Medicaid Modernization

Medicaid modernization encompasses the entire enterprise — policy, processes, systems, and organization.”

Rob Guenther, Senior Principal, Healthcare and Human Services Practice
Rob Guenther

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Medicaid Modernization

A comprehensive approach to program and MMIS modernization is critical to the success and sustainability of the Medicaid enterprise. Drawing on the expertise and experience of CSG can help you maximize the return on your investment in Medicaid modernization.

CSG'S Expertise in Action

 
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Modernizing Medicaid in Ohio

 
Columbus
Columbus

The Ohio Department of Medicaid (ODM) has a network of more than 83,000 active providers and delivers health care coverage to 2.9 million Ohio residents. To ensure it provides the most efficient care and leverages technical advancements within the national Medicaid landscape, ODM is launching an initiative to modernize its current MMIS.

Strategic MMIS Planning and Procurement Support by CSG

ODM selected CSG to develop a comprehensive strategy and provide procurement support services for modernizing its Medicaid enterprise. CSG is working with ODM to identify reusable components via the State’s MITA SS-A to achieve higher MITA maturity levels and maximize federal funding. CSG is assisting the State in analyzing MMIS operational model options, determining implementation priorities, and sequencing modular components. CSG supports ODM throughout the procurement process to define requirements, develop RFP(s), and provide vendor evaluation and selection support.

ODM is committed to modernizing Medicaid in Ohio. CSG is here to help the State meet its objectives and maximize its return on investment.

Transitioning to a Managed Care Model

 
Des Moines
Des Moines

The Iowa Medicaid Enterprise (IME) administers the State’s Medicaid program for over 560,000 Iowans. IME is transitioning from a traditional Fee-For-Service (FFS) claims payment model to a Managed Care Organization (MCO) reimbursement model. To better serve the members of its community, IME has contracted with several professional and systems services providers to support the operations of the Medicaid program.

Research, Planning, and Procurement Support by CSG

IME selected CSG to develop a holistic approach to help the State define and build a foundation for its Medicaid enterprise and affiliated professional and system services that aligns with the operational needs of the new MCO model. We are providing research and planning support to help IME navigate the changing Medicaid landscape and obtain enhanced federal funding in accordance with MITA and the new CMS guidance for certification criteria and modular system standards. CSG is also defining RFP-ready requirements that are mapped to the new MECT 2.0 checklist, developing RFPs and Advance Planning Documents (APDs), and assisting in the evaluation of bids and contract negotiations to procure qualified vendors to support IME operations moving forward. Once vendors are procured, CSG provides ongoing PMO and project management support to assure an efficient transition from the current operational contracts to the future Medicaid environment.

IME is working to advance the State’s vision of improved quality and access to health care services, accountability for outcomes, and a more predictable and sustainable Medicaid budget. CSG is here to help.

Virginia's Medicaid Enterprise Modernization

 
Richmond
Richmond

The Virginia Department of Medical Assistance Services (DMAS) administers the Commonwealth’s Medicaid program for over 950,000 Virginians. In order to provide high quality and cost effective services, DMAS is transitioning from a legacy mainframe MMIS to a modular, interoperable solution that encompasses the entire Medicaid enterprise.

Requirements Definition and Procurement Support by CSG

DMAS engaged CSG to provide procurement support services, including assistance for incorporating the new CMS modularity standards and aligning the new Medicaid enterprise system plans with the Commonwealth’s MITA 3.0 SS-A. We are helping define RFP requirements across each of the modular components, develop the RFP documents, and support federal funding by developing the Implementation Advance Planning Documents (IAPD) and federal budget tables for CMS.

DMAS is committed to transitioning to a holistic Medicaid enterprise model which provides a system of high quality and cost effective health care services for Virginians and their families. CSG is here to help navigate the changing Medicaid landscape to ensure Virginia meets its goals.

Developing the Strategy to Modernize Missouri’s MMIS

 
Jefferson City
Jefferson City

The Missouri Department of Social Services’ MO HealthNet Division (MHD) has been operating its current MMIS for over 30 years, processing over 99 million claims from over 49,000 providers per year.  In order to provide the most effective support to the people they serve, MHD launched a major initiative to improve the administration of the Medicaid program across the entire Medicaid enterprise.

Strategic MMIS Planning and Procurement by CSG

MHD selected CSG to develop a comprehensive strategy and provide procurement support for this strategic initiative. The CSG team assessed the alignment of MHD’s business functions and systems with the CMS’ Seven Conditions and Standards and MITA 3.0 Framework, led visioning sessions with project stakeholders, and produced a MITA SS-A to determine key enhancement efforts. CSG is also working closely with the State to assess the availability of modular solutions, analyze the current vendor landscape, and leverage our experience with CMS and other states to assist MHD in defining an enterprise wide modernization strategy. We will then provide requirements definition and procurement support for the RFP process to procure the most efficient and cost effective MMIS.

The people of Missouri are making a strategic investment in Medicaid modernization. MHD and CSG are working together to assure that the State’s MMIS meets the needs of the people who depend on it.

Medicaid Contract Management in Texas

 
Austin
Austin

The Texas Health and Human Services Commission (HHSC) coordinates the planning and delivery of health and human services programs in the State, including its Medicaid program. In order to provide Texans with enhanced service and performance of their Medicaid program, HHSC is transitioning to performance-based contracting to more efficiently achieve program objectives.

