PL 001.pdf

PL 001

Table 1 MES Acronyms Acronym Definition Details APIs Application Programming Interfaces Interfaces allowing MES Modules to communicate and transfer data.

ATO Authority to Operate Contractor must acquire ATO from

SCDHHS/SCDDSN prior to processing of government data, with ATO maintenance and review intervals determinant upon the term of Contract award.

CDML Contract Deliverables Management List Outlines the minimum expected requirements for SCDHHS third-party contracts, including deliverables and their respective standards.

CEF Conditions for Enhanced Funding CMS-defined expectations State Medicaid Agencies are required to meet in order to receive CMS Certification of MES Modules.

CFO Chief Financial Officer SCDHHS CFO and Executive Steering Committee member.

CIO Chief Information Officer SCDHHS CIO and Executive Steering Committee member.

CISO Chief Information Security Officer SCDHHS CISO.

CLTC Community Long Term Care SCDHHS provider group operating home and community-based waiver programs for persons eligible for institutional care, but prefer to receive their services in the community.

CMS Centers for Medicare & Medicaid Services

Federal governing body for State Medicaid programs.

DASH Delivery of Automated Systems for Healthcare

SCDHHS’ internal Project Management Office.

DDI Design, Development, Implementation Initial solution implementation phase, concurrent with the Implementation Phase of the EVV Contractor’s contract.

DDSN Department of Disabilities and Special Needs

South Carolina state agency that provides services to children and adults with severe, lifelong disabilities.

EDT Electronic Data Transfer The method through which SCDHHS’ case management system, Phoenix, transfers Provider, Beneficiary, and service information to the existing EVV system on a near real-time basis.

ET Eastern Time Eastern Time Zone.

EVV Electronic Visit Verification Method of verification for healthcare services provided in the home or other approved locations.

FedRAMP Federal Risk and Authorization Management

United States federal government compliance program that promotes the adoption of secure cloud services in government agencies.

FERPA Family Educational Rights and Privacy Act

United States federal law governing access to educational information and records by public entities such as potential employers, publicly funded educational institutions, and foreign governments.

FFS Fee for Service Home Health services model in which providers are reimbursed for each service rendered.

HHCS Home Health Care Services Health care services delivered in the beneficiary’s home, or other approved location.

HIPAA Health Insurance Portability and Accountability Act

United States federal law requiring the creation of national standards to protect sensitive patient health information from being disclosed without patient knowledge or consent.

IVR Interactive Voice Response Allows EVV system users to provide EVV data via a landline when cellular and/or GPS connection is not available.

IV&V Independent Verification & Validation SCDHHS’ IV&V Vendor will provide IV&V oversight of DASH Program initiatives, including the EVV Project, and serve as an executive Steering Committee Member.

JAD Joint Application Design Development and finalization of business requirements with the system vendor, following vendor onboarding.

JSON JavaScript Object Notation SCDHHS’ case management system, Phoenix, uses near real time data transfer via Representational State Transfer (REST) APIs using the JSON format.

KPI Key Performance Indicator A CMS-defined, quantifiable measures of performance over time, required for CMS Certification.

LTL Long Term Living Long Term Living is the division whose mission is to promote a comprehensive, coordinated continuum of long-term care options that support South Carolina’s citizens to maintain their health and independence in the setting of their choice at the least cost to taxpayers.

MARS-E Minimum Acceptable Risk Standards for Exchanges

Set of privacy and security standards for Affordable Care Act administering entities and their subcontractors.

MCO Managed Care Organization Entities that serve Beneficiaries on a risk basis through a network of contracted providers.

MDM Master Data Management A discipline in which business and IT work together to ensure the uniformity, accuracy, stewardship, semantic consistency and accountability of the MES’ official shared master data assets.

MES Medicaid Enterprise System The collection of systems, modules, and business functions that comprise SCDHHS’ Medicaid program.

MES Core MES (Medicaid Enterprise System) Core MES Core serves as the SCDHHS enterprise information hub for providing a consistent way of integrating with the different components in the Enterprise Architecture

MMIS Medicaid Management Information System

Automated Medicaid claims processing and information retrieval system.

MMRS Member Management Replacement System

Medicaid Member eligibility and enrollment determination system.

NIST National Institute of Standards and Technology

United States Department of Commerce Agency promoting industrial competitiveness and innovation in government agencies.

OCS Office of Cybersecurity SCDHHS’ internal information assurance office

OIM Office of Information Management SCDHHS subagency led by the SCDHHS CIO.

OS Operating System Software required to support a computer or cellular device’s basic functions, including execution of the proposed EVV application.

PCS Personal Care Services Services provided to eligible beneficiaries, which allow them to stay in their own homes and communities rather than institutional settings.

PDF Portable Document Format Document format.

PMO Project Management Office The DASH Team serves as the PMO for the

SCDHHS CIO.

QIO Quality Improvement Organization Organization that provides utilization control for Medicaid services. This includes utilization reviews, pre-payment reviews, quality reviews and prior authorizations.

REST Representational State Transfer Software architecture that ensures interoperability between different computer systems on the internet by providing communication standards.

RPO Recovery Point Objective Maximum acceptable data loss after recovery from system failure, disaster, or data loss incident.

RTO Recovery Time Objective Maximum acceptable amount of elapsed time SCDHHS South Carolina Department of Health and

Human Services South Caroline state agency responsible for the administration of South Carolina’s Medicaid program.

SCDIS South Carolina Division of Information Security

Part of the South Carolina Department of Administration’s Office of Technology and Information Services that is responsible for a variety of statewide policies, standards, programs and services relating to cyber security and information systems.

SIT System Integration Testing Software testing phase that verifies all system components are integrated and work together as expected.

SLA Service Level Agreement A set of expectations between service provider and customer defining the standards to be followed throughout the established contract period.

SMA State Medicaid Agency Agency responsible for administering a State’s Medicaid program.

SOA Service Oriented Architecture A method of software development that uses software components called services to create business applications.

SME Subject Matter Expert SCDHHS employees and contractors providing subject matter expertise regarding requirements, design and development, and testing.

SSP System Security Plan Required Contractor deliverable via CDML.

SSAE Standards for Attestation Engagements Security and privacy control to be considered in

Contractor’s security and privacy program.

TDE Transparent Data Encryption Encryption method for database files.

TLS Transport Layer Security Protocol that encrypts data transmitted over the internet.

TPL Third Party Liability Third Party Liability MMIS subsystem. System that manages the legal obligation of third parties to pay all or part of the expenditures for medical assistance furnished under a State plan.

UAT User Acceptance Testing The phase of software testing in which the software is tested using real word scenarios by the end users or business representative.

VPN Virtual Private Network A VPN protects users by encrypting their data and masking their IP address making their internet activity and location both private and anonymous.