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January/February 2018 Medicaid Enterprise Systems Newsletter

This bi-monthly e-newsletter is divided into ten main areas:

  • Healthcare Information and Management Systems Society (HIMSS)
  • Healthcare IT Connect Summit
  • Precertification
  • Reuse
  • Health Information Sharing Maturity Model
  • Medicaid Information Technology Architecture (MITA) Governance Board
  • Open Source Provider Screening Module
  • Helpful Certification Tips
  • MMIS Cohort
  • FAQs


MES Training Corner

  • No trainings to report at this time.

MES Upcoming News & Events

  • HIMSS, March 5-9 2018, Venetian - Palazzo, Las Vegas, NV.
  • State Healthcare IT Connect Summit, April 5-6 2018, Hilton Hotel, Baltimore, MD.

Health IT Conference for 2018 | HIMSS18

Attending HIMSS?

If you are attending the Healthcare Information and Management Systems Society (HIMSS) this year, please be sure to check out the Provider Screening Module (PSM) session, titled ‘Innovation in the Medicaid Enterprise: A State and Federal Priority Partnership’. This session will take place on Thursday, March 8 from 11:30 am-12:30 pm.

HIMMS 2018 conference logoThis presentation will provide an overview of the PSM project, including the decision to invest in Open Source development; the four-phased open source development approach including a Minimum Viable Pilot (MVP); three potential deployment approaches; and, the future vision for Open Source within the Medicaid Enterprise. This session is geared toward both state and industry stakeholders. 

Please note that an article titled, ‘Open Source Provider Screening Module’ is highlighted below, which provides an overview of the PSM project.

Healthcare IT Connect Summit

Save the Dates & Register (Comp.) your State Team - 2018 State Healthcare IT Connect Summit

April 5-6 (Pre-Conf. Workshops on April 4), 100+ speakers.

CMS’ Leadership, state and industry participants (see sessions, speakers below) will be presenting at the 2018 State Healthcare IT Connect Summit - April 5-6 (Pre-Conf. Workshops on April 4th), 100+ speakers, presented by Healthcare IT Connect in partnership with NASCIO, APHSA, MHPA, eHI & Health Affairs.

43 state teams attended in 2017, we are hoping all 50 states and territories will attend the 2018 meeting.

Federal Government (Complimentary): Register with Gov. Email ID
State Government (Complimentary): Register with Gov. Email ID

Industry (Vendors & Consultants), Payers & Providers: Register
Payers & Providers: Register with Org. ID

Track 1: Medicaid Modernization, Modularity and MMIS Procurement

Track 2: State Innovation, Data Analytics and Population Health Management (including Combating Opioid Abuse)

Track 3: Enterprise Systems Planning, Health and Human Services Integration

Track 4: Compliance, Security & Combating Fraud, Waste & Abuse (including 3rd Party Liability/Coordination of Benefits)

Track 5: State Marketplace Reform & Managed Care Optimization

CMS Speakers will be presenting at the sessions detailed below. View CMS session details/speakers, full conference agenda and plan your schedule across the three days.

