March26, 2012

DEPARTMENT OF HUMAN RESOURCESAND

DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Affordable Care Act (ACA) Healthcare Reform Project Overview

Maryland Medicaid Advisory Committee

PMO

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Agenda

1. Goals for Health Care Reform Project Implementation

2. Progress at a snapshot

3. Health Care Reform Project Scope Overview

4. IT Vendor (Procurement) Update

5. Project Governance/Supporting Organizations

6. Role of DHR/DHMH

7. High-level Timeline

8. Detailed Timeline (including Milestones)

9. Transition Plan

10. Discussion

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Goals for Health Care Reform Project Implementation

1. Assist MD citizens in getting affordable healthcare by providing a “no wrong door” easy-to-use multiple channel gateways to MD health assistance programs.

2. To provide a technology platform, which facilitates the implementation of Affordable Care Act (ACA) requirements as defined by State of MD stakeholders (DHMH, DHR, Exchange) including:

• Eligibility, Shopping Exchange(s), Enrollment, Plan Certification, Reporting

3. To protect the public trust by providing a technology platform that is:

• Cost Effective, Scalable, Security-Enabled and Designed for Future Enhancements

4. To build a scalable platform that easily integrates health and social services programs.

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Progress at a snapshotFollowing illustration represents progress of MD Healthcare Reform Project, which has

primarily been led by the Program Management Office (PMO), instituted in May 2011.

PMO Team Starts

OctJun Jul Aug SepMay

Strategy

Delivery

Methodologies

Documentation

Strategy

Methodologies Documentation

Delivery

Progressively Elaborated Structured Approach

5/16

BRD (Business Requirement

Document)

Federal ACA Reqs

MD ACA Reqs

As-is / To-be

Risks / Constraints

Scope In / Out

Regulations / Statutory Compliance

RFI(Request for Information)

19 responses / 7 invitations / 6 demos

Market Research 2-hour sessions

Purpose not to down select

Findings based on functionality versus vendors

FRD(Functional Requirement Document)

Detail requirements from all stakeholders, including but not limited to: DHR, DHMH, DOIT, MIA, and various offices within

Detail process flows illustrating user and system interactions

Decomposition and inclusion requirements based on continuously published federal regulations from CCIIO

RFP(Request for Proposal)

Draft Complete

Stakeholders Review

Leadership / Board Approval

Publish RFP

Receive / Evaluate RFP

Includes: DHR, DHMH, DOIT, Governor’s Office

Nov Dec Jan

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Healthcare Reform Project – Scope Overview This is high-level representation of the end-to-end process steps, stakeholders and which

step will be discussed during each JAD session for the Health Care Reform project.

I. P

re-S

cre

en

II.

Inta

ke

& R

eg

istr

ati

on

(C

ust

om

er ID

Val

idat

ion

)

III.

Ve

rifi

ca

tio

n o

f C

us

tom

er

Info

IV.

Eli

gib

ilit

y

De

term

ina

tio

n

VI.

Pla

n P

res

en

tme

nt

& e

Co

mm

erc

e H

UB

VII

. P

lan

En

roll

me

nt

IX.

Pre

miu

m P

ay

me

nt

Tra

ck

ing

X.

Ins

ura

nc

e C

arr

ier

Ma

na

ge

me

nt

XI.

SH

OP

(in

clu

des

Sm

all

Bu

sin

ess

Ow

ner

Man

agem

ent)

XII

. Ag

en

t /

Na

vig

ato

r M

an

ag

em

en

t

XIV

. O

utr

ea

ch

VII

I. A

cc

ou

nt

/ C

as

eM

an

ag

em

en

t

V.

Tax

Cre

dit

/ S

ub

sid

y

Ca

lcu

lati

on

XII

I. R

ep

ort

ing

ExchangeDHMH DHRLegend:

Legend:

Sta

ke

ho

lde

rs*

JA

D

Se

ss

ion

Eligibility Enrollment Change in Circumstances Case Management ACA Functions for Insurance All

*Stakeholder’s include Executive Champion, Policy, End-User as well as Technology experts.

XV

. N

oti

fic

ati

on

s

MIA

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IT Vendor (Procurement) Update

• Vendor Select for the MD HIX is the Noridian Team

• Offers the most complete and mature “out of the box” COTS solution:• Social services eligibility, enrollment, and customer relationship management (Curam),

• Plan Management and online Plan Comparison and Enrollment (Connecture).

