NOTICE OF CONFIDENTIALITY: This presentation is for the sole use of the intended recipient(s) and may contain confidential information. Any review, use, disclosure, duplication, or distribution not expressly requested by the recipient and granted by the sender is strictly prohibited. If you are not the intended recipient, please destroy all copies of the original message and attachment(s) and notify the sender immediately by e- mail. Medicaid Enterprise Management System RFP Vendor Conference KHEAA located at 100 Airport Road, Frankfort, KY 40601 Tuesday 05/14/2013 10 am to 12 pm
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Medicaid Enterprise Management System RFP Vendor Conference KHEAA located at
Medicaid Enterprise Management System RFP Vendor Conference KHEAA located at 100 Airport Road, Frankfort, KY 40601 Tuesday 05/14/2013 10 am to 12 pm. - PowerPoint PPT Presentation
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NOTICE OF CONFIDENTIALITY: This presentation is for the sole use of the intended recipient(s) and may contain confidential information. Any review, use, disclosure, duplication, or distribution not expressly requested by the recipient and granted by the sender is strictly prohibited. If you are not the intended recipient, please destroy all copies of the original message and attachment(s) and notify the sender immediately by e-mail.
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