Seven Standards and Conditions

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The Seven Standards and Conditions, as introduced by the Business Architecture of the Medicaid Information Technology Framework consist of the following[1]:

Modularity Standard

Modularity Standard- Uses a modular, flexible approach to systems development, including the use of open interfaces and exposed Application Programming Interfaces (API); the separation of business rules from core programming; and the availability of business rules in both human and machine-readable formats. The States commit to formal system development methodology and open, reusable system architecture.

MITA Condition

MITA Condition- States align to and advance increasingly in MITA maturity for business, architecture, and data.

Industry Standards Condition

Industry Standards Condition- Ensures alignment with, and incorporation of, industry standards: the Health Insurance Portability and Accountability Act of 1996 (HIPAA) security, privacy and transaction standards; accessibility standards established under section 508 of the Rehabilitation Act, or standards that provide greater accessibility for individuals with disabilities, and compliance with federal Civil Rights laws; standards adopted by the Secretary under section 1104 of the Affordable Care Act; and standards and protocols adopted by the Secretary under section 1561 of the Affordable Care Act.

Leverage Condition

Leverage Condition- States solutions should promote sharing, leverage, and reuse of Medicaid technologies and systems within and among states.

Business Results Condition

Business Results Condition- Systems should support accurate and timely processing of claims (including claims of eligibility), adjudications, and effective communications with providers, beneficiaries, and the public.

Reporting Condition

Reporting Condition- Solutions should produce transaction data, reports, and performance information that contribute to program evaluation, continuous improvement in business operations, and transparency and accountability.

Interoperability Condition

Interoperability Condition- Systems must ensure seamless coordination and integration with Exchange (whether run by the state or federal government), and allow interoperability with health information exchanges, public health agencies, human services programs, and community organizations providing outreach and enrollment assistance services.

Notes

  1. SS-A Companion Guide 3.0, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/SS-A.zip