Vermont’s planned overhaul of IT systems picked up momentum with the release Monday of a request for proposals to build the second stage of its Medicaid system.
The Medicaid Managed Information System (MMIS) is split into three parts and the estimated cost is more than $100 million.
The state has already hired Goold Health Systems to be the pharmacy benefit manager for the revamped Medicaid program, and the RFP for the final stage will be released this month, according to state officials.
Vermont is also receiving bids to build an integrated system that will track Vermonters’ eligibility for state benefits. The integrated eligibility system is expected to cost more than $20 million with a contract expected to be awarded this month and work slated to begin in October.
These projects and the health benefit exchange – valued at $118 million, but which could cost as much as $171 million – are the key components of Vermont’s Health Services Enterprise, a project that will transform the Agency of Human Services’ technology systems during the next decade.
The new IT systems are expected to improve the administration and delivery of safety net programs and services. They will also lay the groundwork for a universal public health coverage program – often called single-payer – that the state could transition to as soon as 2017.
The MMIS Core RFP, released Monday, describes the Health Services Enterprise as, “a mutli-year, multi-phased approach that reshapes and integrates current business processes … modernizes the IT environment, and results in the transformation of the health care experience for the Vermont populace.”
The projects are heavily subsidized by the federal government and must comply with Centers for Medicare and Medicaid Services regulations.
State workers, as well as current and former state officials, say the overhaul is long overdue. Much of the AHS technology systems are several decades old and hinder front-line workers.
Agency Secretary Doug Racine said recently that the federal subsidies, which can pay for as much as 90 percent of human service IT infrastructure projects, is a major reason why the state has committed to building new systems.
The company or companies selected to build the MMIS Core project will design and implement software and provide ongoing technical support for the state’s Medicaid program.
The contract also covers the design and implementation of a customer contact center to deliver support services to providers and the people covered by Vermont’s planned universal public health care program — Green Mountain Care.
While lawmakers and the administration are still designing the legal structure for Green Mountain Care, the MMIS Core system will support Vermont Health Connect, which is now the main avenue for Vermonters to enroll in health coverage through Medicaid.
Racine said the Vermont Health Connect online marketplace is likely to be the user interface for Vermonters to access Green Mountain Care.
The state had originally hoped to bypass an exchange altogether, and leverage federal money for implementing the Affordable Care Act directly toward Green Mountain Care.
When it became clear the feds would not allow that, the state found a way to incorporate the exchange into its health reform agenda.
Vermont Medicaid covers a wide array of programs and services through the state’s federal global commitment waiver, which it has had since 2005.
Global commitment gives AHS the flexibility to pay for mental health services, developmental disability services, school health services and early childhood services through its six departments, which also make sub-grants to private agencies.
The state is looking to pay for long-term care, low-income children’s health coverage and hospital subsidies through its global commitment program, and is negotiating a new global commitment waiver with the feds.
The contractors who build MMIS must be able to integrate all of the services Vermont pays for through the global commitment program, according to the RFP.
MMIS is also expected to keep pace with Vermont’s payment reform initiatives, such as the Medicaid shared-savings program for ACOs and bundled payments to providers that cover a package of services, such as payments to private hospitals for the total cost of inpatient psychiatric care.
Responses from companies hoping to build MMIS Core are due in September with the contract expected to be awarded in November. Work is expected to begin in February.