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Gainwell Technologies Selected to Provide Full Suite of Cost Containment Solutions to State Medicaid Agencies through NASPO ValuePoint Cooperative Contract

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[MM Curator Summary]: Gainwell (nee DXC, nee HP, little nee HMS) is now set up to do TPL nationwide through a group purchasing arrangement.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



Gainwell Technologies LLC

Expands on Gainwell’s recent contract win with NASPO ValuePoint to provide Medicaid Management Information System Claims Processing and Management Services

TYSONS, Va., June 14, 2022 (GLOBE NEWSWIRE) — Gainwell announced today that HMS, a Gainwell Technologies company, has been selected to provide Medicaid Third Party Liability (TPL) services and solutions to state Medicaid agencies through the National Association of State Procurement Officials (NASPO) ValuePoint TPL Services contract.

A pioneer in protecting the integrity of Medicaid programs through comprehensive TPL solutions and services, HMS has been awarded contracts for all five categories: Commercial Recoupment, Recovery, Hospital-Physician, MCO Come-Behind Billing and TPL Systems Module.

“For decades, HMS has been a leader in providing cost containment solutions to state Medicaid agencies,” said Paul Saleh, President and CEO of Gainwell. “This contract win further validates the long-standing quality, effectiveness and innovation of our TPL solutions – and they are invaluable in continuing to keep our nation’s healthcare programs protected and strong.”

HMS was selected as a supplier for ValuePoint’s TPL service offerings, allowing states to gain more efficiency and savings by choosing one sole provider to manage all their data and TPL service needs. This single-vendor approach will result in lower total cost for TPL services and fully streamlines the process by filling in gaps that previously required multiple vendors and disparate point solutions.

Since 1985, HMS has been the leader in TPL solutions for state Medicaid agencies. In addition to HMS’ benchmark fees, our recoveries and savings for states and MCOs surpassed $1.5 billion in recoveries and an additional $2.5 billion in savings in 2021 – providing clients with best-in-class ROI.

About Gainwell Technologies LLC
Gainwell Technologies is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. With more than 50 years of proven experience, Gainwell has a reputation for service excellence and unparalleled industry expertise. We offer clients scalable and flexible solutions for their most complex challenges. These capabilities make us a trusted partner for organizations seeking reliability, innovation and transformational outcomes. Learn more at

About NASPO and NASPO ValuePoint
The National Association of State Procurement Officials (NASPO) is a non-profit association dedicated to advancing public procurement through leadership, excellence and integrity. It is made up of the directors of the central purchasing offices in each of the 50 states, the District of Columbia and the territories of the United States. NASPO is an organization that helps its members as public procurement leaders by promoting best practices, education, professional development, research and innovative procurement strategies. Learn more at

NASPO ValuePoint is the cooperative purchasing division of the National Association of State Procurement Officials (NASPO), facilitating cooperative public procurement solicitations using a Lead State model. NASPO ValuePoint delivers high value, reliable and competitively sourced cooperative contracts –offering public entities outstanding prices, favorable terms and conditions and value-added services. Learn more at

Media Contact
Lacey Hautzinger, Gainwell Technologies

Schae Kane, NASPO ValuePoint


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Mostly Medicaid Announces Medicaid Solution Provider Innovations Awards Submissions

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[MM Curator Summary]: We are highlighting innovative solution providers in the Medicaid space- nominate someone today!


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.




BIRMINGHAM, ALABAMA, UNITED STATES, June 1, 2022 / — MostlyMedicaid, the leading provider of Medicaid solution provider news, trends, insights and best practices announced the 2022 Medicaid Solution Provider Innovations project today.

Medicaid solution providers are a key part of the innovative programs delivered by states and managed care plans. These vendor partner companies provide solutions for things like data analysis, care management, transportation, and a whole range of other critical Medicaid business operations.

While some solution providers are well-known in our space, there are many that are not – and they are doing great work that can be leveraged in more Medicaid programs.

If you want to highlight the great work of a solution provider in the Medicaid space please fill out our simple survey here-

The survey is open for submissions as of June 1st, 2022. You can nominate a Medicaid vendor partner through October 20th, 2022. Early submissions are encouraged.

