An assessment for IV&V analysis of a state's E&E system development effort will be required for APD projects that meet any of the criteria contained in federal regulations at 45 CFR 95.626(a). If CMS determines that the IV&V analysis is required for a state's system development effort, the provisions contained in federal regulations at 45 CFR 95.626(b) and (c) apply. Additional guidance is available in the Medicaid E&E Toolkit, available at https://www.medicaid.gov/medicaid/data-and-systems/meet/index.html.

In zONE, states can find business process models, templates for concepts of operations, and other planning and development artifacts, business and technical requirements, Requests for Proposals (RFPs), Statements of Work (SOWs), system design documents, etc. CMS Eligibility & Enrollment (E&E) state leads are available to discuss and assist states in finding the right artifacts in the zONE collaboration spaces. Your SOTA team and your E&E state lead are available to answer specific questions about what might be available soon that is not already in the CALT.

The requirements of Circular OMB-A-87 apply to the allocation of costs for design, development, and implementation (DDI) and maintenance and operations (M&O) of eligibility and enrollment (E&E) systems including the respective benefiting health insurance affordability programs: Medicaid, CHIP (for states that have separate Title XXI programs or for portions of separate CHIP programs in states that operate a combination CHIP/Medicaid program) and to CCIIO Grant Funding if the project will include functionality for Health Insurance Exchanges.

The twenty-two standards and conditions are listed in the Medicaid Program; Mechanized Claims Processing and Information Retrieval Systems (90/10) rule issued on 12/4/2015. See https://www.federalregister.gov/documents/2015/12/04/2015-30591/medicaid-program-mechanized-claims-processing-and-information-retrieval-systems-9010.

Enhanced Medicaid funding for Eligibility & Enrollment (E&E) activities is available from the approval of an Advanced Planning Document (APD). An ongoing Medicaid administrative match at the 50% rate is available for activities that take place prior to an approved E&E APD, as long as the activities fall within the purview of administering the Medicaid program (42 CFR 433.15). Funding is available ongoing, subject to APD approvals.

Generally, information from the Federal data services hub will only be sent in direct response to a call from the requesting entity. However, in the case of verifications conducted by DHS, there can be up to three steps to a verification, the second and third of which will not be in real time. If the step 1 query fails, the Federal data services hub will automatically invoke step 2, and the response may take up to several days. If step 2 fails, the Federal data services hub will notify the requesting entity which will need to submit additional documentation from the applicant for step 3.

Each federal agency has the authority to define use of its data. Therefore CMS defers to IRS, DHS and SSA who are partnering with us to provide data via the Federal data services hub. Please refer to the CMS Services Catalog to review the Business Service Description (BSD) for the verification of income service to identify the Federal tax information data elements and definitions that will be made available to states through the Federal data services hub.

The Federal data services hub is utilizing the same Department of Homeland Security (DHS) SAVE verification service currently available to states. States will receive both the verification data received from SAVE as well as the Federal data services hub-derived indicators of lawful presence, qualified non-citizen status, and whether the five year bar has been met where applicable.

The Federal agencies involved in data verifications are currently involved in discussions of the overall approach to oversight and audits of safeguards. Certain agencies are expected to conduct their own independent audits.