Cabinet for Health and Family Services Office of Administrative & Technology Services

Division of Medicaid Systems

Medicaid Enterprise Management System (MEMS) RFP Pre-Release Vendor Conference

12 Mill Creek Park, Frankfort, KY 40601Tuesday, 10/21/2014

10:00 – 11:00 am

Cabinet for Health and Family Services

Kentucky Medicaid Enterprise Management System RFP Pre-release Vendor Conference

Discussion Outline

Welcome to Kentucky and Introductions

Kentucky’s Quality Health Information

Medicaid Enterprise Management System RFP Scope of Work

Individual Vendor Conference

Open Comments and Feedback

Kentucky’s Quality Health Information (QHI)

Kentucky has developed a complete and achievable eHealth IT Architecture.

Kentucky has a consolidated Cabinet organization that encompasses all of the program pillars depicted in our vision.

CHFS Secretary Haynes and Governor Beshear have been engaged and aggressive in our efforts to improve healthcare in Kentucky and nationally. 

Early adoption of HIE, GOHIE, HBE, etc.

Focus on improved delivery and quality of healthcare through Managed Care and push to streamline MMIS.

Cabinet for Health and Family Services

Kentucky’s QHI Components

QHI Components for CHFS Supported Systems:

Citizen, Worker, Partner Web Portals SharePoint Document Management

System Corticon Business Rules Engine BizTalk Enterprise Service Bus IBM Infosphere Master Data

Management SAS Fraud Framework KOG (Kentucky On-line Gateway)

Seamless Security Services HP Exstream Fulfillment Service K2 Blackpearl Workflow Management

Cabinet for Health and Family Services

MEMS RFP Scope of Work

There is only 1 option:

The CHFS, Department for Medicaid Services (DMS) is seeking a Vendor(s) to provide Software as a Services (SaaS) solution for the Kentucky MEMS Claims Processing and Fiscal Agent (FA) services, as well as DDI for Encounter Processing and a Decision Support System/Data Warehouse (DSS/DW) hosted  by the Vendor.  

There are no “options to buy”.

Cabinet for Health and Family Services

MEMS RFP Scope of Work

The Commonwealth requires that the future Medicaid Enterprise Management system be built using the following principles:

Seamless data exchange of information with QHI framework including real-time integration with Kentucky Health Benefits Exchange System.

Optimization of Managed Care Relationships and streamlined support for remaining Fee for Service processes.

SOA based solution comprised of components that integrate into the Commonwealth’s SOA framework or directly utilizes the Commonwealth’s components.

MITA based modular solutions from a single Vendor or a “best-of-breed” multi-vendor solution.

Meets CMS certification requirements as defined in the CMS MECT.

Comprehensive data management strategy that organizes all of the data and enables easy access to information.

Configurable and extendible solution to cost-effectively support Kentucky’s future expansion of programs and populations, and to meet current and future regulatory needs.

Cabinet for Health and Family Services

MEMS RFP Scope of Work

Not in RFP Scope:

Utilization Management (UM) Services

Pharmacy Benefit Management

Cabinet for Health and Family Services

Individual Vendor Conference

Vendors will have the opportunity to submit written comments, suggestions and recommendations concerning the RFP.

Vendors will have the opportunity to schedule an individual conference with representatives from CHFS and the Finance Cabinet to discuss your Vendor’s written comments and suggestions, prior to the issuance of the RFP. 

Cabinet for Health and Family Services

Questions

Open Questions and Feedback

Cabinet for Health and Family Services