90/10 Rule is Final: Time to Upgrade to a More Reliable & Efficient Model – Say Ahhh! A Children’s Health Policy Blog

Remember driving an older model car that generally got
you from point A to point B but not without stalling at a traffic light or
having the heater cut out in the dead of winter? Thats a bit like
the old, tired legacy systems currently being used to determine eligibility for
Medicaid (and other programs) in many states today. The good news is that
states now have a strong financial incentive to replace or upgrade those
systems to bring them in line with 21st century technology.

Yesterday, CMS issued a final rule that will provide 90
percent of the cost for states to develop and upgrade their IT systems to help
people enroll in Medicaid or the Children‘s Health Insurance Program
(CHIP), and 75 percent of ongoing operational costs. The rules also establish
performance standards for the improved eligibility systems to promote greater
efficiency and a more consumer-friendly enrollment process.

There is a lot of techie detail in the rule, as well as
responses to comments, regarding the requirements that these systems must meet
in order for system design, development and implementation costs to be qualify
for 90 percent federal financial participation. Im not sure that readers of Say
Ahhh! want to dig into that kind of nitty gritty on a Friday afternoon, so I’ll
try to stick to the highlights. 

The rule emphasizes the need for a modular, flexible
approach to systems development that promotes both the ease of maintenance as
well as the sharing, leverage and reuse of systems within and among states.
really important to most of us is that these systems are expected to improve
enrollment and renewal by:

  • Supporting accurate and timely processing of
    eligibility decisions and effective communications with providers,
    beneficiaries and the public,
  • Producing transaction data, reports and performance
    information that contribute to program evaluation, continuous business
    improvement, and transparency and accountability
  • Ensuring seamless coordination with the Exchange and
    allow interoperability with health information exchanges, public health
    agencies, human services programs and community organizations providing
    outreach enrollment assistance services.

It’s important to keep in mind that this is a
time-limited opportunity. To qualify for the 90 percent funding, states must
incur costs for goods and services furnished no later than December 31, 2015.
But to help states get started right away, the rule waives both the 30- and
60-day delay in effective date.

In the coming weeks and months, we’ll continue
to dig into the technology-related issues to help advocates understand the
opportunities for them to have input into system development as states move
forward. While it may not be as easy as shopping for a new car, driving it off
the lot will be every bit as exciting as we see the emergence of enrollment and
renewal systems that deliver on the promise of a 21st century, customer-focused

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