About Mostly Medicaid

Mostly Medicaid reaches thousands of Medicaid industry professionals, decision makers and influencers with its thought leadership publications and information sharing products. We also provide marketing and strategy consulting services for companies in the Medicaid industry, as well as premium educational content to enhance expertise for industry professionals. Mostly Medicaid offers a unique value in the Medicaid industry by focusing on data-driven business perspectives rather than policy-only or advocacy-only positions.

We began with one simple concept in mind – think of Medicaid as a massive industry. Besides the healthcare services provided to Medicaid enrollees, there are hundreds of thousands of people that process claims, build software, consult with hospitals – just to name a few segments. Those people need services and products to help them do their jobs, increase their revenues and improve their skills.

And that’s where Mostly Medicaid comes in. We are uniquely positioned to reach influencers across all segments and provide them with actionable information and recommendations. We have built a brand with 10,000 Medicaid industry professionals who trust us to bring non-biased information to them.

For inquiries about this announcement:
For Mostly Medicaid
Clay Farris
Mostly Medicaid
+1 919-727-9231
email us here

Clay Farris
Mostly Medicaid
+ +1 9197279231

email us here


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State again delays announcing winners of two Medicaid-related IT contracts

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[MM Curator Summary]: A Fl journo thinks something smells fishy about to open FL tech procurements that app up to more than $170M.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



Florida’s health care agency has abruptly pushed back the timing of when it will reveal who has won major information technology contracts aimed at revamping the system that helps run the Medicaid program.

The Tuesday afternoon announcement that the winning bids would not be disclosed for another month came minutes before the Agency for Health Care Administration (AHCA) was set to announce the names of vendors that submitted winning proposals for two seven-year contracts that combined are worth about $173 million.

This is the second time the state has pushed back the deadlines to announce the winning submissions. 

The state is procuring different services as it remodels the Florida Medicaid Management Information System, known as FMMIS, from a singular system to a modular one instead. The new system is called Florida Health Care Connections (FX) and there are two competitive bids underway.

The vendor that submitted the winning bid for the development of the provider services module was set to be posted at 4:35 p.m., according to a state website known as My Florida Marketplace.


Less than 20 minutes before the deadline, though, the state website was updated with news that the winning vendor wouldn’t be announced until June 30. The contract is worth an estimated $33 million and would run between Sept. 1, 2022 and August 31, 2029.

Likewise, the agency was slated to post the name of the vendor that was chosen for a $139.7 million contract over a seven-year period for the development of a unified operations center. The state was slated to post the winning bid at 5 p.m., but that deadline also was altered and extended until June 30 at 5 p.m. 

Florida Politics requested the names of the vendors that submitted responses to the two procurements, but AHCA did not immediately provide Florida Politics with the information.

According to state documents, the $33 million provider services module will electronically capture, validate and process provider enrollment applications (initial and renewal) including an automated screening and monitoring component to support state and federal requirements.

The system also will provide the capability to consolidate existing Medicaid enrollment and health plan credentialing processes into a single source to minimize errors, resulting in a simplified process for the provider community. 


Meanwhile, the winner of the $139.7 million contract
for the unified operations center module must include all interactions between the agency and its stakeholders. Major components of the unified operation center module include the management of printing, fulfilling and mailing information of any type as approved by the agency, including handling the receipt of inbound mail to the agency as well as production and distribution of the Medicaid membership cards.

The so-called FX system was pushed by former AHCA Secretary Mary Mayhew, who now heads the Florida Hospital Association. The notion behind the redesign is that modular solutions increase the opportunity to select the best technology and services from vendors while simultaneously avoiding vendor lock-in and the risks associated with a single solution.

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Medicaid winds down coverage for PT & OT telehealth

[MM Curator Summary]: NC will stop covering physical and occupational therapy via telehealth starting July 1 in response to CMS policies on not making telehealth changes permanent.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Are you a health care worker? We’d love to hear from you. Email editor at

By Clarissa Donnelly-DeRoven

Before the pandemic, Valerie Fox almost never used telehealth — nobody did at the Veterans Affairs Medical Center in Durham, where she works as a behavioral health occupational therapist.

Now, many patients request it. 