• Provides the robust operational, technical, and data management capabilities required by the State:

• Large scale social service technical and administrative management (Noridian),

• The EXACT™ Service Oriented Architecture (SOA) platform (Noridian),

• Maryland specific data management and integration (CNSI)

• Detailed project management plan and knowledgeable and experienced staff support achievement of aggressive implementation time lines

• Solution and licenses are extensible to later implementation phases: SHOP (Phase 1B), Non-MAGI determinations (Phase 2), & other social services (Phase 3)

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Supporting Organization(s)The following (primary and secondary) organizations are supported by this project:

Exchange

DHR

DHMH

Governor’s Office

DOIT MIA

Legal Counsel

Carriers TPA’s

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Role of Maryland DHR/DHMH• DHR, DHMH and HIX will be participating in a Business Process

Reengineering (BPR) effort to answer key operational questions.

• Decisions around the role of the Department of Human Resources and the Exchange as well as their operating models have not been solidified yet.

• BPR will also address the role of the Local departments• how and when the Local department offices will be affected and to what extent;

• will the Locals need to use multiple systems;

• how to handle the influx and exchange information etc.

• We realize no BPR process can succeed without input from the Local stakeholders and we will be requesting their active participation.

• The BPR effort is expected to start in April 2012 and continue through August 2012.

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Phase 1A – Selected Exchange Functions and MAGI Medicaid

Eligibility Determinations(Mandatory Task Order)

High-Level Timeline Following adjusted high-level timeline illustrates that based on our current

delays we would be compressing Phase 1A already by two months. Maryland does not have the flexibility to extend the end date as it driven by ACA.

2011 2012 2013 2014 2015

Phase 1A – Selected Exchange Functions and MAGI Medicaid

Eligibility Determinations(Mandatory Task Order)

Phase 2 – Integrating Non-MAGI Medicaid

Determinations

Phase 3 – Integrating Social Services

Programs

Phase 1B – Operations, Hosting & Other Selected

Services (Optional Task Order)

2016 2017 2018 2019

Phase 1B – Maintenance Option

(Optional Task Order)

Phase 1B – Maintenance Option

(Optional Task Order)

Phase 1B – Maintenance

Option(Optional Task

Order)

• Establish a Technology Platform (or “HIX”) that allows for enrollment in Exchange plans and SHOP;

• Conducts eligibility determinations and supports case management services for Advance Premium Tax Credits, cost-sharing reductions, Modified Adjusted Gross Income (MAGI)-related Medicaid categories, and MCHP.

• Incorporate eligibility determinations and case management services for Non-MAGI Medicaid eligibility categories

• Incorporate eligibility determinations and case management services for human services programs such as SNAP and TANF.

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Detail Timeline Following detail timeline illustrates that based on current delays, we compress the

Development & Test by almost a full quarter. Additionally, DDR & FDDR milestoneis also extended by the same.

Maryland does not have the flexibility to change the date of Certification that is set by ACA to be January 1, 2013.

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Transition Plan The purpose of the Transition-In Plan is to efficiently and effectively insert the Vendor into the

Exchange environment in order to optimize utilization of resources and time. Additionally, the transition plan will ensure the Vendor and Exchange are in sync across the critical on-boarding tasks that are required for a project of this magnitude and aggressive timeline.

The following diagram articulates some of the key incoming transition activities the Vendor will need to accomplish in order to successfully integrate into the State environment. Details for each task follow in subsequent table slides.

31 – 60 Days 61 - 90 DaysFirst 30 Days

Status Reporting

Kick Off & Project Administration

Validation of Work Products

Requirements to COTS Cross-walk

Facilities and Logistics

Review MD EA Repository

Project Management Documentation

Provide Application Licenses

Detailed Design Documentation

Data Management Plan

Technical Architecture

Testing Strategy

Data Use Agreements

Interface Control Documentation

Capacity Planning & Provisioning

Detailed Design Review

Automated Code Review

Physical & Logical Data Models

Data Conversion Plan

System Integration Strategy

On-Boarding & Training

Sprint Execution

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Discussion

1. Discuss Role of a Navigator

• Will support MAGI components only (Case Workers will continue with Medicaid and Non-MAGI)

• Other Navigator functions to be determined and contracted out by the Exchange

2. CARES

• Current – CARES is a COBOL-based case management system which keeps track of eligibility for Medical Assistance (MA) and other social services. CARES will remain the system of record for Non-MA services. MA Case Management system will have a bi-directional information exchange with CARES.

• To-Be – CARES will remain the system of record for Non-MAGI and social services. Eligibility information for Non-MAGI and social services will flow back and forth from CARES to Exchange.