Date Session One Session Two Session Three
April 4th 1:00pm-2:30pm Track 1 (Pre-Event Workshop): Independent Verification and Validation (IV & V) of Medicaid IT Systems
Eugene Gabriyelov, Technical Director, CMCS/CMS
Ron Backus, MITRE
3:00pm-4:00pm Track 1: Presentation – CMS’ MITA Governance Board Announces the Next Medicaid IT Architecture (MITA)
Sean Mahoney, MITRA
Jeanette James, IT Specialist, CMS
Van Showell, IT Specialist, CMS
Martin Rice, Director, Division of State Systems, CMCS/CMS
4:00pm-5:00pm: MITA Governance Board Meeting
April 5th 10:45am-11:45am Track 1: PLENARY - Integrating the Modular Medicaid Enterprise: Definitions, Expansion & Traction in the Vendor Marketplace
Ed Dolly, CIO, West Virginia Department of Health and Human Resources
Joshua Slen, Immediate Past Board Chair, Private Sector Technology Group
Ryan Howells, Medicaid Technology Alliance,  Principal, Leavitt Partners
David Whitham, ACIO Health and Eligibility, Massachusetts EOHHS
Martin Rice, Director, Division of State Systems, CMCS/CMS
4:00pm-5:00pm Track 1: Vendor Module Pre-certification Program Updates from the Pilot
Eugene Gabriyelov, Technical Director, CMS
Clyneice Chaney, MITRE
Carl Engel, CEO/Chief Architect, Elyon Enterprise Strategies representing PegaSystems
Alison Barnett, Change Healthcare Pharmacy Solutions (CHPSI), formerly Good Health Systems, CMCS Certification Lead
Elizabeth Reed, Program Manager, CSRA State and Local
Dave Rice, MRx IT Solutions Owner, Magellan Medicaid Administration
David Tamayo, Managing Principal & Regulated Programs and Solutions, MedImpact Healthcare Systems, Inc.
Robyn Ballard, Senior Technical Solutions Manager, OptumInsight, Inc
April 6th 8:00am-8:45am States of Implementation Roundtable 1: Enabling State Medicaid MMIS and E&E Implementations
Van Showell, IT Specialist, CMS
Trish Heiman, MITRE
Nick McNeil, MITRE
Tim Peterson, Montana, MMIS Project Manager (TBC)
1:30pm-2:30pm Track 1: CMCS Track 1 #4 The Open Source Provider Screening Module
Eugene Gabriyelov, CMCS/CMS, Technical Director
Trish Heiman, MITRE
David W. Hill, The MITRE Corporation, Principal Software Systems Engineer
James Vasile, Open Tech Strategies, Partner
2:35pm-3:20pm Closing Keynote: The Role of States in Implementing the 21st Century Cures Act’ Speakers
Thomas Novak, ONC/HHS, Medicaid Interoperability Lead, Office of Policy
Genevieve Morris, ONC/HHS, Principal Deputy National Coordinator
April 6th 8:00am-8:45am States of Implementation Roundtable 3: Poplin, A Reference Architecture for Medicaid
Van Showell, IT Specialist, CMS
David W. Hill, The MITRE Corporation, Principal Software Systems Engineer
Andrew Laing, Agency of Human Services, State of Vermont, Director, Business Systems Architecture
1:30pm-2:30pm Track 1: CMCS Track 1 #4 The Open Source Provider Screening Module
Eugene Gabriyelov, CMCS/CMS, Technical Director
Trish Heiman, MITRE
David W. Hill, The MITRE Corporation, Principal Software Systems Engineer
James Vasile, Open Tech Strategies, Partner
2:35pm-3:20pm Closing Keynote: The Role of States in Implementing the 21st Century Cures Act’ Speakers
Thomas Novak, ONC/HHS, Medicaid Interoperability Lead, Office of Policy
Genevieve Morris, ONC/HHS, Principal Deputy National Coordinator

Attention MEET & MECT Users

If you are experiencing any issues with your Medicaid Eligibility Enrollment Toolkit (MEET) and Medicaid Enterprise Certification Toolkit (MECT) checklists, there is a known bug that can be triggered depending on your sequence of updating. If you are experiencing any problems, please contact your CMS analyst or send an email to MMIS_MES_Certification@cms.hhs.gov.

Remember: Checklists only need to be updated and sent for milestone reviews and certifications, not with every quarterly independent verification and validation (IV&V) progress report!


The Precertification Pilot Is Moving Forward!

The Centers for Medicare and Medicaid Services (CMS) is happy to report that the Precertification Pilot is in progress!

