MMIS Re-Bid Project Human Services Department August 24,

Current Project Status Project Scope: – ReBid Medicaid State Fiscal Agent contract – Include Enhancements to meet federal requirements or improve functions – Include operational activities required of fiscal agent Procurement proceeding with proposal evaluations. – Selection has not been finalized or disclosed – estimated award date in Sep/Oct 2011 with contract by Nov/Dec 2011 Goal: – Request PCC approval to move to Planning Phase to enable HSD to finalize, select, and contract Medicaid State Fiscal Agent. 2

Background Medicaid State Fiscal Agent: – Outsourced program operations which include wide range of administrative tasks. – Supports payment and operational services for Medical Assistance Division. – Services range from direct service support (MiVia) to hosting Omnicaid payment application. 3

Objectives Project objective: Successful solicitation of medicaid state fiscal agent contract, implementation of enhancements, and transition to operations. Four phases: Procurement, Transition, Enhancements, and Operations. Currently in procurement. 4

Project Approach NM Medicaid CMS requires HSD to periodically open State Fiscal Agent contract to bid CMS approved funds to support Four Phases with federal match rate: 5 Category Federal Match Rate Purpose Procurement Phase 75% Support costs related to NM staff who will support procurement. Transition Phase75% Support costs related to transition the MMIS from incumbent contractor to new contractor if another vendor is selected. Enhancement Phase 90% Support costs related to remedy current system issues or to improve functionality related to upcoming health reform requirements. Operations Phase75% Support costs related to medicaid operational and direct services for 7 years. IV&V90% IV&V required for (1) incumbent continuation or (2) new vendor transition. IV&V estimate for new incumbent with all enhancements estimated at $1,500,000. Cannot use GSA – required to use RFP.

Required Enhancements Changes required to meet CMS requirements. 6 EnhancementPurpose ICD-10 Remediation Meet national deadline to convert to new ICD-10 diagnosis and surgical procedure codes from the current ICD-9 standard MARS Replacement Replace the legacy Management and Administrative Reporting System with a data warehouse-based system to comply with the ICD-10 standard and increase reporting flexibility HIPAA 270/271 Implement eligibility verification inquiry and response transactions to comply with HIPAA standards HIPAA 276/277 Implement claim status inquiry and response transactions to comply with HIPAA standards HIPAA 820 Implement premium payment transactions for Managed Care Organizations to comply with HIPAA standards HIPAA 834 Implement benefit enrollment and maintenance transactions for Managed Care Organizations to comply with HIPAA standards Client Eligibility Span Dates on the Web Portal Allow providers to inquire on a span of dates when checking client eligibility instead of a single date of service

Optional Enhancements Changes that may improve operational functions but are not necessary to meet CMS requirements. EnhancementPurpose Web-based Direct Data Entry Allow providers to submit claims electronically via the Web portal Web-based Provider Enrollment Allow providers to submit enrollment applications via the Web portal Client Web Portal Give clients new self-service options via a Web portal, including finding service providers and selecting a Managed Care Organization Electronic Billing of Other Carriers Replace current paper billing of other insurance carriers with electronic billing when it is discovered that a client has other insurance coverage Automated Processing and Posting of Third Party Liability Payments Modify the system to accept electronic payment transactions from insurance carriers and use the information to post payments and adjust claims to reflect recoveries NCPDP 3.0 Implement the new National Council of Prescription Drug Programs (NCPDP) subrogation transaction to bill other insurers for drug claims when it is discovered that a client has other insurance coverage 7

Schedule PeriodEvent April 2010Obtain PCC Certification to proceed April 2010Submit RFP/APD to CMS January 2011Issue RFP Sep/Oct 2011Select Contractor Sep/Oct 2011Submit APD Update and Contract to CMS Nov/Dec 2011Contract Signed; Transition and Enhancement Phases begin. September 2012New Contract Operations Begin October 2013ICD-10 Remediation Completed December 2013Project Closeout 8 The procurement schedule is primarily dependent upon the completion of evaluation committee reviews and federal approvals. The schedule below is only a general estimate based on current information. The schedule has been revised as required to meet procurement process requirements.

Certification AreaInitiationPlanningImplementation and Closeout Activity o Acquire state and federal approvals. o Issue RFP. o Review Proposals. o Select Winning Proposal. o Initiate Contracting Process. o Obtain State and Federal Approvals. o Sign contract. o Initiate transition activities. o Initiate project activities. o Perform IV&V on projects. o Finalize transition to new contract. Contracted Services $0 $1,500,000 (IV&V Services) TBD HSD Personnel $0TBD 9 Funding request for this phase tied to IV&V services. Funding will be determined after procurement award. Overall funding will be reviewed by CMS for federal match amounts.

Summary The Medicaid State Fiscal Agent procurement is still in progress. The Department requests approval to move from Initiation Phase to Planning Phase in order to begin contracting after an award. 10