Tag: Tech

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Tech- Wyoming Receives CMS Certification for Its Medicaid Provider Management System Delivered by HHS Technology Group

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Yeah it’s a self-serving press release, but it is interesting to see progress on the decades long path to modularity.

 
 

Clipped from: https://finance.yahoo.com/news/wyoming-receives-cms-certification-medicaid-121100422.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAALMMY3tMR3RhrBoLTCC4IVoMnJqTkqJLK9JvU3K6_47OwWsDqX-MvLdIM-nGFWO39Gv-jR5JqFS5UF0j6GZh55r-5lDL3rrJUfch3b7NXpM7nSCrrZePaXTlrzUbV_EF3nWn5iftRoHCVIcvk4mdCEoLkf12knLVhqBSHzgeCuGg

Discover your Provider® solution streamlines enrollment, screening, and monitoring for Wyoming’s Medicaid providers

FORT LAUDERDALE, Fla., Jan. 3, 2023 /PRNewswire/ — HHS Technology Group, LLC™ (HTG) announced today the Wyoming Department of Health (WDH) received final certification from the Centers for Medicare & Medicaid Services (CMS) for its Provider Enrollment, Screening, and Monitoring (PRESM) system powered by HTG’s Discover your Provider® (DyP®) solution. DyP® offers an advanced online provider portal with electronic and self-service capabilities, such as provider enrollment and license verification, with proven success in improved operational efficiencies, added convenience, and simplified processes, resulting in increased cost savings and a better provider experience.

 
 

HHS Technology Group is a software and solutions company serving the needs of commercial enterprises and government agencies. HHS Tech Group delivers purpose-built, modular software products, solutions, custom development, and integration services for modernization and operation of systems that support a wide spectrum of business and government needs. For more information about HHS Technology Group, visit www.hhstechgroup.com. (PRNewsfoto/HHS Technology Group)

“We are pleased to collaborate with HHS Technology Group to launch the PRESM system,” said Jesse Springer, Medicaid Technology and Business Operations Section Manager, Wyoming Department of Health. “We believe we now have one of the fastest, if not the fastest, Medicaid provider enrollment and re-enrollment systems and processes in the nation.”

A cloud-based, holistic platform, DyP® serves as the system of record for all of Wyoming’s Medicaid, Kid Care CHIP, and WDH provider enrollments. HTG’s contract with Wyoming’s Division of Healthcare Financing includes the operation, maintenance, and enhancement of the PRESM system, which has been in production since April 2021. HTG’s call center also provides critical support and technical assistance to Wyoming Medicaid providers.

“For states to properly administer Medicaid programs that efficiently deliver high-quality medical services to vulnerable populations, it is critical to have clean, accurate, reliable provider data,” said Bradley White, CEO of HTG. “With the launch of PRESM, Wyoming now has an industry-leading solution to optimize all provider management processes, including screening, enrollment, and monitoring.”

In addition to facilitating and promoting greater provider participation, DyP® leverages a modular design for increased functionality and leading-edge technology to streamline once-seemingly cumbersome and time-consuming processes significantly. The significant value delivered by DyP® to states and providers includes:

  • Reduced enrollment time for new providers from over one month to under five days.
  • Significantly reduced state and contractor burden and time (approximately 2 FTEs) from the previous manual process for new applications, renewals, and licensing updates.
  • A fully integrated pharmacy provider enrollment process with streamlined monitoring.
  • A 100% electronic provider agreement process, including signatures.

Notably, DyP® is one of six certified Medicaid Management Information System (MMIS) provider solutions, and HTG is among the few companies to obtain certification for multiple modules, as evaluated and awarded by the National Association of State Procurement Officials NASPO) ValuePoint contracting arm. Most recently, HTG’s Recover your Liability® (RyL®) solution, which automates third-party liability functions and integrates with other MMIS modules, earned NASPO ValuePoint certification.

To learn more about HTG’s Discover your Provider® platform and its proven success, visit HHS Technology Group online.

About HHS Technology Group, LLC

HHS Technology Group (HTG) is a software and solutions company serving the needs of commercial enterprises and government agencies. HTG delivers modular software solutions, custom development, and integration services for the modernization and operation of systems supporting a broad spectrum of business and government needs. For more information about HHS Technology Group, visit www.hhstechgroup.com.

