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Summer 2018 Medicaid Enterprise Systems Newsletter

This Medicaid Enterprise Systems (MES) bi-monthly e-newsletter contains updates on the following:

  • Julie Boughn Returns to CMS!
  • Vermont Completes First Modular Certification for Pharmacy Benefits Management
  • Medicaid Enterprise Systems Conference 2018
  • MEET and MECT Updates Released!
  • MMIS Cohort: Join the Conversation!
  • Precertification Pilot Update
  • MES FAQs


Upcoming Events

Medicaid Enterprise Systems Conference 2018 | August 13-16, Portland, OR | Oregon Convention Center

Julie Boughn Returns to CMS

Photo of Julie BoughnDo we get the systems we get because we buy them?  Medicaid and CHIP programs need new capabilities and new solutions in months, not years. Have the things we have done to date actually helped to improve the outcomes from our information technology projects? Can CMS be a more effective partner with states in implementing and operating Medicaid and CHIP programs?

These are some of the questions I asked myself in thinking about a return to government service. After four years working in the private sector, I have returned to CMS to lead the Data and Systems Group (DSG) within CMS’s Center for Medicaid and CHIP Services (CMCS).  In those years, I read and helped respond to dozens and dozens of procurement requests from both federal government and states. I began to wonder if we could perhaps get different (improved) outcomes from our information technology projects if we simply bought different projects. In other words, how many of the outcomes we get are the result of the things we write in procurement requests?  How might the projects change if we focus on delivering working solutions in months, not years?  How are our efforts helping to make Medicaid and CHIP data more available to decision makers and researchers?

As we usher in what I am calling an “era of experimentation,” I look forward to working with all of you, who are our partners in the systems and operations that support Medicaid and CHIP across the country, as we try new things to improve the project outcomes, develop new tools and data to help understand how well the systems are supporting the programs, and look objectively and critically at the outcomes of the experiments.

Policy makers – in CMS, in state legislatures, and in the federal government – are making decisions that we, the implementers, need to bring to life in months, not years. CMS approved one state waiver recently that went into effect literally the next day. That says something to those of us who work in technology and operations about how responsive we need to be.  Together, can we rise to the challenge? I think the answer is, “Yes!”  I look forward to working with all of you to make that happen.

For those of you who don’t know me, I now have a career in IT that spans more years than I really want to admit lest it make me seem totally un-cool.  As much as  I love my work, my favorite roles in life are as “auntie” to 14 nieces and nephews and as “mom” to two cute dogs.  If I was stranded on a desert island, the one food I would want to have is pizza, but the kind that you find in Italy.  I get my best ideas when I am riding my bicycle.

Julie Boughn

Director, Data and Systems Group

CMS/Center for Medicaid & CHIP Services


Vermont Completes First Modular Certification for Pharmacy Benefits Management

The Vermont Agency of Human Services (AHS) adopted a modular approach to certifying the Medicaid Management Information System (MMIS) in 2016 and implemented the first module—Pharmacy Benefits Management (PBM)—in January 2015. The R3 Final Review was held onsite over three days in Waterbury, VT in late November 2017. The official certification letter was received March 28, 2018.

The journey to certification began mid-2016 after the module was operational and in the late stages of Design, Development, and Implementation (DDI). When CMS published the modular approach in the April 2016 Director’s Letter, we immediately began steps to explore modularity starting with PBM. The first action was to onboard a Certification Lead, who drafted a strategy, a reusable process, and later established a team to support the certification tasks. Achieving PBM certification required the newly founded AHS Certification team to take a retroactive view of the PBM DDI effort and develop an action plan to ensure compliance. We worked closely with CMS to address questions, risks, issues, and decisions that could impact the PBM certification and future modules.

The AHS Certification Strategy consisted of:

  • Following the guidance of the MECT and MECL
  • Building a Certification Team to work in parallel to the DDI project
  • Developing a reusable process for future modules
  • Establishing and maintaining a certification schedule of activities
  • Conducting regular overviews/meetings to prepare the State and contractor for reviews
  • Planning time with CMS wisely

As a result, we walked away from the R3 review with 11 of only 21 action items completed over the three-day review. We completed the remaining action items within 30 days of the Review.

For more information on our success story, please reach out to: MES@cms.hhs.gov and we will be sure to forward the Pharmacy Certification Lessons Learned presented at the MMIS Cohort on April 26, 2018.

View more information about the Medicaid Enterprise Certification Toolkit 2.2.