CSG Develops a Performance-Based Contracting Plan

HHSC selected CSG to help transition the State’s current Medicaid fiscal agent contract monitoring methodology to a performance-based contract management process. CSG assisted the State in establishing an overall vision, defining goals and objectives, developing a performance-based contracting plan, and implementing contract monitoring and reporting methods. CSG also completed a gap analysis of HHSC’s current contract management system to identify potential modifications, reviewed HHSC’s standard contract management-related RFP requirements and provided recommendations for change, and identified new reporting methods to align with the updated monitoring approach. The CSG team also addressed contract monitoring governance, provided recommendations for organizational alignment, and facilitated training sessions to help State staff transition to the new performance-based contracting methodology.

HHSC is committed to modernizing its Medicaid program to enhance services for Texans. CSG is here to help assure its objectives are met.

Modernizing Florida's MMIS

 
Tallahassee
Tallahassee

The Florida Agency for Health Care Administration (AHCA) oversees the State’s Medicaid program providing healthcare coverage to nearly 3.8 million Floridians. To enhance and integrate its MMIS and Decision Support System (DSS) capabilities, the State has launched a major initiative to modernize its Medicaid enterprise.

MMIS Modernization Strategy, Requirements Development, and Procurement Support by CSG

AHCA selected CSG to facilitate development of the modernization strategy, conduct requirements development, and provide vendor solicitation, evaluation, and selection support throughout the MMIS/DSS procurement process. CSG conducted a gap analysis of the State’s MITA SS-A and MMIS/DSS to identify areas for system improvements, and conducted sessions to update Florida’s MITA 3.0 SS-A. We utilized our MMIS Landscape tool to assist AHCA in identifying states with similar MMIS modernization plans and leveraged our MMIS Alternatives Assessment Matrix and Cost Benefit Analysis tools to compare solutions and make recommendations that best fit their modernization needs.

CSG is also applying our set of MMIS baseline requirements to assist the State in creating custom requirements for the technical and operational aspects of its solicitation, and supporting the development of Fiscal Agent requirements, solicitation evaluation criteria, and vendor evaluation training for State staff.

AHCA is dedicated to providing better healthcare for all Floridians. CSG is helping the State achieve this vision.

Successful MMIS Implementation in Ohio

 
Columbus
Columbus

Ohio’s Medicaid program provides healthcare coverage for 1.6 million residents at a cost of $15 billion per year. The Ohio Department of Medicaid (ODM) has reached a major milestone in Medicaid program modernization with the successful implementation of the Ohio Medicaid Information Technology System (MITS). MITS is built on robust business and technical architectures and leverages innovative technology to increase productivity, enhance customer service and ease of use, provide flexibility for complying with dynamic federal mandates and statutory rules, and support MITA goals today and in the future.

IV&V by CSG SM

One of Ohio’s strategies for accomplishing the MITS implementation is the adoption of an Independent Verification and Validation (IV&V) program. CSG has performed comprehensive IV&V services throughout the project. Our services encompass all aspects of the MITS modernization effort, including project management and governance, technical architecture and design, business transformation and training, requirements management, data conversion, technical and operational readiness, and MMIS certification.

The people of Ohio are making a large investment in Medicaid modernization. ODM and CSG are working together to assure that the State’s efforts meet the needs of Ohio’s Medicaid enterprise and the people who depend on it.

Modernizing Medicaid in Iowa’s Best of Breed Model 

 
Des Moines
Des Moines

The Iowa Department of Human Services, through the Iowa Medicaid Enterprise (IME), provides healthcare coverage for 684,000 residents at an annual cost of nearly $4 billion and depends on its MMIS to manage this critical responsibility. IME has undertaken a large and highly visible effort to modernize both the core MMIS and the Pharmacy Point-of-Sale (POS) systems to support dynamic Medicaid policies and address current and future MITA goals. The technology and business rules are complex. But the opportunities are great.

PMO by CSG SM

One of IME’s strategies for overseeing the project is the adoption of a Project Oversight, Management, and Integration services program. CSG is IME’s partner in fulfilling this critical management function. Our oversight and management of the implementation contractors and project team assures that all aspects of the project – including requirements management, adherence to the schedule and budget, project governance, technical architectures, and organizational changes – are effectively achieved.

Together, Iowa and CSG are working to ensure that the MMIS/POS modernization meets the needs of the IME and the people who depend on it.

Medicaid Modernization in Minnesota

 
St. Paul
St. Paul

The Minnesota Department of Human Services (DHS) had been operating its current MMIS for over 20 years. In order to improve interoperability between systems and agencies, DHS launched a major initiative to modernize its MMIS within a common framework Service Oriented Architecture.

MMIS Strategy and Planning by CSG

Minnesota selected CSG to provide strategy and planning services for its MMIS modernization effort. CSG completed an alternatives assessment, feasibility study, and cost-benefit analysis to identify requirements and support buy/build decision making. CSG also developed an MMIS Modernization Roadmap for aligning the MMIS modernization effort with other State systems and technologies. The roadmap is built on a collaborative approach to integrate MMIS, Health Insurance Marketplace, and integrated eligibility systems. CSG also produced an Implementation Advance Planning Document (IAPD) to obtain federal funding for the project.

Minnesota DHS is committed to excellence in service delivery and efficient government. CSG is there to help the State achieve its objectives.