Implementation ADVANCE PLANNING DOCUMENT For Florida ...€¦ · a Research and Planning Vendor to assist the Agency with business needs assessment through a MITA 3.0 State Self-Assessment

Implementation ADVANCE PLANNING DOCUMENT

For Florida Medicaid Management Information System/

Fiscal Agent Operations/ Decision Support System/ Data Warehouse

For

Planning and Research Related to Procurement of a New Fiscal Agent, Enhancements to a MMIS and Development of a DSS/DW

State of Florida Agency for Health Care Administration

Division of Medicaid

June 2015

Florida Medicaid Management Information System, Fiscal Agent Operations, and Decision Support System

Implementation Advance Planning Document: Fiscal Agent 2018 Procurement

ii

Table of Contents

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

Section 2 Summary of Planning Activities ............................................................................... 2

2.1 Planning Phase Budget and Expenditures .................................................................. 2

2.2 Progress of Planning Activities .................................................................................... 3

2.2.1 Research and Options Development ................................................................... 3

2.2.2 Project Management, Oversight, and DDI Support .............................................. 4

2.2.3 Independent Verification and Validation (IV&V) .................................................... 5

2.2.4 Subject Matter Expert (SME) Support .................................................................. 6

2.2.5 User Acceptance Testing (UAT) Services ............................................................ 7

2.2.6 Organizational Change Management (OCM) Services ......................................... 7

2.2.7 Procurement and Solicitation Activities ................................................................ 8

Section 3 Statement of Needs and Objectives ...................................................................... 10

3.1 Statement of Need .................................................................................................... 10

3.2 Agency Programs and Services Environment ........................................................... 11

3.3 Agency Technical and Operational Environment ....................................................... 15

3.3.1 MITA Maturity Capabilities ................................................................................. 16

3.4 Agency Goals and Objectives ................................................................................... 18

3.5 Statement of Objectives for Enhanced FMMIS and Replacement DSS/DW .............. 19

3.6 Adherence to CMS Seven Conditions and Standards ............................................... 21

Section 4 Requirements and Alternatives Analysis................................................................ 22

4.1 Requirements Analysis ............................................................................................. 22

4.1.1 FMMIS/FA and DSS/DW Requirements ............................................................. 23

4.2 Alternatives Analysis ................................................................................................. 24

4.2.1 Procurement Options ......................................................................................... 24

4.2.2 Process of Ranking Procurement Options ......................................................... 25

4.2.3 Alternatives Evaluation Criteria .......................................................................... 26

4.2.4 Final Scores ....................................................................................................... 26

4.3 Cost Benefit Analysis ................................................................................................ 26

4.4 Comparison of Alternatives and Recommended Solution.......................................... 28

4.5 Solution Choice and Potential Advantages ............................................................... 29



iii

Section 5 Project Management Plan ..................................................................................... 30

5.1 Project Scope ........................................................................................................... 30

5.1.1 FMMIS/FA Project ............................................................................................. 31

5.1.2 DSS/DW Project ................................................................................................ 37

5.2 Project Organization and Resources ......................................................................... 44

5.2.1 Project Organization Chart ................................................................................. 44

5.2.2 Roles and Responsibilities of Key Project Governance Entities ......................... 49

5.2.3 Internal and External Stakeholders .................................................................... 51

5.2.4 Personnel Resource Statement ......................................................................... 53

5.3 Project Schedule ....................................................................................................... 53

5.4 Period of Use ............................................................................................................ 54

Section 6 Proposed Budget and Cost Allocation ................................................................... 56

6.1 Proposed Budget ...................................................................................................... 57

6.2 Proposed Cost Allocation .......................................................................................... 59

6.3 MMIS Detailed Budget Template (MDBT) ................................................................. 60

Section 7 Statements and Assurances .................................................................................. 62

Section 8 Attachments .......................................................................................................... 65



iv

Table of Exhibits

Exhibit 2-1: Planning Budget and Expenditures To Date ........................................................... 3

Exhibit 2-2: Research and Planning Milestones and Deliverables ............................................. 4

Exhibit 2-3: Project Management Office Milestones and Deliverables ....................................... 5

Exhibit 2-4: IV&V Milestones and Deliverables .......................................................................... 6

Exhibit 2-5: Contracted SME Leads Milestones and Deliverables ............................................. 7

