MITA 3.0State Self-Assessment

Detailed Report

HHSC

2015

Generated by

Table of Contents1 152 163 174 175 186 197 228 239 26

9.1 269.2 32

9.2.1 329.2.2 329.2.3 34

9.2.3.1 349.2.3.2 349.2.3.3 34

9.2.4 409.2.4.1 409.2.4.2 409.2.4.3 40

9.2.5 439.2.5.1 439.2.5.2 43

9.2.6 489.2.6.1 489.2.6.2 489.2.6.3 48

9.3 529.3.1 529.3.2 529.3.3 54

9.3.3.1 549.3.3.2 549.3.3.3 55

9.3.4 629.3.4.1 629.3.4.2 629.3.4.3 62

9.3.5 699.3.5.1 699.3.5.2 699.3.5.3 69

9.3.6 77

2

Background and OverviewMedicaid Information Technology Architecture OverviewMITA FrameworkMITA Concept of OperationsMITA SS-A Process OverviewTexas Medicaid Enterprise SS-A OverviewBusiness Assessment ProcessTechnical and Information Assessment ProcessBusiness Architecture

Business Assessment Themes BR -- Business Relationship Management

Business Area SummaryRecommendations SummaryEstablish Business Relationship

BR01 Business Process DefinitionAgency ApplicationsScore

Manage Business Relationship CommunicationBR02 Business Process DefinitionAgency ApplicationsScore

Manage Business Relationship InformationBR03 Business Process DefinitionScore

Terminate Business RelationshipBR04 Business Process DefinitionAgency ApplicationsScore

CM -- Care ManagementBusiness Area SummaryRecommendations SummaryEstablish Case

CM01 Business Process DefinitionAgency ApplicationsScore

Manage Case InformationCM02 Business Process DefinitionAgency ApplicationsScore

Manage Population Health OutreachCM03 Business Process DefinitionAgency ApplicationsScore

Manage Registry

Table of Contents9.3.6.1 779.3.6.2 779.3.6.3 77

9.3.7 829.3.7.1 829.3.7.2 829.3.7.3 82

9.3.8 889.3.8.1 889.3.8.2 889.3.8.3 88

9.3.9 949.3.9.1 949.3.9.2 949.3.9.3 94

9.3.10 1019.3.10.1 1019.3.10.2 1019.3.10.3 101

9.4 1079.4.1 1079.4.2 1079.4.3 109

9.4.3.1 1099.4.3.2 1099.4.3.3 109

9.4.4 1139.4.4.1 1139.4.4.2 1139.4.4.3 113

9.4.5 1189.4.5.1 1189.4.5.2 1189.4.5.3 118

9.4.6 1229.4.6.1 1229.4.6.2 1229.4.6.3 122

9.4.7 1279.4.7.1 1279.4.7.2 1279.4.7.3 127

9.4.8 1319.4.8.1 131

3

CM04 Business Process DefinitionAgency ApplicationsScore

Perform Screening and AssessmentCM05 Business Process DefinitionAgency ApplicationsScore

Manage Treatment Plans and OutcomesCM06 Business Process DefinitionAgency ApplicationsScore

Authorize ServiceCM08 Business Process DefinitionAgency ApplicationsScore

Authorize Treatment PlanCM09 Business Process DefinitionAgency ApplicationsScore

CO -- Contractor ManagementBusiness Area SummaryRecommendations SummaryManage Contractor Information

CO01 Business Process DefinitionAgency ApplicationsScore

Inquire Contractor InformationCO04 Business Process DefinitionAgency ApplicationsScore

Manage Contractor CommunicationCO02 Business Process DefinitionAgency ApplicationsScore

Perform Contractor OutreachCO03 Business Process DefinitionAgency ApplicationsScore

Manage Contractor Grievance and AppealCO09 Business Process DefinitionAgency ApplicationsScore

Produce SolicitationCO05 Business Process Definition

Table of Contents9.4.8.2 1319.4.8.3 131

9.4.9 1349.4.9.1 1349.4.9.2 1349.4.9.3 134

9.4.10 1379.4.10.1 1379.4.10.2 1379.4.10.3 137

9.4.11 1419.4.11.1 1419.4.11.2 1419.4.11.3 141

9.5 1459.5.1 1459.5.2 1459.5.3 147

9.5.3.1 1479.5.3.2 1479.5.3.3 147

9.5.4 1509.5.4.1 1509.5.4.2 1509.5.4.3 150

9.5.5 1539.5.5.1 1539.5.5.2 1539.5.5.3 153

9.5.6 1569.5.6.1 1569.5.6.2 1569.5.6.3 156

9.5.7 1599.5.7.1 1599.5.7.2 1599.5.7.3 159

9.5.8 1639.5.8.1 1639.5.8.2 1639.5.8.3 163

9.5.9 1679.5.9.1 1679.5.9.2 167

4

Agency ApplicationsScore

Award ContractCO06 Business Process DefinitionAgency ApplicationsScore

Manage ContractCO07 Business Process DefinitionAgency ApplicationsScore

Close Out ContractCO08 Business Process DefinitionAgency ApplicationsScore

EE -- Eligibility & Enrollment ManagementBusiness Area SummaryRecommendations SummaryDetermine Member Eligibility

EE01 Business Process DefinitionAgency ApplicationsScore

Enroll MemberEE02 Business Process DefinitionAgency ApplicationsScore

Disenroll MemberEE03 Business Process DefinitionAgency ApplicationsScore

Inquire Member EligibilityEE04 Business Process DefinitionAgency ApplicationsScore

Determine Provider EligibilityEE05 Business Process DefinitionAgency ApplicationsScore

Enroll ProviderEE06 Business Process DefinitionAgency ApplicationsScore

Disenroll ProviderEE07 Business Process DefinitionAgency Applications

Table of Contents9.5.9.3 167

9.5.10 1719.5.10.1 1719.5.10.2 1719.5.10.3 171

9.6 1759.6.1 1759.6.2 1759.6.3 178

9.6.3.1 1789.6.3.2 1789.6.3.3 178

9.6.4 1829.6.4.1 1829.6.4.2 1829.6.4.3 183

9.6.5 1889.6.5.1 1889.6.5.2 1889.6.5.3 188

9.6.6 1929.6.6.1 1929.6.6.2 1929.6.6.3 192

9.6.7 1969.6.7.1 1969.6.7.2 1969.6.7.3 196

9.6.8 1999.6.8.1 1999.6.8.2 1999.6.8.3 199

9.6.9 2039.6.9.1 2039.6.9.2 2039.6.9.3 203

9.6.10 2069.6.10.1 2069.6.10.2 2069.6.10.3 206

9.6.11 2099.6.11.1 2099.6.11.2 2099.6.11.3 209

5

ScoreInquire Provider Information

EE08 Business Process DefinitionAgency ApplicationsScore

FM -- Financial ManagementBusiness Area SummaryRecommendations SummaryManage Provider Recoupment

FM01 Business Process DefinitionAgency ApplicationsScore

Manage TPL RecoveryFM02 Business Process DefinitionAgency ApplicationsScore

Manage Estate RecoveryFM03 Business Process DefinitionAgency ApplicationsScore

Manage Drug RebateFM04 Business Process DefinitionAgency ApplicationsScore

Manage Cost SettlementFM05 Business Process Definition Agency ApplicationsScore

Manage Accounts Receivable InformationFM06 Business Process DefinitionAgency ApplicationsScore

Manage Accounts Receivable FundsFM07 Business Process DefinitionAgency ApplicationsScore

Prepare Member Premium InvoiceFM08 Business Process DefinitionAgency ApplicationsScore

Manage Contractor PaymentFM09 Business Process DefinitionAgency ApplicationsScore

Table of Contents9.6.12 212

9.6.12.1 2129.6.12.2 2129.6.12.3 212

9.6.13 2169.6.13.1 2169.6.13.2 2169.6.13.3 216

9.6.14 2199.6.14.1 2199.6.14.2 2199.6.14.3 219

9.6.15 2229.6.15.1 2229.6.15.2 2229.6.15.3 222

9.6.16 2259.6.16.1 2259.6.16.2 2259.6.16.3 225

9.6.17 2289.6.17.1 2289.6.17.2 2289.6.17.3 228

9.6.18 2319.6.18.1 2319.6.18.2 2319.6.18.3 231

9.6.19 2349.6.19.1 2349.6.19.2 2349.6.19.3 234

9.6.20 2379.6.20.1 2379.6.20.2 2379.6.20.3 237

9.6.21 2409.6.21.1 2409.6.21.2 2409.6.21.3 240

9.7 2439.7.1 2439.7.2 2439.7.3 245

6

Manage Member Financial ParticipationFM10 Business Process DefinitionAgency ApplicationsScore

Manage Capitation PaymentFM11 Business Process DefinitionAgency ApplicationsScore

Manage Incentive PaymentFM12 Business Process DefinitionAgency ApplicationsScore

Manage Accounts Payable InformationFM13 Business Process DefinitionAgency ApplicationsScore

Manage Accounts Payable DisbursementFM14 Business Process DefinitionAgency ApplicationsScore

Manage 1099FM15 Business Process DefinitionAgency ApplicationsScore

Formulate BudgetFM16 Business Process DefinitionAgency ApplicationsScore

Manage Budget InformationFM17 Business Process DefinitionAgency ApplicationsScore

Manage FundFM18 Business Process DefinitionAgency ApplicationsScore

Generate Financial ReportFM19 Business Process DefinitionAgency ApplicationsScore

OM -- Operations ManagementBusiness Area SummaryRecommendations SummaryGenerate Remittance Advice