“Especially with the VA, a lot of people come from a lot of different parts of the state to here,” Fox said. “When we go to transition to outpatient work, it’s a lot easier.” With telehealth, people can more easily incorporate OT into their daily schedules — an hour here, an hour there. 

“It doesn’t become this big thing,” she said. 


But that’ll likely be changing soon. By July 1, North Carolina Medicaid will no longer cover occupational and physical therapy services done via telehealth — and getting to and from appointments will become, yet again, a big thing. The change was supposed to take place March 31, but the state extended coverage for 90 more days. 

Kimberly Godwin, the advocacy chair at the state’s occupational therapy association, has been getting a lot of emails over the last few months from therapists such as Fox telling her how telehealth has helped them serve more clients. 

“We’ve heard from a lot of businesses within the pediatric as well as other outpatient settings or specialized care, like mobility clinics, that have been able to just really broadly reach clients,” she said. “There’s been less cancellations, less no shows.” 

Many providers have noted how telehealth increased access for people who can’t afford transportation to and from a clinic, or those who don’t have any transportation to begin with. 

Even the state’s Medicaid program sounds supportive of keeping telehealth for physical and occupational therapy. 

“Over the past two years, telehealth flexibilities helped children and families access valuable PT/OT services during the unprecedented circumstances of the COVID-19 pandemic,” said state health department spokesperson Catie Armstrong. 

But she said that right now, the federal Centers for Medicare & Medicaid Services is not allowing any permanent changes to telehealth services. During the first few months of the public health emergency, the state recorded nearly 60,000 telehealth claims from people on Medicaid. In the months since, that number has declined.

That means, even if it wanted to, North Carolina doesn’t have the authority to permanently authorize the state Medicaid program to cover virtual OT and PT services. The coverage rollback has left many who work in the field worried about the impact it will have on people across the state, especially those in rural areas. 

Unique role telehealth plays in OT and PT

Since the start of the pandemic, researchers at Duke University have been investigating the role telehealth plays in expanding access to care in general. One study is examining the impact virtual care has had for people receiving OT and PT. 

Katherine Norman, a pediatric occupational therapist, is one of the investigators on the study.

“The population we looked at was children and adolescents, so that was anybody from zero to 20, enrolled in Medicaid from April 2020 to March 2021,” she said. The researchers analyzed the Medicaid claims data of about 137,000 children with a musculoskeletal health diagnosis who visited a provider during the time period. 

“The data that we uncovered really suggests that removing access via telehealth could impact as many as one in five kids who were using physical therapy and one in three kids who are using occupational therapy,” Norman said. To add a qualitative dimension to their study, the researchers are also speaking with people on Medicaid, health care providers, and community leaders statewide.

Physical and occupational therapy can be critical for helping kids meet developmental milestones. PT can help children learn how to do critical physical tasks with more ease: walk and run, get on and off the floor, and play, while OT helps kids with the development of fine motor skills, such as brushing their teeth or holding a comb. 

Imagining all those kids missing out on this kind of care deeply worries Norman. 

Also, she says, telehealth holds a unique value within occupational therapy because of the nature of the care. If she’s seeing a patient, rather than just telling her about the stairs they have trouble climbing, or the corner they want to be able to stand behind to surprise their sibling, they can literally bring her into the room.

“They can show me exactly how they do it,” she said, “so that I can see that and be like, ‘OK, so we need to work on your ability to crouch, or your ability to jump, or [whatever] specific movement pattern.'”

Fox agrees. 

In OT, “We think a lot about the environment, and how that impacts function and somebody’s ability to participate,” she said. “When it comes to having somebody leave their natural environment to come to an outpatient clinic, you have to ask a lot of questions: What does your home look like? And how do you move through your home? And what is the environment?

“Telehealth allows you to truly see that in the moment and kind of be there with someone and I think that’s another layer, in addition to accessibility.”

Also, Fox says, it doesn’t have to be all or nothing. In a perfect world, care going forward could be a blend of telehealth and in-person care. 

“I just had that with a veteran,” she said. “He’s 75. He lives about an hour and a half away. So the first visit was that we do a lot of assessments, and now that we kind of know each other and I have more of an idea of his level of function, the next few sessions could be telehealth.”