Exhibit 2-6: UAT Milestones and Deliverables ........................................................................... 7

Exhibit 2-7: OCM Milestones and Deliverables.......................................................................... 8

Exhibit 2-8: Agency Solicitation Schedule ................................................................................. 9

Exhibit 3-1: Agency Values ..................................................................................................... 12

Exhibit 3-2: Growth in Medicaid Caseload ............................................................................... 13

Exhibit 3-3: Growth in Medicaid Service Expenditures ............................................................ 14

Exhibit 3-4: MITA Business Areas Affected by FMMIS/DSS/DW ............................................. 18

Exhibit 3-5: MITA and Agency Goals Alignment ...................................................................... 18

Exhibit 3-6: Agency Goals and Objectives ............................................................................... 20

Exhibit 3-7: CMS Seven Conditions and Standards ................................................................ 21

Exhibit 4-1: FMMIS/FA and DSS/DW Requirements ............................................................... 23

Exhibit 4-2: Summarized Score – Combined Qualitative and Financial ................................... 29

Exhibit 5-1: FMMIS/FA Project – Major Activities .................................................................... 35

Exhibit 5-2: FMMIS/FA Project – Deliverables ......................................................................... 37

Exhibit 5-3: DSS/DW Project – Major Activities ....................................................................... 42

Exhibit 5-4: DSS/DW Project – Deliverables ........................................................................... 44

Exhibit 5-5: FMMIS/FA/DSS/DW Project Organization Chart .................................................. 45

Exhibit 5-6: FMMIS/FA/DSS/DW Project Governance Structure ............................................. 47

Exhibit 5-7: Project Governance Roles and Responsibilities ................................................... 51

Exhibit 5-8: Agency Executive Structure ............................................................................. 52

Exhibit 5-9: Major External Project Stakeholders ..................................................................... 53

Exhibit 5-10: Project Timeline and Milestones ......................................................................... 54

Exhibit 6-1: Budget Detail ........................................................................................................ 58

Exhibit 6-2: Cost Allocation ..................................................................................................... 59

Exhibit 6-3: Cost Allocation – MMIS Detailed Budget Template (MDBT) ................................. 61

Exhibit 7-1: CMS Seven Conditions and Standards Compliance Matrix .................................. 63

Exhibit 7-2: Procurement Assurances ..................................................................................... 64



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SECTION 1 EXECUTIVE SUMMARY

On February 5, 2015 the Centers for Medicare & Medicaid Services (CMS) approved the Florida Medicaid Planning Advance Planning Document (PAPD) for the Agency for Health Care Administration (AHCA or Agency) to contract with consultants to provide research and planning, project management office (PMO), and independent verification and validation (IV&V) services to assist with the procurement of a new fiscal agent (FA) contract and enhancements to, or development of, the Florida Medicaid Management Information System (FMMIS) and Decision Support System (DSS/DW)/Data Warehouse (DW). This project, related to the procurement, is referred to as the FMMIS/FA/DSS/DW Project. Because the Agency anticipates there will be two separate solicitations and awards – one for the FMMIS/FA and one for the DSS/DW – those two initiatives are referred to as the FMMIS/FA Project and the DSS/DW Project, respectively. The Agency expects both implementation phases to complete by July 2018.

To support the definition and selection of a procurement approach, the Agency contracted with a Research and Planning Vendor to assist the Agency with business needs assessment through a MITA 3.0 State Self-Assessment update and requirements and alternatives analysis.

Using the results of the Research and Planning Vendor’s analyses (described in detail in Section 4.2: Alternatives Analysis) and influenced by the complexity of the current health care industry landscape and AHCA’s many initiatives, especially the transition to statewide managed care, Florida selected a system takeover with upgrades and major enhancements as its FMMIS solution. This option involves significant modification or replacement of components of the existing FMMIS, and support of the existing solution is assumed or retained by the successful bidding vendor. Additionally, the Agency will procure the design, development, and implementation of a replacement DSS/DW solution through a separate solicitation.

Current total estimates for the overall FMMIS/FA/DSS/DW Project indicate the 18 month DDI period to cost $54,592,185 and the five year period that the vendors will maintain and operate the systems to cost $263,360,780 for a total project cost of $317,952,965.