Table of Contents9.7.3.1 2459.7.3.2 2459.7.3.3 245

9.7.4 2489.7.4.1 2489.7.4.2 2489.7.4.3 248

9.7.5 2519.7.5.1 2519.7.5.2 2519.7.5.3 251

9.7.6 2549.7.6.1 2549.7.6.2 2549.7.6.3 254

9.7.7 2579.7.7.1 2579.7.7.2 2579.7.7.3 257

9.7.8 2619.7.8.1 2619.7.8.2 2619.7.8.3 261

9.7.9 2649.7.9.1 2649.7.9.2 2649.7.9.3 264

9.7.10 2689.7.10.1 2689.7.10.2 2689.7.10.3 268

9.7.11 2739.7.11.1 2739.7.11.2 2739.7.11.3 273

9.8 2779.8.1 2779.8.2 2779.8.3 279

9.8.3.1 2799.8.3.2 2799.8.3.3 279

9.8.4 2829.8.4.1 282

7

OM14 Business Process DefinitionAgency ApplicationsScore

Inquire Payment StatusOM18 Business Process DefinitionAgency ApplicationsScore

Prepare Provider PaymentOM27 Business Process DefinitionAgency ApplicationsScore

Manage DataOM28 Business Process DefinitionAgency ApplicationsScore

Process ClaimOM07 Business Process DefinitionAgency ApplicationsScore

Process EncounterOM29 Business Process DefinitionAgency ApplicationsScore

Calculate Spend-Down AmountOM20 Business Process DefinitionAgency ApplicationsScore

Submit Electronic AttachmentOM04 Business Process DefinitionAgency ApplicationsScore

Apply Mass AdjustmentOM05 Business Process DefinitionAgency ApplicationsScore

PE -- Performance ManagementBusiness Area SummaryRecommendations SummaryIdentify Utilization Anomalies

PE01 Business Process DefinitionAgency ApplicationsScore

Establish Compliance IncidentPE02 Business Process Definition

Table of Contents9.8.4.2 2829.8.4.3 282

9.8.5 2859.8.5.1 2859.8.5.2 2859.8.5.3 285

9.8.6 2889.8.6.1 2889.8.6.2 2889.8.6.3 288

9.8.7 2929.8.7.1 2929.8.7.2 2929.8.7.3 292

9.9 2959.9.1 2959.9.2 2959.9.3 297

9.9.3.1 2979.9.3.2 2979.9.3.3 297

9.9.4 3029.9.4.1 3029.9.4.2 3029.9.4.3 302

9.9.5 3059.9.5.1 3059.9.5.2 3059.9.5.3 305

9.9.6 3089.9.6.1 3089.9.6.2 3089.9.6.3 308

9.9.7 3119.9.7.1 3119.9.7.2 3119.9.7.3 311

9.9.8 3149.9.8.1 3149.9.8.2 3149.9.8.3 314

9.9.9 3179.9.9.1 3179.9.9.2 317

8

Agency ApplicationsScore

Manage Compliance Incident InformationPE03 Business Process DefinitionAgency ApplicationsScore

Determine Adverse Action IncidentPE04 Business Process DefinitionAgency ApplicationsScore

Prepare REOMBPE05 Business Process DefinitionAgency ApplicationsScore

PL -- Plan ManagementBusiness Area SummaryRecommendations SummaryDevelop Agency Goals and Objectives

PL01 Business Process DefinitionAgency ApplicationsScore

Maintain Program PolicyPL02 Business Process DefinitionAgency ApplicationsScore

Maintain State PlanPL03 Business Process DefinitionAgency ApplicationsScore

Manage Health Plan InformationPL04 Business Process DefinitionAgency ApplicationsScore

Manage Performance MeasuresPL05 Business Process DefinitionAgency ApplicationsScore

Manage Health Benefit InformationPL06 Business Process DefinitionAgency ApplicationsScore

Maintain Reference InformationPL07 Business Process DefinitionAgency Applications

Table of Contents9.9.9.3 317

9.9.10 3209.9.10.1 3209.9.10.2 320

9.10 3239.10.1 3239.10.2 3239.10.3 325

9.10.3.1 3259.10.3.2 3259.10.3.3 325

9.10.4 3299.10.4.1 3299.10.4.2 3299.10.4.3 329

9.10.5 3329.10.5.1 3329.10.5.2 3329.10.5.3 332

9.10.6 3369.10.6.1 3369.10.6.2 3369.10.6.3 337

9.10.7 3429.10.7.1 3429.10.7.2 3429.10.7.3 342

10 34810.1 34810.2 350

10.2.1 35110.2.2 35210.2.3 35210.2.4 352

10.3 35410.3.1 35510.3.2 36010.3.3 36210.3.4 363

10.4 36510.4.1 36610.4.2 36810.4.3 36910.4.4 370

9

ScoreManage Rate Setting

PL08 Business Process DefinitionScore

PM -- Provider ManagementBusiness Area SummaryRecommendations SummaryManage Provider Information

PM01 Business Process DefinitionAgency ApplicationsScore

Terminate ProviderPM08 Business Process DefinitionAgency ApplicationsScore

Manage Provider CommunicationPM02 Business Process DefinitionAgency ApplicationsScore

Manage Provider Grievance and AppealPM07 Business Process DefinitionAgency ApplicationsScore

Perform Provider OutreachPM03 Business Process DefinitionAgency ApplicationsScore

Information ArchitectureInformation Assessment Themes and ResultsBR -- Business Relationship Management

Data Management Strategy (DMS)Conceptual Data Model (CDM)Logical Data Model (LDM)Data Standards

CM -- Care ManagementData Management Strategy (DMS)Conceptual Data Model (CDM)Logical Data Model (LDM)Data Standards

CO -- Contractor ManagementData Management Strategy (DMS)Conceptual Data Model (CDM)Logical Data Model (LDM)Data Standards

Table of Contents10.5 371

10.5.1 37210.5.2 37610.5.3 37710.5.4 378

10.6 38010.6.1 38110.6.2 38610.6.3 38710.6.4 388

10.7 39010.7.1 39110.7.2 39510.7.3 39610.7.4 397

10.8 39910.8.1 40010.8.2 40210.8.3 40210.8.4 402

10.9 40410.9.1 40510.9.2 40710.9.3 40710.9.4 408

10.10 41010.10.1 41110.10.2 41310.10.3 41310.10.4 414

11 41611.1 41611.2 418

11.2.1 41911.2.2 42011.2.3 421

11.3 42311.3.1 42411.3.2 43111.3.3 438

11.4 44711.4.1 44811.4.2 45111.4.3 455

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EE -- Eligibility & Enrollment ManagementData Management Strategy (DMS)Conceptual Data Model (CDM)Logical Data Model (LDM)Data Standards

FM -- Financial ManagementData Management Strategy (DMS)Conceptual Data Model (CDM)Logical Data Model (LDM)Data Standards

OM -- Operations ManagementData Management Strategy (DMS)Conceptual Data Model (CDM)Logical Data Model (LDM)Data Standards

PE -- Performance ManagementData Management Strategy (DMS)Conceptual Data Model (CDM)Logical Data Model (LDM)Data Standards

PL -- Plan ManagementData Management Strategy (DMS)Conceptual Data Model (CDM)Logical Data Model (LDM)Data Standards

PM -- Provider ManagementData Management Strategy (DMS)Conceptual Data Model (CDM)Logical Data Model (LDM)Data Standards

Technical ArchitectureMITA SS-A Technical Themes and ResultsBR -- Business Relationship Management

Access and DeliveryIntermediary and InterfaceIntegration and Utility

CM -- Care ManagementAccess and DeliveryIntermediary and InterfaceIntegration and Utility

CO -- Contractor ManagementAccess and DeliveryIntermediary and InterfaceIntegration and Utility

Table of Contents11.5 461

11.5.1 46211.5.2 46711.5.3 472

11.6 47911.6.1 48011.6.2 48711.6.3 494

11.7 50311.7.1 50411.7.2 51011.7.3 517

11.8 52411.8.1 52511.8.2 52711.8.3 530

11.9 53411.9.1 53511.9.2 53811.9.3 541

11.10 54511.10.1 54611.10.2 54911.10.3 552

12 55712.1 55712.2 559

12.2.1 56012.2.2 56012.2.3 56112.2.4 56112.2.5 56212.2.6 56312.2.7 564

12.3 56512.3.1 56612.3.2 57012.3.3 57412.3.4 57812.3.5 58312.3.6 58712.3.7 592

12.4 59812.4.1 599

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EE -- Eligibility & Enrollment ManagementAccess and DeliveryIntermediary and InterfaceIntegration and Utility

FM -- Financial ManagementAccess and DeliveryIntermediary and InterfaceIntegration and Utility

OM -- Operations ManagementAccess and DeliveryIntermediary and InterfaceIntegration and Utility

PE -- Performance ManagementAccess and DeliveryIntermediary and InterfaceIntegration and Utility

PL -- Plan ManagementAccess and DeliveryIntermediary and InterfaceIntegration and Utility

PM -- Provider ManagementAccess and DeliveryIntermediary and InterfaceIntegration and Utility

Seven Standards & ConditionsSeven Standards and Conditions Themes and ResultsBR -- Business Relationship Management

Modularity StandardMITA ConditionIndustry Standards ConditionLeverage ConditionBusiness Results ConditionReporting ConditionInteroperability Condition

CM -- Care ManagementModularity StandardMITA ConditionIndustry Standards ConditionLeverage ConditionBusiness Results ConditionReporting ConditionInteroperability Condition