As of November 28, 2017, six vendors had submitted modules to the Precertification Pilot, including:

Four Pharmacy Modules from:

  • Change Healthcare Pharmacy Solutions (formerly Good Health Systems) –  Pharmacy Medicaid Service Product Line
  • Magellan Medicaid Administration, Inc. – Magellan RX Management
  • MedImpact Healthcare Systems, Inc. – MedImpact Pharmacy Base Management Platform
  • OptumInsight, Inc. – Pharmacy RX

Three Provider Screening Modules from:

  • CSRA State and Local – Transcend PE provider screening and enrollment module
  • PegaSystems – Pega* 7 Platform with Pega’s Healthcare Industry Foundation and Customer Service for Healthcare Providers application
  • OptumInsight, Inc. – Provider Management Module

The Pilot’s approach includes four key activities:

  1. Vendor checklist review, collection and upload – Checklist criteria are evaluated, evidence is identified and uploaded.
  2. Evidence evaluation – Module’s evidence per the criteria is assessed and rated for its ability to meet the intent.
  3. Module demonstration evaluation – Modules key capabilities per the criteria checklist are demonstrated real-time.
  4. Vendor module findings, analysis, and reporting – Team analysis of evidence and demonstrations is correlated and presented in a final report.

The pilot team is pleased to report that the six vendors are all in the evidence evaluation and module demonstration phase. Planned activities for new processes are progressing well within a comfortable range, and the team is capturing lessons learned and improvement ideas to further enhance pilot activities. To date, the pilot has maintained a strong collaborative environment, and both teams (CMS and vendors) remain excited about the potential that exists for precertification.

Want to stay informed about the Pilot’s progress?

Consider joining the Precertification mailing list. Email: Module_Precertification@cms.hhs.gov.

Consider attending State Healthcare IT Connect Summit and the annual Medicaid Enterprise Systems Conference (MESC) where CMS will share Precertification Pilot results and takeaways.

Additional Questions or Comments?

Please email the CMS Precertification Team at Module_Precertification@cms.hhs.gov or module_precert@mitre.org.

Reuse Corner

Check Out the New Artifacts Available in the Reuse Repository!

New Advance Planning Documents (APDs), Requests for Proposals (RFP), and Other Documents

Since the last newsletter, several states have uploaded many new documents to the repository:

  • Vermont shared structural documents encompassing their healthcare eligibility Business Rules Repository.
  • Nevada uploaded seven planning documents for their Medicaid Management Information Systems (MMIS) modernization, including risk management, training master plan, resource management, modernization quality, modernization project, modernization communication, and change management. They also shared their Electronic Visit Verification Planning APD.
  • Special thanks to Wyoming for being the most prolific state artifact uploader, adding 24 documents related to their upcoming MMIS replacement project to the repository. These include a planning APD, implementation APD, and CMS approval letters for the project, as well as requests for proposals for a Pharmacy Benefit Management System, independent verification and validation (IV&V) services, system integrator, analytics and case tracking, data warehouse, and care/case management.

If any of these artifacts are useful to your state, we highly encourage you to view them on the Reuse Repository today!

New Software Available – Virginia’s Encounter Processing Solution

Virginia recently completed the development and implementation of an in-house Encounter Processing System (EPS), based on IBM’s rules engine. Virginia credits the new system with a significant reduction to their per-transaction data ingestion cost and is willing to share documents, coding, configurations, and more. The system design overview, rules criteria, and a walkthrough video are available on the Reuse Repository under Software and Code. Please log in if you have access and are interested!

Learn more about reuse, including instructions to access the Reuse Repository, on the Medicaid Enterprise Reuse page.

Reuse Survey Coming Soon!

Keep an eye out for our next Reuse Survey in February and March. Your response will help CMS identify reusable artifacts states have available to share, identify and add members to the repository who express an interest in reuse, and create a space for open dialogue between states. Twenty states responded to the August 2017 survey and we collected information on many reusable artifacts. If you are interested in participating, enter your state email address on the CMS Quarterly Reuse Survey Opt-In page.

