DHCS Information Technology Projects
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The Department of Health Care Services (DHCS) sponsors several major information technology projects. This webpage provides high-level information about those projects.
Major DHCS Projects
California Medicaid Management Information Systems (CA-MMIS): DHCS has begun a new Modernization Approach to replace the legacy CA-MMIS, including information technology system maintenance and operations and business operations services. The contractor will be responsible for the takeover and delivery of services for Medi-Cal fee-for-service (FFS) claims, provider and member relations, drug rebate, pharmacy operations support, and other services necessary to support Medi-Cal FFS health care delivery.
Provider Application and Validation for Enrollment (PAVE): PAVE provides an online Medi-Cal provider enrollment portal and automates Medi-Cal provider management activities. PAVE is being implemented in a series of releases to include additional provider types and enrollment actions.
Medi-Cal Eligibility Data System (MEDS) Modernization: MEDS is a statewide data hub
serving a variety of eligibility, enrollment and reporting functions for Medi-Cal and other state and federal benefits.
MEDS maintains eligibility history for Medi-Cal and other health and human services programs. MEDS has data exchanges and interfaces with the Statewide Automated Welfare System (SAWS), the federal Social Security Administration, Medicare intermediaries, and
California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS). The objective of the
MEDS Modernization project is to develop alternatives that will upgrade the MEDS database with a modern technology platform, minimize impacts to ancillary systems, and improve data quality.
Comprehensive Behavioral Health Data Systems Project:
This project is intended to identify technology solutions to modernize and streamline data collection and reporting, analysis, and other data-related functions, and develop a consolidated reporting and analysis platform that integrates data from 12 existing behavioral health data systems. DHCS will solicit Requests for Offers from IT vendors to conduct the business analysis necessary to define business requirements and explore IT solution options.
Major Projects with DHCS as a Stakeholder
California Healthcare Eligibility, Enrollment, and Retention System
(CalHEERS): CalHEERS provides a consumer-oriented online portal (CoveredCA.com) and eligibility determination system for DHCS programs, including Medi-Cal, and Covered California.
CalHEERS interfaces with the SAWS for Modified Adjusted Gross Income (MAGI) Medi-Cal eligibility, enrollment and reporting. CalHEERS also interfaces with several other state and federal systems, including the DHCS MEDS and the federal hub for income and other eligibility verification.
Statewide Automated Welfare System:
SAWS is comprised of two county subsystems (CalACES and CalWIN) used by staff at county social service agencies to administer Medi-Cal and other social services programs. The SAWS have interfaces with both CalHEERS and MEDS. The CalWIN migration to a modified CalACES technical platform, scheduled to begin in 2023, will result in a new single system called CalSAWS.
The Federal Medicaid Information Technology Architecture (MITA) Framework and DHCS IT Projects
The federal MITA Framework is intended to elevate and standardize the way that state Medicaid agencies look at, and do, business. Through the implementation of MITA, DHCS aims to improve management and systems development across the entire department, in support of improved health care for all Medi-Cal members.
By following the guidance in the CMS MITA Framework and other federal requirements, DHCS receives federal approval to develop and operate the IT systems that help run the Medi-Cal program. DHCS builds into the project initiation, planning, and executing processes the following goals from the MITA Framework:
Develop seamless and integrated systems that communicate effectively to achieve common Medicaid goals through interoperability and common standards
Promote an environment that supports flexibility, adaptability, and rapid response to changes in programs and technology
Promote an enterprise view that supports enabling technologies that align with Medicaid business processes and technologies
Provide data that is timely, accurate, usable, and easily accessible in order to support analysis and decision making for health care management and program administration
Provide performance measurement for accountability and planning
Coordinate with public health and other partners, and integrate health outcomes within the Medicaid community