CO -- Contractor ManagementModularity Standard

Table of Contents12.4.2 60012.4.3 60312.4.4 60512.4.5 60812.4.6 61012.4.7 613

12.5 61612.5.1 61712.5.2 62012.5.3 62312.5.4 62612.5.5 63012.5.6 63212.5.7 635

12.6 63912.6.1 64012.6.2 64312.6.3 64812.6.4 65112.6.5 65612.6.6 65912.6.7 663

12.7 66812.7.1 66912.7.2 67212.7.3 67612.7.4 67912.7.5 68312.7.6 68612.7.7 691

12.8 69612.8.1 69712.8.2 69812.8.3 70012.8.4 70112.8.5 70312.8.6 70412.8.7 706

12.9 70912.9.1 71012.9.2 71112.9.3 71312.9.4 71412.9.5 717

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MITA ConditionIndustry Standards ConditionLeverage ConditionBusiness Results ConditionReporting ConditionInteroperability Condition

EE -- Eligibility & Enrollment ManagementModularity StandardMITA ConditionIndustry Standards ConditionLeverage ConditionBusiness Results ConditionReporting ConditionInteroperability Condition

FM -- Financial ManagementModularity StandardMITA ConditionIndustry Standards ConditionLeverage ConditionBusiness Results ConditionReporting ConditionInteroperability Condition

OM -- Operations ManagementModularity StandardMITA ConditionIndustry Standards ConditionLeverage ConditionBusiness Results ConditionReporting ConditionInteroperability Condition

PE -- Performance ManagementModularity StandardMITA ConditionIndustry Standards ConditionLeverage ConditionBusiness Results ConditionReporting ConditionInteroperability Condition

PL -- Plan ManagementModularity StandardMITA ConditionIndustry Standards ConditionLeverage ConditionBusiness Results Condition

Table of Contents12.9.6 71812.9.7 719

12.10 72212.10.1 72312.10.2 72412.10.3 72612.10.4 72812.10.5 73012.10.6 73212.10.7 734

13 73714 74015 74216 743

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Reporting ConditionInteroperability Condition

PM -- Provider ManagementModularity StandardMITA ConditionIndustry Standards ConditionLeverage ConditionBusiness Results ConditionReporting ConditionInteroperability Condition

MITA SS-A Summary of Key FindingsTexas MITA 3.0 RoadmapConclusionAppendices

HHSC 2015

Revision HistoryVersion and Number Date Reviewer Comment

Version 0.6 October 16, 2015 Tristan del Canto Initial draft completed

Version 0.7 October 19, 2015 Mirsa Douglass First draft of Overview reviewed

Version 0.8 October 23, 2015 Alan Scantlen Second draft of Overview reviewed

Version 0.9 June 15, 2016 Clark Snodgrass, Joe Graves Third draft of Overview reviewed

Version 1.0 July 22, 2016 Clark Snodgrass Final draft of Overview reviewed

Version 1.1 September 12, 2016 Bowden HIght Final draft of Overview reviewed

Version 1.2 September 20, 2016 Gary Jessee Final draft of Overview reviewed

Approvals

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1 Background and OverviewMedicaid Information Technology Architecture (MITA) is a national framework promulgated by the federal Centers for Medicaid and Medicare Services (CMS), that establishes national guidelines for business processes and technologies that enable improved program administration for each State Medicaid Enterprise. The MITA initiative promotes business process improvements and IT system enhancements in State Medicaid Enterprises. The framework consists of the models, guidelines, and principles used to carry out this initiative. This assessment is an update to the MITA State Self-Assessment (SS-A) completed in 2012.

Document OverviewThis document is organized into the following sections:

Executive Summary: Presents the main topics discussed in the document including a document overview and terminology clarification.

Medicaid Information Technology Architecture (MITA) Overview: Describes the overall MITA initiative.

MITA Framework: Describes how MITA works.

MITA Concept of Operations: Describes the characteristics of current and planned operations from the viewpoint of those working within the enterprise when assessing current MITA capabilities and outlining future goals.

MITA State Self-Assessment (SS-A) Process Overview: Describes the step by step process of creating the MITA SS-A.

Texas Medicaid Enterprise SS-A Overview: Describes HHSC’s Executive Vision, the project scope and approach and how individuals participated in the project. This section also identifies the outputs from the MITA SS-A and how MITA outputs are transformed for use as strategic inputs.

MITA SS-A Business Assessment Process: Presents the results of the business assessment within nine business areas at the business process level. This includes the "AS IS" (current) and "TO BE" (future) maturity assessments for seventy-five business processes in 9 business areas. Five business process were not included, as one business process was not applicable to Texas and the remaining four in the Member Management business area have not been finalized by CMS at the time of the assessment.

MITA SS-A Technical and Information Assessment Process: Presents the results of the "AS IS" technical and information assessment. This includes the identification and definition of the primary systems supporting the enterprise and the presentation of maturity assessments for these systems relative to fifteen (15) technical functions and seven (7) information capabilities, and technical recommendations structured around the CMS Seven Conditions and Standards. The Texas Medicaid Enterprise SS-A Overview is an additional sub-section that discusses the limitations of the assessment.

This section also describes the current systems used to determine the scores for the technical and information architectures.

MITA SS-A Summary of Key Findings: Describes common themes that emerged from the SS-A, including business assessment and items for CMS’ consideration, information assessment, technical assessment, current system governance and data governance.

Texas MITA 3.0 Roadmap: Explains the purpose of the roadmap, describes the roadmap components required by CMS, presents the high-level MITA 3.0 Roadmap, and addresses required components per project.

Conclusion: Provides a summary highlighting major risks and addressing some of the high-level challenges.

Appendices: Provides detailed supporting documentation for key assessment findings.

Terminology Clarification

15

The definitions that follow offer clarification on usage for several of the concepts and entities referenced throughout this document.

Texas Health and Human Services (HHS) System (i.e., State, Texas): This document uses the term HHS or HHS Enterprise to refer to the 5 health and human services operating agencies as follows:

● Health and Human Services Commission (HHSC)● Department of Aging and Disability Services (DADS)● Department of State Health Services (DSHS)● Department of Assistive and Rehabilitative Services (DARS)● Department of Family and Protective Services (DFPS)

Texas Medicaid Enterprise (i.e., enterprise): The entire Medicaid entity, including staff, business areas, supporting systems, and interfaces that are used to process, hold, or distribute information to support the Texas Medicaid program across the Texas HHS system. See the Texas Medicaid Enterprise Overview and Appendix C: Detailed Outline of the Texas Medicaid Enterprise for more information on the Texas Medicaid Enterprise.

MITA: Medicaid Information Technology Architecture refers to the federal CMS MITA initiative.

MITA Framework: The MITA Framework or the Framework refers to the set of structures and solutions used in implementing the MITA initiative.

MITA Framework 3.0: The MITA Framework 3.0, or MITA 3.0, refers to the particular solution set included in the 3.0 version of the MITA Framework.

Capability: A capability is the competence of an individual, organization, or system to perform a function or process. There are three types of MITA capabilities: business, information, and technical (see Endnote 1).

MITA Maturity Model (MMM): The MMM is a model that describes how operations will mature over time by defining the characteristics of five levels of improvement.

Maturity Level: The MMM describes the capabilities of a business process, technical function, or information component at each of five maturity levels. Considered together the levels show how capabilities progress from the current ("AS IS") operations to the future ("TO BE") environment. Framework 3.0 presents capabilities in matrices that include a varying number of general capabilities and 6 qualities that have a specific metric for each maturity level.

2 Medicaid Information Technology Architecture Overview

MITA InitiativeMITA is a business initiative of CMS, in cooperation with State programs, intended to stimulate an integrated business and technological transformation of the Medicaid Enterprise in all states. MITA provides states with an information technology architecture they can use as a framework for improving the exchange of data throughout the enterprise, including members, vendors and services providers, state and federal Medicaid agencies, and other agencies and programs supported by matching federal funds. While Medicaid agencies rely heavily on technology to operate, MITA envisions changes that enable Medicaid business processes to drive the technological changes over the next decade. The CMS articulates the MITA vision as follows:

“Establish a national framework of enabling technologies and processes that support improved program administration for the Medicaid Enterprise and for stakeholders dedicated to improving health care outcomes and administrative procedures for Medicaid members.” (See Endnote 2)

MITA identifies common Medicaid business processes and seeks to automate them into Web services that encompass standards enabling automated applications to communicate and exchange data over the Internet (or intranet) across many sites and organizations. The development of common data and information standards allows interoperability across different platforms, integration of applications, and modular programming, so changes can be introduced incrementally and existing information assets can be leveraged. Many business processes may be similar among various states and some economies of scale might be realized if these processes were modeled and shared among states.

MITA entails more than paying and documenting claims; it envisions significant business processing, information, and

16

technical changes such as:● Improvements in monitoring programs and the quality of care through data sharing across the State’s Medicaid

Enterprise.● Efficient use of resources through sharing reusable software.● More timely responses to program changes and emerging health care needs.● Improved access to high-quality information so patients and providers can make more informed decisions about

health care.

3 MITA FrameworkCMS established the MITA Framework, which elaborates on the CMS MITA vision and supports the states in achieving that vision. The framework adopts the best practices in the industry and is a consolidation of principles, business and technical models, and guidelines that creates a template for states to use to develop their individual enterprise architectures to meet the unique requirements of Medicaid.

The MITA Framework includes business architecture, information architecture, and a technical architecture that work in concert to define and improve the administration of Medicaid Enterprises.

● Business Architecture (BA) includes all of the business processes defined by the State Medicaid Agency and theirassociated maturity levels. The business architecture is the most robust portion of the MITA Framework 3.0.

● Information Architecture (IA) will define the data and standards necessary to conduct business operations as drivenby the business architecture.

