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Eligibility Performance – Through Quality Assurance

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A state agency needed to ensure their redesigned eligibility system follows the standards and conditions published by The Centers for Medicare and Medicaid Services (CMS). Greentree was brought into the project after a difficult start – the project had been admonished by the state accounting office, had changed vendors twice, and was in danger of not meeting the standards and conditions required to receive matching Federal funds.

The Greentree Group Solution

Playing a critical role between the vendor and the state offices, Greentree developed a quality assurance plan that focused on project management and system development life cycle processes and products. Our consultants worked with I.T. and the business areas at all levels to educate and explain the requirements of the federal standards and conditions. We performed a Fit Gap analysis beginning with the current project management and system development life cycle processes, resources, and products then proposed the appropriate improvements or modifications to meet the standards and conditions. Our team continually monitored the improvement throughout the rollout of the system, performed verification of system design and development, and provided reports to CMS on agency adherence to the standards and conditions. Greentree also developed the process for providing risk and issue identification and monitoring, lessons learned, knowledge transfer, and validation of requirements.

Results

The agency has successfully met the standards and conditions through three consecutive System Advance Planning Process (APP) approval cycles. Greentree’s reports to CMS demonstrated our expert knowledge and our independent view of the state agency’s adherence to the standards and conditions. Greentree reports have been identified by CMS as best practice examples for the rest of the states implementing eligibility systems.

Our verification and validation of the system rollout also produced attestation letters for submission to CMS. This state agency was the first state to provide an attestation letter to CMS for successful connection to the Federally-Facilitated Marketplace.

During the length of the contract, The Greentree Group’s role has transformed from initial quality assurance and reporting to also include process improvement, data conversion, software engineering, and testing as the program continues through new releases. The Greentree Group is recognized throughout the agency as a critical asset to the eligibility system’s success.

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