Overcoming Schedule and Procurement Challenges for ACA

Strategies for States to Realize Fast and Cost-Effective Solutions to Meet ACA Requirements

The Patient Protection and Affordable Care Act of 2010, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act (ACA), seeks to reduce the number of Americans unable to find affordable health care coverage by expanding Medicaid, creating new health insurance markets, and enabling self-service capabilities to support both. The federal government is fully funding system development for health care reform requirements through a series of grants, and matching 90 percent of development costs for new integrated eligibility systems put in place to support those requirements. In spite of this unprecedented level of federal support, many states have not been able to put plans in motion that will meet federally mandated deadlines for implementation of ACA.

Learn how to identify and define IT design, development and deployment services that can be procured by states seeking a fast and cost-effective solution to meet the requirements of ACA, while also taking advantage of this unprecedented funding opportunity for a new integrated eligibility system.

The following capabilities are required to implement health care reform:

• Develop an Eligibility & Enrollment Portal to serve both Medicaid and commercial insurance customers via a Web browser.
  
  
• Develop a Health Benefits Exchange, or insurance marketplace, in which commercial customers can compare plans and enroll.
  
  
• Develop a Call Center required to support the E&E Portal, HBE and (potentially) other healthcare and human services programs.
  
  
• Fully enable new Medicaid Eligibility rules (also built into the portal) through either:
  
  
  • Modification of legacy eligibility systems to enable real-time determinations, or
    
    
  • Development of a new integrated eligibility system, like Accenture Benefits Management System (ABMS) (with 90/10 funding support)
    
    
• Deploy new infrastructure, a print center, data storage, and other technical architecture capabilities required to operate the above systems.

The federal government has already created a backup plan for states that will not meet deadlines for basic compliance with ACA. The Federal Exchange, established and managed by the Centers for Medicare and Medicaid Services (CMS), will make basic portal and marketplace capabilities available to non-complaint states. States participating in the federal exchange will not have to build these capabilities themselves, but they will give up some measure of control over Medicaid eligibility and their insurance marketplace. This document is focused on states that want to do more than comply with ACA by taking advantage of 90/10 funding for a new integrated eligibility system as well.

The traditional approach to procuring the IT services required to design, build, test and deploy the services mandated by ACA would require multiple solicitations, each with their own procurement cycle. ACA provides a unique opportunity to change that, because so many states must implement the same set of requirements (with minor variations state-to-state that can be enabled through configurable software). As a result, each of the required activities has a number of implementation options.

In some cases, more than one option exists for a given capability if there is enough lead-time before October 2013. For example, with a project start date of nine months prior to the deadline, states can temporarily interface with their legacy eligibility system or leverage a cloud solution from another state, but they won’t have time to deploy a new integrated eligibility system. In this case, deployment of the new system would come after October 2013 and the temporary interfaces would be retired.

The Accenture Public Service Platform (APSP) suite of products and a rapid implementation schedule is one example of an integrated eligibility solution. APSP includes:

• APSP Technical Architecture, which is a service-oriented architecture that supports the day-to- day functions performed by users in the APSP solution. Using this enterprise, architecture the department can integrate legacy applications, COTS software, and new customized software while allowing the selective exchange of data across the enterprise through an enterprise service bus.
  
  
• Accenture Citizen Self-Service Portal (ACSSP), which is a secure, public-facing portal that uses a conversational, interview approach to collect data needed to assess the citizen's eligibility for benefits. The ACSSP application is a reliable, personalized application that engages customers, keeps infrastructure costs down, delivers solutions rapidly, and aligns with the APSP standardized application architecture.
  
  
• Accenture Benefits Management System (ABMS), which is an integrated, flexible, client- focused solution designed for a range of public and social welfare programs such as Medicaid, CHIP, SNAP, and TANF. The functionality provided is the integration of eligibility determination and delivery of services and benefits, built on a well-defined and successfully adopted business model. ABMS is a workflow-driven benefits management application and uses a COTS rules engine, such as Oracle Policy Automation, which can be easily updated by experienced business users.
  
  

This solution can support a rapid implementation phasing schedule, which can lead to the state procuring a new integrated eligibility system while meeting the mandates of ACA. Depending on when a state starts the process, their new system may be deployed in time for or shortly after the October 2013 deadline. In all cases, the goal is for states to take advantage of funding while remaining compliant with the ACA statute. As states consider the options available for implementing the requirements of ACA and deploying a new integrated eligibility system, they should also consider the procurement and funding steps to be followed.