May 2017

The HHS 2020 vision is about a transformational, enterprise approach to human services.

Fundamentally, HHS 2020 is about moving from a program-centric structure to a stakeholder-centric structure.

This involves moving away from program and technology silos into an integrated, flexible framework that supports service provision and stakeholder interaction across HHS programs: DOH, ALTSD, CYFD, and all of HSD.

11/7/2016 HHS 2020 3

Now Vision

We are seeking an Enterprise solution for multiple state agency partners, including all the HSD divisions, the DOH, CYFD, ALTSD and others.

We are not buying hardware, or securing a single vendor; we are pursuing Business Process Outsourcing; i.e., the procurement of service vendors to serve the entire Enterprise; we are purchasing OUTCOMES and CAPABILITY.

The Goal: reduce barriers, increase information sharing, increase service effectiveness.

From the beginning of this effort, through 2015 and 2016, representatives of all four agencies have been involved in the planning, design and procurement development of the Enterprise System (MMISR).

DOH and ALTSD also participated in the HSD State Self Assessment that was conducted in 2015 and submitted to CMS, and which has served as a guide to design of the MMISR.

The Gov’s office, LFC and DoIT also engaged and have endorsed the design and effort.

Primarily because our respective agencies: ◦ serve many of the same clients; ◦ need (largely) the same information; ◦ need a more complete picture of clients; ◦ need to avoid duplication of service or

delivery of unnecessary services; ◦ need to be able to target interventions; ◦ have infrastructure and system needs; ◦ have increased demands for demonstration of

value and effectiveness but do not have the tools to do so.

,

90% Fed Funding Available (at least as of now)

It also is the right thing to do for clients. Our Project Plan is guided and driven by the

new CMS perspective on MMIS, the need to avoid the current limitations of the legacy MMIS and the opportunity to maximize purchasing power.

Doing tomorrow what we do today

Continuing manual processes

Requiring rework

Measuring activity instead of impact

Being locked in to yesterday’s technology

Passive reporting without analysis

Medicaid-only focus

Being reactive instead of proactive

Planning without input

Sequential and Modular – Not one RFP A turn away from proscriptive requirements,

and a MAJOR reduction in the number of procedural requirements. Embracing services technology and adaptability.

The role of the State will change, from process and activity reporting to Population Health Measurement, to Vendor outcome monitoring, to validation (instead of “counting”).

The hope is that the Enterprise will be transformational for all participants.

Six Modules: ◦ System Integration

◦ Enterprise Data Services

◦ Quality Assurance

◦ Financial Services

◦ Population Health Management

◦ Unified Public Interface (and CCSC)

For each Module, multiple components, but one prime vendor.

No prime vendor can be selected for more than two modules. The SI vendor cannot win others.

Visioning – HSD and partners

MITA Self-Assessment and Defining where we wanted to be: MITA level four (4)

Approval by CMS of our Framework model, IAPDUs, MITA Self-Assessment, the IV&V RFP and contract.

90% federal match secured

Approval by DoIT, PCC and C2

Legislative approval of the State funds for MMISR

For each RFP we have meetings with and distribute a questionnaire to all Bureaus, Divisions and Partners to solicit input on needs, wishes and requirements for the various components of the module.

We have gathered information from other states, from CMS and other fed agencies, and from existing contracts and vendors.

We have held public hearings on Data Services and QA and shared info with many external partners.

The SI Vendor is to provide the Infrastructure for Connectivity, Interoperability, Standards and Security

Enterprise Service Bus, Master Indices, ID Management, Legacy Data Conversion, including data from OmniCaid

Project Integration Management for all Other Modules

Data definition and Interface standards The RFP has been released; procurement in

process

The Data Services Module will provide: Data Tools and Training Data Analytics (including GIS) Reporting (including all Federal

Reporting) Business Intelligence and Survey Tools Enterprise Data Warehouse The RFP has been released; procurement

in process

The RFP we hope to release this fiscal year (SFY17), will contain multiple components, including the following: Program Integrity ◦ Third-Party Liability (TPL) Detection, Avoidance

and Recovery ◦ Fraud and Abuse Detection and Reporting

Services ◦ Audit and Hearing Coordination, across program ◦ Quality Reporting – proactive instead of passive ◦ Recovery Audit Contracting

Member Management – a new opportunity

Provider Enrollment - across programs

Our plan is to have ALL provider enrollment, whether for the FFS program or Centennial Care (MCO participation) or from other Agencies to come through a single site.

Providers seeking CC enrollment will need to indicate which MCOs they want

The Vendor will forward approved apps to the MCO(s) or the respective state program

Proposal to be drafted in this fiscal year (after the QA RFP is finalized) to be released in summer 2017. It will contain: Claims Processing – One intake point for all

Accounting and SHARE interface

Payments ◦ Capitation, Claims and ATRs (DSH, UPL, SNCP)

Financial Activities ◦ Accounts Payables ◦ Accounts Receivables ◦ Financial Reporting (including 1099s, 1095s, and W2s) ◦ Budget, Projection and Rate Setting tools

An Outcome Focused RFP – in the fall of 2017 Pharmacy benefits management (including

rebate services) and Drug Utilization Managed Care Organization (MCO) and

waivered services management Health analytics related to population health,

outcomes and health improvement The Electronic Health Records Program Case and Care Management (including Prior

Authorizations, Care Plans, etc.) Changes to the Fee-for-Service (FFS) program

to make it more Native American responsive

Proposal date To Be Determined

Unified Portal ◦ All Stakeholders

Access across programs

Mobile Technology friendly

Other User-friendly technologies

◦ One Stop Shop - No Wrong Door

Consolidated Customer Service Center ◦ Integrated Call Center Serving All HSD Programs

and potentially those of other Agencies

Easy Info Exchange at no charge to you

Data Security and Increased Accuracy

Standardization; easy client and provider identification

Access to data across programs and agencies

Increased reporting and analytic capabilities

Expanded fraud and abuse capabilities, and audit coordination

Single provider enrollment

Claims processing capability

Federal financial support

It continues current role and… Assumes responsibility for Centennial

Care/MCO enrollment

Is enhanced with new reporting capabilities Interfaces to the SI services vendor Will eliminate the confusion that exists today

between ASPEN and OmniCaid

Access into ASPEN will be expanded. Real Time Eligibility will be made available this

year. For many Medicaid applicants, a quick determination.