Several factors contributed to the Agency’s decision, including:

Move toward modularity: The base operations of the current system, which was implemented in 2008, are adequate, yet there are opportunities to move the baseline FMMIS toward a more modular solution through major enhancements.

Reduced implementation risk: The solutions selected by the Agency allows Florida to accomplish its FMMIS/FA and DSS/DW objectives at far lower risk to the State versus, for example, custom built solutions.

Composition of service delivery: Following the recent transition to statewide managed care for recipients, the need for enhanced data analytics may overtake the need for traditional capabilities inherent in the existing systems.

MMIS Replacement/Modification Cost: The system takeover with enhancements option is estimated to have the least expense immediately, with a solid return on investment and a competitive break-even year. The financial performance of this



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option is due to a small initial investment and savings associated with lowered operating costs.

As can sometimes occur with large scale implementation projects, Agency goals for this procurement continued to develop and mature following the conclusion of the formal alternatives analysis, resulting in a procurement decision that may differ somewhat with any single alternative analyzed. The procurement options ultimately selected by the Agency – takeover of the FMMIS with upgrades and enhancements and replacement of the DSS/DW – align most closely with, respectively, the Two-Phase Systems Integrator Option and Off the Shelf Complete Solution or COTS. As of the submission of this Implementation Advance Planning Document (IAPD), the Agency has not finalized the concept or fully defined the systems integrator functions. As the Agency resolves outstanding questions, CMS will be updated through an IAPD update.

SECTION 2 SUMMARY OF PLANNING ACTIVITIES

Subsequent to the approval of the PAPD, the Agency selected a system takeover with upgrades and enhancements as their FMMIS solution. As a result, changes to the project schedule were necessary as a system takeover takes less time and has less associated risk than a full-scale system replacement. The Agency elected to shorten the design, development, and implementation (DDI) phase of the project by six months and delay the FMMIS solicitation release to allow additional time to continue planning activities. These changes impacted the original due dates of key activities and milestones described in the approved PAPD. The sections below describe the impact of those changes.

2.1 PLANNING PHASE BUDGET AND EXPENDITURES

The Agency made adjustments to the requested budget due to changes to the project schedule and approach, including the removal of User Acceptance Testing (UAT) and Organizational Change Management (OCM) services from the Independent Verification and Validation (IV&V) Vendor contract.

Exhibit 2-1: Planning Budget and Expenditures To Date shows the requested funding by Vendor for the FMMIS/FA/DSS/DW Project, as approved by CMS on December 24, 2014 through the PAPD and the amounts expended until June 2015.

RESOURCE REQUESTED BUDGET - ALL FED. FISCAL YEARS

CURRENT APPROVED IAPD EXPENDITURES

Research and Planning $2,177,303 $2,947,791 $905,032

PMO/DDI Support $11,478,861 $12,604,855 $0

IV&V $4,603,711 $3,685,742 $0

Contracted SME Leads $9,407,659 $5,099,319 $0

State staff increased FFP $821,873 $821,873 $0

State staff travel $0 $40,000 $0

UAT Vendor* $0 $345,075 $0

OCM Vendor* $0 $689,961 $0

TOTAL $28,489,407 $26,234,616 $905,032



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* formerly in IV&V Contract

Exhibit 2-1: Planning Budget and Expenditures To Date

As of the submission of this Implementation Advance Planning Document (IAPD) in FFY 2015 Quarter 2, the status of budgeted expenditures is:

$905,032 has been expended (for the Research and Planning Vendor only).

$27,584,375 remains unexpended in the overall PAPD approved budget.

Full detail on planning budget and expenditures, including a breakdown by task, can be found in Attachment B.

2.2 PROGRESS OF PLANNING ACTIVITIES

The following subsections summarize the status and progress of activities conducted in the planning phase of the project and funded through the approved PAPD.

Milestones/Deliverables listed as “NEW” in the Approved Date column indicate activities that have been added since the approved PAPD.

“Revised Milestones” in the following exhibits refer to those milestones that have been updated or changed since their inclusion in the approved PAPD to better align with the updated project schedule and the transition to electronic procurement activities.

2.2.1 RESEARCH AND OPTIONS DEVELOPMENT

The Agency contracted with a Research and Planning Vendor, CSG Government Solutions (CSG), for a variety of services throughout the planning phase of the FMMIS/FA/DSS/DW Project.

