Vermont's 2023 - Pre-MESC Update

 

We’re only days away from the 2023 Medicaid Enterprise System Conference (MESC) and we know you’ve been anxiously awaiting Vermont’s annual pre-conference communication.   This allows us to maximize the opportunities at MESC, to further build relationships, gain additional information, and increase awareness about industry standards, best practices, and lessons learned. 

 

Vermont continues to move forward with transforming its Medicaid Enterprise and serving Vermonters in the most time efficient, secure and integrated manner.  Vermont has five Centers for Medicare and Medicaid Services (CMS) Certified modules:  Health Information Exchange (HIE) (Vermont Information Technology Leaders (VITL)), Electronic Visit Verification (EVV) (Gainwell & Sandata), Pharmacy Benefit Management (PBM), (Change Healthcare), Care Management module (Acentra Health (formerly Kepro (formerly eQHealth))), and Provider Management Module (PMM) (Gainwell Technologies).  Vermont is leveraging the expertise of our Independent Verification and Validation (IV&V) vendor (CSG Government Solutions) as we continue our Medicaid Enterprise transformation. 

Regarding Vermont’s Enterprise:

v  Medicaid Management Information System (MMIS) Program:  

o   Note-1:  Medicaid Data Lake and Analytic Solution (MDLAS) procurement was awarded to Deloitte and executed in July 2023.

o   Note-2:  Vermont will be releasing a Request for Proposals (RFP) for an Analytics Data Warehouse (ADW) to be implemented and will integrate with our MDLAS.  Be advised the ADW will be maintained by Vermont’s HIE. 

o   Note-3:  Vermont Medicaid is not a traditional Managed Care Organization (MCO), a traditional Accountable Care Organization (ACO), nor all Fee-for-Service.  Vermont runs a publicly operated PIHP (Prepaid Inpatient Health Plan) delivery model through its 1115 demonstration waiver.  One component of the PIHP delivery model is the ability to implement payment options available under a managed care delivery structure.  The Vermont Medicaid Next Generation ACO (VMNG ACO) payment model is a program for which a risk-bearing Accountable Care Organization (ACO) receives a prospective payment and assumes accountability for the costs and quality of care for prospectively attributed Medicaid members.  Therefore, Vermont must report encounter data for both traditional medical and Home and Community Based (HCBS) or Long-Term Services and Supports (LTSS) programs because encounter data doesn't fall into traditional reporting protocols.  

 

v  Vermont is interested in scheduling MMIS Core Solution Demonstrations. Context and expectations for those demonstrations follow below.

 

o   Vermont’s MMIS Core Claims reprocurement approach:

§  MMIS Procurement Assistance RFP:  Vermont will release an RFP for services to work with VT MMIS staff to deliver a cost-benefit analysis, roadmap, and an MMIS Claims and Fiscal Agent (FA) Services (MMIS & FA) RFP.  MMIS Procurement Assistance RFP to be released this calendar year.

§  MMIS & FA RFP:  The timing of this re-procurement is TBD. This MMIS & FA RFP will leverage NASPO with added details to address Vermont-specific needs. It's these specific needs (some identified further below) that we are interested in hearing at MESC about how vendor solutions can support them. 

o   Vermont wants to hear from MMIS solution vendors and see just how configurable your MMIS solution is for implementing Vermont-specific needs. We realize an hour can limit what can be covered but at a minimum SoV would set up time for vendors to cover the following: 

§  Your current “go-to-market” solution:

·       What's it called and when was it CMS Certified?

·       Where are you actively implementing this solution right now?

·       What is your average implementation time?

§  Show how configurable the system is for implementing any changes associated with Encounter claims for ACO or HCBS/LTSS programming (aka $0 paid claims)

§  Using the example above, show the system’s ability to receive encounter data from Medicaid enrolled and non-Medicaid enrolled providers focusing on how the system captures and displays key elements such as: 

§  Member

§  Service information – amount, duration, number delivered

§  Place of service

§  Dates of service

§  Social Determinants of Health (SDoH) data if provided.