● Technical Architecture (TA) establishes fundamental concepts of technology, such as interoperability, modularity,and flexibility, without naming specific technology or systems

All of the concepts in the MITA Framework allow individual Medicaid agencies the options and flexibility to pursue their own enterprise architectures, while still adhering to the basic principles that move the entity forward on the continuum to more mature capabilities that better meet the State’s established goals and objectives. The structure of the Framework and SS-A deliverables ensure that technology decisions align with Medicaid business needs and achieve business goals. For state Medicaid programs, this means evolving to optimize adaptability, flexibility, interoperability, and data sharing. This evolution enables the implementation of major improvements in policy and decision-making, as well as day-to-day operations.

The MITA Framework 3.0 is an enhancement of the 2.0 and 2.01 frameworks, based on analysis of the following: ● American Recovery and Reinvestment Act (ARRA)● Health Information Technology for Economic and Clinical Health (HITECH) Act● Health Insurance Portability and Accountability Act (HIPAA)● Affordable Care Act (ACA) of 2010● Guidance on Enhanced Funding Requirements: Seven Conditions and Standards

The MITA Framework 3.0 contains business procedures and business rules that comply with federal regulations. MITA guidelines support states’ requests for appropriate Federal Financial Participation (FFP) for a state’s Medicaid Enterprise systems, such as the Medicaid Management Information System (MMIS).

The MITA Framework 3.0 consists of 80 business processes within 10 business areas. Note that Texas only used 75 out of the 80 processes.

4 MITA Concept of OperationsCMS recently reaffirmed its guidance to states to focus on documenting a Concept of Operations (COO) that describes the characteristics of current and planned operations from the viewpoint of those working within the enterprise when assessing current capabilities and outlining future goals. In April 2011, CMS issued the Enhanced Funding Requirements: Seven Conditions and Standards, which refers to a regulation for new standards and conditions that must be met by the states in order for Medicaid technology investments to be eligible for the enhanced match funding. In the Seven Conditions and Standards, CMS states:

“States should develop a concept of operations and business work flows for the different business functions of the state to advance the alignment of the state’s capability maturity with the MITA MMM. These COO and business workflows should align to any provided by CMS in support of Medicaid and exchange business operations and requirements. States

17

should work to streamline and standardize these operational approaches and business work flows to minimize customization demands on technology solutions and optimize business outcomes.” (see Endnote 3).

Figure 1 below provides a high-level view of COO planning and illustrates how improvements in capability can be made in each area to help reach increasing levels of MITA maturity. Note that the diagram does not reflect HHSC's current capability, but rather reflects the CMS MITA framework.

5 MITA SS-A Process OverviewFundamental to implementation of the MITA concept is the requirement for each state to conduct an annual SS-A update. Within the SS-A, each state is to assess its current business processes as compared to the MITA Framework 3.0 provided by CMS and to establish which business processes pertain to its Medicaid operations. Additionally, a state must determine at what maturity level the business processes, technical functions, and information capabilities are currently functioning – the "AS IS" status. The capabilities of a process at each MITA maturity level are specific to that process.

Once the "AS IS" MITA maturity level is determined, the SS-A requires the State Medicaid Enterprise to consider where it would like to be over a period of time. The identified goal is the "TO BE" MITA maturity level for each business process, technical function, and/or information capability. While MITA typically looks at a 5 to 10 year timeframe for implementing "TO BE" goals, the time period is determined by the State. The Texas MITA SS-A assesses "TO BE" goals using a 5 year projection timeframe.

It is important to note that maturity levels were assessed utilizing the guidance that CMS has provided in the MITA Framework 3.0 SS-A Companion Guide. In general, the guidance states that State Medicaid Agencies must meet all the capabilities for a level before it can advance to the next level when evaluating the business, technical, or information architectures. CMS expects the business process to meet all criteria of the maturity level; otherwise, the business process scores at the lower capability level.

Between the "AS IS" and the "TO BE" are issues that must be addressed before the State Medicaid Enterprise can progress to the higher maturity. These issues represent the gaps. As a state defines the "TO BE" MITA maturity level, it

18

must also elaborate on the functionality it needs to achieve that maturity level. The functionality can represent business process requirements, technical requirements, and information architecture requirements to accomplish that goal.

The MITA Framework 3.0 provides guidelines for a MITA 3.0 Roadmap, but each state must prioritize and specify its own roadmap. The SS-A and the plan to achieve the desired "TO BE" MITA maturity levels are developed by the State Medicaid Enterprise and are living documents. Most states are facing budget constraints that may require that State budget and new program initiatives take priority in the coming years affecting the timeframe for improving maturity levels. Over time, priorities may change, new federal and State laws will demand more immediate attention, and technology will continue to evolve. The goal of MITA is to establish a baseline from which to plan and support revision of the plan in order to move the State Medicaid Enterprise forward.

The MITA Business Process Model (BPM) includes common business processes associated with Medicaid operations, but may not include all activities performed by all states. For this reason, the MITA assessment focuses only on the business processes included in the MITA BPM to promote MITA as a standard across all states.

6 Texas Medicaid Enterprise SS-A Overview

Overview of the Texas Medicaid EnterpriseThe primary entity responsible for Medicaid within the Texas Medicaid Enterprise is the Health and Human Services Commission (HHSC). HHSC delegates some of the operational responsibility to State administrative departments, known as the operating departments, which include:

● Department of Aging and Disability Services (DADS)● Department of State Health Services (DSHS)● Department of Assistive and Rehabilitative Services (DARS)● Department of Family and Protective Services (DFPS)

The 84th Texas State Legislature mandated a phased consolidation of these operating departments via S.B. 200. Starting Sept. 1, 2015 the Health and Human Services Commission, the Department of Aging and Disability Services, and the Department of Assistive and Rehabilitative Services began a process of consolidation into one agency. For the time being, the Department of Family and Protective Services and the Department of State Health Services will not be included in this merger. The Texas State Legislature plans to review consolidation progress in 2018 and make further decisions from that point on.

The State also contracts with private organizations to obtain specialized services to support the Texas Medicaid Enterprise activities including:

● Claims Administrator● Eligibility Support Services and Enrollment Contractor● Quality Monitor● Pharmacy Claims and Rebate Administrator● Pharmacy Prior Authorization Vendor● Preferred Drug List Vendor

It is important to note that not all portions of a listed business unit need be included in the Medicaid Enterprise. Those portions of the operating departments and commission that do not support Medicaid business processes are not included in the enterprise. Medicaid activities rely not only on exchanges between the entities listed above, but also on exchanges with entities external to the enterprise.

HHSC Executive Vision

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The Texas Medicaid vision plays a pivotal role in defining the future direction for the Texas Medicaid Enterprise. The vision becomes the catalyst for the next level of strategic planning. Discovery is initiated at this level from the MITA SS-A process and begins to play a pivotal role in identifying the strengths and weaknesses over a broad spectrum of critical process areas within the enterprise. By using the baseline information, the vision statement, and MITA initiatives, strategies, and specific future goals are formulated which describe future expected outcomes over strategic planning periods.

The visioning process benefited from previous HHSC efforts to envision the future and call for transformation and improvements in key business areas. These efforts included developing the enterprise of Texas HHSC State Medicaid Health Information Technology Plan (SMHP) document.

MITA looks to improve health care outcomes and administrative procedures through initiatives such as focusing on a patient-centric view and developing common standards, interoperability, Web-based access, and software reusability. HHS has established goals and objectives to improve its health care system, as demonstrated in the Texas Health and Human Services (HHS) System Strategic Plan for 2013-2017 (see Endnote 4), which aligns with the CMS MITA initiative.

The HHS’ priority goal is to promote the health, responsibility, and self-sufficiency of individuals and families by:

● Making public assistance available to those most in need through an efficient and effective system while reducingfraud.

● Restructuring Medicaid funding to optimize investments in health care and reduce the number of uninsured Texansthrough private insurance coverage.

● Enhancing the infrastructure necessary to improve the quality and value of health care through better caremanagement and performance improvement incentives.

● Continuing to create partnerships with local communities, advocacy groups, and the private and not-for-profitsectors.

● Addressing the root causes of social and human service needs to develop self-sufficiency of the client throughcontracts with not-for-profit organizations.

● Facilitating the seamless exchange of health information among State agencies, health care providers, and otherinformation exchange partners to support the quality, continuity, and efficiency of the health care delivered toclients in multiple State programs.

Texas Health and Human Services (HHS) System’s projects and internal work demonstrate a variety of transformations and improvements that align with the MITA initiative. The following are a list of priority items and focus areas:

● Evolve the Texas Medicaid Management Information System (TMMIS) to include:● A new system that focuses on the review of encounters and MCO oversight needs.● Improve system flexibility and interoperability.● Minimized reliance on current technology, with emphasis on modernization.● Enhance interfaces to be SOA and in alignment with higher MITA maturity levels.● Ensure continued integration of TMMIS improvement efforts with other initiatives and projects including:

● Medicaid Enterprise Data Governance (MEDG) planning● Eligibility as a Service (EaaS)● Affordable Care Act (ACA) integration● ICD-10 planning and implementation

● Major system functionalities such as provider and eligibility will establish systems of record and be distinctsystems that interface with the claims processing engine.

● New development should be best-of-breed using commercial off-the-shelf (COTS) solutions and mainstreamtechnology.

Project Scope and ApproachA MITA SS-A hinges on determining the executive vision for the future, identifying impacted internal enterprise stakeholders, capturing the current maturity level of business processes within the enterprise, and envisioning the capabilities of an MMIS as it is enhanced over time. While MITA establishes a framework, that framework only serves to initiate the discussion.

