Outcomes-Based Certification

The Centers for Medicare & Medicaid Services (CMS) has begun to transition its systems certification process to one that evaluates how well Medicaid information technology systems support desired business outcomes while reducing the burden on states. This streamlined, outcomes-based approach, or “Outcomes-Based Certification (OBC),” is designed to ensure that systems that receive federal financial participation are meeting the business needs of the state and of CMS.

CMS is experimenting with OBC through a combination of developing outcomes statements and evaluation criteria, identifying test cases for system demonstrations, and collecting and assessing operational data. CMS will engage states in OBC through pilots and release guidance as new OBC processes are refined.

Electronic Visit Verification is the first system to which CMS is applying an outcomes-based approach to certification.