Media Contact: 
Janet Mordecai
Amendola Communications (for HHS Technology Group)
jmordecai@acmarketingpr.com

 
 


Cision

View original content to download multimedia:https://www.prnewswire.com/news-releases/wyoming-receives-cms-certification-for-its-medicaid-provider-management-system-delivered-by-hhs-technology-group-301712112.html

SOURCE HHS Technology Group

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TECH- Inconsistent Medicaid coverage for remote patient monitoring hampers adoption

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: RPM is taking off in some areas, but needs more money.

 
 

Clipped from: https://www.insiderintelligence.com/content/scattershot-medicaid-coverage-remote-patient-monitoring-hampers-adoption

The trend: Remote patient monitoring (RPM) interventions can help low-income individuals get healthier. But more consistent state Medicaid coverage will be necessary for these programs to scale up.

What’s driving the trend? Providers and patients are more bullish on using technology to manage their conditions. So, health systems are using more RPM programs and investors are pouring money into RPM-focused tech startups.

Reimbursement roadblocks: Providers have struggled to capture complete reimbursement from insurers for their RPM programs. Many organizations rely on grants or donations to jumpstart an intervention.

The Centers for Medicare & Medicaid Services recently increased the types of remote monitoring services it will cover for Medicare patients, but Medicaid is a different story.

The opportunity: States are proceeding with caution when it comes to covering RPM services, mostly because they want to see more evidence proving that remotely monitoring patients will be cost efficient for Medicaid and clinically valuable for patients.

Health systems have an opportunity to validate the effectiveness of their RPM interventions, particularly for vulnerable populations.
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TECH- CMS Proposes Rule to Expand Access to Health Information and Improve the Prior Authorization Process

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: CMS wants everybody (ok most) to do lots of new stuff around prior auths.

 
 

Clipped from: https://www.cms.gov/newsroom/press-releases/cms-proposes-rule-expand-access-health-information-and-improve-prior-authorization-process

As part of the Biden-Harris Administration’s ongoing commitment to increasing health data exchange and investing in interoperability, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services. CMS proposes to modernize the health care system by requiring certain payers to implement an electronic prior authorization process, shorten the time frames for certain payers to respond to prior authorization requests, and establish policies to make the prior authorization process more efficient and transparent. The rule also proposes to require certain payers to implement standards that would enable data exchange from one payer to another payer when a patient changes payers or has concurrent coverage, which is expected to help ensure that complete patient records would be available throughout patient transitions between payers.

“CMS is committed to strengthening access to quality care and making it easier for clinicians to provide that care,” said CMS Administrator Chiquita Brooks-LaSure. “The prior authorization and interoperability proposals we are announcing today would streamline the prior authorization process and promote health care data sharing to improve the care experience across providers, patients, and caregivers – helping us to address avoidable delays in patient care and achieve better health outcomes for all.”

The proposed rule would address challenges with the prior authorization process faced by providers and patients. Proposals include requiring implementation of a Health Level 7® (HL7®) Fast Healthcare Interoperability Resources® (FHIR®) standard Application Programming Interface (API) to support electronic prior authorization. They also include requirements for certain payers to include a specific reason when denying requests, publicly report certain prior authorization metrics, and send decisions within 72 hours for expedited (i.e., urgent) requests and seven calendar days for standard (i.e., non-urgent) requests, which is twice as fast as the existing Medicare Advantage response time limit. In order to further support a streamlined prior authorization process, this proposed rule would add a new Electronic Prior Authorization measure for eligible hospitals and critical access hospitals under the Medicare Promoting Interoperability Program and for Merit-based Incentive Payment System (MIPS) eligible clinicians under the Promoting Interoperability performance category.

Proposed policies in this rule would also enable improved access to health data, supporting higher-quality care for patients with fewer disruptions. These policies include: expanding the current Patient Access API to include information about prior authorization decisions; allowing providers to access their patients’ data by requiring payers to build and maintain a Provider Access FHIR API, to enable data exchange from payers to in-network providers with whom the patient has a treatment relationship; and creating longitudinal patient records by requiring payers to exchange patient data using a Payer-to-Payer FHIR API when a patient moves between payers or has concurrent payers.