Additional details are included below in Exhibit 2-2: Research and Planning Milestones and Deliverables.

RESEARCH AND PLANNING VENDOR

MILESTONE/DELIVERABLE APPROVED DATE REVISED DATE

COMPLETION

STATUS

Contract Start Up July 1, 2014 August 28, 2014 100%

Develop Draft Work Plan July 30, 2014 September 17, 2014

100%

Comprehensive Review Of The Current MITA SS-A July 18, 2014 September 29, 2014

100%

Updated MITA SS-A and Roadmap November 26, 2014

November 21, 2014

100%

Conduct Needs Assessment And Complete Gap Analysis Based On SS-A

November 26, 2014

November 21, 2014

100%



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RESEARCH AND PLANNING VENDOR


COMPLETION

STATUS

Research of MMIS and DSS/DW technologies and operations throughout the nation

November 26, 2014

November 18, 2014

100%

Recommend Solutions For Enhancement, Replacement, Or Modifications To FMMIS And DSS/DW Based On Gap Analysis

December 12, 2014

December 12, 2014

100%

Develop Draft FMMIS, Fiscal Agent And DSS/DW solicitation Technical Requirements

April 3, 2015 June 15, 2015 88%

Produce Major Enhancements Technical Requirements

NEW July 1, 2015 88%

Crosswalk of Enhancement Requirements to Medicaid Enterprise Certification Toolkit (MECT)

NEW September 10, 2015

5%

Financial Analysis for IAPD NEW April 27, 2015 100%

Develop Evaluation Criteria for MMIS/DSS/DW Solicitation

April 15 – August 31, 2015

June 15, 2015 58%

Develop Evaluation Manual Separated task August 31, 2015 68%

Create Electronic Evaluation Tool NEW July 29, 2015 40%

Electronic Evaluation Tool Training Report NEW May 20, 2016 n/a

Vendor Conference Support for Technical Requirements and Addenda Report

September 15, 2015

February 5, 2016 n/a

Lessons Learned and Research Phase Close Out January 21, 2016 July 11, 2016 n/a

TBD – Protest Support Services Report TBD – Tentative December 2016; Not in current contract

REVISED MILESTONE RATIONALE

Develop Evaluation Criteria, Tools and Evaluator Manual for MMIS/DSS/DW Solicitation

Created separate deliverables for the evaluation criteria and the evaluation manual to reflect different due dates

Evaluator Training Plan

Deleted as separate deliverables as work was redefined to align with the solicitation vehicle and electronic evaluation tools and process

Evaluator Training Summary Report

Final Evaluation Summary And Recommendation Report

Exhibit 2-2: Research and Planning Milestones and Deliverables

2.2.2 PROJECT MANAGEMENT, OVERSIGHT, AND DDI SUPPORT

The Agency contracted with a PMO Vendor, North Highland, to establish a PMO and deliver professional and comprehensive project management services during the planning phase of the project, the DDI of the FMMIS/FA and DSS/DW solutions, and the turnover of fiscal agent operations.

Additional details are included below in Exhibit 2-3: Project Management Office Milestones and Deliverables.



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PMO VENDOR MILESTONE/DELIVERABLE APPROVED DATE REVISED DATE COMPLETION

STATUS

Contract Start Up December 2014 December 17, 2014

100%

Establish PMO December 2014 December 23, 2014

100%

Provide Office Space and Electronic Repository And Training

December 2014 January 26, 2015 100%

Final Make or Buy Analysis Report* Mid-January 2015 February 19, 2015 100%

Develop federally required components of the Implementing Advance Planning Document(IAPD)

January 31, 2015 May 22, 2015 100%

Finalize non-technical requirements and liquidated damages of the MMIS/DSS/DW/Fiscal Agent solicitation(s)

April 20, 2015 June 15, 2015 33%

Manage completion of DSS/DW Solicitation NEW August 10, 2015 29%

Manage completion of MMIS Solicitation NEW August 28, 2015 26%

MMIS/DSS/DW/Fiscal Agent Vendor conference support, Vendor non-technical solicitation requirement question research and prepare amendments written report.