Medicaid Enterprise Systems Conference 2018

MESC 2018 conference logoCMS will have a presence at the upcoming Medicaid Enterprise Systems Conference (MESC) in Portland, OR August 13-16. In addition to live meetings of the MMIS Cohort and MITA Governance Board, CMS will hold state office hours and present the latest updates on current initiatives. If you are able to attend, we look forward to your participation and feedback.

Day at a Glance Agenda

View the recently updated MESC 2018 Day at a Glance Agenda.

CMS Featured Sessions & Speakers

8/13/18 8:30 AMA106MMIS Cohort MeetingEugene Gabriyelov, CMS (moderator)
8/13/18 2:00 PMOregon BallroomCMS WelcomeJulie Boughn, CMS
8/14/18B115/B116What’s the (Re-)Use? State and Vendor Perspectives on Modularity and the MITA Leverage ConditionCarie Clements, Accenture;
Ed Dolly, CMS;
Mary Arcenas, New Jersey;
Nicole Becnel, Berry Dunn;
Nicolle Field, Berry Dunn;
Cynthia Beane, West Virginia
8/14/18 1:00 PMB113/B114Walk It Like You Plan It – A Flexible Approach for Enterprise Data Management StrategyDwayne Carter, Blu Consulting;
Debra Dixon, California, NMEH MITA Co-Chair;
Ed Dolly, CMS;
Zachary J. Rioux, Berry Dunn;
Cathie Ott, Washington
8/14/18 5:15 PMD-129MITA Governance Board MeetingMITA Governance Board Members
‘Open to the Public’
8/15/18 9:45 AMB113/B114CMS Certification: You Can Get There, Here’s How – Stakeholder PartnershipsEd Dolly, CMS;
Matthew Barlow, Ohio;
Mary Arcenas, New Jersey;
Shea Berry, Berry Dunn;
Erica Rice, Berry Dunn;
Brandon Lewis, West Virginia
8/15/18 9:45 AMC123/C124Keep Your Certification on Track: Insights into Effective Milestone Review Inputs for States, IV&V, and CMSVan Showell, CMS;
Ron Backus, MITRE
8/15/18 1:45 PMB110/B111/B112In the Eye of the Storm – Surviving Nature’s Disasters!Ellen Harrison, HMS;
Andrea Danes, Accelerant Health;
Gary Smith, U.S. Virgin Islands;
Ed Dolly, CMS;
Luis Sylvester, Molina Medicaid Solutions
8/15/18 1:45 PMC123/C124New CMS GuidanceEugene Gabriyelov, CMS;
Julie Boughn, CMS;
Tom Novak, ONC
8/15/18 3:00 PMC123/C124MITA: Adding Value and Achieving Program and Business GoalsEd Dolly, CMS;
Willie Tompkins, CMS
8/16/18 8:00 AMC123/C124Certification…Today and TomorrowVan Showell, CMS;
Jamie Miller, CMS;
Matt Barlow, Ohio
8/16/18 9:15 AMC123/C124Experimenting to Improve Outcomes in Technology ProjectsJulie Boughn, CMS;
Eugene Gabriyelov, CMS
8/16/18 1:00 PMC123/C124Outcomes-Oriented Funding Requests and ProcurementsJulie Boughn, CMS;
Sarah Miller, Audacious Inquiry;
Jessie Posilkin, 18F
8/16/18 3:30 PMOregon BallroomClosing Plenary 

MEET and MECT Updates Released

CMS released the Medicaid Eligibility and Enrollment Toolkit (MEET) 1.1 and Medicaid Enterprise Certification Toolkit (MECT) 2.3 August 1 on the MEET and MECT webpages. The new toolkits include the following important changes.

Key changes in MEET 1.1 (ZIP, 4.25 MB):

  • Enhanced guidance tabs for the checklists
  • Consolidation of a few Eligibility and Enrollment checklist criteria

Key changes in MECT 2.3 (ZIP, 5.81 MB):

  • Removal of the MITA Business Area Module Checklist Set
  • Mapping from MITA business areas to each MMIS Module Checklist Set criterion
  • New Pharmacy and Provider Management checklists guidance tabs
  • Enhanced guidance for five core checklists
  • New Program Integrity Checklist Electronic Visit Verification criteria

Both updated toolkits include a milestone review guide and a new CMS email address: MES@cms.hhs.gov.

MMIS Cohort: Join the Conversation

State IT leaders—have you been joining the monthly MMIS Cohort meetings? Here’s what’s been happening!