A MITA team was developed internal to the state in order to re-baseline the state’s MITA status. MITA Senior Analyst

20

and a MITA Business Analyst worked with the State project managers to establish the project management processes and procedures to support the MITA SS-A. These included the support of key management and SMEs throughout the State’s Medicaid business and technology enterprise(s). The MITA Team conducted three MITA SS-A project kickoff meetings: one with Senior Technology Staff; another with the HHSC Health Services Portfolio Management Committee; and one with the State Medicaid Director and other executive senior staff. The three sessions presented an overview of the project goals and engendered support for the project’s objectives.

The MITA Team performed the following tasks to complete the enterprise’s MITA SS-A:

1. Conducted executive visioning sessions to develop Texas’ goals for the future.2. Leveraged the previous MITA 3.0 SS-A, and solicited new content to re-baseline and update Texas’ previous "AS

IS" MITA maturity assessment, which was completed in August of 2013.3. Conducted MITA sessions with SMEs from nine of the ten MITA business areas. SMEs reviewed and updated "AS

IS" and "TO BE" Business Architecture from the MITA 3.0 SS-A completed in 2013. Note that MemberManagement was not included in this SS-A because CMS has yet to finalize this Business Area.

4. Conducted MITA sessions with SMEs from 20 IT systems that were representative of the character of the state’sInformation and Technology Architectures. SMEs reviewed and updated "AS IS" and "TO BE" Information andTechnical Architectures from the MITA 3.0 SS-A completed in 2013.

5. Obtained additional information through a variety of sources including planned State and federal initiatives andother documentation produced by SMEs.

6. Delivered an updated Texas MITA 3.0 SS-A comprised of the following:1. MITA Business, Information, Technical and Seven Conditions & Standards "AS IS" Assessment2. MITA Business, Information, Technical and Seven Conditions & Standards "TO BE" Assessment3. MITA Gap Analysis4. 2015 MITA 3.0 Roadmap that documents a blueprint for business and functional improvements to the Texas

Medicaid Enterprise

The 2015 MITA 3.0 SS-A contained results based on an approach that evaluated each business capability with an emphasis on specific agencies and their programs that had the greatest “volume of business”. This approach gave more weight to programs that handled a greater number of transactions, clients, dollars or other criteria—depending on the nature of the business process. This report shows the scores for the agencies that did not have the highest volume of business; however, those scores were not counted as the final score that is used to represent a given business area for the HHS Enterprise.

ParticipantsOver four hundred stakeholders and SMEs across the enterprise participated in the 2015 MITA 3.0 SS-A, including representatives from the Texas Medicaid Healthcare Partnership (TMHP). SMEs were selected from enterprise staff that play key roles in a specific business process. Participants and SMEs in the MITA 3.0 SS-A project were identified by the HHS management and project leadership staff using the 2012 MITA SS-A as a starting point and updates based on staff changes.

For the business assessment, participation was captured for each business process interview.

For the technical, information and seven conditions & standards parts of the assessment, participants were identified by associating them to systems assessed for this project. The participants were identified as SMEs assigned to one or more of the 20 systems included in this assessment. Participation was captured for each interview.

Identifying the Outputs from the MITA SS-AThe MITA SS-A is a prominent tool in the project and procurement life cycle. The goal of the SS-A is to identify and include for each business process a detailed description of its maturity level, capabilities, and qualities, along with current and potential measures as they relate to meeting state program management needs. This information is an input to strategic project planning areas and deliverables, such as the Implementation Advance Planning Document (IAPD), Requirements Planning, Unified Modeling Language (UML), Business Process Modeling, Cost Benefit Analysis (CBA), and the Request for Proposal (RFP) document. For this reason, it is important to identify the primary outputs from the MITA SS-A process:

21

● A detailed description of the current "AS IS" state of each business process, its associated capabilities, the qualityof these capabilities (what is going right or wrong), and the organizational units responsible for operating eachbusiness process.

● A MITA maturity level assessed for each of the current "AS IS" business processes.● A description of Texas’ current Medicaid IT architecture and environment that identifies the technology and

information baseline that will be taken into consideration when evaluating which business processes to improveand when the enabling technology and information architecture changes will be required.

● An evaluation of each business process for potential process improvements. When aligned with the prioritized "TO BE" goals and objectives of executive management, the future "TO BE" level of maturity for each business process is established.

MITA Outputs Transformed for Strategic InputsAs stated earlier, the MITA SS-A is a living document to be used as a strategic tool throughout the life of the Medicaid program. The SS-A provides the State with a roadmap to future enhancements and will be continuously re-evaluated as business processes progress through the MITA maturity levels. Key uses of this MITA SS-A are identified below.

The MITA 3.0 SS-A and MITA 3.0 Roadmap, in conjunction with future Implementation Advance Planning Documents (IAPDs), will establish future funding and audit trails as part of a governance structure. The summary business capability matrix submitted to CMS identifies potential system enhancements and maturity gains for specific processes and process areas over the project life cycle (End Note 5).

In April 2011, CMS issued guidance on the Enhanced Funding Requirements: Seven Conditions and Standards. The purpose of this guidance is to:

● Ensure that enhanced FFP funding is approved only when Medicaid infrastructure and information system projectsmeet statutory and regulatory requirements to support efficient and effective operations of the program.

● Assist states as they design, develop, implement, and operate technology and systems projects in support of theMedicaid program.

● Ensure states meet the conditions and standards for enhanced federal match for Medicaid technology investments.

The guidance (End Note 6) outlines the seven conditions and standards that CMS is looking for as states develop their APDs:

● Modularity Standard: Requires the use of a modular, flexible approach to systems development, including the useof open interfaces and exposed application-programming interfaces (APIs), the separation of business rules fromthe core programming, and the availability of business rules in both human and machine-readable formats.

● MITA Condition: Requires states to align to and advance increasingly in MITA maturity for business, architecture,and data. CMS expects the states to complete and continue to make measurable progress in implementing theirMITA Roadmaps.

● Industry Standards Condition: Requires states to align with and incorporate industry standards, specificallystandards and protocols adopted in Patient Protection and Affordable Care Act (PPACA); HIPAA security, privacy,and transactions standards; and the Rehabilitation Act accessibility standards or standards that provide greateraccessibility for individuals with disabilities, and compliance with federal civil rights laws.

● Leverage Condition: Promotion and implementation of sharing, leverage, and reuse of Medicaid technologies andsystems within and among states.

● Business Results Condition: Systems should support accurate and timely processing of claims (including eligibilityclaims) and effective communications with providers, beneficiaries, and the public.

● Reporting Condition: Solutions should produce transaction data, reports, and performance information that wouldcontribute to program evaluation, continuous improvement in business operations, and transparency andaccountability.

● Interoperability Condition: Systems must ensure seamless coordination and integration with the exchange (whetherrun by the State or federal government), and allow interoperability with HIEs, public health agencies, humanservices programs, and community organizations providing outreach assistance services.

7 Business Assessment Process

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The 2015 MITA 3.0 SS-A involved identifying business SMEs and managing participation for business validation sessions beginning in August of 2014 and completing in August of 2015. State project managers selected SMEs to represent nine of the ten MITA business areas to update and validate the MITA SS-A for HHS. In total, the MITA team and SMEs confirmed the "AS IS" and "TO BE" MITA maturity levels of 75 business processes (note that one business process is not applicable). These sessions averaged 1.5 hours per business processes depending on the complexity of the process.

The SMEs were invited to participate in sessions assessing each business process to provide input to standardized templates. Prior to the session, the templates were populated with information gathered from the previous 2012 MITA SS-A. Through a facilitated group review process, the SMEs were questioned about their current business processes and encouraged to elaborate on constraints, opportunities, current issues, and plans for improved business functionality. This information was added to the templates and the templates were then submitted to the staff for review and feedback.

Based on the information gathered in the business process sessions, MITA maturity levels were assessed for both "AS IS" and "TO BE" and in consideration of the 5 year MITA maturity milestone dates previously discussed. Maturity assessments for each business process are provided in this report, along with an overall discussion of the "AS IS" and "TO BE" objectives for the business area as a whole.

The MITA business process maturity scoring methodology used is based on guidelines provided by the MITA framework. The MITA team used CMS MITA business process templates, including individual business process descriptions, process ownership, process steps, systems used, and activities that are working well within the process. Definitions for each business process were re-written to fit with the Texas HHS Enterprise version of the business process if such a change was required. Using this information, the "AS IS" and "TO BE" business process capabilities are identified.

The methods in the CMS MITA Framework 3.0 SS-A Companion Guide (End Note 7) were used to assess business processes. The guidance is as follows:

The SMA must meet all the capabilities for a level before it can advance to the next level when evaluating the BA. A business process scores at a Level 3 only when the SMA achieves all business capabilities defined for Level 3 in the BCM. A maturity level will be a whole number (e.g., Level 1, Level 2, etc.). CMS expects the business process to meet all criteria of the maturity level; otherwise, the business process scores at the lower capability level. (End Note 8)

The MITA maturity rating required by CMS for each MITA business process is represented by a single whole number value between 1 and 5 for both the "AS IS" and "TO BE" maturity levels. Individual capabilities are gathered in both the session templates and transferred to the MITA business architecture scorecards. MITA maturity ratings are summarized in the business architecture profiles.

