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Medicaid Enterprise Management System RFP Vendor Conference KHEAA located at - PowerPoint PPT Presentation


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Medicaid Enterprise Management System RFP Vendor Conference KHEAA located at 100 Airport Road, Frankfort, KY 40601 Tuesday 05/14/2013 10 am to 12 pm.

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slide1

Medicaid Enterprise Management System

RFP Vendor Conference

KHEAA located at

100 Airport Road, Frankfort, KY 40601

Tuesday 05/14/2013

10 am to 12 pm

NOTICE OF CONFIDENTIALITY:  This presentation is for the sole use of the intended recipient(s) and may contain confidential information. Any review, use, disclosure, duplication, or distribution not expressly requested by the recipient and granted by the sender is strictly prohibited. If you are not the intended recipient, please destroy all copies of the original message and attachment(s) and notify the sender immediately by e-mail.

slide2

Kentucky Medicaid Enterprise Management System RFP

Pre-release Vendor Conference

Discussion Outline

  • Welcome to Kentucky and Introductions
  • Kentucky’s Strategic Vision for Healthcare Transformation
  • Kentucky Medicaid Expansion
  • Medicaid Enterprise Management System RFP Structure and Scope
  • Medicaid Enterprise Management System Vendor Procurement Timeline
  • Open Comments and Feedback
slide3

Kentucky’s Strategic Vision for Healthcare Transformation

  • Kentucky has developed a complete and achievable eHealth IT Architecture.
  • Kentucky has a consolidated Cabinet organization that encompasses all of the program pillars depicted in our vision.
  • CHFS Secretary Haynes and Governor Beshear have been engaged and aggressive in our efforts to improve healthcare in Kentucky and nationally. 
  • Early adoption of HIE, GOHIE, HBE, etc.
  • Focus on improved delivery and quality of healthcare through Managed Care and push to streamline MMIS.
slide4

Kentucky’s Strategic Vision for Healthcare Transformation

  • QHI Components for CHFS Supported Systems:
  • Citizen, Worker, Partner Web Portals
  • SharePoint Document Management System
  • Corticon Business Rules Engine
  • BizTalk Enterprise Service Bus
  • IBM Infosphere Master Data Management
  • SAS Fraud Analytics
  • KEUPS (Kentucky Secure On-line Gateway) Seamless Security Services
  • HP Exstream Fulfillment
slide5

Kentucky Medicaid Expansion

  • Effective January 1, 2014, the Commonwealth will expand the Kentucky Medicaid program under ACA.
  • The Commonwealth anticipates an increase of 308,000 members. The following areas will be affected by this increase:
  • Managed Care will increase to approximately 1,000,750 or 89% of the total Medicaid population.
  • FFS will increase to approximately 129,000 or 11% of the total Medicaid population.
  • An addendum will be produced for the RFP to address the Expansion.
slide6

Medicaid Enterprise Management System RFP Structure and Scope

  • Option 1 MEMS System Replacement:
  • Design, development, implementation and maintenance of the new Kentucky Medicaid Enterprise Management System and Fiscal Agent.
  • Proposed solutions and pricing for the following “Options to Buy”:
  • System Hosting and Disaster Recovery services
  • Decision Support System
  • Utilization Management Services
  • Option 2 MEMS System Takeover:
  • Planning, migration and operations necessary to assume
  • the operation of the current MMIS and Fiscal Agent services.
  • Option 3 Combined MEMS System Replacement and Takeover:
  • Providing of all services necessary for Options 1 & 2. (Takeover and Replacement)
slide7

Medicaid Enterprise Management System RFP Structure and Scope

The Commonwealth requires that the future Medicaid Enterprise Management system be built using the following principles:

  • Seamless data exchange of information with QHI framework including as close as possible to real-time integration with Kentucky Health Benefits Exchange System.
  • Optimization of Managed Care Relationships and streamlined support for remaining Fee for Service processes.
  • SOA based solution comprised of components that integrate into the Commonwealth’s SOA framework or directly utilizes the Commonwealth’s components.
  • MITA based modular solutions from a single Vendor or a “best-of-breed” multi-vendor solution.
  • Meets CMS certification requirements as defined in the CMS MECT.
  • Comprehensive data management strategy that organizes all of the data and enables easy access to information.
  • Configurable and extendible solution to cost-effectively support Kentucky’s future expansion of programs and populations, and to meet current and future regulatory needs.
slide8

Medicaid Enterprise Management System RFP Structure and Scope

  • The functional requirements cover the business operations of the enterprise. These requirements are grouped as follows:
  • Business Relationship Management
  • Care Management
  • Contractor Management
  • Financial Management
  • Member Management Lite
  • Operations Management
  • Program Management
  • Program Integrity Management
  • Provider Management
slide9

Medicaid Enterprise Management System RFP Structure and Scope

Not in RFP Scope:

  • Medicaid Waiver Management Application
  • Pharmacy Benefit Management
slide11

Open Questions and Feedback

Link to the RFP and Attachments

https://emars.ky.gov/online/vss/AltSelfService

Link to the Procurement Library http://finance.ky.gov/services/eprocurement/Pages/MEDICAIDENTERPRISEMANAGEMENTSYSTEMFISCALAGENTREPLACEMENT