September 15, 2015

February 5, 2016 n/a

Contract Management Plan NEW November 7, 2016

n/a

Comprehensive Monthly Report January 2015 – November 2018

February 2015 – November 2018

Started February 2015 and ongoing

Coordinate System and Operations Performance Standards

Early June 2018 Early June 2018 n/a

Turnover and Post Implementation reporting July 1, 2017 – December 15, 2018

July 1, 2017 – December 15, 2018

n/a

Lessons Learned Report September 30, 2018

September 30, 2018

n/a

Report to Summarize All CMS Certification/State Oversight Activities

November 2018 September 28, 2018

n/a

Project Closeout Report December 15, 2018

December 14, 2018

n/a

*Make or Buy Analysis is Florida State procurement regulation for large scale implementations

Exhibit 2-3: Project Management Office Milestones and Deliverables

2.2.3 INDEPENDENT VERIFICATION AND VALIDATION (IV&V)

On February 24, 2015, the Agency issued a Request for Proposal (RFP) which included UAT and OCM tasks. Although CMS had initially approved this approach, subsequent guidance from CMS prompted the Agency to remove the UAT and OCM tasks through an addendum to



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the RFP. A vendor protest was filed regarding the UAT and OCM tasks, and agreement was reached to reissue the solicitation as a Request for Quote (RFQ) instead of an addendum to the RFP.

The Agency released the RFQ on May 20 2015, and will contract with an IV&V Vendor in August 2015. The selected IV&V Vendor will perform independent verification and validation of the FMMIS/FA and DSS/DW Vendors’ practices in developing, implementing, and testing the system.

Additional details are included below in Exhibit 2-4: IV&V Milestones and Deliverables.

IV&V VENDOR


COMPLETION

STATUS

Contract Start Up March 2015 August 2015

Solicitation Pending

Develop IV&V Management Plan Mid April 2015 September 21, 2015

Report on the MMIS/DSS/DW/Fiscal Agent Procurement Solicitation Document(s)

NEW October 16, 2015

Report on MMIS/DSS/DW/Fiscal Agent Vendors Proposed Technical Solutions

October 16, 2015 March 31, 2016

Comprehensive Monthly Reporting May 2015 and ongoing October 15, 2015

Solicitation Compliance and Traceability Monitoring Methodology

May 2016 August 15, 2016

Implementation Planning Assessment November 2017 November 27, 2017

System Testing Validation January 2018 January 17, 2018

Assess Operational Readiness May 2018 May 18, 2018

Lessons Learned Report January 2018 September 30, 2018

Project Closeout Report December 2017 – May 2018

January 31, 2019


Develop and Execute User Acceptance Test Plan

Deleted based on CMS feedback

Organizational Change Management Plan and Execution

Deleted based on CMS feedback

Exhibit 2-4: IV&V Milestones and Deliverables

2.2.4 SUBJECT MATTER EXPERT (SME) SUPPORT

The Agency will contract with MMIS and DSS business, technical, and subject matter experts (SMEs) in April 2016. The contracted SME leads will be responsible for discussing and providing resolution to strategic business issues affecting implementation. They will be embedded in specified Agency organizational units to organize unit input to project activities,



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track down information from Agency SMEs, organize business unit review of deliverables, and consolidate business unit responses to Vendor deliverables.

Additional details are included below in Exhibit 2-5: Contracted SME Leads Milestones and

Deliverables.

CONTRACTED SME LEADS

MILESTONE/DELIVERABLE

ORIGNAL PLANNED

DATE REVISED DATE

COMPLETION

STATUS

Provide Ongoing Project Guidance, Support, and Subject Matter Expertise

January 2015 May 2, 2016 Solicitation TBD

Exhibit 2-5: Contracted SME Leads Milestones and Deliverables

2.2.5 USER ACCEPTANCE TESTING (UAT) SERVICES

The Agency will contract with an UAT Vendor in October 2017. The UAT Vendor will be responsible for independently verifying the FMMIS and DSS/DW performs appropriately in real-world scenarios users will encounter. The UAT Vendor will work with the Agency to plan, design, develop, train users, test, review, and document results of user test cases to validate FMMIS and DSS/DW functionality.

Additional details are included below in Exhibit 2-6: UAT Milestones and Deliverables.

