implementation advance planning document - …...the operations phase constitutes all operations or...

IMPLEMENTATION ADVANCE PLANNING DOCUMENT - UPDATE

For Systems Integrator/ Florida Medicaid Management

Information System/ Fiscal Agent Operations/ Decision Support System

For

Planning and Research Related to Procurement of a Systems Integration, Enhancements to a MMIS, New Fiscal Agent, and a

Replacement DSS

State of Florida Agency for Health Care Administration

Division of Medicaid

September 2015

Florida Medicaid Management Information System, Systems Integrator, Fiscal Agent Operations, and Decision

Support System Implementation Advance Planning Document:2018 Procurement

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Table of Contents

Section 1 Executive Summary ................................................................................................ 4

1.1 Systems Integrator Role in Operations ........................................................................ 4

Section 2 Project Management Plan ....................................................................................... 6

2.1 Project Scope ............................................................................................................. 6

2.1.1 SI/FMMIS/FA/DSS-DW Project ............................................................................ 6

2.1.2 DSS OPERATIONS ............................................................................................. 9

Section 3 Proposed Budget and Cost ALlocation .................................................................. 12

3.1 Proposed Operations Phase Budget ......................................................................... 12

3.2 Proposed Operations Phase Cost Allocation............................................................. 14

3.3 MMIS Detailed Budget Template (MDBT) for Operations Phase ............................... 15

Section 4 Statements and Assurances .................................................................................. 17


Support System Implementation Advance Planning Document:2018 Procurement

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Table of Exhibits

Exhibit 1-1: Systems Integrator Scope of Effort – Operations .................................................... 5

Exhibit 2-1: FMMIS/FA Major Activities ..................................................................................... 8

Exhibit 2-2: FMMIS/FA Project – Deliverables ........................................................................... 9

Exhibit 2-3: DSS Project – Major Activities .............................................................................. 10

Exhibit 2-4: DSS Project – Deliverables .................................................................................. 11

Exhibit 3-1: Operations Phase Budget Detail .......................................................................... 13

Exhibit 3-2: Operations Cost Allocation ................................................................................... 14

Exhibit 3-3: Cost Allocation – MMIS Detailed Budget Template (MDBT) ................................. 16

Exhibit 4-1: CMS Seven Conditions and Standards Compliance Matrix .................................. 18

Exhibit 4-2: Procurement Assurances ..................................................................................... 19


Support System Implementation Advance Planning Document-Update:2018 Procurement

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SECTION 1 EXECUTIVE SUMMARY

This document is an update to the Design, Development, and Implementation (DDI) Implementation Advance Planning Document (IAPD) created by the Florida Agency for Health Care Administration (AHCA or Agency) for the procurement of a systems integrator (SI), new fiscal agent (FA) contract and enhancements to, or development of, the Florida Medicaid Management Information System (FMMIS) and Decision Support System (DSS). This project, related to the procurement, is referred to as the SI/FMMIS/FA/DSS-DW Project (the Project).

This update to the DDI IAPD (IAPDU) is submitted per CMS’ written request dated August 12, 2015, to separate the funding request by period into two separate documents: one for the DDI period of the Project, and one for the Operations phase. This IAPDU should be considered as an addendum to the DDI IAPD submitted to the Centers for Medicare & Medicaid Services (CMS) on August 24, 2015 and should be reviewed in conjunction with the DDI IAPD.

This IAPDU provides budget and cost allocation information related to the Operations of the FMMIS and DSS. The five year Operations Phase is scheduled to begin on July 1, 2018 and end on June 30, 2023. Current total estimates for the Project indicate the five year Operations period to cost $263,360,780.

1.1 SYSTEMS INTEGRATOR ROLE IN OPERATIONS

The primary vendor of the SI/FMMIS/FA/DSS-DW Project will serve as systems integrator during the Operations phase of the Project. The scope of effort for this role is summarized in Exhibit 1-1: Systems Integrator Scope of Effort – Operations.



