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
05/01/2025 - 05/31/2025	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. • Project plan to change to Agile/Waterfall hybrid methodology has been approved. As a result, there will be a savings in time and cost. • Project is 86% complete.

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	• The project schedule was updated in SPR 1. SPR 1 was first approved on May 14, 2025. However, the letter was incomplete so a letter dated May 19, 2025, superseded the May 14th letter. • The schedule was reduced by 12 months. The new end date for the project is 10/31/2025.
Cost & Contract Management Green	• The project has a contract management plan and cost management plan that are being followed. • SPR #1 supersede letter was signed 5/30/2025. • Total project cost is now $14,871,098.
Scope Management Green	• The scope is being managed according to the Scope Management Plan. • Sprints 147 and 148 were completed in May 2025. Sprint 149 began in May 2025 and is on schedule to be completed 6/18/25.
Resources Green	• The project is actively managing its resources. A recruitment is currently going on to fill a security position. • Staffing management and contractor management practices are being implemented 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. •IV&V provides monthly reports and assessments on the deliverables. The reports are comprehensive and provide easy to implement changes for the project’s health.
Risk And Issues Green	• The RAID is being updated weekly. • The project team is adhering to risk and issue monitoring practices identified in the Risk Management Plan.
Transition Readiness Green	• Organizational Change Management (OCM) is on board and active with the stakeholders. • Completed OCM Plan and OCM Readiness Assessment.
Conditions For Approval Green	• IV&V vendor on board - Condition met.
Corrective Action Green	• No corrective action plans are in place.

20250626 Release-16