These proposed requirements would generally apply to Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) agencies, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs), promoting alignment across coverage types. CMS estimates that efficiencies introduced through these policies would save physician practices and hospitals over $15 billion over a 10-year period.

Finally, the proposed rule includes five requests for information related to standards for social risk factor data, the electronic exchange of behavioral health information among behavioral health providers, improving the exchange of medical documentation between certain providers in the Medicare Fee-for-Service program, advancing the Trusted Exchange Framework and Common Agreement (TEFCA), and the role interoperability can play in improving maternal health outcomes.

The proposed rule is aligned with CMS’ ongoing work to strengthen patient access to care, reduce administrative burden for clinicians so they can focus on direct care, and support interoperability across the health care landscape. It withdraws and replaces the previous proposed rule, published in December 2020, and addresses public comments received on that proposed rule.

For additional information, consult this fact sheet.

The proposed rule is available to review here , and the deadline to submit comments is March 13, 2023. CMS encourages comments from all interested members of the public and, in particular, from patients and their families, providers, clinicians, consumer advocates, health care professional associations, individuals serving and located in underserved communities, and from all other CMS stakeholders serving populations facing disparities in health and health care.

For more information on the CMS proposed rule, please visit: https://www.cms.gov/regulations-and-guidance/guidance/interoperability/index.

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TECH- Google rolls out search features for Medicaid, Medicare patients

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Google seeks to replace your local Medicaid eligibility state employee.

 
 

Clipped from: https://www.fiercehealthcare.com/health-tech/google-rolls-out-search-features-aim-make-it-easier-sign-medicaid-medicare

 
 

LAS VEGAS—When many people are looking to enroll in health benefits, they turn to Google as a source of key information on eligibility, the application process and in-network providers.

In this spirit, the Google Search team has quietly rolled out multiple features for its search engine that aim to make it easier for users to access key information about obtaining Medicaid and Medicare benefits, as well as which doctors locally accept those types of coverage.


(Google)

If someone submits a search query for Medicaid in their state, for example, the top of the results will populate with multiple buttons that direct them to key results on eligibility requirements, how to apply and where they can log in to their accounts. Searching for Medicare generates similar buttons, as well as an option to pull up news about the program.

Hema Budaraju, senior director of product for health and social impact at Google Search, told Fierce Healthcare that access to information is a social determinant of health, and addressing that challenge is a key part of how the tech giant is thinking about equity.

“It’s equity by design in the product,” Budaraju said in an interview at the HLTH conference, “and we’re very proud of being part of the journey.”

Helping people secure coverage is one piece, better enabling them to use it effectively is another. Another recent addition to Google’s search allows people to seek out local physicians and the results will include if those doctors accept Medicare and Medicaid.

When a user clicks into a specific physician, they can also further investigate their options using a “check insurance info” option that allows them to filter by specific Medicare and Medicaid carriers and plans.

Budaraju said the goal was to offer these details in “an easily consumable manner” that enables them to make “timely” decisions about their care and coverage. She added that these tools are not limited to Medicare and Medicaid, and that Google has rolled out similar functionality for the Children’s Health Insurance Program, Supplemental Nutrition Assistance Program and electronic benefit transfer (EBT) programs as well.

The journey in accessing data on these social programs is “nonlinear,” Budaraju said, and often requires people to sift through multiple webpages and sites to find the details they need. That’s why Google saw an opportunity to streamline the experience.

She said the Search team also sees an opportunity to use this framework as a baseline for other scenarios, such as economic security, crisis response or in extreme weather. The focus on equity and easing the user experience is replicable in other areas, she said.

“There is a beauty to understanding, ‘What is the journey?'” Budaraju said.

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Potential Data Disclosure May Have Affected Certain Wisconsin Medicaid Members | Wisconsin Department of Health Services

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Who knew you could fit 12,358 pieces of PHI in a PowerPoint deck?