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Exhibit 1-1: Systems Integrator Scope of Effort – Operations

For the duration of the Operations phase, the systems integrator will be required to:

Ensure that all systems required to be interoperable with Medicaid function together appropriately and have the ability to share and receive data

Deploy the activities, architecture, and tools necessary for achieving consistent access to data across the Medicaid enterprise in order to meet the data needs of Florida Medicaid and its business processes

Be uniquely accountable for the interoperability of the MMIS and DSS with other Medicaid support systems

Deliver business results through effective and efficient business processes

Leverage Code and Technology reuse

Support interoperability between systems inside and outside the Agency, continuing to incorporate industry standards (e.g. HIPAA)



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All other information related to the SI/FMMIS/FA/DSS-DW Project can be found in the DDI IAPD, which includes:

Summary of Planning Activities

Statement of Needs and Objectives

Requirements and Alternatives Analysis

Proposed Budget and Cost Allocation (Design, Development, and Implementation (DDI) period only)

Attachments

SECTION 2 PROJECT MANAGEMENT PLAN

The basis for developing the Agency’s FMMIS/FA/DSS Project Management Plan is centered on the preparation, maintenance, and use of quality deliverables to meet the requirements and expectations of the project’s strategies and plans. The project will follow a well-structured, clearly defined project plan applied in a disciplined manner. A project team consisting of state and contract staff will employ industry standards and best practices for project management throughout the project life cycle.

2.1 SI/FMMIS/FA/DSS-DW PROJECT SCOPE

2.1.1 SI/FMMIS/FA PROJECT

The SI/FMMIS/FA/DSS-DW Project will be conducted in the following phases, which may be adjusted based on the successful Vendor’s approved plan for these phases. Even though the Agency has combined the MMIS and DSS in one contract, it is recognized that the solutions offered will most likely result in a prime MMIS vendor and separate DSS subcontract in order to meet the needs of Florida Medicaid contained in the solicitation requirements. This document separates the two systems to illustrate the diverse activities and deliverables.

Operations

The Operations Phase constitutes all operations or “production processing” work required of the Vendor, and begins at the set point in time when the Vendor receives the first claim for production processing. Operations includes, but is not limited to, the processing of claims and encounters for payment, maintenance and/or upgrading of all components of the claims process system, support of all elements of recipient file maintenance operations, document imaging, mailroom activities, training activities, and support of all elements of the provider relations operations.

The Operations Phase is anticipated to run from July 1, 2018 through the end of the contract on June 30, 2023.

Federal Certification

Federal certification of the FMMIS using the CMS MECT criteria is a mandated requirement. The Vendor, for the purpose of obtaining federal certification, must plan to cooperate fully with



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the Agency and its stakeholders, including all Medicaid Enterprise Vendors and sub-Contractors whose products and/or ancillary services interface with the FMMIS.

Upon the contract effective date, the Vendor will be provided with updated information regarding the MITA SS-A, the Medicaid Enterprise Toolkit Checklists, and the MITA Traceability Matrix. These documents, all of which have been developed to reflect Florida-specific business processes, mapped to specific solicitation document requirements, and included on the MITA Traceability Matrix for measurement and reporting purposes, will provide the information and tools necessary for the Vendor’s development of processes to achieve CMS certification.

While some certification activities will occur directly after the contract is signed, the primary tasks for the Federal Certification Phase are anticipated to run from January 1, 2018 through March, 2019.

Turnover

The Vendor must prepare for turning over responsibilities and operations at the end of the contract. The Vendor must cooperate with the successor fiscal agent, other Vendors, and the Agency in the planning and transfer of operations. The Vendor must dedicate special additional resources to this phase. This phase will begin about twelve months before the end of the contract period and end about six months after the end of the contract period, or as extended by the exercise of contract provisions or amendments to the contract.

Turnover will consist of three sub-phases:

Turnover Preparation

Post-Turnover Support

Transfer of Vendor Operations

The Turnover Phase is anticipated to run from July 1, 2022 through December 31, 2023.

Major Activities

The Vendor shall set the schedule of major activities for Agency review during each phase in the work plan. All key dates are contingent upon Agency approval. All deliverables dates and key dates are contingent upon State approval. Exhibit 2-1: FMMIS/FA Major Activities below contains a general overview of the major activities to occur during each FMMIS/FA Project phase.

PHASE MAJOR ACTIVITY

Operations

Submission of Pre-Operations Deliverables

Operations Start Up

Deliver Updated Communication Plan for Review and Approval



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Deliver Operational Training Plan for Review and Approval

Deliver Data and Document Management Plan for Review and Approval

Deliver System Modification Plan for Review and Approval

Execute Initial Weekly Reports for Review and Approval


Delivery of CMS Certification Management Plan, including Schedule of Activities

Delivery of the completed MECT checklists and supporting documentation.

