Medicare, Medicaid push for modular systems

Medicare, Medicaid push for modular systems

To streamline certification process for Medicaid Management Information Systems, the Centers for Medicare and Medicaid Services wants to pre-certify the modular solutions that make up an MMIS.

Because states must certify their MMIS before they can receive federal funding, CMS hopes that pre-certifying the modular components will streamline the development and eventual certification of MMIS.  

CMS has long promoted modular solutions and architectures because they reduce the need for customization, promote interoperability and facilitate data exchange among compatible systems. “CMS envisions that modular solutions and architectures for state Medicaid enterprise systems will promote the reuse of technical solutions among states, minimize customization and configuration needs and increase competition in the Medicaid enterprise marketplace,” the agency said in a request for information. “Modular architectures will also improve efficiency and effectiveness of system upgrades, reduce costs, improve system interoperability and increase adherence to Medicaid Information Technology Architecture (MITA) and the Standards and Conditions for Medicaid IT.”

In support of modernizing legacy Medicaid IT systems, CMS in December extended the 90 percent federal match for investments in Medicaid systems, noted Andy Slavitt, acting administrator of CMS, in a January blog post. The agency’s annual investment in state Medicaid IT is more than $5 billion, he added.

“Our new regulations require that states evolve their legacy Medicaid IT systems to leverage reusable solutions, and to practice industry-proven IT methods such as use of modularity, reuse, shared services (including Software-as-a-Service),” he wrote. “This opens opportunity to smaller vendors to develop focused solutions for use across multiple states or to introduce solutions from comparable sectors such as commercial insurance or large provider systems. We believe this approach will expedite states’ IT timelines, decrease overall costs, and ignite adoption of advanced technology solution.”

In late June CMS issued guidance for states on the conditions and standards required for funding for MMIS.

The final rule, which took effect Jan. 1, enumerates several changes. Among them is a requirement that  systems integrate with the federal- and state-based healthcare marketplaces and the Federal Data Services Hub, and that they be interoperable with “health information exchanges, public health agencies, human services programs and community organizations providing outreach and enrollment assistance.” It also supports existing requirements for modular systems development and requires “for software systems and modules developed, installed or improved with 90 percent match, the state must consider strategies to minimize the costs and difficulty of operating the software on alternate hardware or operating systems.”

Legacy systems are affected only if a component will be incorporated into a major new IT system or activity, at which point that component would need to be compliant for funding purposes.

About the Author

Kathleen Hickey is a freelance writer for GCN.

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