 
 

The Wisconsin Department of Health Services (DHS) today announced that on August 8, 2022, as part of a cybersecurity incident investigation, DHS was notified that a presentation emailed to the DHS Children’s Long-Term Support Council in April 2021 contained protected health information. This presentation was forwarded to employees working for county government agencies in Rock and other Wisconsin counties and posted to the DHS website as part of the meeting minutes. Information that was potentially exposed includes the first and last name, date of birth, gender, county location, Wisconsin Medicaid member ID number, and social security number of affected members of Wisconsin Medicaid.

After discovering what happened on August 8, 2022, DHS immediately removed the meeting minutes from the website and replaced them with a PDF version, which removed access to the protected health information. Additionally, DHS took steps to confirm that individuals who received the minutes via email deleted the files. DHS will continue to investigate and work to prevent such incidents from occurring in the future.

On October 7, 2022, notifications were mailed to 12,358 Wisconsin Medicaid members whose information may have been accessed by unauthorized individuals. These members have been offered free credit monitoring for one year as well as given access to a dedicated call center to answer questions they might have.

Members who received a notification letter or have questions about this incident can call 833-875-0804 from 8 a.m. to 8 p.m. CT Monday through Friday.

 
 

Clipped from: https://www.dhs.wisconsin.gov/news/releases/100722.htm

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Tech- Cognosante Customer Experience Business Sector to Support CMS Enrollment Assistance Program for Medicaid Unwinding

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: The tech vendor just won another CMS contract with the federal agency.

 
 

FALLS CHURCH, Va. (PRWEB) October 04, 2022

Cognosante’s customer experience (CX) business sector, CognoConnected, has been awarded the Enrollment Assistance Program (EAP) for Medicaid Unwinding contract by the Centers for Medicare & Medicaid Services (CMS). The 19-month contract has an approximate value of $21 million.

Cognosante will support the CMS Center for Consumer Information and Insurance Oversight (CCIIO) in ensuring continuity of coverage for individuals and families impacted by the Medicaid Unwinding at the end of the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE). Cognosante will provide outreach and impartial, free, in-person and virtual enrollment assistance to impacted consumers in multiple states, facilitating their seamless transition into a Qualified Health Plan (QHP) through the Federally Facilitated Marketplace (FFM).

Following the end of the PHE, states must conduct Medicaid and Children’s Health Insurance Program (CHIP) eligibility redeterminations for beneficiaries. Many beneficiaries have remained on Medicaid and CHIP throughout the COVID-19 pandemic due to the continuous enrollment condition authorized by the Families First Coronavirus Response Act (FFCRA). As a result, a large volume of beneficiaries across the country who are determined to no longer be eligible for Medicaid or CHIP, or fail to respond to the redetermination requests, could face a loss of health insurance coverage.

To help these impacted consumers smoothly transition from Medicaid or CHIP to enrollment into QHPs – also referred to as Medicaid Unwinding – Cognosante will provide trained local support teams in designated states to help consumers and their families navigate the Healthcare.gov application process and make informed health coverage decisions. Cognosante will collaborate with local community organizations to maximize outreach efforts and engage directly with the enrolling community where they live and work.

According to CMS, Medicaid Unwinding presents the single largest health coverage transition since the first open enrollment period of the Affordable Care Act (ACA).“The Cognosante team will bring to bear the full depth and breadth of our customer experience expertise to support CMS’ mission of ensuring continuity of coverage for eligible consumers,” said Anita Griner, General Manager of Cognosante’s customer experience business sector.

 
 

Cognosante supported CMS in a similar EAP during implementation of the Affordable Care Act. In addition, Cognosante was recently awarded the CMS No Surprises Help Desk contract, which intends to protect individuals from surprise medical bills for emergency services, air ambulance services furnished by nonparticipating providers, and non-emergency services furnished by nonparticipating providers at participating facilities in certain circumstances.