Delivery of CMS Certification Readiness Testing Results

Delivery of the Certification Readiness Letter to Agency

Pre-Certification meeting with CMS

Completion of the CMS Certification Review

Vendor completion of any remediation activities

Final Certification of the FMMIS

Turnover

Agency approval of Turnover Plan

Agency approval of FMMIS requirement statement

Completion of Turnover training

Completion of Turnover phase

Exhibit 2-1: FMMIS/FA Major Activities

Deliverables

The Vendor shall set the schedule of dates for submittal of major deliverables for Agency review during each phase in the work plan. All deliverables dates and key dates are contingent upon Agency approval. Exhibit 2-2: FMMIS/FA Project – Deliverables below contains a general overview of the deliverables associated with each FMMIS/FA Project phase.

PHASE DELIVERABLE

Operations

Quality Assurance Procedures and Standards Manual

Communications Plan

Weekly Status Reporting

Training Plan

Staffing Management Plan

Documentation Management Plan

Monthly Report Card

Federal Certification CMS Certification Management Plan

CMS Certification Readiness Plan



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PHASE DELIVERABLE

Completed MECT Checklists and Supporting Documentation

CMS Certification Readiness Testing Results

CMS Certification Readiness Letter

Turnover

Turnover Plan

FMMIS requirement statement

Financial Reconciliation Report

FMMIS software, files, and system, and user and operations documentation in hard and soft copy format

Turnover Results Report

Exhibit 2-2: FMMIS/FA Project – Deliverables

2.1.2 DSS/DW PROJECT

Overview

The DSSDW Project will be conducted in the following phases:

Operations

The Vendor must host, operate, maintain, and enhance the DSS and execute all responsibilities described in the procurement until each function is turned over to the successor Vendor at the end of the contract, including any optional additional periods or extensions. The Agency requires that the Vendor provide suitably qualified personnel resources and any software necessary to support the production and operation of the DSS and also meet performance requirements and performance standards described in the ITN.

The Operations Phase is anticipated to run from July 1, 2018 through the end of the contract on June 30, 2023.


Federal Certification of the DSS using the CMS MECT criteria is a mandated requirement. Federal Certification of the DSS will be conducted as a single operation, as a series of computing platforms operating seamlessly within the Agency’s designated computing environments. The Vendor, for the purpose of obtaining Federal Certification, will cooperate fully with the Agency and its stakeholders, including all Medicaid Enterprise Vendors and sub-Vendors whose products and/or ancillary services interface with the DSS.

The Federal Certification Phase is anticipated to run from January 1, 2018 through March, 2019.



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Turnover

The Vendor will prepare for turning over responsibilities and operations at the end of the contract. The Vendor will cooperate with the successor Vendor, other Vendors, and the Agency in the planning and transfer of operations. The Vendor will dedicate special additional resources to this phase. This phase will begin twelve (12) months before the end of the contract period and end six (6) months after the end of the contract period, or as extended by the exercise of contract provisions or amendments to the contract.

The Turnover Phase is anticipated to run from July 1, 2022 through December 31, 2023.

Major Activities

The Vendor shall set the schedule of major activities for Agency review during each phase in the work plan. All key dates and deliverables are contingent upon Agency approval. Exhibit 2-3: DSS Project – Major Activities below contains a general overview of the major activities to occur during each DSS Project phase.


Operations

Operations Start Up

Deliver Updated Communication Plan for Review and Approval

Deliver Operational Training Plan for Review and Approval

Deliver Data and Document Management Plan for Review and Approval

Deliver System Modification Plan for Review and Approval

Execute Initial Weekly Reports for Review and Approval

Deliver Annual White-Paper for Review and Approval


Delivery of CMS Certification Management Plan, including Schedule of Activities

Day One (1) of Operations

Delivery of the completed MECT checklists and supporting documentation

Delivery of CMS Certification Readiness Testing Results

Delivery of the Certification Readiness Letter to Agency

Pre-Federal Certification meeting with CMS

Completion of the CMS Certification review

Vendor completion of any remediation activities

Final Certification of the DSS

Turnover

Agency approval of Turnover Plan

Agency approval of DSS Resource Requirement Statement

Completion of Turnover training

Completion of Turnover

Exhibit 2-3: DSS Project – Major Activities



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Deliverables

The Vendor shall set the schedule of dates for submittal of major deliverables for Agency review and approval during each phase in the work plan. Exhibit 2-4: DSS Project – Deliverables below contains a general overview of the deliverables associated with each DSS Project phase.

