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How EY can help
Public Health Emergency (PHE) unwinding has been completed; however, CMS may begin assessing compliance before then, making the call to action for states immediate.
The key question facing states is how they will confirm that their MES is fully compliant with all existing federal regulations and applicable sub regulatory guidance. While states could manually review each individual regulation in the Code of Federal Regulations (CFR), refer to historic State Medicaid Director Letters (SMDLs) for additional guidance or even review the state’s own project documentation from when legacy regulatory changes were implemented, there are more efficient ways to confirm their compliance. Tools and technologies exist that can support states with this effort. Technology such as artificial intelligence (AI), machine learning, automation and data-driven dashboards can help states:
- Ingest regulations, policies and other documents to identify rules
- Automate rule mapping to responsible units or systems within the agency
- Collect evidence of compliance and build a longitudinal repository
- Test current MES functionality to assess compliance
- Report compliance status in real time through user-based dashboards
While there is an immediate need for states to confirm their current compliance, CMS also plans to continue monitoring smart compliance on an ongoing basis. Now is the time for states to build a long-term, modern strategy for approaching risk and compliance to protect their federal funding. A modernized strategy includes leveraging tools that can increase the efficiency and accuracy of regulatory identification, implementation, reporting and continued compliance. This long-term approach can enable states to: