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The National Association of Medicaid Directors (NAMD) Conference gathered executives and government employees in the bustling city of Washington D.C to discuss Medicaid program initiatives in America. The conference offered a variety of Medicaid workshops while highlighting key advancements in healthcare technology.

In case you weren’t able to attend, check out our NAMD recap of key takeaways:

Next Steps for TMSIS Modularity: states that the Transformed Medicaid Statistical Information System (T-MSIS) is a critical data and systems component of the CMS Medicaid and CHIP Business Information Solution (MACBIS).

“The implementation of TMSIS is a huge organizational change” said Joshua Baker, Director of South Carolina’s Department of Health and Human Services in Tuesday’s plenary session.

States, especially South Carolina, value the use of this new system because it spends time focusing on the quality of data being sent to the Federal funder – The Centers of Medicaid and Medicare (CMS). Baker went on to explain that TMSIS has caused employees to review data several times and analyze even further into individual benefits while measuring network efficiency. Furthermore, states have been concerned with good, quality data and TMSIS pushes them into further analysis.

Baker also describes a staff disruption with executing TMSIS into the workplace, stating “we are trying to implement a message of change.” In more detail, employees need to break through the fear and make themselves adaptable to the ever-changing world of technology.

Calder Lynch, Senior Counselor to the CMS Administrator, then explored the option of rebuild or reuse. “We want to be risk based when working with states” Lynch said.

According to Lynch, the data collected from TMSIS is real and being used. Eventually, he hopes this will lead into the score card initiative to gage performance. He urged individuals to be honest with their government with needs, timeframes, protects, etc.

Elena Nicolella, Executive Director, The New England States Consortium Systems Organization (NESCSO) reported that “the immediate benefit to states is hard to recognize.” She explained that recognition is being received from CMS concerning the challenges to implement modularity and TMSIS. In her opinion, states viewed TMSIS as a technology initiative. Programs should be mindful of the evolution of technology and how it can improve business function.

Nicolella stressed to the audience that Medicaid Directors should start putting technological advancements first. However, she did include that with a lack of human resources, a lot of rework needs to happen before a better product reshapes the healthcare industry. Nicolella also raised the challenge of procurement and how modularity is needed to manage multiple vendors. In summary, Nicolella believes Medicaid will lead the way on modularity across the enterprise.

State and Federal Innovations to Program Integrity:

As defined by, “Program integrity activities are meant to ensure that federal and state taxpayer dollars are spent appropriately on delivering quality, necessary care and preventing fraud, waste, and abuse from taking place.”

Thomas Betlach, Medicaid Director, Arizona Health Care Cost Containment System shared that 1.9 million residents in Arizona are covered by Medicaid, that is 27% of the population. He believes program integrity has been very successful at working with the legislature and securing resources. Betlach then went into detail about how program integrity must perform two key functions: regulate and collaborate. The most important regulator responsibilities include having strong contract language for expectations in managed care plans. As far as the collaborator aspect, the ability to work with plans for real-time information and system wide look evaluations is key.

Dale Carr, Director, Missouri Medicaid Audit and Compliance shared his data on the dropping number of Medicaid participants in his state. Missouri currently insurers 940,000 Medicaid members with a decrease of 15,000 individuals per month. Carr’s state has 3 managed care organizations and a $10 million Medicaid budget. Carr’s biggest challenge with program integrity is the continued ability to employ business analytical individuals. Within his department, they have been replacing MMIS and have already given out contracts to several modules. In the future, Carr would like to adopt processes of machine learning and artificial intelligence.

Clint Eisenhower, Deputy Group Director, Governance Management Group, Center for Program Integrity at CMS told the crowd that over the past 3 years, his department has tried to better partner with states over program integrity. Eisenhower reports “Program integrity needs to work with Medicaid and state policies.” Eisenhower wants to work directly with states on their MMIS data, expanding and simplifying available Medicaid data, work with individuals directly to find leads. It is important for states to work with other states and share best practices. On a final note, Eisenhower strongly articulated “Program integrity should be mission driven and foundational.” Managed care is Eisenhower’s main priority and addressing the lack of best practice documents and toolkits to educate state employees.

The Future of Behavioral Health Integration in Medicaid:

Brian Hepburn, MD, CEO National Association of State Mental Health Program Directors (NASMHPD) focused his talking points on mental health. In Georgia, 7.5 million people are being served by the state mental health authority – 98% of these individuals are receiving community health services. His focuses are on developing a continuum of care that includes adequate psychiatric bed capacity and community-based alternatives to hospitalizations. Hepburn would also like to direct his attention to early identification of mental health issues in children, youth, and young adults. He believes we can use telehealth and other technologies to increase access to care. As far as treatment and recovery, he would like to provide a comprehensive continuum of care and make screening/early intervention a national expectation. In order to make this all possible, he plans to develop a finance strategy to increase availability and affordability of care.

Nancy Smith-Leslie, Division Director, Medical Assistance Division, Human Services Department for New Mexico began with reporting in 2014, New Mexico launched its fully-integrated managed care program, Centennial Care, through a Section 1115 Waiver.  This integrates physical, behavioral, and long-term care services delivered by three managed care organizations (MCOs). The MCOs are required to conduct a health risk assessment with every member and a more comprehensive needs assessment for members identified as needing a higher level of care coordination. Centennial Care encompasses 850 care coordinators and 37,013 in care coordination. MCOs must have designated care coordinators with relevant expertise to meet the needs of specific populations, including members with complex behavioral health needs, members with housing insecurity needs and justice-involved members.

Thank you to everyone who visited the Softheon booth to learn more about Verify, our enhanced eligibility verification platform. Most recently, the platform has been modified to allow for other state agency uses to include Identity Management, Employment and Income verification, as well as Social Services fraud work (child support, alimony collections, etc.). In order to meet new CMS mandates, Softheon Verify AVS is available for immediate procurement through a state Reseller Agreement through our NASPO contract. To learn more, schedule a demo with Michael Sasko, Vice President of Government Solutions.




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