The maturity levels support the following, found in the CMS MITA White Papers, MITA Overview:

MITA will support the following categories of business needs facing state Medicaid organizations:● State needs

● Align with the state’s strategic goals● Align with the state’s enterprise architecture

● Medicaid-wide goals● Align state approaches among states● Align state approaches with national direction

● National goals through MITA alignment with national initiatives and international standardsIn addition to the MITA maturity rating, the state also provides a detailed analysis of individual business processes capabilities to illustrate what capabilities are already met by the state and the relative level of effort over the next five years to achieve "TO BE" goals. This report provides a full one-to-one rating for each capability aggregated by business process. Capability summaries are provided for each business area as well.

Note that the MITA Framework 3.0 is incomplete at this time. CMS did not release four (4) Member-related business processes in the eligibility and enrollment business area. The MITA Team opted to simply omit this business area from the 2015 MITA 3.0 SS-A.

8 Technical and Information Assessment ProcessIn order to capture relevant "AS IS" and "TO BE" information on key Medicaid systems, associated technical SMEs were

23

identified and interviews were conducted just as was carried out with the Business Architecture SMEs and associated questions. The list of 20 key Medicaid systems was developed based on the systems identified by Business Architecture SMEs during those interviews. These systems were then categorized into two groups: (1) Primary Systems and (2) Supporting systems and technologies. These systems were reviewed for approval and inclusion into the category of top systems by Senior HHSC IT Staff. System selection criteria is based on if the system is receives funding support from Medicaid and or if the system provides critical operational functions.

In addition, the decision to evaluate these specific systems stemmed from how the business architecture (BA) and the technology architecture (TA) intersect per the language CMS uses in the MITA 3.0 documentation. CMS notes that the “BA and TA connect and align through hardware, application, and connectivity mechanisms that originate from the BA” (Part III - Technical Architecture, Chapter 1, page 5).

Texas’ systems review used the MITA TA questions in order to gain a functional perspective of the state’s technical architecture. This approach is supported by the MITA 3.0 chapter on the TA’s technical capability matrix, which notes that the “purpose of the Technical Capability Matrix is to describe the boundaries and behavior of each MITA technical function in the context of the five (5) levels of MITA” (Part III, Chapter 7, page 3).

Further evidence for this approach is found in Part III - Technical Architecture, Chapter 1, page 4. In this section, the MITA TA can be understood from conceptual, logical and physical abstraction levels. These levels show how the business owner, system designer or architect and software developer view a given solution’s components, relationships and the way a solution is implemented.

The technical and information survey questions are based on technical functions discussed in the MITA Framework 3.0 Part III – technical architecture and other system criteria.

The results of the Technical, Information and Seven Conditions and Standards interviews were analyzed and a synopsis of the "AS IS" information was written for each technical area and function. An assessment of the technical maturity was performed for each technical function based on the Technical Capability Matrix (TCM) and Information Capability Matrix (ICM) guidelines outlined in the MITA Framework 3.0, where applicable. The matrices include individual capabilities by technical and information area for each of the five levels of MITA maturity.

The methods in the CMS MITA Framework 3.0 Companion Guide were used in determining the capability assignment for each assessed information system. The guidance is as follows:

Information Architecture (IA)

The SMA must meet all the capabilities for a level before it can advance to the next level when evaluating the IA. A business area scores at a Level 3 only when the SMA achieves all information capabilities defined for Level 3 in the ICM. CMS expects the business area to meet all criteria of the maturity level; otherwise, the business area scores at the lower capability level. A maturity level will be a whole number (e.g., Level 1, Level 2, etc.).

Technical Architecture (TA)

The SMA must meet all the capabilities for a level before it can advance to the next level when evaluating the TA. A business process scores at a Level 3 only when the SMA achieves all technical capabilities defined for Level 3 in the TCM. CMS expects the business area to meet all criteria of the maturity level; otherwise, the business area scores at the lower capability level. A maturity level will be a whole number (e.g., Level 1, Level 2, etc.).

The MITA technical and information architecture maturity scoring methodology used is based on guidelines provided by the MITA framework. The State opted to take an average score for the Technical, Information and Seven Conditions and Standards questions based on the group of systems analyzed for each business area. Scores were rounded up for any numbers that averaged out to a “.5” or higher and rounded down for scores of “.4” or lower. These scores were then subjected to the previously mentioned CMS rules outlined in the CMS MITA Framework 3.0 Companion Guide.

The MITA maturity rating required by CMS for each MITA technical or information architecture function is represented by a single whole number value between 1 and 5 for both the "AS IS" and "TO BE" maturity levels. MITA maturity ratings for each of the four areas are summarized in the profiles.

The narrative for the scoring of each system states whether the level of maturity for the "AS IS" is at the same level as the previous assessment in 2012, or has "moved to" a higher level. The "TO BE" scores reflect whether the maturity levele will "move to" a higher level, or remain the same as the current "AS IS" for the next five years. For example: "CMBHS will move to a level 3 for the "AS IS" And move to a level 4 for the "TO BE" for TA, Section 2."

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In order to better understand the terminology that MITA uses around how the Business Architecture and Technical Architecture cross, it is worth considering the following terms: business capabilities, business services, technical capabilities and technical services (Part III, Chapter 7, page 4).

MITA states that “whereas business capabilities define business services, the Technical Architecture maps technical capabilities to technical services. Technical capabilities associate themselves with IT solutions or enablers” and that a “business service is an implementation of a specific business process at a specific level of capability”.

Texas interprets this to mean that business capabilities are indicative of the categories (e.g., “Timeliness of Process”) that contain the business questions, whereas the business services are a combination of a category’s specific question and its level of maturity. For example, “What is the timeliness of the end to end process” would be the question and “Level 1: Process meets threshold or mandated requirements for timeliness…” would be the maturity level.

For the MITA Technical Architecture, technical capabilities are indicative of the five levels of maturity. Unlike business services, technical services coincide with the Technical Service Area (e.g., “Access and Delivery”) and the relevant Service Classification Group (e.g., “Client Support [Business Results Condition]”). Also unlike the business architecture, the Technical Architecture has no formal questions.

Limitations of the Assessment

The information in the SS-A has a number of limitations that must be considered when evaluating the data.

While each of the five operating agencies within HHS has varying levels of technology, processes, and capabilities, the MITA 3.0 assessment requires providing a single maturity level to represent the entire Medicaid Enterprise. Naturally, this presents challenges with describing the maturity of a complex enterprise to a single numerical value.

Comparative analysis of maturity assessments between the 2012 SS-A and the 2015 SS-A cannot be conducted given that the 2015 Assessment is a re-baselining effort. Texas has made progress in improving capabilities and the enterprise has by no means regressed in the level of maturity of its capabilities. However, the assessed maturity level in the 2015 SS-A may be lower, or may not have improved in comparison to the 2012 SS-A. These apparently lower assessments should not be automatically interpreted as a change for the worse. In most cases, the apparent loss of maturity is due to a more thorough understanding of the business process capabilities.

At the time of this assessment, CMS had not released the four (4) member-related business processes in the eligibility and enrollment business area for the MITA Framework 3.0. The assessment for these business processes will need to be revisited once CMS has released the update.

Additionally, defining changes related to longer-term strategies will remain a challenge because it is dependent upon technologies, business processes, and standards that may not exist at present, or are not yet fully evolved by a state or by CMS.

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HHSC 2015

9 Business Architecture

9.1 Business Assessment Themes In the Texas MITA SSA from 2012, common themes emerged that needed attention. Interviewers captured these themes during the assessment of the business architecture. They included concepts around governance, data management, fragmented data sources, standards and automation, information of record sources, and stakeholder satisfaction.

Governance at the IT level has made great progress since the last MITA SSA in 2012. In 2014, HHSC IT began operating under a governance model that supports setting and managing standards and process changes of all types. The Enterprise Business Strategy now addresses a variety of business, information and technical needs through the HHSC governance model.

The HHS Enterprise’s 2014-2015 priorities are outlined in the table below, in no specific order. The MITA SS-A Business Assessment Results are listed after the table below.

Mandate, requirement or other concern Associated Project

Implementation of International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) code sets ICD-10 project

Meeting compliance dates for new ACA operating rules requirements CAQH Core Rules

Development of HIE capabilities and the ongoing job of interfacing with the HIX EDG and TIERS Projects

Data management, fragmented data resources and standardization EDG and EDW Projects

Information of Record EDG and EDW Projects

Automation PPS and BIP projects

For the Business Architecture a total of 827 questions within the 75 business processes were scored. Of these 827 questions, 41 questions are at a Level 1 for the "AS IS" score. This represents 5% of the total questions for the Business Architecture (BA). Of the 41 BA questions at a L1:

● Total remaining at a L1 for TO BE: 19 (46%)● Total moving to a L2 for TO BE: 21 (51%) ● Total moving to a L3 for TO BE: 1 (2%)

Of the 41 BA questions at L1, 20 (49%) are for timeliness.

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Each determination of MITA business process maturity consists of a series of questions which guide the state to select the appropriate maturity level. While the factors associated wit h each business process and question differ, some themes regardin each maturity level emerge. These are shown in the following table:

MITA Maturity Levels

Maturity Description

Level 1

● Process is primarily manual and labor intensive, with low reliability of accuracy, cost- effectiveness,and efficiency;

● The process uses no standards, or only State specific standards, for information exchange;● Very little collaboration occurs with other agencies to standardize information exchange or business

tasks;● The process meets mandated requirements for timeliness;● Information related to the process is stored in disparate systems, including paper storage, with

information obtained manually;● Stakeholder satisfaction rate is low.

Level 2

● Process is a mix of manual and automated processes, increasing accuracy, cost-effectiveness andefficiency over level 1;

● The process uses a mix of HIPAA and State-specific standards for information exchange;● The State Medicaid Agency (SMA) collaborates with state agencies or entities using Electronic Data

Interchange (EDI) transactions or other standardized information exchange;● Timeliness for the end-to-end process exceeds legal requirements;● Information stored in disparate systems, but accessibility is improved through automation and

standardization;● Stakeholder satisfaction is greater than level 1.