Reuse gives CMS and the states the opportunity to share Medicaid Enterprise Systems (MES) IT assets, thereby helping to reduce costs and time for MES development or upgrades. CMS developed the Medicaid Enterprise System Reuse Repository on zONE as a place for states to share MES artifacts for reuse between states.

Health Information Sharing Maturity Model (HISMM)

The Health Information Sharing Maturity Model (HISMM) is a tool to help states adapt to new payment models and greater health care integration across the care continuum. This model is the first step in ensuring that states know what is needed to ensure that health information sharing supports additional populations and stakeholders in a greater number of care settings. It was built in response to State Medicaid Agencies’ requests for tools and guidance.

States may employ HIMSS to ensure that funding is used effectively to meet health information sharing needs and to help future state planning to build the right new health IT capabilities.

The maturity model provides states with a mechanism to assess the maturity of health information exchanges (HIEs) within a state’s Medicaid enterprise. The HIEs can use HIMSS to ensure the most effective use of scarce resources by leveraging value from common efforts—both public and private—and communicating best practices and lessons learned, such as increased modularity to improve reuse of solutions across states.

HISMM provides guidance by identifying 29 common capabilities that are bundled according to what is needed to support sharing information for common programs, such as Behavioral Health Integration. HISMM identifies 11 dimensions to help states self-assess their maturity level on a scale from 0 (low maturity) to 5 (high maturity). The maturity model provides guidance and criteria for each dimension level.

As the model is continually evolving, work continues to ensure that it is usable, intuitive, and addresses its intended purpose.

If you are interested in finding out more about the Health Information Sharing Maturity Model, please contact Tom Novak at Thomas.Novak@hhs.gov.

The Medicaid Information Technology Architecture (MITA) Governance Board (MGB)

The MGB Celebrates Its One-Year Anniversary!

The Medicaid Information Technology Architecture (MITA) Governance Board (MGB) celebrated its one-year anniversary on December 14. MGB’s first year was filled with collaborative and thought-provoking working sessions and special events. Here is a snapshot of what the MGB has been up to this past year.

Since its inception in 2016, the MGB has worked feverishly to advance the MITA Framework by identifying and prioritizing opportunities and forming working groups to spearhead the desired changes. To date, the MBG has formed the following working groups to make enhancements to the MITA Framework.

  • Member Management: This working group completed the MITA Business Process definition and related Maturity Matrix for Manage Member Information, Manage Applicant and Member Communication, Perform Population and Member Outreach, and Manage Member Grievance and Appeal.
  • Modularity: This working group developed guidance to strengthen CMS’ MITA Modularity Guidance in the MITA Framework.
  • Data Analytics: This working group revised the Case Management, Manage Population Health Outreach business process to incorporate a data analytics function.
  • Poplin: This working group provided technical guidance for achieving interchangeable modularity and interoperability. The working groups will release their deliverables this year (MITA 3.0 Sup 2)—more information coming soon.

If you have any questions, please do not hesitate to contact Sean Mahoney (smahoney@mitre.org) and Jeanette James (jeanette.james@cms.hhs.gov), and cc: Van Showell (van.showell@cms.hhs.gov), Pamela Misuraca (pmisuraca@mitre.org), Chandra Robinson (chandra@mitre.org), and Dane Underwood (dunderwood@mitre.org).

Open Source Provider Screening Module


The Center for Medicaid and CHIP Services (CMCS) developed a prototype Provider Screening Module (PSM) in 2013 through a crowd-sourced Provider Screening Challenge and a pilot with one state. Because of the potential of open source software development to lower costs, promote reuse and allow new vendors to enter the market, CMCS reestablished the project. The PSM project aims to:

  • Allow states greater control and flexibility over the provider screening process
  • Provide a way for new vendors to enter this market and competitively bid for support work
  • Reduce recurring IT costs for implementing and deploying a provider screening module
  • Improve state processes for exchanging data with federal databases, other external data sources, and other Medicaid Management Information System components
  • Meet the State Medicaid Director Letter modularity guidelines
  • Establish a model for procuring, developing, and maintaining shared modules

