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Kansas Department of Health and EnvironmentDivision of Health Care Finance

Medicaid Management Information System (MMIS) and Fiscal Agent

Services Reprocurement

Request for Information (RFI)

Version 1.5

Date: November 4, 2013


MMIS and Fiscal Agent Services ReprocurementRequest for Information

Contents 1.0 INTRODUCTION.....................................................................................................................................11.1 Background..........................................................................................................................................11.2 Purpose of Request for Information (RFI)...........................................................................................1

2.0 VISION, GOAL, AND OBJECTIVES.........................................................................................................12.1 Vision Statement..................................................................................................................................12.2 Goal Statements...................................................................................................................................12.3 Objectives.............................................................................................................................................2

3.0 MEDICAID, CHIP, AND OTHER STATE SUPPORTED PROGRAMS.......................................................43.1 KanCare...............................................................................................................................................43.2 Kansas Eligibility and Enforcement System (KEES)..........................................................................43.3 MMIS Projects.....................................................................................................................................53.4 Primary Entities and other Major Programs........................................................................................54.0 SCOPE OF WORK CONSIDERATIONS....................................................................................................65.0 RFI SUBMISSION...................................................................................................................................75.1 Response Submission, Date, Time, and Location................................................................................75.2 Designated Point of Contact................................................................................................................75.3 Kansas Public Information Act............................................................................................................75.4 Disclaimers Disclosure of Proposal Content and Proprietary Information..........................................86.0 CONCLUSION.........................................................................................................................................87.0 REQUESTED VENDOR RESPONSE.........................................................................................................97.1 Vendor Identification...........................................................................................................................97.2 MMIS Reprocurement Timeline..........................................................................................................97.3 Data Center Operations......................................................................................................................107.4 State Framework................................................................................................................................107.5 Operational Efficiencies.....................................................................................................................107.6 Improvements for Managed Care......................................................................................................117.7 Other Comments................................................................................................................................11

APPENDIX A: MMIS RELATED STANDALONE SYSTEMS AND MAJOR PROJECTS..................................12A-1 Standalone Architectures...................................................................................................................12A-2 Technologies Currently Under Development....................................................................................13A-3 Shared Services..................................................................................................................................14A-4 Leveraging Electronic Health Record (EHR) and HIE......................................................................14A-5 Regional Health Information Organization (RHIO) Data Analysis for Beneficiaries.......................14A-6 Recommendations for MMIS HIE/HIT Projects...............................................................................14

Figures Figure 1: Kansas Proposed Medicaid Architecture.......................................................................................2

Tables Table 1: Response Page Count Guidance......................................................................................................9Table 2: MMIS Reprocurement Timeline......................................................................................................9

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1.0 INTRODUCTION

1.1 Background The Kansas Department of Health and Environment, Division of Health Care Finance (herein referred to as KDHE) serves as the designated Medicaid single state agency for Kansas, as defined by 45 Code of Federal Regulations (CFR) 205.100. The statutory mission of KDHE is to develop and maintain a coordinated health policy agenda that combines effective purchasing and administration of health care with health promotion oriented public health strategies. KDHE intends to exercise its powers, duties, and functions to improve the health of the people of Kansas by increasing the quality, efficiency, and effectiveness of health services delivery and public health programs.

1.2 Purpose of Request for Information (RFI)This RFI is issued for the purpose of obtaining information on a reprocurement approach for consideration by KDHE in the preparation of one or more Request for Proposals (RFPs) (to be awarded in one or more distinct contracts) that separate the duties for the management, development, and operation of the modernized Medicaid Managmeent Information System (MMIS) and certain associated fiscal agent services. KDHE is using this RFI as the vehicle to explore various options for the reprocurement.

2.0 VISION, GOAL, AND OBJECTIVES

2.1 Vision Statement Implementation of a modernized MMIS is an important cornerstone of KDHE’s overall vision of accessible quality health care services for Kansans at an affordable cost to the State. The modernized MMIS will support KDHE’s strategic plans for the increased use of health information technologies and emerging health care initiatives that will improve health care quality, effectiveness, and efficiencies in Kansas.

