Chapter 1 - Alignment of MITA and ReadyCert

From RCWiki
Jump to: navigation, search

MITA Background and Context

MITA is first a framework, then an initiative. As a framework, it provides structure for State Medicaid Agencies (SMA) as they create and deploy enterprise solutions. MITA’s principles, guidelines and models effectively form a blueprint for achieving the goals of the SMA.

As an initiative, MITA is a systematic program to introduce improvements, across the nation, to create State Medicaid Enterprises. State Medicaid Enterprises collaborate with CMS, other states and an intricate network of partners to integrate business processes, information and technology between and among the partners.

The framework and initiative, taken together, improve Medicaid administration by establishing national guidelines for business processes, information standards and technical platforms. The MITA framework includes planning guides for State Medicaid Enterprises to encourage national coordination of transformation initiatives, while recognizing unique local needs.

Figure 1-1: MITA is comprehensive in its composition and use. States and vendors need methods, tools and techniques to help them apply the right information to the right process to affect the right action.

Though the framework is solid and the initiative worthwhile, coordinated change across the nation is a monumental undertaking. Each state has its own challenges, not the least of which is funding for the state portion of Medicaid. The opportunity to obtain funding for Medicaid, including technology investments, is an attractive proposition. The FFP formula generally provides 50 to 75 percent matching federal funds for technology investments. In 2010, provisions were made to increase funding for technology investments to 90 percent for a greater number of initiatives, as long as the investments comply with the MITA framework. In effect, the federal government, needing to increase the level of coordination and “sameness” among states for the goals of the Affordable Care Act (ACA) to be realized, provided an incentive to states to become more MITA-aligned. That decision, and a series of actions taken to implement the decision, gave MITA the context of a compliance framework, as well as preserving its grounding as an architectural framework and change initiative.

MITA’s evolution, from its inception to the current Version 3.0, has taken it from a concept to a comprehensive set of guidelines that integrate multiple frameworks and models. As each version of MITA has been developed and released, its complexity has increased. While the complexity is understandable, owing to the expansiveness of the Medicaid program, the unique needs of states and numerous federal mandates, the advancement of MITA is jeopardized by this complexity. MITA will become more tangible when it is understood, adopted and practiced throughout the Medicaid sector. ReadyCert and the accompanying methodology helps organizations understand the MITA framework, put it into practice and comply with its guidelines.

ReadyCert Use and Context

ReadyCert is Compliance Software. Compliance is the process of adhering to policies, procedures and directives, which can be derived from internal or external regulations, standards and agreements. Compliance Software helps organizations obey policies, procedures and directives and prove that they are operating in accordance with policies, procedures and directives. Compliance Software serves a defined purpose, as described above. When used in conjunction with a well-conceived and managed change program, compliance software helps organizations improve, advance their vision and become more practiced in executing their responsibilities.

ReadyCert is used for SS-As under MITA 3.0 and for advancing through the six CMS milestones to certify Medicaid technology investments for FFP. States must prove to CMS that their plans and solutions are compliant with MITA guidelines. ReadyCert helps states and vendors to efficiently and effectively complete the processes as prescribed by CMS in its MITA 3.0 documentation.

When used in conjunction with a broader enterprise change plan, ReadyCert helps SMAs and vendors improve their understanding of MITA, advance the maturity of business processes and become more MITA-aligned in everyday practice.

In addition to its relevance to MITA, ReadyCert is compatible and aligned with Microsoft technology, which is used extensively in the nation’s SMAs and the vendor market.

ReadyCert is based on the Microsoft Suite of products and frameworks for seamless integration in state and vendor organizations.
Web-based Components Client-based Components
Microsoft .Net 4.0 Microsoft Access
Microsoft VB.Net Microsoft Excel
Microsoft SQL Server Microsoft Word
Microsoft Internet Information Server Adobe PDF

ReadyCert 6CM Methodology

The ReadyCert 6CM Methodology is named for the six CMS certification milestones, which are depicted in figure 1-2.

