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 SMC pathway consists of the three following phases and is independent of the state system implementation lifecycle methodology:

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

As shown below, engagement during each phase of the Information Technology (IT) investment lifecycle will include the following touchpoints:

For information on each phase please visit the following phases:

• Planning
• Development
• Production

The information included in this reference material is supplemental to the SMC Guidance. This material 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 Document – see Appendix C for Required Artifacts and Appendix D for Framework for the Independent Third-Party Security and Privacy Assessment Guidelines for Medicaid Enterprise Systems
• 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
• Streamlined Modular Certification for Medicaid Enterprise Systems Guidance Document