2.2 Goal Statements KDHE’s goals for the planned reprocurement are as follows:

1. Obtain information management tools and business partners to assist KDHE in managing Medicaid, Children’s Health Insurance Program (CHIP) and other State supported programs in an era of rapid transformation of the health care system occurring through health care reform, managed care expansion, and implementation of electronic Health Information Technology (HIT).

2. Align modernization efforts for the MMIS to improve accessibility, analytical capabilities, and oversight activities for healthcare delivery of programs across State agencies.

3. Implement modernization solutions for the existing MMIS that improve and maintain data integrity and comprehensiveness.

4. Implement and operate a modernized MMIS that meets the Centers for Medicare and Medicaid Services (CMS) Seven Conditions and Standards (Medicaid Information Technology Supplement (MITS)-11-01-v1.0, April 2011) and promotes the use of industry standards for information exchange and interoperability among the installed system modules, providing a seamless business services environment for all of KDHE’s diverse system users located in multiple geographic locations.

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http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/EFR-Seven-Conditions-and-Standards.pdf

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/EFR-Seven-Conditions-and-Standards.pdf



Figure 1: Kansas Proposed Medicaid Architecture

2.3 ObjectivesKDHE is fine-tuning the vision and strategy for the RFP and the modernized MMIS. The strategy will include modernizing the current MMIS functionality into modules that will interoperate to deliver enhanced capabilities that align with Medicaid Infornmation Technology Archiecture (MITA) goals and the seven conditions and standards. An illustration of the current modular development strategy is illustrated in Figure 1, Kansas Proposed Medicaid Architecture.

The State’s health care delivery system and supporting technology operate in an environment of constant change to remain current with federal, legislative, and other emerging health care reform demands. This reprocurement must meet the following objectives:

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1. Take over the existing MMIS system within eight (8) months from the date of contract award.2. Enhance the existing MMIS to process encounters, such that there is increased functionality and

reporting for oversight of Managed Care Organizations (MCOs).3. Provide innovative options for processing Fee-for-Service (FFS) claims.4. Maintain existing components that allow for use of a modular structure for core data categories,

(e.g., member name, provider, service authorization, historical claims and encounters, MCO historical assignments, MCO historical premium payments, Medicaid FFS rates, and MCO rate cells).

5. Support the administration and oversight of existing and expanding service delivery models. 6. Enhance the existing data management processes and implement new, innovative processes to

improve data management, (e.g., identification, reporting, and resolution of data deficiencies). 7. Improve accessibility within the MMIS system and usability of data across the State enterprise

systems to improve KDHE’s ability to administer Medicaid, CHIP, and other State supported programs.

8. Maximize KDHE’s qualification for enhanced Federal Financial Participation (FFP) for MMIS development, implementation, and operation.

9. Ensure compliance with federal standards, including CMS Seven Conditions and Standards (MITS, 11-01).

10. Develop a phased approach for modernization of the MMIS that minimizes risk, achieves successful accomplishments, and meets State and federal timeframes.

11. Provide a cost-effective plan. 12. Manage the development, implementation, and ongoing maintenance of the MMIS to secure and

maintain federal certification.

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3.0 MEDICAID, CHIP, AND OTHER STATE SUPPORTED PROGRAMS

KDHE contracts with Hewlett Packard Enterprise Services (HPES) to operate its MMIS and serve as Fiscal Agent and managed care enrollment broker. HPES operates the Kansas MMIS from the HPES Oklahoma account data center in Oklahoma City. The current MMIS contract expires June 30, 2015. In October 2003, HPES implemented an MMIS system called “interChange.” The system is a CMS-certified, client server technology centered on a tightly coupled Medicaid-specific relational data model. The 2003 version of interChange supports FFS, partially capitated Medical Home (MH), and fully capitated MCO claims processing (including some capacity to process shadow or encounter claims for managed care clients).

3.1 KanCare In 2012, the State of Kansas awarded contracts to three managed care organizations (MCOs) to provide the following services within a full-risk capitation managed care model for the Medicaid, CHIP, Long Term Care (LTC), and waiver programs in Kansas:

Physical health services Behavioral health services Dental services Vision services Pharmaceutical services

LTC services, including Nursing Facility (NF) care and Home and Community Based Services (HCBS).

