User needs

There are two core user groups: states and federal reviewers. There are some overlapping needs across both user groups, but there are also some key differences.

State users

The state users include states and territories but are commonly referred to, simply, as states. An APD is often authored by multiple people on the state-side. Some of these people include program managers, contractors, HIT coordinators, and finance.

State user pain points

• The lengthy turnaround time for APD approvals
• Doing the budget math manually
• Copying and pasting information and tables from multiple places without a single source of truth
• Versioning APDs is done via redlining which can be overwhelming after several edits
• There are multiple communication methods with their State Officer (email, phone call) and back and forth conversations aren't always timely
• The CMS review process is a black box

State user needs

• States need to know what's expected by their State Officer
• States need an easy way to fill out and submit their APDs
• States need to be able to ask questions and respond to questions in a straightforward way
• States need a timely approval for their APD so they can begin their projects and plan accordingly
• States need help with the math and should be able to rely on automatic calculations
• States need to be able accommodate external writers/contractors who manage the APD creation process

Federal users

The federal users include State Officers who are the CMS folks who review the states' APDs. This user group is commonly referred to as "federal reviewers." It can be a little confusing that CMS reviewers' official titles are State Officer, but keep in mind that State Officers are CMS employees who are responsible for overseeing and reviewing the state's APDs.

Federal user pain points

• Having to sift through long narratives to pull out the relevant information
• Having to follow up with states when there is missing or unclear information in their APD
• Double checking all of the math to make sure it adds up correctly
• APD formats vary from state to state which adds additional burden to reviewing because it takes time getting used to each format
• State officers are intended to oversee the IT implementations of projects and how they align to Business needs of the Medicaid project, however they spend most of their time reviewing APDs/Contracts, so the actual oversight part is not as strong.

Federal user needs

• CMS needs to be able to determine if the APD request is allowable, reasonable, and realistic
• CMS needs to be able to review the APD in a timely manner
• CMS needs a standardized, consistent view of APDs for reviewing
• CMS needs an easy way to ask follow-up questions about the APD
• CMS needs a quick response from states to any questions that are asked
• CMS needs states to transition from previous usual content of APDs to an outcomes focus
• CMS needs financial information to be more manageable, structured, and available to other CMS staff