What’s New

The recent Minimum Viable Pilot development phase included:

  • Ongoing input and feedback from Wyoming, Vermont, Ohio, and West Virginia – more states are welcome to join
  • An initial PSM User Manual that enables states to insert their policy and processes
  • Americans with Disabilities Act Section 508 improvements
  • Improved user interface reusability by using templates across the application for consistent look and feel
  • Additional technical documents for states and integration vendors, including schema diagram for PSM Logical Data Model and Interface Control Document
  • Fortified code with added test cases, including running regression testing with each software build

Next Steps

  • Work with states to review the documentation and provide feedback
  • Continue working directly with states to validate workflow and business rules

Please visit the open source PSM repository on GitHub as well as the discussion forum. Please feel free to join the discussion group conversations.

To learn more about the PSM or how to get involved, please contact Eugene Gabriyelov at eugene.gabriyelov@cms.hhs.gov and Van Showell at Van.Showell@cms.hhs.gov.

Helpful Certification Tips

Does your state have a Milestone Review or Certification Review coming up? If so, CMS has the following tips to aid you as you prepare for those activities:

Pre-Milestone / Certification Review

When completing the checklists:

  • Complete all checklists and provide evidence for all criteria – nothing should be blank or without evidence / explanation, regardless of current MITA maturity level.
  • Provide appropriate justification for criteria marked as “No” or “N / A.”
  • Populate the evidence column with one direct link per criterion that leads to a single folder containing all corresponding evidence.
  • If the system being evaluated has a criterion that covers functionality being performed by a different system housed in a different agency (e.g., Eligibility and Enrollment), the state must demonstrate how data interaction and data flow occurs between the two systems and have the information / evidence to support the explanation and reasoning.

After fully completing the checklists:

  • Provide all evidence in the state’s own repository set up with folders corresponding to each of the criteria in the checklist
  • Indicate which evidence contains PHI / PII (e.g., labeling the evidence with “Confidential”)
  • Provide a list of existing system defects, by severity and priority, prior to the Milestone / Certification Review

During the Milestone / Certification Review

  • During checklist review sessions, have necessary resources available to walk through each checklist and answer questions as to how the system meets each criterion, using demos where necessary.
  • Checklist sessions should focus on criteria CMS had questions on or needed clarifications on in advance, including, but not limited to, criteria IV&V had provided “Doesn’t Meet,” “Partially Meets,” or “Not Assessed” assessments for on the checklists.
  • Demos should explicitly tie back to checklist criteria, grouped by MITA Business Area or Critical Success Factor (CSF).

The MMIS Cohort is alive and well

The first meeting of 2018 took place on Wednesday, February 21 from 2-3 pm EST. As we “reboot,” we are seeking to engage more senior state IT leadership and build upon the informative, collaborative, and useful nature of this group toward further improving and evolving state Medicaid IT efforts.

For more information or be included in MMIS Cohort meeting invitations, please contact Eugene Gabriyelov at eugene.gabriyelov@cms.hhs.gov and Van Showell at Van.Showell@cms.hhs.gov.


Q: Does the IV&V contractor need to be on board before issuing other MMIS and E&E and related RFPs?

A: It is highly recommended that the IV&V contractor be in place to provide valued insight into the state's system needs, MMIS goals, and system requirements, and be available to review the Design Development and Integration (DDI) RFP prior to RFP release. The IV&V contractor must be on board and available for work before the DDI contractor begins work. The IV&V contractor is expected to produce the IV&V progress report before the Project Initiation Milestone Review (Activity 11).

Q: Is MITA considered during milestone reviews?

A: Yes, our milestone review process is fully aligned with MITA. During each milestone review, CMS will verify that the state has considered MITA maturity during system definition, and whether the state is actively moving toward higher MITA maturity as defined in the state's latest MITA State Self-Assessment. Please see 42 CFR 433.112 (b) (11).

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