UAT VENDOR


COMPLETION

STATUS

Contract Start Up NEW October 9, 2017

Solicitation TBD

Develop and Execute User Acceptance Test Plan

January 25, 2018 December 4, 2017

UAT Protocols and Training Manual February 15, 2018 January 2, 2018

UAT Testing Execution and Status Reporting Mar 1 – May 10, 2018 January 9, 2018 – April 20, 2018

UAT Final Results Report June 1, 2018 May 7, 2018


UAT Plan

Separated from IV&V Vendor per guidance from CMS UAT Protocols and Training Manual

UAT Testing Execution and Status Reporting

Exhibit 2-6: UAT Milestones and Deliverables

2.2.6 ORGANIZATIONAL CHANGE MANAGEMENT (OCM) SERVICES

The Agency plans to contract with an OCM Vendor in July 2017. The OCM Vendor will be responsible for managing the effect of potential changes to business processes, organizational structure, culture, etc., to maximize the benefits of change for the Agency (e.g., increased



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efficiency, improved service delivery, cost savings, etc.) while minimizing potential negative impact (e.g., employee resistance, increased cost, lost productivity, etc.).

Additional details are included below in Exhibit 2-7: OCM Milestones and Deliverables.

OCM VENDOR


COMPLETION

STATUS

Contract Start Up NEW July 10, 2017

Solicitation TBD

Organizational Change Management (OCM) Plan

April 3, 2017 September 2017

OCM Delivery Schedule and Materials Report June 16, 2017 December 2017

OCM monthly reports: OCM Sessions and Assessment of OCM Effectiveness

August 17, 2017 – March 30, 2018

December 2017 – March 2, 2018

OCM Final Report NEW March 30, 2018


Organizational Change Management (OCM) Plan

Separated from IV&V Vendor per guidance from CMS OCM Delivery Schedule and Materials Report

OCM monthly reports

Exhibit 2-7: OCM Milestones and Deliverables

2.2.7 PROCUREMENT AND SOLICITATION ACTIVITIES

The Agency will solicit via Invitations to Negotiate (ITNs) a vendor or vendors to conduct a takeover of the Agency’s MMIS/FA operations, and design, develop, and implement the desired enhancements. ITNs meet Florida’s procurement regulations and are very similar to a Requests for Proposals (RFPs), but allow the state to negotiate certain terms of the contract in order to receive the best products for the best price. In a separate ITN, the Agency will seek a vendor or vendors to design, develop, and implement a new DSS/DW solution for Florida.

The Agency’s solicitation activities are included in Exhibit 2-8: Agency Solicitation Schedule below.

AGENCY PROJECT TEAM


Submit PAPD to CMS November 22, 2013 November 22, 2013

Develop SOW for Consultant Contracts February 28, 2014 February 28, 2014

Issue Research Solicitation March 21, 2014 May 23, 2014

Award Research Contract June 2, 2014 July 10, 2014

Issue PMO Solicitation March 21, 2014 July 22, 2014

Research Contract Start Up July 1, 2014 August 27, 2014



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AGENCY PROJECT TEAM


Award PMO Contract June 2, 2014 October 10, 2014

PMO Contract Start Up July 1, 2014 December 4, 2014

Submit PAPD Update to CMS New November 21, 2014

Issue IV&V Solicitation November 24, 2014 February 24, 2015

Award IV&V Contract March 2015 August 2015

IV&V Contractor Start Up January 5, 2015 August 2015

Submit IAPD to CMS February 28, 2015 June 2015

Develop SOW For The MMIS/DSS/DW/FA Operations solicitation & Submit For Agency Review

February-March 2015 January-July 2015

Submit Solicitations for CMS review April 2015 August 2015

CMS Approval of Solicitations June 1, 2015 Ocrober 2015

Issue Solicitations July 2015 November 2015

Receive Responses September 1, 2015 March 2016

Evaluate Responses November 16, 2015 April-May 2016

Award Contracts January 4, 2016 June 2016

DDI Startup February 15, 2016 July 2016

Oversee Projects Ongoing throughout life of the project

Ongoing throughout life of the project

Day One of Operations July 1, 2018 July 1, 2018

Lessons Learned September 30, 2018 September 30, 2018

Project Closeout (end of warranty period) September 30, 2018 July 1, 2019

Exhibit 2-8: Agency Solicitation Schedule



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SECTION 3 STATEMENT OF NEEDS AND OBJECTIVES

The State should summarize the current environment and the new system needs, objectives,

and anticipated benefits. Needs may be expressed in terms of deficiencies in existing

capabilities, new or changed program requirements, or opportunities for economies or

efficiencies.

