Streamlined Modular Certification Process

As outlined in the State Medicaid Director Letter (SMDL) #22-001, released on April 14, 2022, states may request enhanced Federal Financial Participation (FFP) at 75% of expenditures for the operation of a Mechanized Claims Processing and Information Retrieval Systems (MCPIRS) following adherence to the Streamlined Modular Certification (SMC) process for Medicaid Enterprise Systems (MES).

This page includes information supplemental to the SMC Guidance. It does not replace the SMC Guidance but includes additional details for states to help them navigate the certification process.

Advance Planning Documents

The Advance Planning Documents (APD) serve as the starting point for the process and should include Conditions for Enhanced Funding (CEF), CMS-required outcomes, state-specific outcomes, and metrics. These conditions, outcomes, and metrics will be used throughout the SMC process.

After the APD is approved and prior to releasing a Request for Proposal (RFP), the state should copy the CMS-required outcomes, state-specific outcomes, and metrics from the APD to the SMC Intake Form Template. Once this is drafted, it can be discussed with the MES Certification Team, and a preliminary list of evidence should be added for the CEF, Outcome, Metrics, and Required Artifacts tabs. Those determined to be not applicable should include the reason why they are not applicable to the module’s certification. The drafted SMC Intake Form will then be used throughout the process and updated as needed. Refer to the Intake Form guidance for filling out the Intake Form.

Entry Criteria

The state is required to submit entry criteria to schedule an Operational Review Readiness Review (ORR) or a Certification Review (CR). The calendar opens three months before each review month (for example, on January 1, March dates become available). States may request an ORR or CR at any time. Still, a review date can only be confirmed once the calendar for that month opens and the state has submitted its materials and received confirmation of Entry Criteria.

Note that meeting the entry criteria only clears the way for scheduling the review (ORR or CR). Two weeks prior to the review, the state must provide the most up-to-date documents in the applicable certification CMS-designated Repository for evaluation by the MES Certification Team.

Prior to scheduling an ORR, the state must provide the following to the MES Certification Team:

* Testing results preferred, but an anticipated completion date is required at a minimum, with results uploaded at least two weeks prior to review.
^ Items must have been conducted within two years of the ORR date. Note: the two-year timeframe is based on the actual assessment date, not the publication date of the final report.

Prior to scheduling a CR, the state must provide the following to the MES Certification Team:

* Items must have been conducted within two years of the CR date. Note: the two-year timeframe is based on the actual assessment date, not the publication date of the final report.

Operational Readiness Review (ORR)

In accordance with the Entry Criteria, the high-level timeline of activities for an ORR is provided below. For more details on what is required, please see the SMC Guidance.

Certification Review (CR)

In accordance with the Entry Criteria, the high-level timeline of activities for a CR is provided below. For more details on what is required, please see the SMC Guidance.

Operational Reporting

Once a system is in production, states should be able to regularly and consistently provide metrics that demonstrate that the system complies with applicable regulations and meets outcomes. States begin reporting on metrics after go-live and before the Certification Review. From then on, as long as the state continues to receive enhanced funding for its MES solution, the state should submit metrics to CMS monthly. The Operational Report Workbooks (ORWs) of Electronic Visit Verification (EVV) modules must be submitted at least quarterly (broken down by month), with monthly reporting recommended for timely updates. Please refer to the Metrics and Ongoing Reporting page for more information on operational reporting.

Best Practices/Tips

• The state must use the exact filename(s) loaded in CMS-designated Repository when populating the evidence columns in the SMC Intake Form (do not use hyperlinks).
• The state is encouraged to utilize existing documentation (typically stated in RFP as deliverables from the Design, Development, and Implementation [DDI]) for evidence and required artifacts, ultimately reducing or eliminating the additional level of effort associated with “evidence curation” for reviews. There is no need to create a “package” or new file for evidence. However, CMS reserves the right to request updated documentation, as needed, to satisfy certification requirements.
• Transformed Medicaid Statistical Information System (T-MSIS)
  • The state should confirm with the Division of Information Systems (DIS) State Liaison (CMS T-MSIS team) if the state will be required to go through the T-MSIS large system enhancement (LSE) Standard Operating Procedure (SOP). If so, the T-MSIS LSE SOP requires extensive artifacts and testing, so the timeline should be carefully considered when planning for review.
  • CMS recommends getting confirmation in writing from CMS DIS State Liaison that the T-MSIS LSE SOP is not applicable for the scope of this DDI.
  • If it is applicable to the scope of the DDI, then the schedule should reflect the required artifacts and testing timelines.
• All testing-level tasks should be included in the state’s project plan.
• If the state is conducting an Eligibility & Enrollment (E&E) review, the state must provide the most recent Authority to Connect (ATC) to the CMS Hub approval letter in addition to the CEF evidence.
• Operational procedures should be documented prior to the Operational Readiness Testing so these procedures can be tested and updated prior to go-live.
• If a state is using agile methodology or is taking a phased approach to implementation, the state and the MES Certification Team will decide the appropriate point at which to conduct the ORR and CR. The state must map the phases to the applicable CMS-required and state-specific outcomes to help the MES Certification Team determine when to hold the ORR and CR.
• At the beginning of the DDI phase, the state should develop a Master Test Plan, in consultation with the Testing Guidance Framework.
• States are encouraged to utilize the sample agendas (see Templates page), but can use their own template if the appropriate topics are included.
• CMS encourages states to include all appropriate programs, business operations, and subject matter experts in the reviews.
• States may update their metrics over time, but must discuss the changes with their CMS MES State Officer and submit an updated APD.

Resources

• SMDL # 22-001, released on April 14, 2022
• SMC Guidance
• Code of Federal Regulations
• Writing a Good Outcome Statement
• Templates
• Metrics and Ongoing Reporting
• CEF Example Evidence, Tips, and Best Practices
• SMC Intake Form Guidance
• Medicaid Enterprise Systems Testing Guidance Framework
• Using CMS-designated Repository (Box)
• SMC Kickoff

References

• SMDL #02-005 Attachment A: An APD Guidance Document. April 4, 2002 (page 18)
• Medicaid and CHIP Frequently Asked Questions (FAQs) Advanced Planning Documents (APD) for System Development Associated with 1115 Demonstrations June 13, 2019
• SMD # 16-009 Mechanized Claims Processing and Information Retrieval Systems – APD Requirements June 27, 2016
• SHO #25-003 Streamlining Medicaid Enterprise Systems (MES) Templates to Improve Monitoring and Oversight to Ensure Fiscal Integrity
• Transformed Medicaid Statistical Information System (T-MSIS)
• T-MSIS LSE SOP