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Data & Systems

Affordable Care Act IT Guidance

The ACA IT Guidance section provides assistance for states making substantial investments in information technology systems for the expansion of Medicaid eligibility and the 2014 Affordable Insurance Exchanges.

Request for Information: Performance Indicators for Medicaid and Children’s Health Insurance Program (CHIP) Business Functions: Solicitation of Public Input

This solicitation seeks public input to aid in the development of an initial set of business process performance indicators for all state Medicaid and Children’s Health Insurance Program (CHIP) programs, which CMS indicated they would begin to collect in association with the development of new IT systems in the final rules entitled “Federal Funding for Medicaid Eligibility Determination and Enrollment Activities” (75 FR 21950) and “Eligibility Changes under the Affordable Care Act of 2010” (77 FR 17144).

Request for Information Performance Indicators White Paper

Also in this section:

Eligibility and Enrollment System Planning April, 2011
Guidance for Exchange and Medicaid IT Systems May, 2011

Medicaid Information Technology Architecture (MITA)

The MITA initiative is intended to foster integrated business and IT transformation across the enterprise.

Solicitation of Public Input

The 30-day comment period for the draft update to MITA 3.0 Part I, Appendices C and D, is now closed.  After consideration of the comments, CMS will release the final version of MITA 3.0 including the Eligibility and Enrollment Supplement.

Further information may found in the Informational Bulletin issued on “Medicaid Information Technology Architecture Guidance Version 3.0,” http://www.medicaid.gov/federal-policy-guidance/downloads/CIB-07-05-2013-MITA.pdf

PartI_AppendixC_BPM_DRAFT_Jun2013.pdf

PartI_AppendixD_BCM_DRAFT_Jun2013.pdf

Also in this section:

Seven Conditions and Standards for Enhanced Funding April, 2011
MITA 3.0 Downloads
MITA White Papers
MITA and Behavioral Health
State Technical Assistance Teams

Collaborative Application Lifecycle Management Tool (CALT)

Access to CALT- a centralized repository for sharing and collaborating on IT project deliverables and artifacts.

Federal Policy Guidance

Guidance in the form of letters to State Medicaid Directors, letters to State Health Officials (often regarding CHIP policy or financing issues), and more recently, Informational Bulletins to communicate with states and other stakeholders regarding operational issues related to Medicaid and CHIP.
 

Also in this section:

Search Letters, Bulletins, and Regulations

Medical Statistical Information System (MSIS)

The MSIS gathers key eligibility, enrollment, program, utilization, and expenditure data for Medicaid and CHIP. This data provides a database of all those eligible and receiving services for every state and territory.

Also in this section:

MSIS Procedures
Data Dictionary
Manual Submission Format
MSIS State Summary Data Marts
MSIS Drug Utilization Data Marts

Medicaid Analytic Extracts (MAX)

MAX data sets are created to support research and policy analysis and are extracted from MSIS. MAX data is organized into annual calender year files and combine MSIS initial claims, interim claims, voids, and adjustments for a given service into final action events.

Also in this section:

MAX Pharmacy Benefit Use and Reimbursement
MAX RX Tables 
MAX Chartbooks
MAXEM
MAX DOD
MAX Provider Characteristics
Mini-MAX
Beta-MAX
MAX and NCHS Linkage

Medicaid Budget and Expenditure System (MBES)

The MBES is a web-based application that reports budgeted and actual expenditures.  States submit forms CMS-64, CMS-37, and CMS-21 electronically. Summarized statistical data is available for download.

Also in this section:

CMS-64
CMS-37
CMS-21
CMS-21B

Medicaid Management Information System (MMIS)

The MMIS is an integrated group of procedures designed to meet principle objectives and the mechanized claims processing and information retrieval system for States.
 

Medicaid Managed Care Enrollment Report

The Medicaid Managed Care Enrollment Report profiles enrollment statistics on Medicaid managed care programs on a plan-specific level. The managed care enrollment statistics include enrollees receiving comprehensive benefits and limited benefits and are point-in-time counts as of July 1,2011.

Managed Care Encounter Data Toolkit

This toolkit provides a practical guide to collecting, validating, and reporting Medicaid managed care encounter data. It is designed as a step-by-step guide for state Medicaid staff responsible for managing the daily operations involved in encounter data, as well as for senior managers and policymakers who oversee this function. It contains case studies, checklists, and links to resources that provide helpful tips and tools.

National Summary of State Medicaid Managed Care Programs
The National Summary of State Medicaid Managed Care Programs is composed annually by the Data and Systems Group (DSG) of the Centers for Medicare & Medicaid Services (CMS).  The report provides descriptions of the States’ Medicaid managed care programs as of July 1, 2011.

 

Health Information Technology

The American Recovery and Reinvestment Act (ARRA) provides for hospital and provider incentives to accelerate the adoption and use of Health Information Technology (HIT).

Also in this section:

Federal Health IT Strategic Plan
HealthIT.gov

Electronic Health Record Incentive Programs

The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.
 

Also in this section:

HIT Program Timeline
Barriers to Meaningful Use
e-Prescribing

Health Information Exchanges

The appropriate and secure electronic exchange and consequent use of health information to improve quality and coordination of care is a critical enabler of a high performance health care system.

Also in this section:

FAQs Regarding HITECH funding for Health Information Exchange activities
State Health Information Exchange Programs
Approved State Plans

Health Disparities

Health gaps occur among groups who have persistently experienced historical trauma, social disadvantage, or discrimination and who systematically experience worse health or greater health risks than more advantaged social groups.

Federal Health IT Plan to reduce Health Disparities

Health IT Conferences

Our conferences bring together stakeholders and thought leaders from the public and private sectors to share ideas, learn and exchange information related to Medicaid programs, systems and initiatives.

Medicaid Enterprise Systems Conference (MESC) August 19-23 2013, Boston, Massachusetts
  -2012 MESC list view agenda
Medicaid HITECH Conference-Spring 2013
  -Past resources are available from the 2011 and 2012 Medicaid HITECH Conferences

Medicaid and CHIP Learning Collaboratives

The MAC Collaboratives bring together federal and state partners to address common challenges and pursue innovations in Medicaid program design and operations

Workspace Login:  MAC Collaborative States
Workspace Login:  Early Innovator Collaborative States

Waiver Management Systems (WMS)

Access to online Waiver Applications

Also in this section:

1915(c) Waiver Application & 372 Reports
1915(b) Waiver Application

View waivers in process and other information in the Waiver Topic Section.

Environmental Scanning and Program Characteristics (ESPC)

The Medicaid / CHIP ESPC is in a Microsoft (MS) Access database that contains Medicaid and CHIP data, for the 50 states and District of Columbia.

Medicaid Model Data Lab (MMDL)

International Classification of Diseases Tenth Revision (ICD-10)

The ICD-10 codes are markedly different from their predecessors and substantial system and procedural changes will be necessary to implement and correctly use the new codes. The updated code sets require significant changes in how health plans reimburse services, and in the way coverage of services is determined.

Also in this section:

ICD-10 Changes from ICD-9
ICD-10 Final Regulation and Training

The National Correct Coding Initiative (NCCI) in Medicaid

The NCCI promotes national correct coding methodologies and minimizes improper coding leading to inappropriate payments of Medicaid claims.