Effective January 1, 2013, almost all Medicaid members and 100 percent of CHIP members were required to enroll in a managed care plan. All Medicaid eligibles as identified in the 1115 waiver are mandated to be in the capitated managed care program. The American Indian and Alaskan Natives (in accordance with federal law) are the two population groups who may choose to not be in capitated managed care. The State of Kansas has determined that contracting with multiple MCOs will result in the provision of efficient and effective health care services to the populations currently covered by Medicaid and CHIP in Kansas, as well as ensure coordination of care and integration of physical, dental, vision, pharmaceutical, and behavioral health services with each other and with HCBS.

3.2 Kansas Eligibility and Enforcement System (KEES) Kansas is in the process of implementing the KEES, which will determine eligibility for all Medicaid groups and CHIP. Development and implementation of an online application for all Medicaid, CHIP, and medical assistance programs was procured as a part of KEES, as well as an online presumptive eligibility tool. KEES will provide a single integrated portal for these functions.

The architecture of KEES will be such that the entire system, or components thereof, can be reused by other programs and agencies. For example, when the State’s MMIS is reprocured in 2015, Kansas may use the eligibility system as the beneficiary subsystem, rather than rebuilding or replacing the current system. Additional functionality will need to be added later to accommodate these changes; however, the system is being designed with this type of reusability in mind. KEES also will be used by other State agencies (such as the Kansas Department for Children and Families, the State’s social services agency) to modernize the technology supporting the human services programs those agencies administer. It is the intent of KDHE to design and implement a system that will provide economies by reducing the number of redundant purchases for similar functionality and/or technology across state agencies. KDHE currently is in discussions with other states regarding their reuse of this technology. The above referenced online

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application was implemented in 2012. The core KEES components are scheduled to be implemented in the fall of 2013, with further enhancements to be implemented at a later date.

3.3 MMIS Projects KDHE is in the process of implementing several federally mandated initiatives on the MMIS, including but not limited to International Classification of Diseases, version 10 (ICD-10) coding, Transformed Medicaid Statistical Information System (TMSIS), Affordable Care Act (ACA) Provider Enrollment changes, and ACA Standard Operating Rules.

3.4 Primary Entities and other Major Programs KDHE is responsible for the reprocurement, operation, and maintenance of the systems and

processes that support the publicly funded medical assistance programs. KDHE manages the relationship with the MMIS Contractor and any Independent Verification and Validation (IV&V) or Quality Assurance (QA) contractors.

CMS is a federal agency within the federal Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the state CHIP, and health insurance portability standards.

HPES is KDHE’s incumbent Medicaid Fiscal Agent and MMIS Contractor, providing claims and prior authorization processing; provider relations; customer services; managed care broker functions; program integrity; Design, Development, and Implementation (DDI) activities for MMIS changes; and managing and operating the Kansas MMIS.

Accenture is currently under contract with KDHE to develop the KEES for processing applications to determine eligibility for Medicaid, CHIP, and other medical programs.

MCOs are contracted entities that KDHE uses to provide comprehensive health care services to qualified program recipients through a managed care delivery system.

LTC programs are State administered programs providing long term care services to a wide range of individuals, including the elderly and individuals with physical, intellectual, or developmental disabilities.

Children with Special Health Care Needs (CSHCN) Services Program is a State administered program that provides services to children with extraordinary medical needs, disabilities, or chronic health conditions. CSHCN Services Program health care benefits include payments for medical care, family support services, and related services not covered by Medicaid, CHIP, private insurance, or other third-party payers.

County Indigent Health Care Program (CIHCP) is a State program locally administered by the counties, hospital districts, and public hospitals that provide health care services to eligible residents in Kansas. CIHCP eligibility is based on various categorical criteria, such as residence, income, household, and resources. Any individual on Medicaid or categorically eligible to receive Medicaid is ineligible for CIHCP.

Kansas Women’s Health Program is a State funded program that provides low-income women with gynecological exams, related health screenings, and birth control.

Medically Needy Program (MNP) is a Medicaid program that serves individuals with high medical expenses, most commonly due to extended hospital stays or nursing home care. These individuals meet Medicaid’s categorical requirements (i.e., children, parents, the elderly, or

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individuals with disabilities), but their income is too high to allow them to qualify for categorically needy coverage. Instead, they qualify for MNP coverage by spending down or reducing their income by the amount of their incurred medical expenses.

