Intake Form Guidance

Purpose

The Streamlined Modular Certification (SMC) process uses the SMC Intake Form template to track information about a state’s single Medicaid Enterprise Systems (MES) system(s) or module undergoing certification. States must complete the SMC Intake Form by entering the CMS-required outcomes and metric ID, demonstrating compliance with the relevant regulations for their specific system or module. States must also include their state-specific outcomes and the metrics used to demonstrate that the project is achieving them continuously.

Using the Intake Form

CMS requires the state to use the SMC Intake Form throughout the SMC process, from the approval of the Advance Planning Document (APD) to the completion of the Certification Review (CR). Following approval of their APD, a state populates the SMC Intake Form with all outcomes and conditions for enhanced funding (CEF) for the systems or module seeking certification, providing explanations in the applicable State Operational Readiness Review (ORR) and CR Comments column for any instances where CEFs or CMS-required outcomes do not apply. Additionally, the state must also complete the Operational Report Workbook (ORW) with the Metric ID that correlates to the ORW metrics. During the ORR and CR, the CMS Certification Team will utilize the SMC Intake Form to record their evaluation of the state’s demonstration of compliance. The SMC Intake Form becomes part of the official record for the state’s certification, including the ORR and CR.

States must always use the most current version of the SMC Intake Form and follow the instructions noted within the first row of each page. “Evidence” refers to documentation or data that demonstrates the achievement of an outcome or condition. Required artifacts are documents that describe the progression of a state’s project and are not typically used as evidence for outcomes.

As states prepare for their review, they must continuously add or update the SMC Intake Form content in preparation for submission. States may wish to share this draft with the MES Certification Team for discussion or preliminary feedback. the state must upload a finalized SMC Intake Form to the CMS-designated repository at least 2 weeks before the review date, along with all required evidence and artifacts for the ORR or CR. The MES Certification Team will use this version during their review. Following completion of the review, the SMC Intake Form will be returned to the state with the CMS Certification Team’s adjudication and comments.

Tips and Best Practices

The following sections provide tips and best practices for completing the CEF, Outcomes and Metrics, and Required Artifacts tabs of the SMC Intake Form.

Conditions for Enhanced Funding Tab Instructions

the state will use this tab to demonstrate the applicability of the Conditions for Enhanced Funding (CEF) and to provide evidence for the system under review.

In the Evidence columns, list the file name(s) of documents containing supporting evidence as loaded in the CMS-designated repository. For lengthy documents, use the Comments column to specify relevant sections or paragraphs to assist the CMS Certification Team in the review process. If links to PDF files are included in the SMC Intake Form, the corresponding PDF versions of any web file must also be uploaded to the CMS-designated repository for review.

In the Comments column, the state can also describe how the contents of the evidence files meet the condition and any other information needed for evaluation. CEF criteria do not require demonstrations. States can refer to the Conditions for Enhanced Funding for example and/or required evidence.

All CEF criteria must be listed within the SMC Intake Form. If a condition is not applicable, the state must mark “N/A” in the “State ORR Evidence” and “State CR Evidence” columns. the state must justify why the outcome is not applicable to their system in the “Comments” column for both the ORR and CR.

Outcomes & Metrics Tab Instructions

the state will use this tab to demonstrate evidence for the CMS-required outcomes and any state-specific outcomes for ORRs and CRs.

The MES Module Outcomes and Metrics section in the MES Certification Repository provides a complete listing of CMS-required outcomes for each specific MES module. CMS-required outcomes align with statutory, regulatory, and policy requirements that states must demonstrate compliance with when implementing modules.

For a given module, states must include all CMS-required outcomes for the module being certified, as listed in the MES Certification Repository, and clearly indicate which outcomes are applicable. If a given outcome is inapplicable, the state should mark “N/A” for “Metric ID”, “State ORR Evidence”, and “State CR Evidence” columns. the state must include a justification of why the outcome is inapplicable to their system in the “State ORR Comments” and “State CR Comments” columns.

In the Evidence column, list the file name(s) of documents containing supporting evidence as loaded in the CMS-designated repository. For lengthy documents, states should specify relevant sections or paragraphs within the Comments column to assist the CMS Certification Team in the review process.

State-specific outcomes reflect the unique goals and characteristics of a state’s Medicaid program and focus on improvements to the program not specifically addressed by the CMS-required outcomes. These outcomes should target specific business or policy problems that the new system or module will resolve, and enable the state to demonstrate direct Medicaid program benefits. The metrics related to these outcomes should show how the states will measure their success. States should work with their CMS MES State Officer during the APD process to finalize outcomes and metrics that address the proposed functionality.

States will create a unique reference number for their state-specific outcomes in the SMC Intake Form. If the outcome is a state-specific outcome and not a CMS-required outcome, use the acronym “ST”, followed by the appropriate module abbreviation and the appropriate numerical code. For example, if State “A” provides a state-specific measure for its LTSS module, the first outcome reference number would be STLTSS01. Note that these reference numbers must match the Outcome Reference # column in the Operational Reporting Workbook.

The MES Certification Team is a valuable resource for states with questions or who need additional clarification. Many states employ the best practice of requesting early input to limit rework and produce a more efficient review.

Required Artifacts Tab Instructions

the state will use this tab to identify the applicable required artifacts. It is important to distinguish between required artifacts and evidence. Evidence is documentation or data that demonstrates the achievement of an outcome, as listed on the SMC Intake Form, Outcomes & Metrics tab. Required Artifacts, on the other hand, are documents that demonstrate the progression of a state’s project and are not typically used as evidence for outcomes. The SMC Guidance provides minimum requirements for the artifacts required for an ORR and a CR.

In the “State ORR Required Artifact” and “State CR Required Artifact” columns, list the file name(s) of the documents loaded in the applicable CMS-designated repository. As necessary, use the Comments column for any additional explanation or comments related to that artifact.

Resources

For more information on CEFs and Outcomes:

States can also find more details within the SMC Guidance, including additional details on:

Scope of Certification
SMC process
Required Artifacts List
Guidelines for the Independent Third-Party Security and Privacy Assessment for Medicaid Enterprise Systems