In April, we discussed how CMS is streamlining certification checklist sets to use only the MMIS set moving forward. Vermont shared lessons learned from their recent Pharmacy Benefits Management module certification, including how they approached the R3 milestone review, what went well, and recommendations for how other States can prepare for upcoming certification reviews. Questions regarding Vermont’s lessons learned should be sent to Kaitlin Epstein (Kaitlin.Epstein@vermont.gov), Tobi Daniels (Tobi.Daniels@partner.vermont.gov), and Nancy Hogue (Nancy.Hogue@vermont.gov). 

In May, we discussed Project Partnership Understanding (PPU) documents, including the purpose, process, and structure. Pennsylvania shared their MMIS project timeline and we discussed how CMS uses this information to align the Medicaid Enterprise Certification Life Cycle (MECL) and plan for milestone reviews. Questions about Pennsylvania’s MMIS project should be sent to Sam Moore (c-sammoore@pa.gov).

In June, Tennessee announced their Enterprise Data Warehouse (EDW) / Decision Support Services (DSS) RFP feedback survey to gather information about other states’ EDW/DSS module efforts, functionality, and lessons learned. Montana introduced their Claims module procurement strategy, and we discussed certification and the role of IV&V vendors. Delaware shared their experience working with IV&V, the vendor’s role in milestone reviews, and lessons learned. Questions about Tennessee’s survey should be sent to Raichon Morand (raichon.morand@tn.gov). Questions on Montana’s procurement strategy should be sent to Tim Peterson (TPeterson@mt.gov).

In July, Delaware continued the conversation about certification and the role of IV&V, focusing on R3 certification readiness and how the state and IV&V worked together to prepare for the final milestone review. Montana provided additional information about the multi-state cooperative procurement for a claims processing and management module including the projected timeline, how it will work, what types of state involvement are needed, and the overall benefits of participation. Questions regarding Delaware’s experience with IV&V, milestone reviews, and lessons learned should be sent to Al Boulogne (Alexander.Boulogne@state.de.us).

CMS invites State IT leadership to join the MMIS Cohort on the last Wednesday of every month from 2-3 pm ET. As a reminder, participation is limited to States; vendors should not attend Cohort meetings. Vendors are welcome to subscribe to this newsletter to keep up to date. To be invited to future MMIS Cohort meetings, please email Van Showell (van.showell@cms.hhs.gov).

What is the MMIS Cohort?

  • A monthly discussion on key topics, such as States' modular certification experiences and preliminary precertification pilot results
  • A chance for States to share experiences and challenges
  • A forum for States to identify opportunities to collaborate with one another and/or with CMS to find actionable solutions
  • An opportunity to hear “sneak peeks” and provide State feedback on upcoming CMS initiatives

The next MMIS Cohort meeting will be live at MESC on Monday, 8/13 at 8:30AM PST, and will feature State-to-State networking and opportunities to collaborate. If you can join or would like to share, please complete this brief survey.

Precertification Pilot Update

The Vendor Module Precertification Pilot results, currently being evaluated by CMS, will provide indicators on whether Precertification could attract new vendors and streamline State certification, as well as the level of effort required to sustain a program. CMS is evaluating the Pilot and will make a decision whether or how to move forward.

The Precertification Pilot was conducted from October 2017 through March 2018. Six vendors submitted a total of seven modules, either Pharmacy or Provider Screening or both, for evaluation. Participants completed multiple rounds of documentation and demonstration and provided valuable insights and feedback throughout the process.

While participating vendors did not receive precertification status for submitted modules, they each received a detailed module evaluation report from CMS that can be shared with States considering their module. CMS would like to acknowledge the following vendors for being active and engaged participants:

Pharmacy vendors include Change Healthcare, MagellanRx Management, Medimpact, and OPTUM. Provider screening vendors include OPTIM, Pegasystems Inc., and CSRA.


Q: I am a vendor not currently in the Medicaid space, but interested in learning more about opportunities for MMIS and/or E&E modular solutions. Whom can I contact for more information?

A: CMS is looking for new innovators in the Medicaid IT space. Please direct MMIS inquiries to: MES@cms.hhs.gov?subject=MMIS and E&E inquiries to MES@cms.hhs.gov?subject=E&E.

Q: We are procuring a COTS solution. This prevents us from providing some of the technical evidence requested in the checklists. Will this pose a problem?

A: CMS encourages the use of COTS solutions where possible, and the milestone review process supports certification of COTS products. The review criteria are intended to be tailorable to support different solutions, including COTS. In this case, the technical criteria in the checklists that do not apply to COTS may be marked "Not Applicable" with an explanation as to why they do not apply.

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