Note: ACA Watch is an ongoing, bi-weekly series with aggregated stories and insights on the latest developments regarding the Affordable Care Act. Look out for it every other Thursday.
State Medicaid agencies face a changing climate: increasing enrollment, rising healthcare costs and CMS requirements to comply with more stringent technology standards. As a result, many state Medicaid agencies are replacing systems that have been in place for more than 30 years.
While modularity, standardization, and interoperability make changes easier and quicker, states generally do not have the staff required to maintain day-to-day operations while designing, developing and implementing complex program and technology mandates. That’s where our healthcare and technology experts come in. Keep reading to see what the CIO of Montana has to say on MMIS rollouts.
The Centers for Medicare and Medicaid Services (CMS) has signed a web-broker entity agreement with eHealth, the nation’s leading online health insurance exchange for individual and family health. The agreement will allow eHealth to enroll tax-subsidy-eligible residents of 36 states in qualified health insurance plans under the ACA. As a web-broker entity, eHealth will have access the Federal electronic data hub, allowing the company to determine tax subsidy eligibility and the amount of a subsidy. It also provides consumer- and privacy-protective requirements and standards beyond those spelled out in regulations.
The Piper Report highlights an article by Texas’ former Medicaid director, Billy Millwee, that addresses state approaches to reimbursement methodology based on quality and linking payment to health outcomes. The Texas program, approved by the state legislature in 2011, focuses on targeting quality measures that could be prevented and that are directly linked to payments. The Piper Report notes that this type of reimbursement model decreases Medicaid spending while incentivizing providers to improve quality of care.
Medicaid claims systems have made local and state news amid growing pains in Medicaid Management Information Systems (MMIS) rollouts, showing the complexity of these programs and the equally complicated public-private contracting that makes them possible. Ron Baldwin, Montana’s CIO, is trying to avoid disorder with a modernization of Medicaid.
CNSI recently announced a partnership with Michigan and Illinois to develop and implement a completely automated real-time and cloud enabled Medicaid Management Information System (MMIS), referred to as Medicaid as a Service (MaaS). This cloud solution will leverage efficiency and create savings for both states and the federal government. This partnership provides opportunities for states to share knowledge and resources and to efficiently implement federally mandated operating rules and compliance standards.