“What is the harm in keeping it as an option?” 

Fox, who in addition to her full-time job at the VA is also the president of the North Carolina Occupational Therapy Association, said she was unaware of any outreach the state health department had done to ask occupational and physical therapists how virtual coverage was going for them and if they’d want it to continue going forward. 

“This came to our attention when we were informed of the date of the sunset,” Fox said. Medicaid refers to the end of coverage for certain services as ‘sunsetting.’ 

“So, we did not realize that this was coming, and definitely not that it was coming as fast as it was,” she said. “We’ve been told that they did not have the data showing that the telehealth modality was utilized enough. We are unclear on what type of data that was, or how it was collected or what their cutoff is for ‘enough,’ but that was what we’ve been told so far.”

Spokespeople from DHHS did not directly answer the question of if they conducted outreach to providers, but said that they have qualitative data from families showing support for telehealth. Still, they said, the data the department has collected and analyzed “did not demonstrate the use of these services.”

In a public webinar presentation on March 17, the associate director of program evaluations at North Carolina Medicaid, Sam Thompson, presented the data collected by Norman and the other Duke researchers, but came to a different conclusion than the researchers.

“As a proportion of care, telehealth is just substantially lower in this group,” he said. “Because it’s such a small proportion of care, it’s a little bit less meaningful”

But, Fox argues, even if utilization rates were low, if anyone used it, it’s worth keeping. 

“It’s about access,” she said. “And so if five people throughout the year use it, what is the harm in keeping it as an option?” 

The state Medicaid office did worry at first that adding telehealth as an option would increase costs, but that’s not what they’ve seen. 

“We have not found it to be significantly more expensive,” Thompson said. “We have some evidence to suggest that it can help prevent complicating factors that might be more expensive.”

It’s unclear if private insurance plans will continue to cover tele-OT and PT or sunset their coverage as well. But historically, Godwin said, private insurance plans often follow what Medicaid does, meaning there’s a good chance that if telehealth for OT and PT is made permanent by the federally funded health care program, other insurance plans may follow. 

While the state Medicaid office is limited in its ability to make permanent changes to its telehealth coverage policy, providers spoken to for this story want to encourage officials to do everything they can to make sure the coverage remains permanent. 

If it goes away, they argue, fewer people will get the care they need. 

“And that makes me really sad,” Godwin said.

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 Providers worry as Medicaid winds down coverage for OT and PT done via telehealth

by Clarissa Donnelly-DeRoven, North Carolina Health News
April 4, 2022



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Government Accountability Office asks CMS to assess telehealth quality for Medicaid beneficiaries

[MM Curator Summary]: GAO is calling on CMS to report on the quality of telehealth services paid for by Medicaid during the pandemic.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


The number of Medicaid beneficiaries using the technology is on the upswing, with five states showing big increases during the pandemic.


Photo: Geber86/Getty Images

The U.S. Government Accountability Office is asking the Centers for Medicare and Medicaid Services to gauge the effect that an increase in telehealth utilization is having on the care quality experienced by Medicaid beneficiaries. The GAO cited statistics showing usage continues to rise.

GAO culled data from five states – Arizona, California, Maine, Mississippi and Missouri – and found exponential increases in both the number and percentage of services delivered through telehealth, as well as the number of Medicaid beneficiaries receiving remote care.

For example, from March 2020 through February 2021, 32.5 million services were delivered via telehealth, vs. 2.1 million services the prior year.

The number of Medicaid beneficiaries using the technology is also on the upswing, with 4.9 million beneficiaries in those five states receiving telehealth services over that time, compared to just 455,000 in the 12-month period prior to the COVID-19 pandemic.

The percentage of Medicaid patients receiving at least one service through telehealth increased greatly in all five states, with the greatest increase occurring in Maine: From March 2019 to February 2020, just 2.5% of Maine Medicaid enrollees utilized a telehealth service. From March 2020 to February 2021, that number shot up to 41.8%.

California showed a similar increase (2.5% vs. 41.4%), as did Arizona (11% vs. 43.8%). Mississippi saw the percentage jump from 1.2% to 25.4%, while Missouri saw a jump from 2.3% to %19.9%.