About Cognosante


Cognosante is a mission-driven technology company delivering innovative and transformative solutions that improve the health and safety of Americans. With more than a decade of experience working with Federal and state government agencies, we aim to expand access to care, improve care delivery, deliver solutions addressing social determinants of health, and ensure safety and security through multi-faceted technology and customer experience (CX) solutions. Our broad range of capabilities includes enterprise IT and cloud, data science, telehealth, interoperability, public health surveillance, clinical performance, eligibility and enrollment, and consumer engagement. For more information, visit http://www.cognosante.com

 

 
 

 
 

Clipped from: https://insurancenewsnet.com/oarticle/cognosantes-customer-experience-business-sector-to-support-cms-enrollment-assistance-program-for-medicaid-unwinding

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Google adds Medicaid, Medicare enrollment info to Search

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Did you know Google is trying to fix the Medicaid network access dumpster fire? Or that your Fitbit data is being researched by researchers focused on however they define “equity”? Or that Youtube and Kaiser Family Foundation are about to start making a ton of health-related content together?

 
 

Photo: Courtesy of Google

Google announced several health equity-focused updates to its products Monday, including an addition to Search that provides information about public insurance programs like Medicare and Medicaid.

In a blog post, the tech giant said users will see eligibility requirements and how to enroll when they search for Medicare or Medicaid health plans. People currently covered under Medicaid will also be able to filter nearby providers who accept these plans, alongside a previously added filter for Medicare plans.

“Over the coming weeks, when people search for these programs, they’ll see additional information about eligibility requirements and the enrollment process for your state and the federal government,” Hema Budaraju, senior director of product, health and search social impact, at Google said during the company’s Health Equity Summit. “We believe that this can help people enroll more easily into these programs.”

Additionally, YouTube revealed THE-IQ, a partnership with the Kaiser Family Foundation to help organizations create high-quality informational video content on health topics like mental health, maternal care and access to care.

YouTube and KFF will offer seed funding and video production assistance to The Loveland Foundation, which will create videos on mental health access for Black women and girls; the National Birth Equity Collaborative, which will focus Black maternal healthcare and outcomes; and the Health Equity Leadership and Exchange Network at the Satcher Health Leadership Institute, which will work on the root causes and drivers of health inequities. 

“I think particularly in this age, where we’re seeing misinformation so prevalent [and] targeted disinformation efforts that are out there to undermine confidence in science and information. It’s really critical that we amplify credible voices and provide it in ways that people can relate to and connect with,” said Tina Hoff, senior vice president at KFF and executive director of the organization’s Social Impact Media Program.

Google also announced it would expand its health equity research program, first announced last spring as the Fitbit Health Equity Initiative. The expanded program, now called the Google Health Equity Research Initiative, will offer selected researchers at academic institutions and nonprofits in the U.S. access to direct funding, Google Cloud credits, Fitbit devices and analytics platform Fitabase’s services.

THE LARGER TREND

Google has added several updates to Search that aim to provide more information about healthcare services at a glance. In March, the tech giant said it was launching new functionality that gives users a list of available appointments when searching for a specific provider. It also added a tool late last year that helps users find in-network providers. 

In the wake of the Dobbs decision that overturned Roe v. Wade, Google made abortion-related changes to its tools as well. Following push from Congressional Democrats, Google said it would clearly label healthcare facilities that provide abortions in Search and Maps to differentiate them from crisis pregnancy centers, which try to dissuade people from seeking abortions and may not offer accurate medical information. 

The tech giant also said it will automatically delete location history when users visit sensitive places like abortion clinics. 

Health misinformation has become a major concern on social media platforms like YouTube. An analysis published earlier this spring in BMJ Global Health found about 11% of YouTube’s most viewed videos on COVID-19 vaccines, accounting for 18 million views, contradicted information from the World Health Organization or the CDC. 

YouTube rolled out new guidelines surrounding vaccine misinformation last year, and has been expanding features that identify the source and context behind health videos and provide content from medical sources at the top of results.

 
 

Clipped from: https://www.mobihealthnews.com/news/google-adds-medicaid-medicare-enrollment-info-search

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TennCare: Update may have disclosed personal information of Medicaid recipients

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: People in one family may have been able to see data about 1 other family. And some of them are related.

 
 

 
 

 
 

NASHVILLE, Tenn. (WTVF) — Personal information for about 1,700 Medicaid recipients in Tennessee may have been disclosed during an update to a computer system, officials said.

