Process Overview

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).

The MES Information Technology (IT) investment lifecycle consists of three phases:

• Planning phase: When the state is in the planning phase of a project, it develops the initial outcomes desired for the new module and works with CMS to refine them.
• Development phase: When the state and the vendor are in the Design, Development, and Implementation (DDI) phase, the state works with CMS to prepare for the Operational Readiness Review (ORR).
• Production phase: When the module is live, the state works with CMS to prepare for the final CR.

As shown below, engagement during each phase of the MES IT investment lifecycle will include the following SMC touchpoints (see unshaded boxes):

For information on SMC in each phase, please visit the following phases:

• Planning
• Development
• Production

This reference material 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.

Resources

• SMDL # 22-001, released on April 14, 2022
• SMC Guidance
• Code of Federal Regulations

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