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MES Certification Repository

Outcomes and the Certification Process

Outcomes and metrics are important aspects of the Advance Planning Document (APD) and Streamlined Modular Certification (SMC) processes. However, not all Medicaid Enterprise System (MES) projects require certification, and not all APDs require outcomes.

Typically, outcomes and metrics are required when states receive enhanced funding. Outcomes and metrics are not required if the activities and projects involved are routine or consist of planning and operational functions, such as hardware maintenance, gap analysis, Request for Proposal development, and security patches.

CMS-required outcomes are based on statutory or regulatory requirements to promote the efficient, economical, and effective administration of a state’s Medicaid program. State-specific outcomes and the associated metrics measure the success of a MES project. State-specific outcomes should target specific state problems and produce Medicaid program benefits. See Writing a Good Outcome page for more information on outcomes.

This general overview explains when outcomes and metrics are applicable to the APD and SMC certification processes.

APD Process

States submit an APD to obtain federal financial support for certain system-related expenditures. Regulations establishing the different types of APDs and requirements for each system are available at 45 CFR §95.610. There are three main types of APDs: Planning (PAPD), Implementation (IAPD), and Operations (OAPD). (Other APDs include APD Updates (APD-U) and As Needed APDs). States should draw on the following guidance when working with their CMS State Officer to establish specific details for a proposed MES project and to determine when the APD must include outcomes and metrics.

  • Planning – The PAPD may only need state-specific outcomes (no metrics) for planning functions like proof-of-concept activities, gap analysis, or strategic planning. When PAPDs involve new or replacement MES modules, they should include both CMS-required and state-specific outcomes as well as metrics.
  • Implementation – CMS-required and state-specific outcomes, along with metrics, are required if the IAPD involves design, development, and implementation; services; or enhancements to the MES.
  • Operations – An OAPD requires outcomes and metrics if the new activities, such as enhancements or new technology, will improve or extend the life of the system. For routine operations, however, such as hardware or software upgrades, patches, or reference code updates, an OAPD does not require outcomes and metrics.

Including outcomes and metrics within an APD does not mean that the proposed project requires certification. For any projects requiring certification, the outcomes and metrics identified within an APD help define the scope of the certification under the SMC engagement model.

Certification Process

CMS relies on the SMC process to assess whether systems comply with federal requirements (CMS-required outcomes) and, when applicable, with state requirements (state-specific outcomes).

Generally, a certification must be performed for systems that:

  • Replace an existing MES component
  • Implement new MES components
  • Develop major modifications and/or enhancements
  • Execute system rebuilds
  • Implement commercial off-the-shelf solutions
  • Employ related services supporting certain Medicaid business and system areas

States should work with their CMS State Officer to determine if their proposed MES project requires certification.

Using This Repository

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

From this repository states can:

  • Find examples and understand CMS expectations for developing outcomes and metrics
  • Share outcomes and metrics with other states, suggest changes and provide feedback to CMS about outcomes and processes via MES@cms.hhs.gov

From this repository CMS will:

  • Provide publicly available resources to guide states on how to write outcome statements and measure impact
  • Share and update examples of outcome statements and metrics for use in state APDs and certification documents
  • Review and upload state-approved outcomes and metrics

From this repository vendors can:

  • Get direct access to the CMS-required outcomes or default metrics
  • Share suggestions on changes and provide feedback to CMS about outcomes and processes via MES@cms.hhs.gov