RD312 - Annual Report on the Replacement of the Medicaid Management Information System – October 1, 2017

Executive Summary:

The Department of Medical Assistance Services (DMAS) is replacing its Medicaid Management Information System (MMIS) with a Medicaid Enterprise System (MES). As regulations have increased since the initial implementation of the MMIS, the system has become defined by several significant constraints, including: (1) a general lack of development agility; (2) increasing operational costs; and, (3) growing consumption of technical resources necessary to update this dated systems platform. At the same time, demands for new programs and services have increased. Virginia citizens expect more accessibility to these services and to the information related to obtaining the services. Consequently, it is DMAS’ desire to establish mutually beneficial partnerships with business-driven, healthcare technology leaders to transition to a more modern Medicaid Business and Technical environment.

In 2016, DMAS began the procurement process to solicit proposals from qualified firms to collaborate with the Agency and other partners to achieve a more modern Medicaid Business and Technical environment. The Agency issued Request for Proposals (RFPs) to identify innovative, cooperative, flexible, and customer-oriented organizations that were willing to collaborate with each other and with DMAS to achieve common goals.

DMAS collaborated with the Centers for Medicare & Medicaid Services (CMS) and a CMS-sponsored state cohort group on the MES procurement. The cohort group created an RFP template for the procurement. DMAS also has been actively involved in CMS-sponsored workgroups that have helped ensure DMAS’ vision aligns with CMS’ goals concerning certification of the new MES solutions. CMS requires a formal Medicaid Enterprise Certification Lifecycle (MECL) and Medicaid Enterprise Certification Toolkit (MECT 2.2) checklists be followed for the Virginia MES modules to qualify for enhanced federal funding during the Operations and Maintenance period of the systems. An Independent Verification and Validation contractor is required to rate the states progress toward certification.