Kidney Health Care (KHC) is a State Prescription Assistance Program (SPAP) for eligible individuals with end-stage renal disease.

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4.0 SCOPE OF WORK CONSIDERATIONS

The following scope of work considerations are intended to provide a brief outline of anticipated requirements for the MMIS reprocurement. (A comprehensive, detailed scope of work will be included in the upcoming planned MMIS RFPs).

KDHE seeks to enhance its capabilities in monitoring the performance of MCOs in delivering health and human services to eligible clients. As part of this expectation, the scope of work includes the development, enhancement, and implementation of the modernized MMIS functionalities. The MMIS would perform the following (and other) functions:

1. Process encounters for Medicaid, CHIP and other State supported programs. This includes processing encounters for medical business areas including: medical care, LTC, vision, dental, behavioral health, pharmacy, and waiver services.

2. Support all managed care program data on Medicaid, CHIP, and other non-Medicaid clients.

3. Ensure system capability for collecting, validating, and storing data that supports the managed care model.

4. Assist KDHE in achieving its goals for more complete and accurate managed care data.

5. Provide for ease of sharing information between the Kansas Medicaid-CHIP programs, other State programs, MCOs, and trading partners.

6. Ensure system capability for monitoring the MCOs’ obligation for timely and improved service delivery.

7. Ensure system capability for timely data processing for on-time reports, such that stakeholders can initiate necessary interventions and business process improvements.

8. Interface with KEES. Use the State’s system of record for member eligibility information to ensure minimal data redundancy. (Note: KEES currently determines eligibility by sending an eligibility file to the MMIS. The eligibility data are duplicated in the MMIS and used to perform managed care broker functions and claims processing).

9. Support all Health Insurance Portability and Accountability Act (HIPAA) transactions.

The scope of work includes partnering with one or more contractors to provide the necessary systems, applications, and interfaces to administer the programs listed above. The contractor(s) would conduct the following activities:

1. Process claims for all Medicaid, CHIP, and other non-Medicaid clients not enrolled in an MCO.

2. Process claims to request payment by the state for Medicaid, CHIP, and other State supported programs. This includes processing claims in all medical business areas (see list above).

3. Process encounters in the MMIS for all claims processed by the MCOs.

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5.0 RFI SUBMISSION This RFI is issued for the purpose of obtaining information to develop the scope of work for the MMIS and Fiscal Agent Services Reprocurement RFP.

All interested vendors are requested to respond in writing to this RFI, per the items outlined in Section 7, Requested Vendor Response. Responses should be limited to the number of pages stated in Section 7 (including all attachments).

This RFI does not constitute a solicitation of proposals, a commitment to conduct procurement, an offer to contract, or a prospective contract. KDHE will not award a contract because of this RFI. KDHE will not be liable for any costs incurred by respondents in the preparation and submission of information in responses to this RFI. All information received by KDHE becomes the property of KDHE and will not be returned to the responder.

KDHE will not acknowledge receipt of any responses. Acceptance of responses to this RFI places no obligations of any kind on KDHE. The descriptions presented in this RFI are tentative and may change prior to release of the RFP.

5.1 Response Submission, Date, Time, and LocationKDHE welcomes written comments and questions related to this RFI by December 2, 2013, at 2:00 p.m. Central Time.

Responses must be submitted to KDHE’s designated point of contact, as identified below. Responses may be submitted by email to [email protected]. Faxed responses or verbal inquiries will not be accepted. It is not the intent of KDHE to respond to comments or questions; however, any additional information related to the RFI issued by KDHE will be made available on the Kansas Department of Administration web site (http://da.ks.gov/purch/Contracts/bids.aspx).

5.2 Designated Point of ContactThe following address is the official point of contact for KDHE regarding this RFI and the delivery point for all responses and correspondence:

Kansas Department of Administration Procurement and Contracts 800 SW Jackson St, Suite 600 Topeka, Kansas 66612-1216

5.3 Kansas Public Information Act All responses to this RFI are subject to public disclosure under the Kansas Open Records Act (KORA) K.S.A. 45-215 et seq.), unless the response, or any part thereof, can be shown to fall within one or more of the exceptions to required public disclosure. If a respondent believes any sections of the response are exempt from the required public disclosure, the respondent must specify which sections and the exception(s) it believes apply, with specific detailed reasons. KDHE will process any request for public information for all or part of a response in accordance with KORA procedures. Respondents should consult the KORA web site at http://www.kdheks.gov/open_records.html for information concerning application of KORA provisions to responses and potentially proprietary information.