Figure 1-2: States must achieve 6 CMS certification milestones to receive federal funds for their IT investments

The ReadyCert tool is relevant through each of these milestones, as well as the SS-A, which is performed before commencing on the Medicaid Enterprise Certification Roadmap. The ReadyCert 6CM Methodology is an approach for:

  • Streamlining the SS-A process
  • Re-using and leveraging SS-A information in downstream CMS certification milestone activities
  • Continuously improving and advancing the MITA framework, initiative and compliance

ReadyCert 6CM is an innovative, best-practice-based approach for performing the activities contained in the SS-A Companion Guide and Medicaid Enterprise Certification Roadmap documentation. ReadyCert 6CM is intended to be used in the context of an inclusive project management methodology as part of a broader change program.

ReadyCert 6CM seeks to push knowledge to all levels of the organization so that each worker understands the context and contribution of individual activities to the MITA initiative. ReadyCert 6CM helps the state Medicaid team understand the relationship among business processes, the three MITA architectural layers, (business, information and technical), and the Seven Standards and Conditions for Enhanced Federal Funding. The greater the understanding of MITA 3.0, the greater the relevance of the SS-A to influence and inform the downstream activities, such as the APD, RFP, and eventual solution selection and deployment.

A brief explanation of the SS-A and six CMS Certification Milestones follows.

State Self-Assessment

The SS-A is performed to map the state’s business processes to the MITA BPM, assess the maturity of the current business process based on four distinct views and declare the future state, based on its vision and goals. The delta between the current state and future state comprises the Gap Analysis. The Gap Analysis informs the MITA Maturity Roadmap, which provides the foundation for long term planning.

The objective of the SS-A is to develop State Medicaid Enterprise architectures that align with and advance MITA maturity for business, information and technology. The SS-A sets in motion SMA requests for appropriate FFP for its MMIS and IT projects for eligibility and enrollment, collectively called Medicaid solution in the ReadyCert 6CM methodology.

Milestone 1: State Goals and Objectives

The SMA sets its goals and objectives for the new or replaced Medicaid solutions using the MITA BPM framework. The goals and objectives are then mapped to the applicable MECT checklists.

The objective of this milestone is to clearly identify the outcomes that the SMA seeks in its new or replaced Medicaid solution. This activity produces a more granular expression of goals and objectives than that performed in the SS-A. The goals and objectives in this milestone, while aligned to those from the SS-A, are specifically related to the new or replaced Medicaid solution.

Milestone 2: Advance Planning Documents

APDs have two main purposes: to formalize and solidify the State Medicaid Enterprise’s strategic plans and tactical initiatives to implement those plans; and to inform CMS of initiatives that require CMS approval and request FFP.

In April 2011, CMS published the Seven Standards and Conditions for Enhanced Federal Funding. Commonly called the Seven Conditions, these standards attempt to provide states the evaluation criteria CMS uses to certify solutions for increased FFP. The Seven Conditions, which are part of the MITA initiative, are assessed as part of the SS-A.

Since the implementation of the Seven Conditions, APDs are inextricably linked with them. In as much as the APD is the vehicle to inform CMS of initiatives that require CMS approval and request FFP, the treatment of the Seven Conditions in APDs should be supported with scorecards that summarize underlying supporting evidence.

The APD process results in formal plans to close the gaps identified in the SS-A. The linkage between the Gap Analysis and APD is very tight. What is described as a plan to close a gap in the SS-A becomes a formal initiative submitted for CMS approval and FFP.

Milestone 3: RFPs, Proposals and Contracts

The RFP, Proposals and Contracts milestone is concerned with procuring the sources and installing those sources to affect the changes described in the MITA Maturity Roadmap. The SMA may issue one or several RFPs for products and services. Typically, there is at least one very large procurement, such as for a replacement MMIS, and additional discrete ones, such as for PBM or data analytics. While the general direction is the same among states in this milestone, the needs of each state are unique. Each state has its own procurement regulations and current sourcing arrangements to contend with.