The update may have led to a limited number of people from one household to be able to view some information about individuals in another household that included some of the same people, a statement from TennCare said. The breach happened when a new application listed the name of a person who was already in another household, the statement said.

TennCare quickly determined the scope of the breach, addressed the issue and notified those impacted.

There’s no indication that any information was misused, but the agency is offering 12 months of free identity theft protection services to those affected as a precaution.

TennCare provides health care insurance to 1.7 million Tennesseans.

Clipped from: https://www.newschannel5.com/news/personal-information-for-about-1-700-medicaid-recipients-in-tennessee-may-have-been-disclosed

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MO – Former state vendor awarded $23M in lawsuit over Missouri Medicaid system implementation

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[MM Curator Summary]: A jury has vindicated EngagePoint after years the of systems vendor claiming unfair treatment by IBM and the state.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The verdict comes as the Department of Social Services faces increased scrutiny for its handling of Medicaid application backlogs

 
 

EngagePoint first filed its lawsuit in August 2016, alleging the state owed the company millions for work it conducted but hadn’t been paid for (Getty Images).

A software integration company’s six-year legal saga against the state reached a resolution last week, when it was awarded a little over $23 million in its lawsuit alleging contract breaches over extra work to implement a Department of Social Services’ case management system.

On Wednesday, Cole County Circuit Judge Jon Beetem granted a directed verdict of a little over $4 million that the company argued it was owed, said Ken Barnes, an attorney representing EngagePoint. A day later, a jury sided with EngagePoint and awarded an additional $18.9 million out of the $31 million it had requested on additional claims, Barnes said.

Beetem also issued a directed verdict in the state’s favor and found EngagePoint did not meet its burden of proof on a claim regarding software maintenance.

EngagePoint first filed its lawsuit in August 2016, and Barnes said the verdict affirmed that EngagePoint’s conduct did not play a role in the case management system’s issues and that it delivered the software it promised.

He said he hopes the state sees “that it’s time to put this to rest.”

“It feels like vindication for my client after a really long and hard battle,” Barnes said, “that, I think candidly, the state had every opportunity to avoid.”

A signed judgment was not posted to the case’s docket as of Monday morning.

Asked if the Department of Social Services was considering appealing the verdict, Caitlin Whaley, a department spokeswoman, said, “the agency will consider all options open to the state moving forward.”

Chris Moreland, a spokesman for the Office of Administration, which handles state contracting, said the agency is evaluating the jury’s verdict and the trial.

“Because all stages of this litigation are not yet final,” Moreland said, “OA will not comment on pending litigation.”

Meanwhile, Chris Nuelle, a spokesman for the attorney general’s office, said the office plans to appeal the verdict, but refrained from commenting further.

EngagePoint, a Florida-based firm, was hired by the state in 2013 in response to a request for proposals for a vendor to implement the Missouri Human Services Eligibility, Enrollment and Case Management System, a comprehensive, fully-integrated system for Department of Social Services’ programs, like Medicaid.

EngagePoint was hired over competitors such as IBM, and alleged in its lawsuit that the state ignored the company’s advice and licensed a software known as Cúram directly from IBM and then later held EngagePoint accountable for flaws with the software, which was “unstable and not functionally ready.”

As a result, numerous change order requests were made which EngagePoint alleged the state denied without proper review and out of compliance with federal regulations. The company also alleged the state breached its contract by changing the methodology for determining completion of the project and refused to pay for additional work EngagePoint conducted in order to be compliant with federal mandates.

“Despite not getting paid, EngagePoint continued to service the needs of the citizens of the state and continued to endeavor (to) fix problems with the Curam system,” the 2016 lawsuit read.

In 2014, state employees threatened they “would put EngagePoint out of business,” the lawsuit alleges, and that the company was issued an ultimatum to turn the contract over to IBM or face termination. IBM, who had been passed over for the initial contract, was paid $2 million by the state as a consultant to assess EngagePoint’s performance — a conflict of interest, EngagePoint argues.

IBM was eventually hired to complete the contract after EngagePoint was terminated by the state in May 2015. At least $37 million was owed to the company, EngagePoint argued in its 2016 lawsuit, which the state had moved to dismiss.

