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MES Certification Repository

Outcomes + the certification process

Outcomes statements and metrics are part of the Advance Planning Document (APD) process and the Streamlined Modular Certification (SMC) process. The program outcomes a state hopes to realize with a proposed Medicaid Enterprise Systems (MES) project not only serve as justification for the investment, but also serve as a way to measure whether or not a project was a success. Not all projects require certification and not all APDs require outcomes. The following is a general overview of when outcomes and metrics are applicable to the APD process and the certification process.

APD process

An APD serves as the mechanism by which states obtain Federal support for certain systems related expenditures. Regulations establishing the different types of APDs and requirements for each can be found at 45 CFR 95.610. The APDs identified include Planning, Implementation and Operations. As CMS considers program outcomes in its review of states’ proposed MES projects, the following will help determine when outcomes and associated metrics are required as a part of the APD. The following is a general guide and states should work with their respective State Officer on the specific details as they relate to a proposed MES project and the need to include outcomes and metrics in an APD.

  • Planning - Activities related to systems planning require outcomes and metrics. The outcomes and metrics within the Planning APD will be primarily focused on state-specific outcomes.
  • Implementation - Activities related to the design, development and implementation of an automated component of the MES require outcomes and metrics. The outcomes and metrics within the Implementation APD will generally include a combination of both CMS-required and state-specific outcomes.
  • Operations - Activities that improve system performance or extend the life of the system require outcomes and metrics. Routine operating activities do not require outcomes and metrics separate from those that were identified as a condition for continued maintenance and operations support.

Certification process

The Streamlined Modular Certification process is the certification process that CMS is piloting to ensure systems are assessed and determined to be either compliant or non-compliant with Federal requirements (CMS-required outcomes) and, when applicable, state requirements (state-specific outcomes). As previously mentioned, program outcomes and associated metrics serve as a way to measure whether or not a project was a success. The inclusion of outcomes and metrics within an APD does not necessarily mean that the proposed project will require certification. However, for those projects that do require certification, the outcomes and metrics identified within the APD help define the scope of the certification under the SMC engagement model.

Generally, certification must be performed for systems that replace an existing MES component, new MES components, major modifications/enhancements, system rebuilds, commercial off-the-shelf solutions and related services supporting certain Medicaid business and system areas. This is a general, non-exhaustive list and states should work with their respective State Officer on the specific details as they relate to a proposed MES project and the need for a certification engagement.

State-specific outcomes

States requesting enhanced FFP for systems that fulfill state-specific program needs, beyond minimum legal requirements and the baseline of the CMS-required outcomes, should propose State-Specific Outcomes which address the proposed enhancements.

State-Specific Outcomes should target specific problems and derive Medicaid program benefits.

Utilizing this repo

The CMS Certification Repository is a space for states, CMS, and vendors to learn, share, and contribute information about the MES Certification process and its related artifacts.

From this repo states can:

  • Find examples and expectations for developing outcomes and metrics
  • Share outcomes and metrics with other states and see examples of what other states have created
  • Suggest changes and provide feedback to CMS regarding outcomes requirements and processes via MESCertificationRepo@cms.hhs.gov

From this repo CMS will:

  • Provide publicly available resources to guide states in how to write outcome statements and measure impact
  • Share and update examples of outcome statements and metrics for use in their APDs and certification documents
  • Baseline the outcomes and metrics received from states, and compare outcomes and metrics to examples and submissions from other states

From this repo vendors can:

  • Get direct access to the CMS required outcomes or recommended metrics
  • Share suggestions and feedback to CMS regarding outcomes requirements and processes via MESCertificationRepo@cms.hhs.gov