Am Samoa gets $4.2M to design & develop new Medicaid systems
Pago Pago, AMERICAN SAMOA — The American Samoa Medicaid State Agency has been awarded $4.2 million at a 100% Federal Matching Assistance Percentage (FMAP) from the Centers for Medicare and Medicaid Services (CMS) to plan, develop and adopt an Eligibility and Enrollment (E&E) system and a Medicaid Management and Information System (MMIS). The new systems will improve responses to inquiries, automate Medicaid systems operations — including claims processing, streamline information retrieval, and manage reporting for planning and control, according to a media release from the ASMSA.
There is no local match needed for these funds.
The press release, dated December 5, 2023, states that the funds are a share of the $20 million made available to American Samoa, Guam, CNMI and the US Virgin Islands under the Consolidated Appropriations Act of 2023.
All four territories were mandated to submit a Four-Year Strategic Plan and two separate Planning Advanced Planning Documents (PAPD) to CMS to get access to the funds.
American Samoa received 21% of the funding based on the percentage of regular annual Medicaid funding received by all territories.
The ASMSA Director Tofoitaufa Sandra King Young said, “I’m grateful for the technical assistance provided by CMS on this project.
“We are fortunate for this design and development award at 100% FMAP.”
She pointed out that “this project is part of our mandate to maintain program integrity in the Medicaid program and implement processes to prevent fraud, waste and abuse.
“Medicaid relies on data to drive policies within our office and our program.
“It is becoming more critical to adopt automation of operations to keep up with the volume of data and information that we must manage for patient care coordination.
“We will eventually require patients to register and manage their referrals online.
“This is a process that improves how we do our work and also protects the rights to equal access for patients and program integrity for Medicaid.”
Samoa News asked the local Medicaid director about the two systems the $4.2Mil grant was awarded to plan, develop and adopt.
Tofoitaufa said, “Cloud based security and CMS certification of systems is key.” And that it is a collaborative process to bring the systems to fruition.
“We are collaborating with the other 3 territories — Guam, CNMI and the US Virgin Island — to assess what we call "Leverage and Reuse" from other states and territories who have existing systems in place, but we already know we cannot afford even the local match required.
“For example, the USVI system is a Leverage and Reuse from West Virginia at a cost of about $25 million to the USVI —with a 10% local match.
“We barely have local match for our medical program. We will be hard pressed to get local match for an expensive system like that.
The first step in the process is to conduct a feasibility study, Tofoitaufa said, noting that “like all things we do with Medicaid, it is part of “the requirements of the PAPD as approved and required by CMS.”
Depending on the feasibility assessment done by the 4 territories and how they decide to procure their E&E and MMIS systems, the Medicaid director said its likely to be outsourced to an outside vendor to build, and any bid would be done in consultation with the CMS.
She explained, “We could all agree to pool our resources and bid through a CMS approved provider through one territory, or partner with a state that has an existing system that we can join, or some other procurement vehicle that must be approved by CMS — currently I don't know.
“It is a collaborative effort and I will take my guidance from CMS and the other territories once we all decide how to proceed.”
Samoa News asked about the systems in terms of usage — for the Medicaid clients, as well as Medicaid provider(s). She replied that “it has to be client interactive as you put it; and also provider interactive.”
Tofoitaufa pointed out that “the objectives of CMS and the federal government is to make government systems interoperable. Interoperability — the ability to communicate with other systems, customers, providers — it’s a real thing.
“Developing systems that are not interoperable and operate in silos are outdated and will likely not be approved.
“There has to be options for systems to share information and make sharing information seamless, especially with the federal government that requires performance data and financial accountability.
“Whatever system we procure, my objective is to ensure that our system has the capability to communicate with other government agencies if those government agencies need data from our office."
She concluded, “This funding is going to help advance the objectives of our Medicaid program to automate operations and improve data reporting.
“Being able to automate our procedures ultimately ensures we provide fair and equitable access to Medicaid services for our patients — removing the human element from decision-making and undue influence — because all our program integrity policies, as much as possible, will be defined in the business rules of our systems.
“Any system we adopt must be auditable by our office and CMS.
“We will continue to work with our patients to ensure that transition policies will be in place to help them transition to online services.
“This is good for our patients and good for the Medicaid program,” Tofoitaufa stated.
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Samoa News also asked the ASMSA director about the role of Dr. Annie Fuavai at the local Medicaid Office, as there seems to be some confusion expressed to Samoa News about her role, as the ASMSA “Chief Medical Director”.
According to Tofoitaufa, Dr. Fuavai is a consultant — providing “advice on the ‘legitimacy’ of referrals from LBJ and she may request additional information from LBJ to ensure we make the right decisions in approving referrals.
“Once she completes her clinical screening on documentation, I make the final decision to approve a referral.”
“She is a part-time consultant working only 5 hours a week to review only MedEvacs and difficult cases that are not easy for our Benefits staff to screen for approval,” she concluded.