Information Technology Committee September 18, 2018 Department of Human Services • Update on Eligibility and Enrollment System and Medicaid Management Information System (MMIS)
Update on Eligibility and Enrollment System
Eligibility System Mondernization Project Release Schedule: • February 8, 2016 – Medicaid/CHIP under the Affordable Care Act • March 2019 – Child Care Assistance, Supplemental Nutrition Assistance and Temporary Assistance for Needy Families • December 2019 – Medicaid for Age Blind and Disabled • Fall of 2020 – Low-Income Home Energy Assistance Program
Update on Medicaid Management Information System (MMIS)
Medic icaid Cla laim ims Processing and Prompt Pay Prompt Pay Trending - 2018 100.00% 95.00% 90.00% 85.00% 80.00% 75.00% 70.00% 65.00% 60.00% 55.00% 50.00% 45.00% 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Clean Claims < = 30 days (90%) Clean Claims < = 90 days (99%) 90% Threshold 99% Threshold
Medicaid Claims Processing – Adjudicated Claims ADJUDICATED YEAR AND MONTH COUNT (DISTINCT TCN NUMBER) Jul-17 372,934 Aug-17 346,033 Sep-17 347,470 Oct-17 334,343 Nov-17 344,090 Dec-17 390,910 Jan-18 305,854 Feb-18 335,094 Mar-18 354,697 Apr-18 343,895 May-18 369,813 Jun-18 342,207 4,187,340 Average claims processed per month is 348,945, including pharmacy claims
MMIS Certification • In order to qualify for enhanced Federal Financial Participation (FFP) for MMIS operations, the system must be certified by the Centers for Medicare and Medicaid Services (CMS). • Until the MMIS is certified, operation expenditures from the date of “go live” (October 5, 2015) are matched at 50% FFP. Once certified, operation expenditures are matched at 75% FFP. • Assuming CMS certification is effective back to October 5, 2015, the state will receive the additional 25% FFP for operations since “go live”, upon certification. • The final certification activity is an on-site visit by CMS and their contracted certification vendor. After the on-site visit, the Department will receive notification from CMS which will indicate if the system has been certified, the effective date of the certification, and any corrective action that may be needed. • DHS is expecting the on-site in the first quarter of Calendar Year 2019. • Assuming the on-site occurs at that time, DHS expects to receive documentation from CMS during the current biennium and is hopeful the retroactive FFP will be available before the end of the 2017-2019 biennium.
Questions? Eligibility and Enrollment System and Medicaid Management Information System (MMIS)
Recommend
More recommend
