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Medicaid Management Information System (MMIS)

The MMIS is an integrated group of procedures and computer processing operations (subsystems) developed at the general design level to meet principal objectives. For Title XIX purposes, "systems mechanization" and "mechanized claims processing and information retrieval systems" is identified in section 1903(a)(3) of the Act and defined in regulation at 42 CFR 433.111. The objectives of this system and its enhancements include the Title XIX program control and administrative costs; service to recipients, providers and inquiries; operations of claims control and computer capabilities; and management reporting for planning and control.

The Medicaid program, enacted in 1965 under Title XIX of the Social Security Act (the Act) is a grant in aid Medical Assistance Program financed through joint federal and state funding and administered by each state according to an approved state plan. Under this plan, a state reimburses providers of medical assistance to individuals found eligible under Title XIX and various other titles of the Act.

In October 1972, Public Law 92-603 was enacted in which Section 235 provided for 90-percent federal financial participation (FFP) for design, development, or installation, and 75-percent FFP for operation of state mechanized claims processing and information retrieval systems approved by the secretary. For Medicaid purposes, the mechanized claims processing and information retrieval system which states are required to have, unless this requirement is waived by the secretary, is the Medicaid Management Information System (MMIS). An implementing regulation, 45 CFR 250.90 was published May 20, 1974, and subsequent reorganization and clarification of this regulation have been made with the current regulation contained in 42 CFR 433, subpart C.

Contractual services may be utilized to perform work for the design, development, installation, or enhancement of a mechanized claims processing and information retrieval system. A fiscal agent who is a private contractor to the state, normally selected through a competitive procurement process, may operate the state's MMIS. A state MMIS fiscal agent contract status report is prepared quarterly from CMS central office following the input from regional offices. The report is usually prepared within 30 days after the close of a quarter and infrequently when there is a demand due to several state contractor revisions. The report data includes the name of the state fiscal agent contractor, the contract term with option extension period, and regional office contact person with phone and fax number.