Maryland Department of Health Medicaid Management Information Systems (MMIS)

Department of Health - Medicaid Program

The State of Maryland Medicaid Program is a unit of the MDH, which has State responsibility for operation of the Medicaid Program authorized under Title XIX of the Social Security Act. The Maryland State Medicaid Program has approximately 1,300,000 enrollees, of which, 1,100,000 are enrolled in managed care organizations. MDH has the primary responsibility for the management of Medicaid’s Medical Care Programs (MCP) for the State of Maryland.

Management of MCP is divided into five administrations: OET, Office of Health Services, Office of Planning, Office of Finance and the Office of Eligibility Services. The mission of the MCP is to ensure access to medically necessary and appropriate health care services for Marylanders who cannot afford them. The MCP’s vision is to ensure that all Marylanders have access to quality health care services regardless of their financial status through delivery systems that will be models in the health care industry.

The current MMIS system was procured in 1992. It is a legacy system used for the claims processing needs of the State of Maryland utilizing batch operations running on a mainframe processor. Over the years, the MCP has become increasingly complex, with service changes, eligibility changes, and new regulations. New program requirements are difficult to address with the existing MMIS system. Labor-intensive “workarounds” are used to address these changes in the short-term. In addition, like other Medicaid programs, rising costs threaten the MCP’s long-term financial viability, pushing the State to find ways to ensure that the State delivers the maximum value for the cost.

CMS released the Medicaid Program Final Rule: Mechanized Claims Processing and Informational Retrieval Systems in December 2015. This final rule modifies regulations pertaining to 42 Code of Federal Regulations (CFR) 433 and 45 CFR 95.611, effective January 1, 2016. This final rule supports increased use of the MITA framework.

MDH submitted a MMIS Planning Advanced Planning Document (PAPD) to CMS for approval of MDH’s intentions for improvements to the Maryland Medicaid enterprise. In September 2016, MDH received CMS approval for the funding to complete a MITA 3.0 State Self-Assessment (SS-A) as the initial step towards a modular transformation of Maryland’s MMIS. The MITA SS-A will serve as a guide for transforming Maryland’s Medicaid systems and business processes for replacing the MMIS.

Current System

Operations and maintenance of the MMIS II subsystems constitute an ongoing challenge as shifting federal and state regulations require tailoring of services, eligibility and reimbursement. Enhancement and maintenance are required for all subsystems including Claims, Recipient, and Management Administrative Reporting Subsystem (MARS). The MMIS II presently consists of 6 core subsystems: Recipient; Provider; Claims processing; Reference file; Surveillance and Utilization Review; and MARS. For Maryland, the MMIS II subsystems support the following functions: Eligibility; Health Choice; Third Party Liability; Buy-in; Maryland Children’s Health Program (MCHP); MCHP premium; Eligibility Verification System; Pre-Authorization; and Early and Preventive Screening, Diagnosis and Treatment (EPSDT). The State owns the system, all hardware, software, databases, etc.

The Contract provides mainframe application developers and specialists to support development, enhancement and maintenance of the MMIS II application and supporting network applications. The purpose of this procurement is to obtain a TO Contractor who has the technical and professional capabilities to continue the ongoing support and maintenance of Maryland’s MMIS II by implementing maintenance, support and enhancements to MMIS II subsystems.

GANTECH - GCOM

Gantech Inc./GCOM as a primary vendor support and maintains the MMIS system in the following areas.

  • Claims processing and payments to the Maryland Health care providers
  • Eligibility verification of Maryland citizens for Medicaid program
  • Reporting various Medicaid program information to State and Federal government agencies (CMS)
  • Support the network and devices of MDH and its users.

Why GCOM?

GCOM has established an outstanding reputation of delivering innovative, tailored technology solutions with a focus on modernizing legacy IT systems. We combine the scale to support large complex projects with the agility and accessibility of a smaller company giving state and local leaders a third option when looking for a partner to their technology challenges. Our reputation for innovation and reliability has been earned by helping clients leverage cutting edge technology while mitigating risk. Our team collectively brings decades of successful government experience to the table. GCOM combines its experience and domain expertise with user-centric design for solutions that improve agency performance, accessibility and transparency.

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