To respond to the COVID-19 pandemic, states have expanded their coverage of telehealth in Medicaid.

The CARES Act includes a provision for GAO to report on the federal response to the pandemic, and the agency was also asked to examine the use of Medicaid flexibilities in response to the pandemic.

GAO analyzed state-reported data on telehealth use in five states, based in part on variation in geography, Medicaid program size and percentage of population living in rural areas. GAO reviewed federal oversight documents, interviewed state and federal Medicaid officials, and assessed CMS’ oversight against its guidance on using data to identify disparities in healthcare and target improvements.

CMS does not collect, assess or report information about any effect delivering services via telehealth has on the quality of care Medicaid beneficiaries receive, and has no plans to do so, GAO said. That’s what it hopes to change.

“It would also be consistent with how CMS has encouraged states to use data on quality of care to identify disparities in healthcare and target opportunities for improvement to advance health equity,” the GAO said. 

These efforts could begin with data for quality measures CMS already collects or through other means. CMS has not issued a response to GAO’s recommendations.


To help beneficiaries maintain access to care amid stay-at-home orders to reduce COVID-19 related exposure, CMS used emergency waiver authorities enacted by Congress, as well as existing regulatory authorities, to implement policies expanding access to telehealth services during the pandemic.

These included waiving several statutory limitations, such as geographic restrictions, and allowing beneficiaries to receive telehealth in their home.

Telehealth utilization increased 63-fold during the pandemic, according to a December 2021 report from the U.S. Department of Health and Human Services. Behavioral health providers saw the highest telehealth utilization, in a 32-fold increase, HHS said.

In 2020, telehealth visits comprised a third of total visits to behavioral health specialists, compared to 8% of visits to primary care providers and 3% of visits to other specialists.

While utilization of telehealth services increased and improved access to services for many beneficiaries, more research is needed to understand the impact on quality of care and why certain beneficiaries used less telehealth than others, HHS said.

Twitter: @JELagasse
Email the writer:



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Illinois Sets Aside $66 Million for Medicaid Innovation Collaborative

[MM Curator Summary]: Tech providers and FQHCs will get funding to address SDH in Illinois.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


The state funding will go to OSF HealthCare and four federally qualified health centers that have launched a five-year program to develop new technology platforms and services to help underserved communities access healthcare.

Illinois is spending almost $66 million on a new program aimed at helping underserved communities access care.

The state’s Department of Health and Family Services is funding Peoria-based OSF HealthCare and a group of federal qualified health centers (FQHCs) that have launched the Medicaid Innovation Collaborative (MIC). The MIC will use the money to develop innovative new technologies and services that help people struggling with social determinants of health, such as financial issues, housing and food insecurity, which affect how they access healthcare.

“We learned during the pandemic that virtual care was a game-changer for patients, and the new funding will help us implement the latest technologies to expand access to care for underserved communities and vulnerable populations,” Michelle Conger, CEO of OSF OnCall Digital Health, said in a press release. “As a leader in digital health, we are excited to develop, implement and evaluate innovative, evidence-based strategies that will improve health and wellness for all residents in the communities served by OSF and our partners, regardless of their income level or where they live.”

Healthcare organizations across the country are using digital health platforms to address those barriers to care often found in Medicare and Medicaid populations. Without that access, consumers often avoid or skip needed healthcare services, exacerbating chronic conditions, reducing healthy lifestyles and leading to costly healthcare services and reduced clinical outcomes down the road.

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OSF OnCall, the health system’s digital health platform, will be working with four FQHCs – Heartland Health Services in Peoria, Chestnut Health Systems in Bloomington, the Eagle View Community Health System in Oquawka, and Aunt Martha’s Health & Wellness in Danville – to equip community health workers and medical care teams with digital health tools to help assess and treat patients, including giving them resources and access to virtual care opportunities.

Those services will include chronic care management, behavioral health treatments, maternal and child health services, cancer screenings, and dental services. In addition, the program will support additional staff at community health clinics, EHR implementations, mobile health units and digital health connectivity in underserved areas.

The project will also create about 100 new healthcare jobs, potentially affected about a third of the state. The MIC is partnering with Illinois Central College in East Peoria to train people to fill those community health worker positions.