Level 3

● Process is automated to the full extent possible within the intrastate, increasing accuracy, cost- effectiveness, and efficiency over level 2;

● The process uses industry and other nationally recognized standards for intrastate informationexchange;

● The SMA collaborates with intrastate agencies and entities to adopt national standards and sharereusable business services;

● Timeliness improves via state and federal collaboration, information sharing, and standards,exceeding level 2;

● Information is easily exchanged with intrastate agencies, improving accessibility over level 2;● Stakeholder satisfaction is improved, with intrastate information exchange; State Medicaid Agency

(SMA) uses survey/questionnaire for information collection.

Level 4

● Process is automated to the full extent possible across the interstate, increasing accuracy, cost- effectiveness, and efficiency over level 3;

● Industry and other nationally recognized standards are used for interstate information exchange;● The SMA collaborates with interstate agencies and entities to adopt national standards and share

reusable business services;● Information is available in near real time, with interstate interoperability; Timeliness exceeds level

3;● Information is easily exchanged with interstate agencies, improving accessibility over level 3;● Stakeholder satisfaction is improved with interstate information exchange, exceeding level 3.

Level 5

● Process is automated to the full extent possible across the nation, increasing accuracy, cost- effectiveness, and efficiency over level 4;

● Industry and other nationally recognized standards are used for national information exchange;● The SMA collaborates with national/international agencies and entities to adopt national

standards and share reusable business services;● Information is available in near real time, through connectivity with other States and Federal

agencies; Results are almost immediate;● Information is easily exchanged with national agencies, improving accessibility over level 4;● Stakeholder satisfaction is improved with national information exchange, exceeding level 4.

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HHSC 2015

Comparison of "As-Is" Distribution By Business Area 2012 vs. 2015Level 1 Level 2 Level 3 Level 4 Level 5

2012 2015

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.7%

0.0%

0.0%

0.0%

1.0%

2.5%

0.0%

0.0%

0.0%

0.0%

8.5%

0.0%

0.0%

0.0%

24.5%

15.7%

13.8%

0.9%

0.0%

0.0%

69.4%

54.4%

87.6%

18.2%

70.6%

70.6%

75.9%

88.8%

65.9%

53.7%

21.4%

45.6%

12.4%

81.8%

3.9%

11.3%

10.3%

10.3%

34.1%

46.3%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%% of Questions

Total

PM

PL

PE

OM

FM

EE

CO

CM

BR

0.9%

0.0%

0.0%

0.0%

0.0%

0.5%

5.7%

1.0%

0.0%

0.0%

1.8%

0.0%

1.1%

0.0%

2.9%

5.0%

0.0%

0.0%

0.0%

2.4%

26.8%

5.3%

11.5%

49.1%

46.7%

31.8%

28.7%

27.6%

14.6%

2.4%

65.4%

86.0%

71.3%

49.1%

46.7%

60.7%

64.4%

65.7%

78.0%

92.7%

5.1%

8.8%

16.1%

1.9%

3.8%

2.0%

1.1%

5.7%

7.3%

2.4%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%% of Questions

Total

PM

PL

PE

OM

FM

EE

CO

CM

BR

BR - Business Relationship Management

EE - Eligibility & Enrollment Management

PE - Performance Management

CM - Care Management FM - Financial Management PL - Plan ManagementCO - Contractor Management OM - Operations Management PM - Provider Management

28

HHSC 2015

Comparison of "As-Is" Distribution By Business Area 2012 vs. 2015# of Questions

2012 2015Level 1 176 42

Level 2 572 535

Level 3 70 219

Level 4 6 15

Level 5 0 7

2012

Level 50%

Level 41%Level 38%

Level 269%

Level 121%

2015

Level 51%Level 42%

Level 327%

Level 265%

Level 15%

The breakdown of the difference by maturity level between the 2012 and 2015 assessments is as follows:

Level 2012 2015 Increase/Decrease (>/1%

The business areas which showed the most improvement were Business Relationship Management and Performance Management. Business Relationship Management reduced questions rated at a level 1 from 46.3% to 2.4%, and increased the questions at a level 2 from 53.7% to 92.7 %. Improvements in accuracy, accessibility, cost-effectiveness, and efficiency were attributed to the consolidation of the majority of the business to the HHSC Procurement Office and increased use of the Medicaid Contract Administration Tracking System (MCATS) by the Health and Human Services Enterprise.

Performance Management reduced questions rated at a level 1 from 81.8% to 1.9%, while increasing questions at a level 2 from 18.2% to 49.91% and those at a level 3 from 0 to 49.1%. Increased automation and integration with electronic interchange, and use of national standards (e.g., compliance with HIPAA standards), resulted in improved accuracy, efficiency and cost-effectiveness, contributing to the improvement in the maturity levels.

29

HHSC 2015

Distribution of Questions By Business Area - 2015Level 1 Level 2 Level 3 Level 4 Level 5

As-Is To-Be

0.9%

0.0%

0.0%

0.0%

0.0%

0.5%

5.7%

1.0%

0.0%

0.0%

1.8%

0.0%

1.1%

0.0%

2.9%

5.0%

0.0%

0.0%

0.0%

2.4%

26.8%

5.3%

11.5%

49.1%

46.7%

31.8%

28.7%

27.6%

14.6%

2.4%

65.4%

86.0%

71.3%

49.1%

46.7%

60.7%

64.4%

65.7%

78.0%

92.7%

5.1%

8.8%

16.1%

1.9%

3.8%

2.0%

1.1%

5.7%

7.3%

2.4%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%% of Questions

Total

PM

PL

PE

OM

FM

EE

CO

CM

BR

1.5%

0.0%

2.3%

0.0%

2.9%

0.5%

5.7%

1.0%

0.0%

0.0%

5.7%

0.0%

1.1%

37.7%

6.7%

5.0%

6.9%

0.0%

1.2%

4.9%

42.2%

22.8%

31.0%

34.0%

61.9%

53.7%

48.3%

42.9%

19.5%

26.8%

48.3%

73.7%

62.1%

26.4%

25.7%

40.3%

39.1%

52.4%

74.4%

65.9%

2.3%

3.5%

3.4%

1.9%

2.9%

0.5%

0.0%

3.8%

4.9%

2.4%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%% of Questions

Total

PM

PL

PE

OM

FM

EE

CO

CM

BR

BR - Business Relationship Management

EE - Eligibility & Enrollment Management

PE - Performance Management

CM - Care Management FM - Financial Management PL - Plan ManagementCO - Contractor Management OM - Operations Management PM - Provider Management

30

Distribution of Questions By Level - 2015# of Questions

As-Is To-BeLevel 1 42 19

Level 2 535 395

Level 3 219 345

Level 4 15 47

Level 5 7 12

As-Is

Level 51%Level 42%

Level 327%

Level 265%

Level 15%

To-Be

Level 51%Level 46%

Level 342%

Level 248%

Level 12%

31

HHSC 2015

9.2 BR -- Business Relationship Management

9.2.1 Business Area Summary

The Business Relationship Management business area processes are handled by HHSC’s Procurement Contracting Services (PCS) and the Medicaid/CHIP Division (MCD). Additional processes exist under other agencies in the HHS Enterprise; however, much of the consolidation efforts in procurement have lessened the prominence of these entities with relation to PCS. As a result, the highest volume of business and business process scores are based on the interviews conducted with PCS and with MCD. The overall score for the 2015 MITA 3.0 SS-A Business Relationship Management Business Area is the same as it was on the 2012 MITA 3.0 SS-A; however, in the 2015 MITA 3.0 SS-A two of the four business processes moved up from a level 1 to a level 2.

9.2.2 Recommendations Summary

Although the Business Relationship Management business area made great strides in the last two years, some barriers to advancement up the MITA maturity levels exist.

The first of the two questions that are still at a 1 in this business area is question number 4 under “Establish Business Relationship.” The question asks “How timely is the end-to-end process?” This question is at a 1 because this process may require weeks to complete due to the need to customize each agreement. Additional resources are needed to help procurement take less than multiple weeks to complete an agreement.

The second of the two questions still at a 1 is question number 2 under “Manage Business Relationship Communication.” The question asks “Is communication linguistically, culturally, and competency appropriate?” This question is at a 1 because there is no systematic process in place to gauge whether or not communications are competency appropriate or linguistically accurate. The resources needed to improve steps to guarantee appropriateness—and thereby move this process to a level 2—are not available.

Another recurring general concern is the last question for every business process. Level 3 of the last question asks if the HHS Enterprise evaluates stakeholder engagement via a questionnaire. The answer from most business owners is a “no”. Therefore, HHS agencies must use stakeholder satisfaction questionnaires in order to reach a level 3.

In addition, for the HHS Enterprise to house all procurements and contracts in one place HHS agencies need to either fully adopt the Health and Human Services Contract Administration & Tracking System (HCATS) or the State must create a new system that serves as a single repository for all agencies’ procurements and contracts. All agencies in the HHS Enterprise use HCATS by feeding the system with data for contract reporting purposes; however, not all agencies make use of all of HCATS’ procurement and contract functions.

