Chapter 3 - CMS Certification Milestone 1: State Goals and Objectives

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Primary Guidelines MITA 3.0 Documentation, Medicaid Enterprise Certification Roadmap
Primary Methodology State- or Vendor-specific Methodology
Input BA, IA and, TA and Seven Conditions Scorecards, Gap Analysis, MITA Maturity Roadmap, MECT Checklists
Primary Activities Goal Setting, Impact Assessment
Output SMA Goals Aligned with MECT Checklists
Downstream Activities Supported APD Development

Introduction

While the SS-A process is broad and aimed at helping the SMA achieve higher levels of MITA maturity, the Medicaid Enterprise Certification Roadmap process is more narrowly focused. The process is intended to guide states as they seek CMS approval and funding for the deployment of Medicaid technology solutions that support achievement of the To-Be state from the SS-A.

Figure 3-1: States must achieve 6 CMS certification milestones to receive federal funds for their IT investments

The term technology is interpreted loosely in the Medicaid Enterprise Certification Roadmap. One SMA may elect to outsource certain business processes, while another may elect to deploy technology components to advance the maturity of the underlying business processes. The net result, however, is that if the MITA Maturity Roadmap is advanced, the solution is generally covered within the context of the Medicaid Enterprise Certification Roadmap.

The goals and objectives for Milestone 1 are set based on the state’s goals for the new or replacement Medicaid solution. While these are aligned to the State Medicaid Enterprise’s goals and objectives, they are more specifically for the new or replacement Medicaid solution. For example, the State Medicaid Enterprise may have a goal to share data and seamlessly integrate and collaborate with CMS, states and partners. The corresponding goal for the new or replaced Medicaid solution may be to eliminate all non-standard transmission protocols and deploy a solution capable of adapting to new standards without programming changes. The predecessor activity to the SS-A has an enterprise-wide focus, while the output from Milestone 1 has a solution focus. However, the two must be in complete alignment.

Leverage SS-A Input, Supporting Evidence and Output

ReadyCert facilitates alignment between the enterprise-wide and Medicaid solution-specific goals and objectives. The state’s vision and goals for the Medicaid Enterprise are input to the SS-A and form the basis for the future, To-Be state. The delta between the As-Is and To-Be states is captured in the Gap Analysis. The priorities embedded in the Medicaid Enterprise’s vision and goals provide the foundation for the MITA Maturity Roadmap. The linkage from the To-Be states to the Gap Analysis to the MITA Maturity Roadmap is enforced by ReadyCert’s design. The input, supporting evidence and output from the SS-A automatically carries forward into the next.

The linkage between enterprise-wide goals and objectives from the SS-A and those used for the resulting Medicaid solution deployment must be completely aligned. ReadyCert also enforces this linkage automatically. The To-Be states for the BA, IA, TA and Seven Conditions assessments are linked to the applicable Business Objectives. Business Objectives have underlying MECT checklists, which are used extensively throughout the Medicaid Enterprise Certification Roadmap. ReadyCert automatically populates the As-Is and To-Be assessments and supporting evidence to the MECT checklists. Therefore, when the journey moves from enterprise-wide strategic planning, (i.e., the SS-A), to the practical, tactical Medicaid solution planning, (i.e., the Medicaid Enterprise Certification Roadmap), ReadyCert has already linked the To-Be state and supporting evidence to the MECT Checklists that are used to procure the new solution. This ensures the linkage of enterprise-wide goals and objectives to the plans for the new or replacement Medicaid solution.

Generate MECT Checklists

Each Business Objective from the MITA BPM has, (or will have when released by CMS), corresponding MECT Checklists. ReadyCert is pre-loaded with the body of MECT Checklists.

During the BPM mapping exercise, the SMA selected all of the business processes it needs for the State Medicaid Enterprise, including state-specific business processes. The baseline MECT Checklists are created as part of the mapping exercise. While the MECT checklists are not used during the SS-A, they are automatically created as part of the SS-A.

Navigate to the MECT Checklist tab in ReadyCert to view the MECT Checklists created during BPM mapping.

Select MECT Checklists Needed to Close Gaps

The Medicaid Enterprise Certification Roadmap, of which this milestone is part, deals with plans to close the gaps, prioritized by the SMA, as identified in the Gap Analysis. As such, every MECT Checklist created as part of the BPM mapping activity may not be required to complete this milestone.

Using the Gap Analysis, select the MECT Checklists that are represented in the state’s plans to deploy the new or replacement Medicaid solution.

Express State Goals and Objectives for Business Areas

The framework for Business Areas and Business Process Objectives, (collectively called the MITA BPM), is the same as that used for the MECT checklists. As this activity is concerned with linking the state’s goals and objectives for the new or replacement Medicaid solution to the applicable MECT checklists, the linkage of the SS-A Scorecards to the MECT checklists is key.

Use the Scorecards created in the SS-A to create Business Area summary views. Use the Gap Analysis to isolate the plans to close the gaps, (for those gaps that are to be included in the new or replacement Medicaid solution). Map the Business Area summary views to the plans to close the gaps to provide a baseline for setting state goals and objectives.

Evaluate the Scorecards, Gap Analysis and plans to close the gaps at the Business Area level. It is recommended that a facilitated-team approach, using the overall project management methodology, be used to identify the goals and objectives for each Business Area. It is also recommended that the goals and objectives be very clearly tied to the Business Areas so they are not confused with State Medicaid Enterprise Goals and Objectives.

Continue this process until each of the Business Areas has associated goals and objectives for the new or replaced Medicaid solution.

Summarize the Goals and Objectives for Business Areas

For each Business Area represented in the plans to close the gaps by deploying the new or replacement Medicaid solution, list the SMA goals and objectives for that Business Area.

Using the overall project management methodology, develop documentation that captures the SMA’s goals and objectives for the new or replacement Medicaid solution.

Express State Goals and Objectives for Business Objectives

Using the Scorecards created in the SS-A, create Business Objective summary views. Using the Gap Analysis, isolate the plans to close the gaps, (for those gaps that are to be included in the new or replacement Medicaid solution). Map the Business Objective summary views to the plans to close the gaps to provide a baseline for setting state goals and objectives.

Evaluate the Scorecards, Gap Analysis and plans to close the gaps at the Business Objective level. It is recommended that a facilitated-team approach, using the overall project management methodology, be used to identify the goals and objectives for each Business Objective. It is also recommended that the goals and objectives be very clearly tied to the Business Objectives so they are not confused with State Medicaid Enterprise Goals and Objectives.

Continue this process until each of the Business Objectives has associated goals and objectives for the new or replacement Medicaid solution.

Enter Goals and Objectives in MECT Checklists

In the header for each MECT Checklist selected, enter the state’s goals and objectives for that Business Objective.[1]

Notes

  1. The Medicaid Enterprise Certification Roadmap calls for impact assessment as part of Milestone #1. However, that reference pre-dates the SS-A Companion Guide, which recommends impact assessment as part of the Gap Analysis