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Open Source Provider Screening ModuleA State and Federal Priority Partnership
Eugene Gabriyelov, CMS Data Systems GroupColleen Line, MITREJames Vasile, Solution Guidance Corporation
2018 HIMSS
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• Open Source 101
• Open Source in the Medicaid Ecosystem
• Provider Screening Module
• What's Next
Agenda
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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
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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Without performing a pull request, forks can quickly become out of date
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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
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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
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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
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Additional Opportunity
•Pilot stage
•Vision: Pre-certified MMIS Modules
•Give states confidence in selecting a new vendor
Precertification
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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:
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