MMIS Technical Analysis

Medicaid Management Information System (MMIS) replacement projects are technically complex, large-scale efforts to transform the business processes and technologies that are used by state Medicaid Agencies (SMAs) to manage their Medicaid operations. Each state is responsible for performing due diligence to ensure that the technology solutions are sound.

The Centers for Medicare and Medicaid Services (CMS) provides extensive guidance to SMAs on the required due diligence process.

The following CMS frameworks support this process:

• Medicaid Information Technology Architecture (MITA 3.0)
• MITA 3.0 Business Process Areas and Business Processes
• Medicaid Enterprise Certification Toolkit (MECT ver. 2.3)
• Medicaid Outcomes-Based Certification (OBC)

Charles Goolsby has extensive experience in monitoring and assessing State and MMIS vendor compliance with CMS and other industry best practices for monitoring and controlling the technical quality of MMIS solution designs and solutions.

As a highly experienced software developer, Charles applies his experience to the technical assessment of MMIS solutions to ensure compliance.

Services:

• Review of solution requirements and design documentation to ensure compliance with CMS standards and MMIS system certification criteria
• Provide review of vendor requirements and design document deliverables to ensure alignment with Medicaid Information Technology Architecture (MITA 3.0) technical standards for MMIS solutions.
• Provide guidance and recommendations to State Medicaid Agencies (SMAs) regarding the best solution options for a given technical scenario
• Create system design document (SDD) content for solutions
• Author MITA concept of operations (ConOps) documents
• Author MMIS solution designs and related Unified modeling Language (UML) diagrams
• Present on solution technical subjects at CMS certification review conferences for MMIS solutions