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mailto:[email protected]



5.4 Disclaimers Disclosure of Proposal Content and Proprietary Information

All RFI responses become the property of the State of Kansas. KORA requires that public information be placed in the public domain at the conclusion of the selection process and be available for examination by all interested parties (http://www.da.ks.gov/purch/KSOpenRecAct.docx).

The State reserves the right to destroy all responses in accordance with Kansas law. Trade secrets or proprietary information legally recognized as such and protected by law may be requested to be withheld if clearly labeled “Proprietary” on each individual page and provided separate from the main document. All information requested to be handled as “Proprietary” must be submitted separately from the main document, in a separate envelope or clipped apart from all other documentation, and clearly labeled. The responder shall provide detailed written documentation justifying why this material should be considered “Proprietary.” Procurement and Contracts reserves the right to accept, amend, or deny such requests for maintaining information as proprietary in accordance with Kansas law. The State of Kansas does not guarantee protection of any information that is not submitted as required.

6.0 CONCLUSION

Kansas recognizes the challenges in moving from a tightly coupled legacy MMIS to a CMS standards-compliant MMIS, while simultaneously shifting the focus from a claims driven system to a managed care centric system. The strategy which Kansas is using for the vision of this vast architectural shift, requires advanced, innovative methodologies from both the State and the awarded vendor.

Kansas is looking to collaborate with vendor(s) who will bring significant business efficiencies and system solutions to improve operations for the Kansas Medicaid program and other State supported programs.

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Beginning Date Closing Date Calendar Days

RFP Period

Friday, March 14, 2014 Friday, August 01, 2014 140

Question & Answer Period

Friday, March 14, 2014 Friday, June 06, 2014 84

Bid Evaluation Period Monday, August 04, 2014 Friday, September 05, 2014 32

Contract Negotiations Friday, September 05, 2014 Monday, September 15, 2014 10

Takeover Period

Monday, September 15, 2014 Saturday, May 14, 2015 240

DDI Phases Saturday, May 15, 2015 Wednesday, May 15, 2019 1,460



7.0 REQUESTED VENDOR RESPONSE

All respondents to this RFI are requested to provide as much information as possible for the following sections of their response.

Table 1: Response Page Count Guidance

Item # Section Page Limit7.1 Vendor Identification 17.2 Timeline 27.3 Data Center Operations 27.4 State Framework 27.5 Operational Efficiencies 47.6 Improvements for Managed Care 47.7 Other Comments 2

Total: 17

7.1 Vendor Identification Provide the company name, mailing address, and phone number

Provide a contact name, email address, and phone number

Describe your current involvement in working with any MMIS fiscal agent operations and/or the Kansas Medicaid program

7.2 MMIS Reprocurement TimelineComment on the proposed timeline and related issues from the vendor’s perspective.

What risks or issues do you anticipate by this proposed timeline?

What information, considerations, or requirements should the State include in the MMIS RFP to help mitigate any timeline risks or issues?

What alternative timelines or schedule would you recommend to mitigate risks and issues?

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Table 2: MMIS Reprocurement Timeline



7.3 Data Center Operations The existing HPES Kansas account uses the HPES Oklahoma account data center in Oklahoma City.

Describe how you would propose to manage the takeover of the existing HPES interChange system and move to the vendor’s data center within a short timeframe (e.g., eightmonths), upgrade to the current generation of hardware, and upgrade to the current generation of network technologies.

What data center would you use, or would a new data center be required? What information or requirements should be included in the RFP to support a successful MMIS

takeover? What specific data center requirements should be included in the RFP to support a successful

MMIS takeover? What information about the current MMIS and data center should be included in the RFP (or

made available in advance) to support your takeover of the existing MMIS?

7.4 State Framework The State is interested in a framework based on the Oracle®1 Service Bus (component of the Oracle SOA Suite), Oracle Policy Automation for rules, and Oracle Identity Management for security roles.

Comment on your ability to use this framework with your developed solutions or future enhancements.

What are the potential risks or issues related to using this framework with your developed MMIS solution or future enhancements?