The state argued EngagePoint sought “money for work not performed” and in January 2017 filed a counterclaim alleging that EngagePoint breached its contract and “repeatedly failed to deliver, and those failures cost the State tens of millions of dollars,” or a total of roughly $84 million.

As a result, the state was justified in terminating its contract and hiring IBM, it argued.

“From January of 2014 forward, EngagePoint’s failures brought the eligibility determination and enrollment operations of the State’s Medicaid program to the brink of dysfunction,” the state wrote in its 2017 counterclaim, arguing overtime work of temporary staff was one of the only reasons that operations remained in place for nearly 18 months through a manual by-pass system.

DSS and OA officials highlighted those issues and placed blame on EngagePoint in 2015 legislative hearings scrutinizing the backlog and delays in the Medicaid system, the Jefferson City News Tribune reported at the time.

Ultimately, the jury last week issued three verdicts in EngagePoint’s favor.

The verdict comes at a time when the Missouri Eligibility Determination and Enrollment System that EngagePoint was hired to implement has come under increased scrutiny as part of the Department of Social Services’ delays in enrolling newly eligible participants under expanded Medicaid. 

The delays — more than twice the limit allowed under federal regulations — have led to the Centers for Medicare and Medicaid Services stepping in and requiring a mitigation plan for improved processing of applications.

“The state of Missouri has had seven years since they terminated EngagePoint to get their act together,” Barnes said, “and they’re just not doing it.”

Updates to the state’s Medicaid system to make eligibility determinations were previously cited as the reason why applications wouldn’t be processed for 60 days after the state was court-ordered to implement expanded Medicaid last year.

DSS officials have since vowed to get delays below the 45-day maximum allowed under federal regulations by Sept. 30.

“At some point, you got to say, ‘Who’s the common denominator here?'” Barnes said. “It isn’t EngagePoint. It isn’t even IBM. It isn’t the other contractors. The common denominator here is the state and how they manage their business.”

 
 

Clipped from: https://missouriindependent.com/2022/08/16/former-state-vendor-awarded-23m-in-lawsuit-over-missouri-medicaid-system-implementation/

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GDIT Wins $65 Million Medicare and Medicaid Cloud and Data Integration Contract

MM Curator summary

[MM Curator Summary]: The award will be to implement a data warehouse that includes claims and member data for Medicare and Medicaid programs.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Government Technology and Services Coalition member and mentor partner General Dynamics Information Technology (GDIT), a business unit of General Dynamics, has been awarded a new $65 million contract by the Centers for Medicare & Medicaid Services (CMS) Enterprise Architecture Data Group to support its Integrated Data Repository (IDR). The five-year contract has a one-year base period, three one-year and one eight-month option periods, and one four-month transition period.

CMS maintains the largest volume of healthcare data files in the world. The IDR is a high-volume data warehouse integrating claims, beneficiary and provider data sources to support various Medicare and Medicaid programs. Access to this robust integrated data supports analytics across CMS, including insights into medical trends, healthcare costs, and fraud, waste and abuse.

Under this contract, GDIT will provide agile transformation and development, security and operations services in support of on-premise and cloud systems. GDIT will support the migration to the cloud and provide operations and maintenance services on both systems.

“CMS has made incredible progress as it moves its enterprise systems to the cloud,” said Kamal Narang, vice president and general manager for GDIT’s Federal Health sector. “This is another step in improving the agency’s data accessibility and analysis capabilities. As one of the largest providers of cloud services to CMS, we are proud to continue providing our cloud expertise to support their modernization journey.”

The contract continues GDIT’s 40-year partnership with CMS. In September 2020, CMS selected GDIT to evolve one of the largest public clouds in the federal government. Under that task order, GDIT is supporting the agency to help optimize its cloud technology investments and financial operations as it implements a mature multi-cloud environment designed to deliver critical healthcare services to tens of millions of Americans through hosted sites, Medicare.gov and Healthcare.gov.

Read more at GDIT

 
 

Clipped from: https://www.hstoday.us/industry/industry-news/gdit-wins-65-million-medicare-and-medicaid-cloud-and-data-integration-contract/