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Medicaid Enterprise Management SystemRFP Vendor Conference

KHEAA located at100 Airport Road, Frankfort, KY 40601

Tuesday 05/14/201310 am to 12 pm

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Welcome to Kentucky and Introductions

Kentucky’s Strategic Vision for Healthcare Transformation

Kentucky Medicaid Expansion

Medicaid Enterprise Management System RFP Structure and Scope

Medicaid Enterprise Management System Vendor Procurement Timeline

Open Comments and Feedback

Kentucky Medicaid Enterprise Management System RFP

Pre-release Vendor ConferenceDiscussion Outline

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 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.

Kentucky’s Strategic Vision for Healthcare Transformation

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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 Analytics

KEUPS (Kentucky Secure On-line Gateway) Seamless Security Services

HP Exstream Fulfillment

Kentucky’s Strategic Vision for Healthcare Transformation

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Effective January 1, 2014, the Commonwealth will expand the Kentucky Medicaid program under ACA. The Commonwealth anticipates an increase of 308,000 members. The following areas will be affected by this increase:•Managed Care will increase to approximately 1,000,750 or 89% of the total Medicaid population.

•FFS will increase to approximately 129,000 or 11% of the total Medicaid population.

An addendum will be produced for the RFP to address the Expansion.

Kentucky Medicaid Expansion

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Option 1 MEMS System Replacement:Design, development, implementation and maintenance of the new Kentucky Medicaid Enterprise Management System and Fiscal Agent.

Proposed solutions and pricing for the following “Options to Buy”:•System Hosting and Disaster Recovery services•Decision Support System•Utilization Management Services

Option 2 MEMS System Takeover:Planning, migration and operations necessary to assumethe operation of the current MMIS and Fiscal Agent services.

Option 3 Combined MEMS System Replacement and Takeover:Providing of all services necessary for Options 1 & 2. (Takeover and Replacement)

Medicaid Enterprise Management System RFP Structure and Scope

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Medicaid Enterprise Management System RFP Structure and Scope

Seamless data exchange of information with QHI framework including as close as possible to 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.

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

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The functional requirements cover the business operations of the enterprise. These requirements are grouped as follows:

Business Relationship Management

Care Management

Contractor Management

Financial Management

Member Management Lite

Operations Management

Program Management

Program Integrity Management

Provider Management

Medicaid Enterprise Management System RFP Structure and Scope

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Medicaid Waiver Management Application

Pharmacy Benefit Management

Not in RFP Scope:

Medicaid Enterprise Management System RFP Structure and Scope

MEMS Procurement Timeline

Open Questions and Feedback

Link to the RFP and Attachmentshttps://emars.ky.gov/online/vss/AltSelfService

Link to the Procurement Library http://finance.ky.gov/services/eprocurement/Pages/MEDICAIDENTERPRISEMANAGEMENTSYSTEMFISCALAGENTREPLACEMENT