Management System Live since September 2009 Federal Requirements Certified by CMS in August 2011 Compliant with HIPAA 5010 Compliance with ICD-10 by 2014 Compliance with ACA (Provider Credentialing and CORE Operating Rules) by end of 2013 Compliance with EHR Incentive Program meeting Stage 1 Meaningful Use CHAMPS Technology Modular Framework with COTS integration Aligns to CMS Seven Standards and Conditions Hosted in the State of Michigan Infrastructure with high availability 5

6 Synergy Both MI and IL use the same vendors for their Enterprise Data Warehouse and will be supported by MaaS. (Teradata and Optum) Illinois is currently a Fee For Service state that is transitioning to Managed Care. MI has made that transition and will be able to assist IL in that transition. Illinois IES is based on the Michigan Bridges eligibility system. Both MI and IL MMIS use JSURS for the exception processing system, and is included in the CMS certified MMIS. 6

7 MaaS Rationale The benefits of using MaaS as the Illinois replacement MMIS: Time Reduce time for operational compliance. Reduce the lengthy procurement and contracting process. Reduce system implementation time. Cost Reduce CMS and State Investment. Cost sharing for future enhancements and initiatives. Reduce costs for implementation, maintenance and operations. Risk Mitigate overall risk. Leverage the fully operational, Federally Certified MI MMIS System. Leverage MI Medicaid experience and lessons learned. 7

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9 Cost Analysis: Illinois Implementation Implementation Cost Breakdown $200 Total $190M $175 $150 $125 $100 $75 Planning $15 Infrastructure $25 DDI/SI $150 Total $85M Planning $5 Infrastructure $15 Assumptions: Implementation uses a 90/10 CMS/State Split Infrastructure includes hardware and software licensing. Stabilization is included in DDI. $50 $25 DDI/SI $65 $0 IL Standalone MaaS 9 (All numbers rounded to the nearest million.)

10 Cost Analysis: Implementation Cost / Federal Match IL $19M CMS $171M IL Standalone MaaS option saves IL $100m in up front expenditures Implementation uses a 90/10 CMS/State Split IL Share $9M CMS $76M MaaS 10

11 Time Comparison MaaS The State is responsible for 100% of operating cost until certification ends; Federal reimbursement is retroactive once certification occurs Il Standalone 11

12 Benefit Summary: Operations and Maintenance 5 Year Michigan Savings STATES Standalone Cost: $40M Maas Cost: $33M Difference: Illinois Savings $ 7M 18% Savings Standalone Cost: $90M MaaS Cost: $33M Difference: $57M 63% Savings CMS Savings FEDERAL CMS Savings Standalone Cost: $386M MaaS Cost: $190M Difference: $196M 51% Savings 12 Assumptions: 75/25 Federal/State Split. 2% annual inflation assumed. State staff cost is not included All projections based on FY2013. States share MaaS costs equally. Infrastructure includes server hosting, licensing, equipment upgrades..

13 13 Technology and Infrastructure

14 Federal Perspective 14

15 Solution Framework: Shared Model Initial implementation model to support rollout of Provider Enrollment (PE) and EHR Incentive Payment Program (emipp) Web Phone Mobile Notifications Dashboard Michigan Presentation Layer Single Sign-On Illinois Presentation Layer Single Sign-On Configurable Module CHAMPS Business Layer emipp Module Core Functions Database Tenant Specific Features COTS Configurable Module PE, emipp Business Layer emipp Module Core Functions Database Tenant Specific Features COTS Leverages State Of Michigan Infrastructure that currently supports CHAMPS FileNet Document Repository EDI Validation & Translation Cognos Reporting Interfaces File Exchanges COTS Siebel CRM Credentialing Provider Adjudication RuleIT Grouper ClaimsSure FileNet Document Repository RuleIT Provider Enrollment COTS Interfaces File Exchanges Siebel CRM Credentialing Provider 15 Separate installation of required Software Components to support Illinois PE and emipp rollout IaaS DEG Exchange Gateway Networking Shared Infrastructure Services Storage SAN & NAS Telecom Hardware Servers Monitoring Software Licensing Disaster Recovery

16 Solution Framework: Cloud Model (ecams HCE 2.0) Framework to align to CMS Cloud Reference Architecture Model SaaS (Software as a Service) PaaS (Platform as a Service) IaaS (Infrastructure as a Service) Leverages 16 Single Code Base Shared middleware with multiple application instances Sharing Core Services using mediation layer Separate database providing data isolation Shared Infrastructure

17 Technology Strategy and Approach Leverage Virtualization Agnostic to Underlying Hardware and OS Support Multiple Platforms (Oracle, IBM, Redhat) Support for Standards-Based Middleware Optimized for Virtualization Reuse of COTS products IaaS SaaS Isolate Core Transaction Data Set Balance of Design vs. Run Time Shared Assets Cloud Service Mediation Framework Scalability and Adaptability for Multiple Tenants Guiding Principles for MMIS in Cloud PaaS Domain-Specific Principles Private Cloud Phased Approach to Cloud Enablement Tenant Portability Tenant Flexibility 17

18 Infrastructure 18 Private Cloud Solution will be hosted by the State of Michigan (SoM) Initial infrastructure investment greatly reduced; only those items not shared with Michigan need be purchased. Leverage existing SoM Infrastructure: Facilities Telecom Security Networking Disaster Recovery Storage Servers Upgrade infrastructure to align to proposed cloud model: Hardware COTS Software Licensing Hosted Software Applications & Features Middleware Application Framework Operating Systems Windows, Linux, UNIX

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20 Benefits Illinois Compressed procurement and contracting process Compressed Implementation Timeline (33 months versus 60 months) Cost sharing for future enhancements and initiatives Leverage Michigan s knowledge base of established processes and lessons learned Reduction of implementation, infrastructure and operation costs (approximately 63%) Compliance with Federal Mandates including 7 Standards and Conditions and MITA 3.0 CHAMPS- Federally certified system No loss of Federal reimbursement during Certification process $100m less in up front expenditures 20

21 Proposed Timeline (by Quarter) Jan 2013 Apr 2013 Jul2013 Oct2013 Jan 2014 Mar 2014 Dec 2015 Jan 2016 emipp Jun2013 EHR Medicaid Incentive Payment Program (emipp) Provider Enrollment (PE) Planning Fit Gap Sessions Development Testing Training PE Jan 2014 MMIS Core IGA, Project Plans & Planning Fit Gap Development Testing Training Jan 2013 Jan

22 Prepare for Ready Set... GO!!! IGA planning approval Determine architectural direction (Cloud vs. SSO) April 2013 Federal MMIS PAPD-U approval April 2013 Federal HIT (emipp) IAPD-U approval PE Implementation EHR/PIP Implementation Core MMIS Design 22

23 Contract Strategy States Approach to MI contracts will be updated to include Statement of Work (SOW) for IL and other states. IL-MI IGA will be modified to include specific SOW for components included in the service offering, i.e. Provider Enrollment, e-mipp, SLAs, Provider Enrollment Help Desk Federal CMS will review and approve for funding: MI Contracts & SOW IL-MI IGA & SOWs All subsequent APDs

24 Needs HFS Executive decision to proceed with project Do we need an additional DM or other vehicle to ratify? OAG involvement once project is initiated HFS OPM/OIA/OGC involvement to ensure contractual and other legal, procurement and audit needs are met. IGA Amendments to include: Statement of Work (SOW) for each implementation Service Level Agreements Documented Joint Governance Structure 24