Greetings from the Green Mountain State! Our lead researcher has been providing these updates for years, and we continue to encourage other State Medicaid Agencies (SMAs) and vendors to join in. This outreach is a great way to maximize time at MESC, set expectations for the week, strengthen relationships, and gain valuable insights. Thank you for reading, and we wish you all a fantastic summer and look forward to seeing you in Portland, Oregon.
Status of Vermont’s Medicaid Enterprise Modernization
In
collaboration with the Centers for Medicare and Medicaid Services (CMS), we continue
to make progress in transforming our Medicaid Enterprise. We are proud to have
five CMS-certified modules:
·
Care
Management: Acentra Health
·
Provider
Management Module (PMM): Gainwell Technologies
·
Health
Information Exchange (HIE): Vermont Information Technology Leaders (VITL)
·
Electronic
Visit Verification (EVV): Gainwell Technologies
·
Pharmacy
Benefit Management (PBM): Optum
Vermont continues to follow the strategic plans we made with
CMS starting with ‘getting our data
in order”, remaining compliant with mandates, and proceeding in a fashion that
meets Vermont’s needs. We’re more than
welcome to discuss the whole heap of our accomplishments before, during or
after MESC vittles are served.
Below are some updates of our other key modernization activities underway :
·
Vermont’s
Medicaid Data Warehouse and Analytics Solution (MDWAS) (Deloitte) is live, and
CMS Certification Review is scheduled in August. Vermont continues to reap many benefits of
having claims, clinical and other Medicaid related data in a singular solution
and establishment of a longitudinal record
·
Vermont
has many vendors that support our Enterprise Modernization work including:
o
Independent
Verification and Validation (IV&V) via CSG Government Solutions
o
Procurement
support by BerryDunn including their tHHS State Health Dashboard (SHD) to support
CMS’ Operational Reporting Workbooks (ORW), Medicaid Information Technology
Architecture (MITA), Status reports, and Advanced Planning Documents (APD).
o
CorrecTek
and Gainwell for implementation activities to support CMS Department of
Corrections Justice Re-entry requirements
o
Deloitte
on implementation of Noticing Solution replacement and aforementioned MDWAS work
o
Gainwell
Technologies to meet the CMS Interoperability and Prior Authorization Final
Rule (CMS-0057-F)
·
Procurement
notes:
o
Vermont’s
Integrated Eligibility System (VT-IES) is an active procurement, and we will
provide an announcement once a contract has been executed.
o
Our
NASPO Pharmacy Benefits Solution procurement is an active procurement, and we
will provide an announcement once a contract has been executed.
o
Vermont’s
Agency of Human Services (AHS) has begun releasing Request for Proposals (RFPs)
and Notice of Funding Opportunities (NOFOs) associated with our Rural Health
Transformation (RHT) Program. Active
NOFOs and RFPs can be found on this webpage: RHT
Program RFPs/NOFOs.
o
Vermont’s
Medicaid Enterprise Solution (MES) – formerly referred to as the Core Claims
and Fiscal Agent Services. The MES title provides a more holistic view of this
procurement.
§ We anticipate this
Request for Proposals (RFP) to be released by the end of the summer. This solution will not only address the many
variations of claims processing and fiscal agent services but will also take
advantage of our unified data to meet various workflow/case management and
tracking needs, care management features, and administrative savings
opportunities.
§ Vermont will be seeking a proven Medicaid claims Design, Development, & Implementation (DDI) vendor. The potential partner must own a software/technology solution that was either: a) Designed, Developed and Implemented by their organization; or b) acquired and integrated into their core product(s) by the proposing organization; and in either case their solution must be CMS Certified and implemented by that vendor. Operating and maintaining a solution developed by another contractor does not meet this qualification. (Example: takeover scenarios.)
Expectations and plans for MESC 2026
Building on last year's conference and our ongoing modernization
efforts, not to mention our continued interest in collaborating with other SMA,
Vermont staff will continue our practice of visiting every booth to learn about
vendors, their recent accomplishments, and upcoming projects. We look forward to the continued building of
relationships as we are all part of the HHS family…and for some in
attendance, you are literally family!
SMA and Vendors:
Vermont staff are more than happy to set aside specific time at MESC for
intimate and focused discussions. If we
are unable to find accommodating times in Portland, we can certainly set up
something virtually after MESC. Vermont
is finalizing the list
of Vermont attendees for MESC 2026
and we will share at a future time. We've included a series of questions at the end of this
update to help frame conversations.
Overview of Vermont’s Medicaid Program
Vermont Medicaid operates a publicly operated PIHP (Prepaid
Inpatient Health Plan) delivery model through its 1115 demonstration waiver. It
is not a traditional Managed Care Organization (MCO), Accountable Care
Organization (ACO), or a full Fee-for-Service program. For further information, refer to our annual report.
Quick
Vermont Stats:
Be well and have a wonderful summer.
Thank you,
Joe
Send your responses to the following questions to Joseph.Liscinsky@vermont.gov by Friday,
June 19.
Questions for Vendors
Questions:
1.
How
do you organize the work associated with an implementation of the size and
scope of Medicaid Enterprise Solution?
2.
What
are the top 2 activities you wish SMA would accomplish or have in place prior
to you kicking off your implementation work?
Questions for SMA
Questions:
1.
If
you have had a Core Claims implementation in the past 5 years, would you be
willing to:
·
Share
your implementation timeline and any associated staffing plans
·
Share
your base MMIS Core Claims contract with the Vermont team
2. If you could go back and change
1 or 2 things about your original base contract, what would they be?
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