PHASE DELIVERABLE

Operations

Communication Plan

Training Plan

Data and Document Management Plan

System Modification Plan


CMS Certification Management Plan

CMS Certification Readiness Plan

Completed MECT Checklists and Supporting Documentation

CMS Certification Readiness Testing Results

CMS Certification Readiness Letter

Turnover

Turnover Plan

DSS Resource Requirement Statement

Financial Reconciliation Report

DSS software, files, and system, and user and operations documentation in hard and soft copy format

Turnover Results Report

Exhibit 2-4: DSS Project – Deliverables



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SECTION 3 PROPOSED BUDGET AND COST ALLOCATION

This section presents the proposed budget and cost distribution across funding sources for the Operations Phase of the Project.

Detail budget information for the Operations Phase of the project is presented by quarter in Exhibit 3-1: Operations Phase Budget Detail.

Calculations of federal and state shares are provided in Exhibit 3-2: Operations Cost Allocation.

Cost allocation details are provided in the CMS-required format in Exhibit 3-3: Cost Allocation – MMIS Detailed Budget Template (MDBT).

3.1 PROPOSED OPERATIONS PHASE BUDGET

This sub-section includes a summary of the proposed Operations Phase budget by State and Federal fiscal years.

The following table contains a summary of the estimated budget for the overall Operations effort. Current estimates indicate the five year Operations Phase to cost $263,360,780.

Florida Medicaid Management Information System, Systems Integrator, Fiscal Agent Operations, and Decision Support System Implementation Advance

Planning Document-Update:2018 Procurement

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Exhibit 3-1: Operations Phase Budget Detail

Operations Phase

Summary Year 1 Year 2 Year 3

Total

State FY Q1 2018-19 Q2 2018-19 Q3 2018-19 Q4 2018-19 Q1 2019-20 Q2 2019-20 Q3 2019-20 Q4 2019-20 Q1 2020-21 Q2 2020-21

Federal FY Q4 2017-18 Q1 2018-19 Q2 2018-19 Q3 2018-19 Q4 2018-19 Q1 2019-20 Q2 2019-20 Q3 2019-20 Q4 2019-20 Q1 2020-21

Project overhead

State Owned Equipment $7,000,000 $350,000 $350,000 $350,000 $350,000 $350,000 $350,000 $350,000 $350,000 $350,000 $350,000

Postage $12,000,000 $600,000 $600,000 $600,000 $600,000 $600,000 $600,000 $600,000 $600,000 $600,000 $600,000

Printing $2,000,000 $100,000 $100,000 $100,000 $100,000 $100,000 $100,000 $100,000 $100,000 $100,000 $100,000

Subtotal Project Overhead $21,000,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000

Operations Contract

SI/FMMIS/FA/DSS-DW Contract

$242,360,780 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039

Subtotal Operations Contract $242,360,780 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039

Total Operations Period $263,360,780 $13,168,039 $13,168,039 $13,168,039 $13,168,039 $13,168,039 $13,168,039 $13,168,039 $13,168,039 $13,168,039 $13,168,039

Year 3 (cont.) Year 4 Year 5

State FY Q3 2020-21 Q4 2020-21 Q1 2021-22 Q2 2021-22 Q3 2021-22 Q4 2021-22 Q1 2022-23 Q2 2022-23 Q3 2022-23 Q4 2022-23

Federal FY Q2 2020-21 Q3 2020-21 Q4 2020-21 Q1 2021-22 Q2 2021-22 Q3 2021-22 Q4 2021-22 Q1 2022-23 Q2 2022-23 Q3 2022-23

$350,000 $350,000 $350,000 $350,000 $350,000 $350,000 $350,000 $350,000 $350,000 $350,000

$600,000 $600,000 $600,000 $600,000 $600,000 $600,000 $600,000 $600,000 $600,000 $600,000

$100,000 $100,000 $100,000 $100,000 $100,000 $100,000 $100,000 $100,000 $100,000 $100,000

$1,050,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000 $1,050,000

$12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039

$12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039 $12,118,039

$13,168,039 $13,168,039 $13,168,039 $13,168,039 $13,168,039 $13,168,039 $13,168,039 $13,168,039 $13,168,039 $13,168,039



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3.2 PROPOSED OPERATIONS PHASE COST ALLOCATION

This sub-section describes the cost allocation methodology and presents the overall distribution of estimated Operations Phase project costs to various funding sources.

The Agency follows the principles and standards described in the OMB Circular A-87 (Revised) in establishing an overview of anticipated costs related to the operations the FMMIS and DSS. Of particular interest to CMS, the Agency presents a cost allocation plan based on the guidelines defined in the State/Local Wide Central Service Cost Allocation Plans.