§  Ability to use ‘shadow’ nature of the service – delivered but paid $0 because the provider is being paid differently (e.g., a bundled payment or a PMPM) but to capture a Would Have Paid amount, based on codes, so that we can track what the service would have otherwise cost, and do cost avoidance if necessary. 

§  If using claims to do this, then a way to allow these to travel down a different path than a regular Medicaid claim with all of the checks, edits and audits.

§  Ability to easily distinguish Medicaid / non-Medicaid in terms of services delivered in a program with mixed attribution – easily reported separately and together.

o   Benefit package flexibility

§  Ability to create programs with services via a configurable mechanism.

§  Ability to include / exclude benefits, services from the Medicaid Total Cost of Care

§  Ability to adjust attribution of members to programs.

§  Easier linking of members and providers to these different benefit packages and programs

§  Easy way to change rates for services with one-to-many relationships with different programs.

o   Financial module allowing for easier tracking of value-based purchasing arrangements with providers.

§  Bundles

§  PMPMs

§  Case rates, including tiers.

§  Special program payments

§  Review of Reimbursement Methodology – how flexible is your solution with regard to the procedures and adding codes to pay for new services such as housing.

o   Additional solution flexibility to address COVID-19 waiver, 1115 Waiver, and the upcoming unwind activities related to members and providers.

o   Ability to integrate with provider information, including demographics and patient population.

 

The following are additional details of other Vermont related efforts:

v  Integrated Eligibility and Enrollment (IE&E) Program:    

o   Vermont has engaged in multiple Requests for Information (RFI) to increase the collaboration and exchange of information with the vendor community. 

• Vermont’s IE&E Program Team is pursuing a “Prime” vendor to implement a "customer-focused" core system that includes a Customer Portal, Case Management, and Business Rules Engine while taking advantage – where possible – of existing technologies to meet our end-to-end customer experience needs. This effort is called the Vermont Integrated Eligibility System (VT-IES).
• The VT-IES (pronounced VEE-Ties) Project will optimize eligibility, enrollment, and benefits management functionality to allow Vermonters to apply for, receive, and manage health coverage and economic assistance benefits through a user-centric access point that is personalized, welcoming & comprehensive.

o   VT-IES is an integral component of Vermont’s IE&E System Modernization efforts and will work alongside the IE&E Noticing Project to simplify the process of applying for and managing healthcare and financial benefits for Vermonters.

o   The VT-IES Project is in the final stage of RFP development and is supported by NTT DATA. The RFP is slated for release during 4th calendar quarter of 2023.

o   For additional information on VT-IES, please visit Integrated Eligibility and Enrollment (IE&E) System | Agency of Human Services (vermont.gov)

v  Health Information Exchange (HIE) Program:

o   Has started various initiatives related to establishing Data Governance for AHS

o   Key stakeholders have met to discuss our modernization efforts and the future role HIE plays to address Social Determinants of Health (SDoH)

 

v  Systems Testing workgroup – as you may recall from last year, Vermont, with the support of NESCSO, has established this workgroup to discuss and review best practices for User Acceptance Testing, Section 508 Compliance, Testing Maturity, Testing Automation, and more.  The next System Testing workgroup meeting will be held September 21, 2023. If you are interested in joining, please sign up here.  (State and State partners only, please).   This workgroup has been working with TransformHHS (tHHS) on their workgroup page and State Health Dashboard (SHD).   If you have any questions, please contact Vermont’s Quality Testing Director, Renee Taylor, at renee.taylor@vermont.gov.

 

v  Certification workgroup – as you may recall from last year, Vermont, with the support of CMS, Shelley Dimick, Vermont’s Certification Director, has established a national Certification workgroup to support State Medicaid Agencies collaboration.  This workgroup shares best practices, lessons learned, and provides clarity related to CMS Certification policies and workflows.  Tuesday (8/22) morning, Shelley will be having an in-person S-TAG Certification meeting over breakfast at 8:30. If you are interested in joining this workgroup of if you have any questions, please contact Shelley at Shelley.Dimick@vermont.gov.

Vermont staff attending MESC include the following: 

 

 

We look forward to our interaction during MESC - safe travels and see you in Denver!