CMS Certification Management

The Centers for Medicare & Medicaid Services (CMS) certification for enhanced Federal Financial Participation (FFP) has changed significantly, which means how your state’s Medicaid systems qualify for FFP has changed. Eclipse Certification and Compliance Services (ECS) is designed with your project’s success in mind and provides comprehensive and cutting-edge management based on the new Streamlined Modular Certification/Outcomes-Based Certification (SMC/OBC) requirements.

ECS provides states with the knowledge, experience, guidance, and tools to plan, prepare for, and ultimately achieve ongoing FFP needs. Leveraging PCG’s decades of Medicaid experience, ECS brings valuable lessons learned, leverageable successes, and most importantly, unparalleled expertise to support your certification and funding goals.

Why PCG’s Certification Management Services?

More Time, Less Worry

Certification can be easier than you think. ECS removes some of the uncertainty involved in critical Medicaid Enterprise System (MES) milestones by helping states understand and navigate federal regulations and CMS' evolving approach to MES certification and enhanced federal funding. Our experienced team eases the burden on state resources by monitoring for updates to CMS requirements and guidance and helping adjust plans when changes occur. By engaging ECS, states can reduce the number of staff needed to manage artifacts, coordinate schedules, and run preparation meetings.

PCG brings best practices and decades of experience from our work on certification efforts across states and agencies. PCG has collaborated with each state’s CMS State Officer and recognizes the critical importance of strong partnerships and collaboration between state and federal agencies. We can help to reduce risk by identifying potential areas of concern for early review with federal partners.

As an organization at the forefront of SMC/OBC Certification, PCG expertly and collaboratively supports organizations, either module-by-module or at the enterprise level, through the critical stages of CMS Federal Certification.

How can ECS help you?

Strategic Planning
System Development Support
Quality Performance Measurement
Data Analytics and Management
System Security Compliance Assessment
Testing Compliance Assessment
Governance Support
Operations and Maintenance Support
Ongoing Compliance

Strategic Planning—States require strategies for successful planning and long-term, tactical development. From assisting with advanced planning documents (APD) drafting, to establishing MES roadmaps and module sequencing, ECS devises impactful approaches for requesting and receiving enhanced federal funding. Our clients are assured of a comprehensive understanding of multifaceted federal regulatory requirements.

System Development Support—ECS System Development Support covers a wide range of services including verifying solution requirements, aligning requirements with outcomes/metrics, and developing state-specific outcomes/metrics. ECS supports states in drafting the CMS Certification Intake Form, preparing intake form criteria responses, and validating the proposed evidence prior to both Operational Readiness Review (ORR) and Certification Review (CR) milestone events.

Quality Performance Measurement—State Medicaid Agencies need to craft strategic outcomes and precise metrics, so that they can ensure tangible results and measurable successes. ECS serves as a valuable resource for states as they navigate Medicaid program complexities and develop solutions tailored to their needs.

Data Analytics and Management—Data validation, management, and analytics are top priorities for achieving business goals and objectives. ECS utilizes the power of data to drive business successes. This work is central to successful CMS certification and qualification for ongoing, or operational, enhanced federal funding.

System Security Compliance Assessment—System security is vital to successful CMS certification and qualification for enhanced federal funding after a system goes live. ECS draws on a wealth of industry experience in providing states with seamless execution, as well as meticulous monitoring, of third-party security assessments. Whether PCG is conducting or monitoring the assessment, each state’s success remains the top priority.

Testing and System Training—Each state’s certification success relies on robust testing capabilities aligned with CMS testing guidance framework. ECS assists states with developing their capabilities. This process includes three primary target areas: quality assurance, effective and dynamic training, and the most ideal testing resource allocation.

Governance Support—

When states achieve strong governance practices, they promote transparency, accountability, improved decision-making, risk management, and long-term sustainability. Strategic organizational change management (OCM) planning and data quality assurance are at the heart of ECS’s governance support services. This enables the ECS team to assist states with Medicaid Information Technology Architecture (MITA) State Self Assessments, Health Insurance Portability and Accountability Act (HIPAA) compliance, risk management and mitigation, and vital project management office (PMO) functions.

Operations and Maintenance Support—States need a certification roadmap that takes them well beyond go-live. ECS helps clients draft operational reports for the final certification review and continues to support them through their maintenance and operations phases. ECS also develops the processes and plans for managing parts of the enterprise that receive enhanced funding but do not go through certification milestone reviews. This supports reporting across all components of the MES.

Ongoing Compliance—Streamlined modular certification (SMC) makes it critical for states to monitor operational reporting and confirm that they maintain compliance with the Conditions for Enhanced Funding. As CMS may identify MES modules for reapproval, continuous evaluation of the metrics and early identification of possible issues helps to secure enhanced funding without interruption. The ECS team works proactively and handles issues in a timely manner, with the goal of preserving enhanced funding.