Other constraints include:● State, Federal and Legislative rules that inhibit change● Lack of legislation that is needed to move a process forward● Lack of resources required to provide enough man power to advance a process● The inability to fully automate a process due to the need for human intervention

BR -- Business Relationship Management Maturity ProfileBusiness Process Level 1 Level 2 Level 3 Level 4 Level 5

Manage Business Relationship Information As-Is

To-Be

Manage Business Relationship Communication As-Is

To-Be

Establish Business Relationship As-Is

To-Be

32

Business Process Level 1 Level 2 Level 3 Level 4 Level 5

Terminate Business Relationship As-Is

To-Be

BR -- Business Relationship Management Question Distribution# of Questions

As-Is To-BeLevel 1 1 1

Level 2 38 27

Level 3 1 11

Level 4 1 2

Level 5 0 0

As-IsLevel 50%

Level 42%Level 32%

Level 293%

Level 12%

To-Be

Level 50%

Level 45%

Level 327%

Level 266%

Level 12%

33

HHSC 2015

9.2.3 Establish Business Relationship

9.2.3.1 BR01 Business Process Definition

The Establish Business Relationship business process encompasses activities undertaken by the State Medicaid Agency (SMA) to enter into business partner relationships. Agreements are between state agency and its partners, including collaboration amongst intrastate agencies, the interstate and federal agencies. It contains functionality for interoperability, establishment of inter-agency service agreements, identification of the types of information exchanged, and security and privacy requirements. These include Trading Partner Agreements (TPA), Service Level Agreements (SLA), and Memoranda of Understanding (MOU) with other agencies; electronic data interchange (EDI) agreements with providers, Managed Care Organizations (MCOs), and others; and Centers for Medicare & Medicaid Services (CMS), other federal agencies, and Regional Health Information Organizations (RHIO).

HHS Enterprise Definition

The HHS Enterprise definition is the same as the CMS definition for Procurement Contracting Services (PCS) and for DSHS.

9.2.3.2 Agency Applications

The applications associated with this business process are primarily HCATS and HHSAS. Secondary applications include DSHS’ Source and Compass systems.

HHSC● HHSAS is used as an ERP (Enterprise Resource Planning System). Purchase orders (P.O.) and requisitions are

entered into HHSAS. A requisition is signed and encumbers funds before it is entered into HHSAS. HHSAS is also connected to HCATS. HHSAS is a real time application.

● HCATS is a web-based tracking system designed to facilitate the maintenance and tracking of contracts from theprocurement process through contract expiration/termination. HCATS provides electronic storage and immediate retrieval of contracting and procurement documents. HCATS also provides contract staff with the option to electronically track contract deliverables, such as performance measures, timely contractor billings, etc. HCATS has APIs with outside entities.

● How the two work together: HHHSAS pulls contract data from agency databases (e.g. DADS Share Point, DFPSImpact, etc.) and transfers this data to the financial data warehouse. HCATS pulls its data from this financial data warehouse by looking at all contracts with numbers that are tied to a P.O. Despite the fact that HCATS regenerates overnight in batches and that HHHSAS is a real time application, this process may take one to two days due to the time delay in getting information from the agency to HCATS (i.e., Agency data--to--HHHSAS--to--Financial data warehouse--to--HCATS).

DSHS● The Source: A contracting system used to develop contracts at DSHS.● Compass: A contracting system used to develop contracts at DSHS. The Source is going to be retried and data

migrated over to Compass.

9.2.3.3 Score

The “AS IS” scores for the MITA 3.0 2015 Assessment improved from the previous assessment for question 1. All other “AS IS” scores remained the same. The new “TO BE” scores for the MITA 3.0 2015 Assessment are also listed. The final total score is a 1.

Metric ScorecardMetric As-Is To-Be

Business Capability 2 3

34

Metric As-Is To-Be

Descriptions

Q1. Is the process primarily manual or automatic?

2 3

Evidence PCS: Question 1 will move from a level 1 to a level 2. The Enterprise uses a mix of manual and automated processes for communication and distribution among leadership and other agencies. HIPAA standards are included. Q1 will not advance from a level 2 to a level 3 until state legislation mandates that all trading partners sign electronic information interchange agreements.

Although the processes are fairly manual, they are very sound processes. State legislation drives the manual nature of the process; namely, via the Texas Government Code, Sections 2254, 2262 and 2155 (subsection 4) and through the Texas Administrative Code, Sections 391 (subchapters B and C) and 417. In addition, the HHSC Procurement Manual will be put online by the end of 2015. The Procurement section of the Texas Administrative Code (TAC) and the Comptroller Procurement Manual are online. The Comptroller is the final authority on procurement. This process will not move from a 2 to a 3 until state legislation mandates that all trading partners sign electronic information interchange agreements.

DSHS: Question 1 will move from a level 1 to a level 2. A mix of manual and automated. DSHS plans to move towards full electronic exchange with the migration to Compass from the Source and thereby get to a level 3. dd

Q2. Does State Medicaid Agency use standards in the process?

2 4

Evidence PCS: Question 2 will move from a level 1 to a level 2. HIPAA and state standards are used. The Enterprise uses a standard methodology when developing the business relationship and associated electronic and manual documentation. There are data use agreements and data exchange standards in place. Electronic signatures are accepted and must conform to security standards but hard copies may also be required (see TAB 3: MAJOR PROCUREMENT/ RFP/SOLICITATION, Section 5.11.1 Electronic Processing of Contracts (Paperless Process), Revised: March 1, 2013, pages 92-94).

The concept of "industry standards, and other nationally recognized standards for intrastate exchange of information defined in the Service Level Agreement (SLA) with trading partner" is not applicable because the nature of this business process only entails the exchange of information regarding the actual RFP or other type of agreement and not the data exchange that ensues once the agreement has been settled. The levels defined in this question seem to pertain to information exchange standards that are outlined inside the agreement itself. If this is the case, national/industry standards are used. See the

35

Metric As-Is To-Be

HHSC UNIFORM MANAGED CARE MANUAL CONSOLIDATED DELIVERABLES MATRIX. For example, line 18 specifies that for encounter data coming from an MCO to the state " must follow the format and data elements as described in the HIPAA-compliant 837 format. The MCO must include all Encounter Data and Encounter Data adjustments processed by the MCO. Encounter data quality validation must incorporate assessment standards developed jointly by the MCO and HHSC. Other standards that are followed in the exchange of information with MCOs include:

42 U.S.C. § 1396a(a)(37) [§ 1902(a)(37) of the Social Security Act] 42 U.S.C. § 1396u-2(f) [§ 1932(f) of the Social Security Act] Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191 42 C.F.R. § 433.139 42 C.F.R. § 438.242 42 C.F.R. § 447.45 42 C.F.R. § 447.46 45 C.F.R. §§ 160 164 Texas Insurance Code § 843.349 (e) and (f) 1 Tex. Admin. Code § 353.4 28 Tex. Admin. Code Chapter 21, Subchapter T, "Submission of Clean Claims" Texas Insurance Code Chapter 843, Subchapter J, "Payment of Claims to Physicians and Providers" 28 Tex. Admin. Code § 21.2826 waives the application of certain statutes and rules regarding prompt payment of claims as to Medicaid and CHIP managed care plans. HHSC has developed its own Claims Processing requirements that are informed by, but are not governed by, the Texas Department of Insurance requirements, unless noted in the statutory and regulatory authorities National Correct Coding Initiative (NCCI) All authorities cited in Chapter 2.0, "Uniform Managed Care Claims Manual Texas Insurance Code § 843.339, "Deadline for Action on Prescription Claims Payment 1 Tex. Admin. Code Chapter 353, Subchapter J, Outpatient Pharmacy Services (Medicaid) 1 Tex. Admin. Code Chapter 370, Subchapter H, "Outpatient Pharmacy Services" (CHIP) Texas Government Code Chapter 533, including §533.00251, §533.002515, §533.002521 Tex. Admin. Code, Part 15, Chapter 35540 Tex. Admin. Code Chapter 19, Subchapter AA VendorPayment, including 40 Tex. Admin. Code §19.2604 and 40 Tex.Admin. Code §19.2609, are Department of Aging and DisabilityServices rules informing the Nursing Facility claims paymentprocess.Texas Medicaid & Healthcare Partnership E-Mail EncryptionBasics/Help Guide

Q3. How does the State Medicaid Agency collaborate with other

2 3

36

Metric As-Is To-Be

agencies or entities in performing the process?

Evidence PCS: Question 3 will stay at a level 2 and may move from a level 2 to a level 3 in the next five years. PCS, the program area and the General Council work together on this. Duties for each are specified in C-037: Procurement Roles and Responsibilities. The State Medicaid Agency collaborates with other agencies per state standards although the adoption of national standards for this purpose is N/A. The State is open to sharing reusable business services such as HCATS; however, this process will not move to a level 3 until all agencies either adopt HCATS or until the State creates an all-encompassing new system.

Note that in order for the HHS Enterprise to house all procurements and contracts in one place, HHS agencies need to either fully adopt the Health and Human Services Contract Administration & Tracking System (HCATS) or the State must create a new system that serves as a single repository for all agencies' procurements and contracts. All agencies in the HHS Enterprise use HCATS by feeding the system with data for contract reporting purposes; however, not all agencies make use of all of HCATS' procurement and contract functions.

DSHS: Question 3 is same as PCS. Contract development is only a DSHS-HHSC collaboration and no change to this process is foreseen.

Timeliness of Process 1 1

Q4. How timely is this end-to-end process? 1 1

Evidence PCS: Question 4 will remain a level 1. Each agreement is customized, so the process requires multiple weeks to complete, in part due to resource constraints.

DSHS: Question 4 is same as PCS.

Data Access and Accuracy 2 2

Q5. How accurate is the information in the process?

2 2

Evidence PCS: Question 5 will remain a level 2. It is difficult to automate decision-making due to the need for customized agreements across the Enterprise. Nonetheless, the information in the process is very accurate.

DSHS: Question 5 is same as PCS.

Q6. How accessible is the information in the proce