Senior Lead Behavioural Health Consultant

• This RFP is part of South Dakotas Rural Health Transformation initiative which focuses on strengthening rural healthcare systems and improving access to quality care across the state.
• Under this effort the Department of Social Services Division of Behavioral Health (DBH) wants a qualified vendor to evaluate the current billing data collection and reporting systems used by DBH South Dakota Medicaid and providers working toward CCBHC certification or becoming a DCO.
• The goal is to create a technology roadmap that supports CCBHC-related billing reporting and data collection including better data sharing between EHRs and state systems.

The selected vendor will assess current systems and provide a roadmap with:

• detailed recommendations
• timelines
• estimated effort
• technology gap analysis
• fiscal impact analysis
• provider education recommendations
• specific system change recommendations for CCBHC and DCO needs

Systems to be reviewed include:

• STARS (State Treatment Activity Reporting System)
• MMIS (Medicaid Management Information System)
• up to 11 Community Mental Health Center EHR systems
• other selected provider EHRs tied to CCBHC/DCO readiness

• This is a Behavioral Health Modernization / Systems Evaluation and Technology Roadmap Project.
• More specifically it is a consulting and assessment project focused on CCBHC systems evaluation billing/reporting readiness and technology roadmap development

Years of Experience:

Experience Requirement:

• Demonstrated understanding experience and expertise in CCBHC and DCO data collection reporting and payment best practices.
• Experience working with state Medicaid systems MMIS behavioral health providers and various EHRs.
• Experience evaluating billing data collection and reporting systems and supporting a technology roadmap with directions recommendations timelines and estimated effort.
• Experience with stakeholder engagement with state and providers including presenting data gathering evaluation analysis and recommendations.
• Experience in similar settings to South Dakota especially agencies serving large geographical regions in predominantly rural settings.
• Experience supporting change management for provider and state adoption of new processes and systems.
• Experience creating and implementing data gathering methods including timelines and secure handling of collected information.
• Experience recommending data collection reporting and billing methodologies including impact assessment and action plans for providers STARS and MMIS.
• Experience defining performance indicators such as data accuracy timeliness and provider adoption and recommending provider training and education.

Skill Set Requirement:

• Strong knowledge of CCBHC and DCO operations reporting billing and payment models.
• Knowledge of Medicaid payer models including the two required paths:
  1. CCBHC with Medicaid as payer via PPS rate
  2. Medicaid and state-funded pathway for income-qualified non-Medicaid individuals using the same PPS rate.
• Strong knowledge of state Medicaid systems MMIS STARS and provider EHR ecosystems.
• Ability to assess technology gaps and recommend specific system changes to support the CCBHC and DCO model.
• Ability to support data sharing between EHRs state systems and EHR-to-state systems.
• Knowledge of CMS guidelines HIPAA South Dakota DSS policies South Dakota Medicaid policies and state IT security standards.
• Knowledge of secure data handling including encryption and secure transfer protocols.
• Ability to prepare a comprehensive assessment methodology and findings fiscal impact analysis provider education recommendations and system change recommendations.
• Ability to contribute to a preliminary project work plan project management plan status reporting and information-sharing approach.

Education Background:

• Education and training in a relevant field. Masters degree preferred.