5225-184 CalAIM-Medi-Cal Reimbursement System (MCRS)

The California Correctional Health Care Services (CCHCS), Information Technology Services Division (ITSD) currently maintains the information technology infrastructure and medical grade network that enables our clinical staff to provide continuity of care to the justice-involved residents. Assembly Bill (AB) 133 requests federal authority to implement the California Advancing and Innovating Medi-Cal (CalAIM), a framework that encompasses broad-based delivery systems, and payment reform across the statewide Medi-Cal program. Currently, CCHCS does not have a billing/notification claim system and proposes to develop a new billing/notification system to receive federal reimbursement for CalAIM services and medications to comply with AB 133. As a result, a new Medi-Cal billing claim system is needed to be developed and integrated with multiple state, county, and third-party entities no sooner than April 1, 2024, with a 24-month implementation window to be compliant with AB 133. It is estimated that the state will receive federal reimbursements of $10.8 million annually.

Project Details

IPOR Reporting Period	Overall IPOR Rating
10/01/2024 - 10/31/2024	Green

Independent Project Oversight Dashboard

Key Questions

Is the project on track to satisfy the customer's business objectives?Yes

Is the project on track to achieve the objectives in the approved timeframe?Yes

Is the project on track to achieve the objectives within the approved budget?Yes

Project Overall Health	Comments
Green	• Overall project health is green. There are no major risks, issues or decisions that need to be escalated.

Focus Area/Rating	Comments
Governance Green	• The project’s governance practices align with the current approved Governance Plan. • The program/business representatives are actively engaged and empowered to ensure that the project brings value to the program/business
Time Management Green	• Project is progressing in alignment with the baseline schedule. •The project has filled in the project schedule, as recommended, and there is no longer a one-year gap of activities.
Cost & Contract Management Green	• CCHCS has a cost tracking tool. • The project expenses are within the planned budget amount.
Scope Management Green	• Stories are selected on a priority basis for inclusion in upcoming sprints by the SCRUM team. • The scope is being managed according to the Scope Management Plan.
Resources Green	• The project is actively managing its resources. • Staffing management and contractor management practices are being executed in accordance with the Staffing Management Plan.
Quality Green	• A hybrid – Agile and Waterfall – methodology is being followed. • The Product Owners and the project’s State Agile Team are involved in quality processes, including testing activities.
Risk And Issues Green	• The RAID is being updated weekly. •CDT recommends going through risk review as soon as possible as there are potential risks and issues that should be followed. • The project team is adhering to risk and issue monitoring practices identified in the Risk Management Plan.
Transition Readiness Green	• The project is preparing to fill the OCM role. The is no OCM process at this time, but with the filling of this role the OCM program seems to be on the heading the right direction to make sure change is managed throughout the stakeholders.
Conditions For Approval Green	• Independent Verification and Validation (IVV) vendor contract signed and executed on April 15, 2024. Condition met.
Corrective Action Green	• No corrective action plans are in place.

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