The development of the cost allocation plan followed the following assumption:

The Agency expects to close out the DDI period and enter the Operations Phase on July 1, 2018, which will continue through June 30, 2023.

Shared Costs

Benefiting Category Share Amount ($) Match Rate

Federal Share ($) State Share ($)

Operations Phase

SI/FMMIS/FA/DSS-DW Contract $242,360,780 75% $181,770,585 $60,590,195

Operations Phase Overhead (State Owned Equipment) $7,000,000 75% $5,250,000 $1,750,000

Operations Phase Overhead (Postage and Printing) $14,000,000 50% $7,000,000 $7,000,000

TOTAL SHARED COSTS $263,360,780 $194,020,585 $69,340,195

Exhibit 3-2: Operations Cost Allocation



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3.3 MMIS DETAILED BUDGET TEMPLATE (MDBT) FOR OPERATIONS PHASE

This sub-section presents the cost allocation methodology in the CMS-required MDBT format, which breaks the funding request out by FFY, FFP rate, and Medicaid Budget and Expenditure System (MBES) line item.

M&O

Equip. Overhead

CMS Share (75% FFP)

State Share (25%)

MMIS CMS Share

(75% FFP)

State Share (25%)

MMIS Enhanced

Funding 75% FFP Total

State Share Total

4A - 4B -

FY2018, Q4 $262,500 $87,500 $9,088,529 $3,029,510 $9,351,029 $3,117,010

FY2019 $1,050,000 $350,000 $36,354,117 $12,118,039 $37,404,117 $12,468,039

FY2020 $1,050,000 $350,000 $36,354,117 $12,118,039 $37,404,117 $12,468,039

FY2021 $1,050,000 $350,000 $36,354,117 $12,118,039 $37,404,117 $12,468,039

FY2022 $1,050,000 $350,000 $36,354,117 $12,118,039 $37,404,117 $12,468,039

FY2023, Q1-Q3 $787,500 $262,500 $27,265,588 $9,088,529 $28,053,088 $9,351,029

TOTAL for FFY 2018-2023

$5,250,000 $1,750,000 $181,770,585 $60,590,195 $187,020,585 $62,340,195

M&O (Mechanized

Systems)

Equip. Overhead

CMS Share (50% FFP)

State Share (50%)

MMIS CMS Share

(50% FFP)

State Share (50%)

MMIS CMS Share

(50% FFP)

State Share (50%)

Print/Post Overhead

Funding 50% FFP Total

State Share Total

5A - 5B - 5C -

FY2018, Q4 $350,000 $350,000 $350,000 $350,000

FY2019 $1,400,000 $1,400,000 $1,400,000 $1,400,000

FY2020 $1,400,000 $1,400,000 $1,400,000 $1,400,000

FY2021 $1,400,000 $1,400,000 $1,400,000 $1,400,000

FY2022 $1,400,000 $1,400,000 $1,400,000 $1,400,000

FY2023, Q1-Q3 $1,050,000 $1,050,000 $1,050,000 $1,050,000


$7,000,000 $7,000,000 $0 $0 $0 $0 $7,000,000 $7,000,000



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MMIS CMS

Share State Share

MMIS CMS Share

State Share MMIS CMS

Share State Share

TOTAL FFP STATE SHARE TOTAL

APD TOTAL (TOTAL

COMPUTABLE) 2A&B+ - 4A&B+ - 5A,B&C+ -

FY2017, Q2-Q4 $0 $0 $0

FY2018 $9,351,029 $3,117,010 $350,000 $350,000 $9,701,029 $3,467,010 $13,168,039

FY2019 $37,404,117 $12,468,039 $1,400,000 $1,400,000 $38,804,117 $13,868,039 $52,672,156

FY2020 $37,404,117 $12,468,039 $1,400,000 $1,400,000 $38,804,117 $13,868,039 $52,672,156

FY2021 $37,404,117 $12,468,039 $1,400,000 $1,400,000 $38,804,117 $13,868,039 $52,672,156

FY2022 $37,404,117 $12,468,039 $1,400,000 $1,400,000 $38,804,117 $13,868,039 $52,672,156

FY2023, Q1-Q3 $28,053,088 $9,351,029 $1,050,000 $1,050,000 $29,103,088 $10,401,029 $39,504,117


$0 $0 $187,020,585 $62,340,195 $7,000,000 $7,000,000 $194,020,585 $69,340,195 $263,360,780

Exhibit 3-3: Cost Allocation – MMIS Detailed Budget Template (MDBT)



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SECTION 4 STATEMENTS AND ASSURANCES

This section includes the following statements and assurances:

Security/Interface and Disaster Recovery/Business Continuity Requirements Statement.