What information or requirements should be included in the RFP to support successful implementation and operation of this framework?

Comment on how your proposed framework will support the modular requirements of MITA and the CMS Seven Conditions and Standards. Briefly outline your approach to modularize the MMIS.

7.5 Operational Efficiencies Appendix A contains a list of systems that KDHE wants considered for incorporation into the MMIS environment to achieve operational efficiencies.

Using your response to the State Framework question above, as a basis for the development work, comment on your ability to effectively develop an approach for converting these systems to integrate into the MMIS and implement your plan. Describe whether any of these systems would be converted to a modular system.

What KDHE systems or programs do you believe could be supported by a modularized MMIS?

What systems or programs have you successfully integrated into MMIS modules in other states?

What potential risks and issues are expected from this approach?

What requirements or information could be included in the MMIS RFP to mitigate the potential risks and issues of this approach?

1 Oracle is a registered trademark of Oracle and/or its affiliates. Other names may be trademarks of their respective owners.

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7.6 Improvements for Managed Care Describe system improvements or other creative and efficient solutions for supporting a Medicaid program in a state that is approximately 99% managed care.

How would claims processing for a small volume of FFS claims be more economically supported?

What are viable alternatives to using the MMIS for processing a small volume of FFS claims?

7.7 Other Comments Provide additional comments or issues regarding any aspect of the planned RFP that KDHE should consider.

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APPENDIX A: MMIS RELATED STANDALONE SYSTEMS AND MAJOR PROJECTS

A-1 Standalone Architectures The following standalone systems may, at KDHE request, be integrated with the Kansas MMIS to create operational efficiencies.

Data Analytic Interface (DAI)

The DAI is a data repository for Medicaid, State Employee Health Program, and private insurance data. Truven Health Analytics, Inc., is currently the vendor for this service. The DAI functionality allows a wide range of staff with varying levels of expertise to produce reports through an interface. Analysis based on episodes of care of individual beneficiaries, disease management, predictive modeling, and evaluative analysis to measure costs and outcome effectiveness is possible. The DAI is designed to use data to compare health care service and utilization patterns and identify trends and areas for focus and improvement. KDHE uses the data to develop programmatic improvements in Medicaid and the State Employee Health Program and to advance health policy for the State as a whole.

Kansas Immunization Registry (Kansas WebIZ)

Kansas WebIZ, operated and maintained by KDHE, has enrolled more than 1.3 million patients, tracking more than 9 million immunizations across 205 provider offices statewide. The registry continues to expand.

Autism Waiver

This application is used to track applications to the Autism Waiver and generate and track waiting lists and letters of eligibility to individuals.

Basic Assessment & Services Information System (BASIS)

BASIS is a Mental Retardation and Developmental Disabilities (MR/DD) system used by the Division of Disability and Behavioral Health Services – Community Support Services (DBHS-CSS) to track client information, including eligibility, level of care, “special population and psychotropic medication information,” services, and provider. BASIS also is known as Benchmark Effectiveness Aggregate for Community Outcomes Networking (BEACON).

Developmental Disability Community Service Provider (DDCSP) License Management Tool

DDCSP license management tool, operated by DBHS-CSS.

Developmental Disability Ineligible (DDI) Tracking Tool

DDI tracking tool, operated by DBHS-CSS.

Kansas Lifestyle Outcomes (KLO2)

KLO2, operated by DBHS- CSS, is an MR/DD system to measure quality enhancement outcomes for waiver services (QA).

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Medical Assistive Technology Level of Care (MATLOC) Technology Assisted (TA) Waiver Services

MATLOC instrument allows assessment information on TA children to be collected by contract providers. Provides Level of Care/Eligibility assessment for TA Waiver services. Supports needed and proposed Service Plan. Approvals occur via Program manager.

Statewide Contractor Reimbursement Information & Tracking System (SCRIPTS)

SCRIPTS is used to support federal and state expenditures for services delivered by Child Welfare Contract Management Providers.

Automated Information Management System (AIMS)

AIMS collects and stores demographic, status, and encounter data for mental health clients served by local Community Mental Health Centers (CMHCs) in Kansas.

