Operational Readiness Review
Through our MMIS Replacement Project (MRP), we are transitioning from our current Envision MMIS to our new system, MESA: Medicaid Enterprise System Assistance. Under the Streamlined Modular Certification (SMC) approach, there are two milestone reviews required by the Centers for Medicare and Medicaid Services (CMS). DOM is approaching the first milestone known as the Operational Readiness Review (ORR), which must occur prior to MESA Go-Live. As such, immediate efforts are focused on this review. The second milestone review is known as the Certification Review and comes 6-12 months following MESA Go-Live.
Successful ORR and subsequent CMS certification are critical to DOM, our providers and beneficiaries. Without CMS certification, DOM would not receive federal reimbursement. In our case, this equates to 75% of our total Medicaid expenditures.
What is Certification?
Federal certification is the procedure by which CMS validates that State Medicaid systems are designed to support the efficient and effective management of the program and satisfy the federal requirements, regulations, and directives. The CMS authority for requiring Federal certification is based, in part, on language found at Public Law 92-603, and the Code of Federal Regulations (CFR) at 42 CFR 433 and 45 CFR 95.611(d). In the absence of Federal certification, Medicaid systems are not authorized to receive enhanced Federal matching funds for their operation which places a significant impact on the State of Mississippi’s Medicaid budget.
The following vendors along with DOM have identified leads to handle the various activities associated with certification. The following individuals comprise the Certification Team.
- Solution Provider (Gainwell): Amy Strait
- Independent Validation and Verification (PCG): LeAnne Scott
- Project Management Office (CSI): Vivian de la Gandara
- DOM: Susan Wadsworth
In a series of meetings with each functional module, the MRP Certification Team will be meeting with DOM Subject Matter Experts (SMEs) to review CMS defined outcomes, metrics and identify which outcomes will need to be demonstrated to CMS, develop state ORR evidence and presentation material. Part of these efforts will determine who from each DOM functional area will present their respective MESA elements to CMS.
Between August 9-19, DOM will hold various practice sessions wherein the Certification Team and DOM will review presentations and provide feedback. The practice sessions will culminate in a “dry run” consisting of an end-to-end dress rehearsal of all SMC areas.
SMEs should plan to prioritize certification efforts for dates below. Scheduling activities will evolve as it is determined which MESA modules will be presented across the three days. DOM has agreed with CMS that the state’s ORR dates will be as displayed below.
Please be on the lookout for additional information from the Certification Team. Any questions should be directed toward Susan Wadsworth: firstname.lastname@example.org.