For states, the process of developing RFPs, releasing them, evaluating resulting vendor proposals and negotiating contracts is complex and resource-intensive. For vendors, the process for tracking opportunities, bidding on them and negotiating resulting contracts is also complex and resource-intensive. The objective of this milestone, to select and install sources to close the gaps identified in the SS-A, is facilitated by better procurements and proposals. The more states can streamline their procurements and request evidence-based proposals that align with the MITA Maturity Roadmap, the better able the vendor market is able to respond and the more efficiently resulting contracts are executed.

Milestone 4: Validated MMIS Functionality

Throughout the solution deployment project, the state and applicable vendors are validating functionality through formal test plans and processes. The purpose of this milestone is to validate solution functionality against the SRC described in the MECT checklists.

The activities leading to the completion of this milestone are complex and resource intensive. The validation activities are executed over a multi-month, possibly a multi-year, project plan. The processes are iterative and require structured, standard and repeatable review protocols. When this milestone is complete, the state is ready to move into formal engagement with CMS for MMIS certification.

Milestone 5: Pre-certification Meeting with CMS

The objective of this milestone is to ensure the state understands the needs of the CMS Certification Review (CR) Team and that the CR Team understands the new or replaced MMIS well enough to schedule the certification visit.

The major activity in this milestone is to present the CR Team with a solution overview and have a detailed discussion about MMIS functionality. At the conclusion of this milestone, the state and CR Team progress to formal certification review.

Milestone 6: CMS Certification Visit

The CMS certification visit is the culmination of the Medicaid Enterprise Certification Roadmap journey. The CR Team performs verification by interacting with and using the solution, reviewing documentation and interviewing staff. The team’s objective is to verify that the SRC contained in the MECT checklists, for CMS and state-specific functionality, are met in the new or replaced Medicaid solution. CMS decides after the visit if the Medicaid solution is to be certified and prepares a report with its decision.

At the conclusion of Milestone #6, the journey is complete. It restarts when the state decides that new, replacement or significantly upgraded technology investments are necessary to meet the goals of the MITA framework and initiative.

Moving Forward

Before the SS-A process can begin, the state must engage in a formal process for setting its vision and goals for Medicaid. This activity considers the vision and goals for the entire Medicaid Enterprise and informs the SS-A and all downstream activities. Formal state vision and goal setting for the State Medicaid Enterprise is performed using the overall project management methodology.

Once the vision and goals have been set and formalized in documentation, the SS-A project commences. ReadyCert is first used in the SS-A process. The documentation from the State Medicaid Enterprise vision and goal setting serves as supporting evidence, which is used to validate As-Is and To-Be assessments.

Organization of the ReadyCert 6CM Methodology

The ReadyCert 6CM Methodology is described in chapters. Each chapter is used to describe the approach for completing the SS-A and six certification milestones.

At the start of each chapter, a table is presented, outlining key details that frame the major activity. A brief explanation of the table entries follows. After the table entry, the approach for completing the activity using ReadyCert is described.

Key Detail Description
Primary Guidelines

(This is what must be done—what’s mandated)

The main federal material that influences the activity is entered here. The state or vendor may have additional guidelines.
Primary Methodology

(This is how it is done)

The overall approach that the state or vendor uses to perform the activity is entered here. ReadyCert 6CM describes how to approach specific activities using the principles embedded in ReadyCert’s design.
Input The pre-requisites to the activity are listed here. The entries form the minimum input required; additional input may be needed by states and vendors.
Primary Processes The substance, or key processes, performed in the activity are entered here.
Output The primary items produced during the activity are listed here.
Downstream Activities Supported Each chapter in the methodology describes an activity, the output of which informs and influences downstream activities. The primary activities supported by the output from the subject activity are listed here.