Officials says the program’s goal is to provide 1 million episodes of care for Medicaid patients over the next five years, especially targeting the state’s most vulnerable and marginalized communities.


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Statement Regarding Unauthorized Medicaid Data Access

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[MM Curator Summary]: Gainwell released details on a member-data breach that happened June and October last year.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Gainwell Technologies LLC announced it has notified 2,765 Georgia Medicaid members of a privacy issue that may have impacted their protected health information. These separate incidents occurred on June 25, 2021 and October 29, 2021, and relate to an unauthorized individual(s) gaining access and viewing payment information of two health care providers. 

The unauthorized individual(s) attempted to obtain payments intended for the providers. There is no indication that the unauthorized individual(s) attempted to access Medicaid member information; however, the individual(s) were able to view documents for 2,765 Georgia Medicaid members that included the names, Medicaid member IDs, medical record numbers, and billing codes for services covered under Georgia Medicaid. Social Security numbers were not disclosed as part of these incidents. Members who were impacted were sent a notification letter from Gainwell. 

Members who receive a notification letter or have questions about this incident can call 1-833-903-3648 from 9 a.m. to 9 p.m. Eastern Time Monday through Friday.

For more information, click here link to press release.


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Telehealth Utilization Increasing Medicaid Provider Reimbursement

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[MM Curator Summary]: A study of telehealth grants in CA during the pandemic shows a surge from 2% to 45% of all physician visits.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Not only has Medicaid ensured care access for enrollees during the pandemic, but its coverage of telehealth services has proved a boon to Medicaid providers in California.


Source: Getty Images


By Kyle Murphy, PhD

March 15, 2022 – Increased use of telehealth services by Medicaid beneficiaries in California is leading to positive financial outcomes for providers in the state.

Increased Telehealth Boosts Medicaid Provider Revenue in CA

Sixty percent of Medicaid providers in California said that telehealth provided financial stability for their organization, a new report shows.

The report was released by Health Net, a payer supporting members on Medi-Cal, California’s Medicaid program. In 2020, Health Net awarded 138 Medi-Cal providers about $13.4 million in grants to implement and expand telehealth services. The grant period was from May 2020 to April 2021, after which the grantees submitted information about how they used their funds. The new report is a summary of the reports submitted by 98 Medi-Cal providers.

Overall, telehealth use among Medi-Cal patients increased from 2 percent of all doctor visits prior to the pandemic to 45 percent at the end of 2020, representing a 20-fold increase.


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CNSI’s Provider Services Module to Support Georgia Department of Community Health’s Medicaid Enterprise System Transformation Program


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[MM Curator Summary]: The tech giant will get $116M for its role in the GA provider management system over the next 10 years.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



CNSI’s CMS-certified, configurable, web-based system aims to enhance provider experience and support Medicaid modernization with an efficient, scalable platform

MCLEAN, Va., March 7, 2022 /PRNewswire/ — CNSI, a leading provider of innovative healthcare technology-driven products and solutions, announced today a new contract with the Georgia Department of Community Health (DCH) to implement a new provider services module (PSM) as part of the state’s Medicaid Enterprise System Transformation (MEST) program. Under the terms of the 10-year, $116 million agreement, CNSI will implement its provider management information system, evoBrix X PMIS™, delivering an enhanced user experience around enrollment and real-time claims status for the state’s Medicaid providers enrolled with DCH to administer essential health services.  

DCH selected CNSI as an approved Centers for Medicare and Medicaid (CMS) PSM vendor through the National Association of State Procurement Officials (NASPO) ValuePoint procurement platform. CNSI’s configurable, web-based provider module supports states’ Medicaid system infrastructure modernization efforts with a secure platform that increases self-service functionality for providers while delivering efficiency and scalability for state Medicaid programs.

“We are delighted to partner with the Georgia Department of Community Health in its efforts to optimize quality controls and provide the best experience for its valued healthcare providers,” said Todd Stottlemyer, CNSI CEO. “With this new contract, we are excited to support the state agency’s mission to create A Healthy Georgia.”

“Our Medicaid Enterprise System Transformation project will elevate how we interface with providers across Georgia,” said Caylee Noggle, DCH Commissioner. “We look forward to working with CNSI to develop and implement a modern user experience that helps providers reduce time spent on administrative tasks so they can focus on delivering high quality care.”

