Precertification Pilot Overview

The Precertification Pilot is now accepting module submissions!

What Is the Precertification Pilot?

To facilitate lower-risk, more cost-effective, and technically successful IT solutions for Medicaid IT, the Centers for Medicare & Medicaid Services (CMS) envisions a program that will permit any company to submit its modular, reusable, Medicaid IT solution for precertification. CMS is now piloting a precertification process that is designed to evaluate and assess these technology solutions.

By previewing and assessing vendor solutions that meet core business function and technical criteria, CMS expects to help reduce some of the hurdles in state procurements of new technology, increase opportunities for innovation in the solutions space, and smooth the state certifications of their enterprise systems.

CMS is introducing a Precertification Pilot to launch the precertification program and determine the most effective approach to precertifying modules. The Precertification Pilot will assess Pharmacy and Provider Screening module solutions only. At the same time the Pilot will also test the proposed precertification approach and process. CMS will incorporate feedback from vendors for future decisions on Precertification.

Who should participate?

Vendors with experience in developing technology solutions are highly encouraged to participate. Those with experience in pharmacy technology, and provider screening solutions are especially encouraged to participate in the Pilot. CMS seeks innovative technology solutions that can support the Medicaid enterprise.

Why should vendors participate?

Vendors participating in the Pilot receive early insight into the processes and general approach. Vendors will be able to provide feedback to CMS, and refine the criteria used to evaluate each module type. The Pilot will inform and help streamline state certification processes, resulting in improved experiences for both states and vendors.

Participation in the Pilot will not result in precertification or any precertified module. Instead, participation will result in a written report that vendors can distribute publicly, and provide vendors with an opportunity to receive early feedback and insight in how future precertification processes will work.

Participants in the Pilot can expect to experience the full precertification process. Vendors will submit modules for evaluation, conduct live demonstrations with evaluators and learn the details of the logistics, and receive a full report of how their module performs against the precertification criteria.

What is Assessed?

Submitted modules will be evaluated on specific requirements and demonstrated capabilities. The requirements cover business and technical functionality for either Pharmacy or Provider Screening modules. Modules evaluation will be based on a subset of the following Medicaid Enterprise Certification Toolkit (MECT) checklists and additional criteria for open APIs and interoperability.

Technical checklists:

  1. Access and Delivery
  2. Information and Architecture
  3. Integration and Utility
  4. Intermediary and Interface
  5. Standards and Conditions

The Precertification Checklists are now available for download.

Vendors will be asked to submit documented implementation evidence, and participate in demonstrations of their module as part of the Pilot.

Pilot Timeline

The Pilot will be conducted during the fall of 2017.

Date Milestone
October 2, 2017 Pilot Launch
December 11, 2017 Last date to submit evidence
January 15, 2018 Pilot closes

Please note that dates are subject to change.

Instructions for Participation

Vendors that wish to participate in the Pilot must submit a Notice of Intent to Participate. CMS will send participants additional details and instructions upon receipt of the notice.

Frequently Asked Questions (FAQs)

View answers to frequently asked questions about the Precertification Pilot Program.