Required assurances of compliance with cited Code of Federal Regulations (CFR) and CMS Seven Conditions and Standards attestation (CMS Expedited Eligibility and Enrollment Advance Planning Document Checklist).

The Agency will comply with all security and interface requirements relevant for the design, development, and implementation of the next MMIS. Specifically, the Agency will comply with the following Federal Regulations:

42 CFR 431, Subpart F (Safeguarding Information on Applicants and Beneficiaries)

42 CFR 435.960 (Standardized formats for furnishing and obtaining information to verifying income and eligibility)

45 CFR 95.617 (Software and Ownership Rights in Specific Conditions for FFP);

45 CFR 95.601 (Scope and Applicability)

45 CFR 205.50 (Safeguarding Information for the Financial Assistance Programs)

45 CFR 303.21 (Safeguarding and disclosure of Confidential Information)

Current state disaster recovery procedures and guidelines will be revised and updated appropriately to ensure security and business continuity. All MMIS, DSS, and ancillary contractors will be required to comply with these procedures and guidelines.

In its Medicaid IT Supplement (MITS-11-01-v1.0) Enhanced Funding Requirements: Seven Conditions and Standards, CMS issued conditions and standards to be met by states to be eligible for enhanced match funding. As indicated in Exhibit 4-1: CMS Seven Conditions and Standards Compliance Matrix below, the State of Florida Agency for Health Care Administration attests that the project will comply with the CMS Seven Conditions and Standards.

# CONDITION NAME AND DESCRIPTION COMPLIANCE

YES NO

1

Modularity Standard

Use 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.

X

2

MITA Condition

Align to and advance increasingly in MITA maturity for business, architecture, and data. Complete and continue to make measurable progress in implementing MITA roadmaps.

X



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# CONDITION NAME AND DESCRIPTION COMPLIANCE

YES NO

3

Industry Standards Condition

Ensure 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 law; 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.

X

4

Leverage Condition

Promote sharing, leverage, and reuse of Medicaid technologies and systems within and among states.

X

5

Business Results Condition

Support accurate and timely processing of claims (including claims of eligibility), adjudications, and effective communications with providers, beneficiaries, and the public.

X

6

Reporting Condition

Produce transaction data, reports, and performance information that would contribute to program evaluation, continuous improvement in business operations, and transparency and accountability.

X

7

Interoperability Condition

Ensure seamless coordination and integration with the 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.

X

Exhibit 4-1: CMS Seven Conditions and Standards Compliance Matrix

The Agency plans to use open and competitive procurements for all contracted work related to the design, development, and implementation of enhancements to the FMMIS, and the procurement of the DSS. The procurement process will be in compliance with all applicable federal regulations and provisions as indicated in Exhibit 4-2: Procurement Assurances.

PROCUREMENT STANDARDS COMPLIANCE

YES NO

45 CFR Part 95.613 Procurement Standards X

45 CFR Part 92 Uniform Administrative Requirements for Grants and Cooperative Agreements to State, Local, and Tribal Governments

X

SMM Section 11267 Required Assurances X

SMD Letter of 12/04/1995

Letter to State Medicaid Directors regarding the policy on sole source procurements and prior approval requirements for certain procurements.

X

ACCESS TO RECORDS COMPLIANCE

YES NO

45 CFR Part 95.615 Access to Systems and Records X




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SOFTWARE & OWNERSHIP RIGHTS, FEDERAL LICENSES, INFORMATION SAFEGUARDING,

HIPAA COMPLIANCE AND PROGRESS REPORTS

COMPLIANCE

YES NO

42 CFR Part 431 Safeguarding Information on Applicants and Beneficiaries X

42 CFR Part 433.112 (b) (5)-(9)

FFP for Design, Development, Installation or Enhancement of Mechanized Claims Processing and Information Retrieval Systems

X

45 CFR Part 95.617 Software and Ownership Rights X

45 CFR Part 164 Security and Privacy X


IV&V COMPLIANCE

YES NO

45 CFR Part 95.626 Independent Verification and Validation X

Exhibit 4-2: Procurement Assurances

implementation advance planning document - …...the operations phase constitutes all operations or...

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