Wednesday Perspectives Guenther - MESConference€¦ · August22,$2012$...

Bob Guenther Client Execu2ve, Health and Human Services

August 22, 2012

Perspec'ves of Strategic Planning: CMS Tools

Tools Agenda

8/23/12 © 2012 CSG Government Solu5ons 2

MECT MITA

CALT

MECT


Medicaid Enterprise Cer'fica'on Toolkit

MECT Overview


Ø Toolkit developed to support new business area perspec5ve and to provide guidance to users

Ø Toolkit can be used during all phases of SDLC

Ø New format and content for checklists

Ø Toolkit contains checklists, protocols, and templates

Ø Each SDLC milestone is discussed in Toolkit; State and CMS ac5ons are described

Tools in the Toolkit


Ø Three review protocols ü  APD Development and Review Protocol

ü  State Cer5fica5on Readiness Protocol ü  CMS Cer5fica5on Review Protocol

Ø 20 comprehensive checklists:

ü  Business objec5ve driven ü  May be mul5ple checklists per business

area

Ø Templates for documents and leUers (not mandatory)

Procurement Roadmap


REFERNCE DATA MANAGEMENT CHECKLIST BACKGROUND Background for this checklist: Reference Data refers to the body of codes, attributes, and descriptions used by applications within or interfacing with the MMIS. The traditional

Reference Subsystem is a composite of applications that periodically update or replace tables of codes. Reference data are created and maintained by many external entities, many of which are named Standard Developing Organizations. Some of these

are recognized by HHS as the owners or developers of data standards required by the Health Insurance Portability and Accountability Act (HIPAA).Sources for the criteria in this checklist are s follows:

SMM – State Medicaid Manual, MMIS Section, available from http://www.cms.hhs.gov/Manuals/PBM/list.asp,

Reference Data Management (RF)

BUSINESS OBJECTIVES Refer# Business Objectives

RF1 Manage Reference Data to Support Claims Processing, data to consist of proper procedure, diagnosis, formulary and drug pricing codes, charge information, and data that supports different payment methods (e.g. Outpatient Prospective Payment System (OPPS), Diagnosis Related Group (DRG), etc), and other items as needed by the State.

RF2 Comply with Health Insurance Portability and Accountability Act (HIPAA) requirements.

RFSS-1 Add State-specific business objectives for the Reference Data Management Checklist here.

RF1– Manage Reference Data to Support Claims Processing Ref # System Review Criteria Source Yes No Comments

RF1.1 Maintains reasonable and customary charge information for Medicaid and Medicare to support claims processing:

SMM

FI2.2 Supports Payment for Services by providing reference data, including procedure, diagnostic, and formulary codes (42 CFR 447).

SMM

FI2.3 Archives all versions of Reference Information and updates transactions

IBP

MECT Updates Needed


Ø Sync with MITA 3.0

Ø Revise APD guidance to include 7 C&S

Ø Consider Adop5ng the gate review approach

MECT


Medicaid IT Architecture

The MITA Ini'a've


Ø Collabora5ve effort among the feds, the states, and the industry to standardize Medicaid business processes and data exchange

Ø Emphasis on business driving technology and maturing Medicaid toward HIT/HIE goals

Ø Architecture based on SOA Ø AUempts to standardize the approach to Medicaid IT replacement

Ø Provides metrics for system maturity

3.0 Framework


MITA and Strategic Planning


Ø Concept of Opera5ons Document

Ø Business Processes Model

Ø Capability Maturity Matrices

Ø State Self Assessment

State Self Assessment Process


CALT


Collabora've Applica'on Lifecycle Management Tool

(CALT)

CALT Overview


Ø  The CALT is a collabora5ve tool that creates a centralized loca5on for storing, collabora5ng on and sharing deliverables and ar5facts from IT projects in support of Medicaid administra5on and establishment of Exchanges.

Ø  CALT is deployed on a secure cloud compu5ng environment, so that States can submit informa5on regarding IT systems development to a na5onal repository regardless of geographic loca5on.

Ø  CALT is a plaborm that supports the en5re socware life cycle, from requirements and release management, to code review and defect tracking, to build management, test and file releases.

Ø  Access to CALT is limited to CMS, states, non-‐CMS Federal partners and authorized vendors.

CALT Applica'on


Ø  CALT collabora5on features allow States to manage systems development ac5vi5es related to planning, developing, tes5ng, implemen5ng, and maintaining numerous Medicaid/Exchange IT socware/system applica5ons, and to communicate their progress and innova5ve ideas with other States.

Ø  CALT contains useful informa5on on:

ü  Ini5al guidance to states on Exchanges

ü  IT system architecture and reference models

ü  Eligibility and Enrollment

ü  Security and Privacy

ü  Blueprints for approval of state-‐based exchanges

CALT Communi'es


Ø  CALT Community – Informa5on exchange forum for CALT (48)

Ø  CALT Sandbox – “Experimenta5on” area for CALT tool usage (99)

Ø  CMS OIS CIISG Exchange Opera5ons -‐ Exchange of informa5on between the XOC, states, and the vendor community (4)

Ø  Exchange Community – Area where project teams can share informa5on and collaborate (1138)

Ø  Medicaid State Collabora5ve Community – Area for collabora5on among states for IT advanced planning (865)

Ø  Support (18)

Ø  Training (20)

Ø  No MMIS procurement specific informa5on.

CALT Access


[email protected]

8/23/12 © 2012 CSG Government Solu5ons, Inc. 20

Bob Guenther Client Execu5ve CSG Government Solu5ons 180 North Stetson Avenue Suite 3200 Chicago, Illinois 60601 [email protected] (410)972-‐1714

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Wednesday Perspectives Guenther - MESConference€¦ · August22,$2012$...

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