RD474 - Annual Progress Report on the Replacement of the Medicaid Management Information System – October 1, 2021

Executive Summary:

In 2016, the Virginia Department of Medical Assistance Services (DMAS) embarked on a path to replace its aging Medicaid Management Information System (MMIS) with a modern, modular Medicaid Enterprise Solution (MES), pursuant to new standards set forth by the Centers for Medicare and Medicaid Services (CMS).(*1) For the last five years DMAS has worked aggressively to implement the new MES, seeking to improve the Commonwealth’s development agility while meeting the rising demand for new services and increased access for its citizens.

In 2020, however, the MES program underwent radical transformation. A months-long effort to realign the program’s scope, redefine program costs, and carve out a methodical, calculated new plan for implementing and integrating the program was completed. The result of this effort was a newly minted Integrated Master Schedule, or IMS, that intensified the necessary rigor to manage multiple co-dependent work-streams. DMAS worked in concert with CMS throughout this effort to ensure compliance with regulatory requirements and secure the necessary federal funding to continue on. With the scope fully realized, new costs understood, and individual work plans tied together, the MES program is now marching toward an April 4, 2022 implementation.

Further cementing the success of the program’s fully realized re-baselining efforts is the program’s “GREEN" rating from our partners at the Virginia Information Technologies Agency (VITA) Project Management Directorate (PMD). As of the writing of this report, the program is on schedule.

To date, five modules have been successfully implemented in the DMAS production environment, further increasing the program’s ability to provide Virginians with access to high-quality health care coverage. The others, three in total, are actively being developed and will be deployed when the MES program goes live in April of next year.

As previously reported to the General Assembly, DMAS will integrate the current MMIS into the MES modular framework. As such, the following modules will make up the MES system, along with MMIS: Encounter Processing Solution (EPS); Pharmacy Benefit Management Solution (PBMS); Enterprise Data Warehouse Solution (EDWS); Integration Services Solution (ISS); Provider Services Solution (PRSS); Care Management Solution (CRMS); and Appeals Information Management System (AIMS).
(*1) The standards and conditions for implementing Medicaid information technology (IT) require states to use a modular approach for systems development. Reference: CMS Final Rule, 80 FR 75817 - Medicaid Program; Mechanized Claims Processing and Information Retrieval Systems.