3.1 STATEMENT OF NEED

The Agency coordinates and manages health care coverage for nearly 3.8 million Floridians in all sixty-seven (67) counties, and has enrolled more than 117,000 health care providers as part of the managed care organization (MCO) network. The FMMIS and DSS/DW are the key elements of the Agency’s management and operation of the Medicaid program.

HP Enterprise Services (HPES) is the Agency’s fiscal agent for the current contract period, July 2008 through June 2018. The planning, preparation and eventual transition of a fiscal agent contract is a costly and time intensive project that historically has spanned several years. The current Medicaid fiscal agent contract with HPES ends on June 30, 2018, thus requiring the Agency to procure a new fiscal agent contract. Historically, procurement of a new fiscal agent contract has signaled either enhancement of the existing FMMIS during the turnover to the new fiscal agent or a full design and implementation of a new FMMIS.

Florida recently initiated significant changes impacting the operation of Florida Medicaid and it’s MMIS:

Florida’s transition to full state-wide managed care: The Agency implemented the long term care managed care program in November 2013 and the managed medical assistance program in August 2014.

Conversion to Diagnosis-Related Groups (DRG) inpatient hospital reimbursement methodology on July 1, 2013. The Agency anticipates additional activities associated with this critical methodology change to include outpatient services.

Florida’s planned partnership with Puerto Rico for MMIS/DSS/DW operations.

In addition to state projects, there are several critical federal initiatives affecting Florida Medicaid. Some of the more high-profile initiatives include:

Installation of ACA-mandated operating rules necessary for the electronic exchange of information with the objective of realizing administrative simplification of Health Insurance Portability and Accountability Act (HIPAA) standard transactions.

Enhancements needed to implement Transformed-Medicaid Statistical Information System (T-MSIS) which will provide CMS with expanded enrollment, utilization, and expenditure data for Medicaid and CHIP programs.

New requirements for Medicaid as a result of the Affordable Care Act, including the concept of the health insurance exchange and increased provider enrollment and screening capability.



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Transition to the mandated ICD-10 codes.

As for the DSS/DW, Florida expects support for a greater range of analytical capabilities beyond standard reporting of aggregated data. To meet these increased expectations, the Agency expects to integrate external data sources (e.g., immunization and public health records) into the Medicaid data warehouses and supply more advanced analytical tools to detect fraud and abuse and measure health outcomes. The Agency is looking for comprehensive databases allowing users to perform link analysis, predictive modeling, and anomaly detection across many disparate data sources on an ad hoc basis. Ideally, those comprehensive databases are securely hosted online (without the need for proxy access or multiple platforms), are structured and hosted with enough hardware to support several hundred users, and are designed to accommodate ad hoc querying, large volume data extraction, as well as canned state and federal reporting requirements.

The Agency is committed to furthering a culture of business intelligence and data analytics facilitating an enhanced understanding of the delivery system and the opportunity for improved health outcomes for recipients. The MITA framework is intended to support improved systems development and health care management for the Medicaid enterprise. The Agency desires to leverage the FMMIS/FA and DSS/DW procurement planning activities to fully understand the opportunities to establish more interconnected data systems to support the Medicaid enterprise. Integrating systems to create a single source of truth allows for near real time updates, enhanced monitoring of providers and prompt program exclusions. The MITA framework and the seven conditions and standards are being used throughout the project as a guide to the FMMIS and DSS/DW solutions.

3.2 AGENCY PROGRAMS AND SERVICES ENVIRONMENT1

The Agency is responsible for the administration of the Florida Medicaid program, licensure and regulation of Florida’s health facilities, and for informing Floridians on the quality of care they receive, all of which further the Agency’s mission to provide better health care for all Floridians via a health care system empowering consumers; rewarding personal responsibility; and where patients, providers, and payers work for better outcomes at the best prices. FMMIS and DSS/DW are key elements of the Agency’s management and operation of the Medicaid program.

In order to accomplish its mission, the Agency adopted the four key values seen in Exhibit 3-1: Agency Values:

1 This information was sourced from the AHCA Long Range Program Plan (LRPP) for Fiscal Year 2015-2016 through Fiscal Year 2019-2020.



