The Centers for Medicaid and Medicare Services (CMS) is encouraging states to adopt systems with modular components. This includes combining new products, open-source code and commercial off-the-shelf (COTS) products, as well as sharing services across states and programs where appropriate. In light of this, states across the country are preparing to move away from a monolithic MMIS approach to implementing an integrated suite of services that are modular, flexible and interoperable to help improve outcomes for members, providers and program stakeholders.
With this services approach, states and vendors will need a common understanding of business requirements and desired outcomes — which can then be matched to an appropriate service. This will give states broad options for implementing Medicaid Enterprise Systems software and services that match their business requirements with reduced cost of operations.
Enhanced CMS funding rates have been crucial to state Medicaid Enterprise Systems modernization efforts. For states to contemplate adopting MMIS as-a-service, they’ll need assurance the services approach qualifies for the enhanced federal match.
For state administrators, an effective service-oriented MES function that aligns with CMS policy is one that achieves the right balance of modules, manages data efficiently and promotes reusability of components. A modular framework structure should allow states to get the best composite solution with greater flexibility as well as more options in both acquisition and implementation.
Rather than building incredibly complex systems, states can instead contract for services, lowering MMIS deployment costs, as well as ongoing operating and maintenance expenses. Vendors will be responsible for system upgrades and complying with new regulations and requirements.
How states can identify the right vendors
States can now leverage competitive multi-state cooperative procurement initiatives through the National Association of State Procurement Officials (NASPO) to choose from lists of approved vendors for available modular solutions. This provides an alternative to a complex solicitation process at the state level.
The cooperative procurement process happens through a lead state and involves CMS-approved Master Agreements that allow qualified contractors to market their product and negotiate Participating Addendums with individual participating states. Awarded vendors offer some of the best standards-based modular solutions available on the market today.
NASPO is a non-profit organization comprised of chief procurement officials from all 50 states. ValuePoint facilitates and coordinates agencies’ solicitations and open competitions for government contracts. This enables states to lower their administrative costs and share resources. Any state, as well as the District of Columbia and U.S. territories, can procure services through NASPO
Through a seven-year contract with NASPO, Conduent is onboarded to provide government agencies with Medicaid services. States and territories can now procure Conduent’s services through ValuePoint, including Medicaid claims processing, financial management and solutions for customer service and reporting of federal data.
Important benefits for states
In the NASPO ValuePoint master agreement, Conduent offers:
- Core Services – A COTS SaaS claims processing and management services solution
- Option A – Financial management and financial reporting.
- Option B – Call Center (Member and Provider Call Center)
- Option C – Federal reporting
Below are five key benefits of this new contract:
- It provides master agreements for claims processing systems and operational services requirements for healthcare programs administered by state Medicaid agencies.
- It makes agreements available to state governments, the District of Columbia and territories of the United States, and government subdivisions (potentially cities or counties in need of the Claims processing and Management services Module).
- It provides CMS-approved RFP and master services agreements with comprehensive terms and conditions.
- It includes qualified, pre-approved suppliers to provide modern, flexible, and configurable solutions using Software as a Service (SaaS) to support the changing needs of healthcare for state Medicaid agencies.
- It specifies considerations for states executing a Participating Addendum.
To learn more about the contract or initiate the PA process contact us.
About the AuthorMore Content by Kelley Carson