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FX Strategic Roadmap

The Agency refreshed the Florida Health Care Connections (FX) Procurement Strategy in July 2020 with a new roadmap focusing on the resolution of the fiscal agent contract and the replacement of the existing Florida Medicaid Management Information System (FMMIS) by December 2024.

FX Phased Procurement Strategy
  • Phase 1 (Established Fall 2017) – Procure a Strategic Enterprise Advisory Services (SEAS) Vendor and an Independent Verification and Validation (IV&V) Vendor
  • Phase 2 (Fall 2019 – 2022) – Establish the technical foundation of the modular transformation through the Agency’s procurement of an Integration Services and Integration Platform (IS/IP) Solution and an Enterprise Data Warehouse (EDW) Solution
  • Phase 3 (Fall 2019-2024) – Transition the current fiscal agent contract by December 2024, which includes activities to procure modules to transform and improve the FMMIS business processes and replace functionality with solutions that are interoperable with other systems within FX and the larger Florida Health and Human Services agency ecosystem
  • Phase 4 (Spring 2023-2027) – Acquisition and implementation of modular processing capabilities, systems and services that upgrade, modernize, and replace the functions currently performed by multiple existing systems
FX Roadmap
The activities included in the FX Roadmap are contingent on Legislative budget approval and are subject to change as needed to meet the State’s goals for this project.
 
Modules for the FX FMMIS Replacement

Overview: Foundation of interoperability – IS/IP serves as the conduit, or interface, through which all information is requested and returned. IS/IP includes a business rules engine that will ensure all federal and state Medicaid rules are accurately applied across all systems.

Module Status:The IS/IP contract was executed November 2019 and project activities were separated into three Workstreams A, B, and C with some project activities running simultaneously. Workstream A was completed in August 2020. Workstream B was completed in November 2020. For contract and contract amendment information, please see the Florida Accountability Contract Tracking System (FACTS).

Contract Vendor: Accenture

(Updated: 12/2020)

Overview: A combination of software, hardware, infrastructure, and services to support effective data analysis and predictive analytics related to health care utilization in Medicaid.

Module Status: The EDW contract was executed in December 2020. The implementation will occur over 24 months with the first major milestone being an established Operational Data Store from the existing Florida Medicaid Management Information System (MMIS). For contract and contract amendment information, please see the Florida Accountability Contract Tracking System (FACTS).

Contract Vendor: Deloitte

(Updated: 12/2020)

Overview: The Provider Management Module will consolidate the health care facility and practitioner licensure and Medicaid enrollment and plan credentialing processes into a single source to minimize errors and confusion in the provider community. The Provider Management Module will leverage the Unified Operations Center.

Module Status: The Provider Management Module is currently being evaluated for alternative procurement strategies.  

Contract Vendor: To be determined.

(Updated: 12/2020)

Overview: The Core Module adjudicates all fee-for-service claims for Medicaid reimbursement, processes all managed care encounter claims, and handles all Medicaid financial activity.

Module Status:The procurement development will begin early in 2021.

Contract Vendor: To be determined.

(Updated: 12/2020)

Overview: Systems and infrastructure to support inbound and outbound communications between the Agency’s vendors and Medicaid providers and Medicaid recipients. The Unified Operations Center will coordinate and interact with phone, email, chat, short message service (SMS) text, social media, voice assistant, internal/external conference, physical mail and in person channels. It will gain administrative and operational efficiencies by consolidating multiple contact center systems by creating a central provider/recipient touch point.

Module Status: Procurement development is underway. Regular updates will be provided at the FX Executive Steering Committee Meetings.

Contract Vendor: To be determined.

(Updated: 12/2020)

Overview: The Recipient Management Module includes business functions to manage recipient information, grievances, appeals, communications, and interactions. It will create a self-service portal for recipients to select their Medicaid health plan, single consolidated view of eligibility, and will generate recipient communication for the Unified Operations Center.

Module Status: Procurement planning for the Recipient Management Module is currently projected to begin February 2021.

Contract Vendor: To be determined.

(Updated: 6/2020)

Overview: The PBM Module performs financial and clinical services for the fee-for-service Medicaid population. PBM includes a system to process pharmacy claims and e-prescribing and integration with pharmacy point-of-sale systems, pharmacy fee collection, and pharmacy rate negotiation. It also includes prior authorization for certain required drugs.

Module Status: Procurement planning for the PBM Module is currently projected to begin April 2023.

Contract Vendor: To be determined.

(Updated: 6/2020)