About CNSI:

CNSI delivers a broad range of health information technology enterprise solutions and customizable products to a diverse base of state and federal agencies in the United States. We align, build, and manage innovative, high-quality, cost-effective solutions that help clients achieve their mission, enhance business performance, reduce costs, and improve the health of individuals and communities.  Headquartered in the United States with global operations, CNSI employs a world-class team of technologists, program managers, and subject matter experts with large scale mission-critical information technology implementation experience. Learn more at

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CNMI- Governor vetoes Medicaid personnel bill

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[MM Curator Summary]: The Governor of CNMI has shot down a bill that would codify various authorities for the Medicaid agency.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



GOVERNOR Ralph DLG Torres on Friday vetoed House Bill 22-53, which proposes to “further enable recruitment, retention and appropriate classification and compensation” in the Commonwealth Medicaid Agency.

Introduced by Rep. Leila Fleming Staffler, the bill aims to:

1) Codify the authority of the Medicaid director to reprogram funding appropriated for Medicaid program among the established business units in a fiscal year budget;

2) Direct the Office of Personnel Management to undertake a repricing study for eligibility, enrollment, claims processing, and health information technology personnel and retention based on the classification and compensation of Commonwealth Healthcare Corp.; and

3) Authorize OPM to hire Medicaid Enterprise System, data analysis, program integrity, and auditing personnel under excepted service employment contracts until the market-based repricing classification and compensation study is completed.

According to the bill, the CNMI government’s fiscal year 2021 budget established a Compliance and Medicaid Enterprise System as a new business unit “to balance the program needs for administration and medical reimbursement with the legal requirements of Title XIX of the Social Security Act.”

In addition, the Legislature also provided the Medicaid director the authority to reallocate the funds appropriated in the budget law.

H.B. 22-53 clarifies the authority of the Medicaid director to reprogram funds among the Medicaid business units categories or any other business units the Legislature may establish in the appropriation measure.

The bill also stated that positions for Medicaid Enterprise System personnel approved and funded, at a minimum, with 50% to 90% federal funds, as approved by the Centers for Medicare and Medicaid Services, “have yet to be recruited, resulting in delays to important project activities and time lines.”

The measure states that “specialized health information technology and Medicaid data analytics personnel required by Medicaid are in short supply until OPM is able to undertake a market-based classification and compensation pricing study for health information technology and data analytics personnel that, in minimum, reflects the comparable classification compensation of like positions at CHCC.”


In his veto message, the governor said due to ambiguities in the language of the bill as noted by the attorney general, and similar concerns of OPM, “I must respectfully exercise my constitutional authority to veto this bill.”

He said if approved, the measure would create a narrow exception to the reprogramming restrictions in the Planning and Budgeting Act, with regard to the Medicaid Agency.

He said funds appropriated to the Medicaid Agency may be reprogrammed by the director regardless of whether the funds are for personnel or non-personnel expenditures.

Right now, the governor said, the Planning and Budgeting Act permits the reprogramming of funds from personnel to non-personnel or operations, but not vice versa.

The governor also noticed that the bill would require OPM to establish personnel positions for the Medicaid Agency that fall under Medicaid Enterprise System. The MES positions, he added, are approved by the Centers for Medicare & Medicaid Services.

OPM is further tasked with performing a review and study of the classification of personnel required by the Medicaid program with classification and compensation rates comparable to CHCC and private insurers and providers.

In recruiting prospective employees, the governor said OPM would be directed to interview and employ individuals who have demonstrable and specific knowledge, skills, experience, training and abilities applicable in Medicaid administration and similar healthcare management and analytics program.

But the governor said H.B. 22-53 would exempt MES employees from the civil service system. Upon completion of OPM’s classification and compensation study to be approved by the Medicaid director, the MES employees may opt to convert to the civil service system and become civil service employees.

According to the governor, the attorney general makes it clear that Legislature’s lawmaking authority over the civil service system “is not plenary.” Only the Civil  Service Commission has the authority over civil service system and is the sole authority to exempt positions from civil service classification, the governor said.


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