Do 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

Julie.boughn@cms.hhs.gov

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?subject=MESNewsletter and we will be sure to forward the Pharmacy Certification Lessons Learned presented at the MMIS Cohort on April 26, 2018.

For more information about the Medicaid Enterprise Certification Toolkit 2.2., please click here.

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.