Rhode Island IT Infrastructure Transformation Abstract
In 2007, 27 states received Medicaid Transformation Grants under Section 6081 of the Deficit Reduction Act of 2005. The grants were rewarded to states that proposed innovative methods which in the end of the two years are designed to produce better health outcomes at lower cost.
The Center for Health Transformation is highlighting states that have received these Medicaid Transformation Grants, and will be following their progress for the next two years. In order for key decisionmakers and industry leaders from around the country to learn from others’ successes, it is our intention to provide this resource in order to showcase innovative practices from across the nation. In the future, this site will be interactive, allowing program directors to submit updates and comments regarding their program.
Click here for the complete grant application>>
Consistent with its ongoing efforts to detect and prevent fraud and abuse activities, identify and correct improper billing practices, and develop appropriate fraud control strategies in the Rhode Island Medical Assistance Program, the Department of Human Services (DHS) under the direction of the Executive Office of Health and Human Services (EOHHS), is submitting a Medicaid Transformation Grant Application to fund the IT infrastructure costs associated with:
- Updating and replacing its current MMIS Surveillance Utilization and Review Subsystem (SURS)
- Purchasing software and technical support to implement the National Association of Public Health Statistics and Information Systems (NAPHSIS) vital statistics database to meet the citizenship verification requirements of the Deficit Reduction Act (DRA) The current SURS system, based on 1970-era code, has serious shortcomings. Among other things, the system can take upwards of weeks to generate routine reports, and it does not allow users to drill down into data to investigate trends or case-specific lines of inquiry.
A primary goal of this grant application is to take advantage of the new generation of decision support tools, such as EDS’ DSSProfiler proposed here, and to maximize recoveries from SURS activities. Compared to the current SURS, the DSSProfiler represents a technology upgrade of analytical functionality and software and hardware processing capability. The benefits of an updated system will have a significant impact on the scope, efficiency and precision of the SURS program.
The verification of birth records is a critical component of the citizenship verification provisions outlined in Section 6036 of the Deficit Reduction Act (DRA). Rhode Island seeks resources to acquire the software and technical support for the electronic verification of birth records from the state vital records office in each of the fifty states. NAPHSIS has created a database EVVE that allows for the electronic exchange of birth records. In order to use this database, agencies must purchase the appropriate software and technical support.
The increased functionality of DSSProfiler will enable expanded reviews of provider and beneficiary claim activity for quality of care issues and program inefficiencies. It will also position the RI to be compliant with forthcoming Medicaid Integrity Program (MIP) requirements. The implementation of the vital statistics database will transform the eligibility verification process through an expedited citizenship verification process.
Funding sought under the grant application will finance all aspects associated with the design, installation and start-up of the DSSProfiler system and the EVVE vital statistics database, including project management, system programming, report building and customization, and training and documentation. Requested funding also includes the software and hardware associated with the application. To this end, the project’s total estimated budget is $725,253.00.
