Open Source Provider Screening ModuleA State and Federal Priority Partnership

Eugene Gabriyelov, CMS Data Systems GroupColleen Line, MITREJames Vasile, Solution Guidance Corporation

2018 HIMSS

2

• Open Source 101

• Open Source in the Medicaid Ecosystem

• Provider Screening Module

• What's Next

Agenda

3

Open Source is a Disruptor

Source: PC World Apr 17 2013 https://www.pcworld.com/article/2035651/open-source-is-taking-over-the-software-world-survey-says.html :

Why Open Source?

“HHS is actively using and repurposing free open source software and collaborating with interagency and intra-agency partners…usage of open source software can fuel innovation, lower costs, and benefit the public.”

Competition

Flexibility

Product quality

Reuse

Cost

Risk

Source HHS.gov https://www.hhs.gov/open/2016-plan/open-source-software.html

How Open Source Works

5

Community-driven

Derives roadmap iteratively via stakeholders

Leverages agile processes

Continuously evolves to reflect

current requirements

Provides a minimum floor of functionality

Vendors, Stakeholders (States and CMS), and

developers collaborate on an ever-evolving platform

Open Source Development

Master Branch

Without performing a pull request, forks can quickly become out of date

7

Open Source in the Medicaid Ecosystem

• Module development

• Interoperability framework and standards

Disrupt the MMIS

Solutions Space

• Development

• Configuration

• Integration

• Support

Offer New Vendor

Opportunities

Open Source Provider Screening Module

A Federal and State

partnership to pilot Open

Source module development

Pilot model for procuring,

developing, and maintaining

shared modules

Fully functional, configurable module that vendors can

freely incorporate

Why Pilot Provider Screening?

Screening is currently a

manual process in many states

Big efficiency gains

All States need to screen providers

against the same Federal

databases

Ready for sharing

Screening is comparatively

simpler to separate from the rest of the

MMIS

Modularity

Provider Screening Module to Date

2012-2013

• Crowd-source challenge produced initial PSM

• Evaluated by Minnesota and South Carolina but not implemented

2016-2017

• Performed gap analysis

• Developed a minimum viable pilot

• Explored governance options

2018-2019

• Release 1.0: a mature, ready-for-integration module

• Implement governance

11

Key Provider Screening Functionality

Screen provider applicants in accordance with Federal and State requirements

• Run automated queries against Federal exclusion lists

• LEIE – List of Excluded Individuals and Entities

• DMF – Death Master File

• EPLS – Excluded Parties List System

• Check provider licenses

Verify that providers are qualified to care for Medicaid patients

Visit www.projectpsm.org

for information (coming soon) and to download the code

Get the Code

Join the discussion group: groups.google.com/forum/#!forum/psm-dev/join

Run Provider Screening in Your Sandbox

Follow the installation instructions to set up local copy

Log in and experiment with sample user

• Username: P1

• Password: P1

14

PSM Opportunities

Development

Contribute back to the master

branch

Leverage OS code to develop

your own module

Configuration

Configure and support State

implementation

Integration

Help States incorporate PSM into their MMIS

Shape open API discussions to

your needs

Support

Provide PSM operations and maintenance

support to States

15

Additional Opportunity

•Pilot stage

•Vision: Pre-certified MMIS Modules

•Give states confidence in selecting a new vendor

Precertification

16

What’s Next

Release Provider Screening Module in Fiscal Year 2019

Evaluate ROI and business case

Expand Open Source model to

more MMIS modules

For more information, contact:

Eugene.Gabriyelov@cms.hhs.gov

Join the discussion:

groups.google.com/forum/#!forum/psm-dev/join

Questions

Backup Slides

Enter Provider Data

Review Provider Applications

Easily see disqualifying

problems

Run Automated Checks

Edit Business Rules