Overview
To receive enhanced federal funds for MES modules, states must produce data, reports, and performance information from their MES modules. This facilitates evaluation, continuous improvement in business operations, transparency and accountability (in accordance with 42 C.F.R. §§ 433.112(b)(15) and 433.116(b), (c), and (i)). CMS reserves the right to request data related to system operations at any time to ensure compliance with mechanized claims processing and information retrieval systems per 42 CFR 433.19. States must submit monthly operational reports with metrics, unless otherwise agreed by CMS, and annually with their OAPD requests. EVV metrics should be captured monthly and submitted quarterly.
CMS reviews the metrics included in the operational reports during the APD review process to determine whether they demonstrate a benefit to the state Medicaid Program and align with CMS-required and/or state-specific outcomes. The operational reports ensure continued system functionality and regulatory compliance and provide a business case for the funding requested in each OAPD. According to the State Health Official (SHO) letter released on August 6, 2025, a state must submit operational metrics for any IT system for which the state requests enhanced funding for costs related to maintenance and operations.
Metrics provide evidence of whether intended outcomes are achieved through the delivery of a new module or enhancement to an existing module. Metric reporting enhances transparency and accountability and helps to ensure that a state’s MES and its modules meet statutory and regulatory requirements, as well as the state’s own program goals. Metrics reporting also gives states and CMS early and ongoing insights to use for program evaluation and continuous improvement.
Detailed MES Data Submission and Intake Process
Defining Outcomes and Metrics
Module-specific outcomes and metrics must be included when submitting an APD or OAPD. Every state’s OAPD submission must include an attestation that the state’s operational metrics and data are uploaded to a CMS Box folder location, and the state must include the link to the metrics file(s) in its OAPD. This process ensures timely data submission and compliance with reporting requirements for enhanced funding. Reports should cover data from the system’s go-live date or the last OAPD submission through the most recent month of available data.
Default metrics for MES modules are available on the CMS MES Certification Repository.
For information on how to develop state outcomes and metrics statements, refer to Writing a Good Outcome.
States may need to update outcomes and metrics due to lessons learned, changing Medicaid priorities, or feedback from a certification. If a state revises its outcomes and metrics, an APD-Update (APD-U) is required. States should consult their CMS MES State Officer to discuss such updates.
Step 1: Create the Operational Report
States are required to use the Operational Report Workbook (ORW) template (please reach out to your State Officer to get the template) to submit their operational metrics by module. The Excel template includes three tabs: the first contains general instructions completing it, followed by two tabs for data entry, titled “Metric Definitions” and “Metric Values.” Additional instructions for the ORW are located on the MES Certification Repository.
For the state-submitted metrics data to be successfully processed, the state needs to fill in and correctly format the required data fields. Refer to the Operational Report Workbook Validation Rules, for the list of required data and data entry rules.
The state should use the following filename format and should not exceed 255 characters:
Operational_Report_StateAbb_ModuleAbb_YYYY-MM-DD.xlsx
The date used should be the date when the state submits its data file to the state’s metric folder located on CMS Box. The filename should use standard State abbreviations and Module Type abbreviations. For example, “Operational_Report_VA_CP_2022-01-22.xlsx”.
Step 2: Submit to CMS Box
The state should upload the operational report(s) to the state’s metric folder on CMS Box. Each state has a folder named using the state’s abbreviation, followed by “– Metrics/1.State Submission”. For example, the state of Virginia will upload the Operational Report Workbook to the “VA – Metrics / 1. State Submission” folder.
The state should upload all metric-related files to this folder; processed files will be moved to the “Archive” subfolder.
If the module is going through the Streamlined Modular Certification (SMC), the state should upload all metric data captured since go-live to the state’s metrics folder. Once a module has been certified, the state should continue to submit its operational metrics to this folder according to the frequency required by CMS.
When the state uploads an operational report file to the state appropriate CMS Box folder, CMS will receive an automatic email alert generated by CMS Box.
Step 3: Data Ingestion
To be successfully processed, the state-submitted metrics reports must meet the reporting specifications described in the Operational Report Workbook Validation Rules, e.g., the correct file name format, content in the required columns, and correctly formatted data.
If the file is processed successfully and loaded into the CMS database, the report’s status is Completed, and the processed file is moved to the “archive” subfolder within the state’s metrics folder. If there are issues importing the data, CMS will work with the state to help resolve the issues. When re-submitting a corrected file, the state should rename the file to the new submission date and upload it to the same metrics folder on Box.
For example, if Wyoming originally submitted its EVV data file on September 1, 2020, the filename would be Operational_Report_WY_EVV_2020-09-01. However, if there were issues with the file and the state was asked to resubmit it, and did so on September 21, 2020, the resubmitted filename would be called Operational_Report_WY_EVV_2020-09-21.
Resources
- SMC Guidance
- CMS Box
- Metrics FAQs
- Operational Report Workbook (Please reach out to your State Officer to get the template.)