Kansas Client Placement Criteria (KCPC)

The KCPC system collects and stores demographic and service information on clients with substance use disorders served by local substance abuse treatment providers to assist in determining the appropriate level of treatment.

KHS Lucidity System Serious Emotional Disturbance (SED) Waiver Plans

The Lucidity system stores SED Waiver Plans of Care, budgets, functional eligibility information, and provider contact records in a web-based application housed and maintained by Kansas Health Solutions (KHS).

Kansas Aging Management Information System (KAMIS)

KAMIS is used by Area Agencies on Aging, service providers for Aging programs, the public, and State staff. The system collects and reports data on customer assessments plans of care and services provided under all Aging programs.

A-2 Technologies Currently Under Development The modernized MMIS must integrate or interact with the following health information technologies currently under development in Kansas.

KEES As described in Section 3.2, above, Kansas recently implemented, KEES, an online Medicaid/CHIP eligibility and enforcement system. KEES provides a single integrated portal for customers to determine eligibility and complete an online application for all Medicaid, CHIP, and insurance programs.

Child Support Services (CSS) Waivers QA Surveys

This system will be used to collect and report on all CSS Waiver QA surveys.

ICD-10 Coding Initiative

Kansas plans to adopt ICD-10 diagnosis codes, as prescribed by HIPAA, subject to any timeline adjustments made by CMS.

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ACA Provider Enrollment Changes

This project is to implement provider enrollment changes required by ACA.

ACA Standard Operating Rules

ACA Section 1104 applies to HIPAA covered entities and business associates engaging in HIPAA standard transactions on behalf of covered entities. The legislation requires that the standards and associated operating rules adopted by the Secretary will:

o Enable the determination of an individual’s eligibility and financial responsibility for specific services prior to or at the point of care

o Be comprehensive, requiring minimal augmentation by paper or other communications

o Provide for timely acknowledgment, response, and status reporting that supports a transparent claims and denial management process (including adjudication and appeals)

o Describe all data elements (including reason and remark codes) in unambiguous terms, require that such data elements be required or conditioned upon set values in other fields, and prohibit additional conditions (except where necessary to implement state or federal law or to protect against fraud and abuse)

A-3 Shared Services The following are shared integration services that are under consideration by KDHE as a part of the Kansas Medicaid Enterprise.

Master Person Index (MPI)

A MPI is an electronic database that holds information on every client registered within an organization. MPIs ensure that every person is represented only once within that organization’s subsystems and with constant demographic identification.

An Enterprise Master PatientIindex (eMPI) is a large-scale index that could link together several smaller MPIs across multiple agencies as a shared service.

Record Locator Services (RLS)

A RLS is a key infrastructure component to support interoperability in a decentralized health care environment. The RLS, in conjunction with the eMPI, provides pointers to the location of patient information across the extended network, enabling users to access and integrate health care data from distributed sources without relying on a national patient identifiers or centralized databases.

Shared Provider Directory

Explore whether there is a real opportunity in the way that provider directory requirements for major state-level initiatives — such as the MMIS provider master file, Health Benefit Exchanges (HBEs), and Health Information Exchanges (HIEs) — all converge and can share a common method for provider authentication and shared provider directory services across the Kansas Medicaid Enterprise.

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Clinical Data Integration to MMIS

Clinical data integration addresses long-standing issues of interoperability, adaptability, and data sharing, including clinical data, across organizational boundaries by creating models based on nationally accepted technical standards. MITA allows Medicaid programs to participate actively in the DHHS Secretary’s vision of a transparent health care market that utilizes Information Technology (IT) and clinical data.

Medical Home (MH) Coordinated Care

Health IT has potential for facilitating physician efforts to coordinate patient care in MH models.

Meaningful Use Data

Incorporation of meaningful use data reporting into an analytic tool.

A-4 Leveraging Electronic Health Record (EHR) and HIE Kansas is assessing the roles of EHR systems and state HIE efforts and the best ways the MMIS can assist in those efforts.

A-5 Regional Health Information Organization (RHIO) Data Analysis for Beneficiaries

Kansas is looking for the best approach for a MITA based architecture to support regional RHIO data and analysis.

A-6 Recommendations for MMIS HIE/HIT Projects Kansas is looking at available technologies other states are using in their Medicaid programs, to provide options and recommendations regarding future strategies for the Kansas MMIS systems.

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