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Exhibit 3-1: Agency Values

Florida is the third most populous state in the country, with the U.S. Census Bureau reporting 19.9 million residents2. Medicaid enrollment has seen a steady growth over the last decade in line with the increasing state population. Recently, due to poor economic conditions beginning with the national recession in 2009, the state’s Medicaid enrollment has grown at a faster rate than in previous years. In State Fiscal Year (SFY) 2014-2015, it is estimated that Medicaid will have served more than 3.7 million beneficiaries. Medicaid caseloads in SFY 2013-2014 were more than 65 percent higher than a decade ago. The caseload increased by 4.2 percent in SFY 2013-2014 over the prior fiscal year and is projected to increase in SFY 2014-2015 by 7.7 percent compared to SFY 2013-2014.

2 U.S. Census Bureau. (2014). Population Estimates: State Totals. Retrieved from http://www.census.gov/popest/data/state/totals/2014/index.html



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Exhibit 3-2: Growth in Medicaid Caseload

With expenditures of $22.2 billion in SFY 2013-2014, Medicaid is the largest single program in the State, accounting for roughly 31 percent of the State’s total budget. It is also the largest source of federal funding for the state. In the last ten years, expenditures in the Medicaid program grew from almost $13.1 billion in SFY 2003-2004 to $22.2 billion in SFY 2013-2014, growing nearly 70 percent in that time period (Exhibit 3-3: Growth in Medicaid Service Expenditures).



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Exhibit 3-3: Growth in Medicaid Service Expenditures

The primary factors contributing to expenditure growth have been the cost of prescription drugs, an increase in the costs to provide medical services and long-term care, and an increase in enrollment.

As a social safety net program, Medicaid enrollment and expenditures are closely tied and inversely related to economic performance. Even with improved economic conditions, Medicaid enrollment is likely to remain higher due to the federal insurance mandates at the federal level and the roll out of Statewide Medicaid Managed Care (SMMC) on the state level. Both have increased awareness of the availability of Medicaid, and many of those already eligible but not previously enrolled will likely join the Medicaid program.

Increased enrollment is not the only factor that influences Medicaid expenditures. Health care cost inflation has surpassed cost increases in other economic sectors for years. Florida’s Medicaid program was implemented as a Fee-for-Service (FFS) model more than four decades ago and since the beginning, had been primarily a FFS based program. Over the years, enrollment grew rapidly and costs soared until Medicaid expenditures were more than one-fourth of the state budget. The rapid growth in enrollment and costs made it increasingly important to find ways to manage the diverse needs of the Medicaid population while also being able to better predict and plan for cost increases.

Florida Medicaid recently implemented significant program changes resulting in improved efficiency, cost predictability and accountability for the program and enhanced service provision for program recipients. The most significant change, perhaps the single greatest change in Medicaid since the program was adopted, is the implementation of the SMMC program.



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3.3 AGENCY TECHNICAL AND OPERATIONAL ENVIRONMENT

In accordance with its mission and values, the Agency oversees and manages FMMIS, which manages recipient eligibility, provider enrollment, reimbursements, and other related services. The Agency contracts with HPES to provide FMMIS functionalities and services, which include provider enrollment, provider relations, claims authorization and processing, file exchange, and recipient eligibility management.

HPES performs services to support the following areas of FMMIS operations:

FMMIS

Core Claims and Encounter Processing – Supports editing, auditing and pricing of claims and encounters

Claims Submission – Provider application supporting claims submission, eligibility verification and claims’ status inquiry

Automated Inquiry System (AIS) – Supports phone inquiry of claims and eligibility related information for providers

Online Interface – Supports end-user functions for interaction with claims and related information

Third Party Liability (TPL) System – Supports third party recovery and liability processing conducted by a third party vendor

Pharmacy Benefits Management (PBM) – Supports payment processing and health quality program monitoring for pharmacy claims

Medicaid Enterprise User Provisioning System (MEUPS) - Security application for user access

Electronic Data Interchange (EDI) – Provides Health Insurance Portability and Accountability Act (HIPAA)-compliant / EDI transaction routing

Document Repository – Supports system documentation and change/project management

Provider Portal – Web-based interface for providers to access information and perform eligibility verification and claims’ status inquiry

Cash/Financial System – Supports cash and financial processing

Learning Management – Supports state user and provider FMMIS training and system documentation

Electronic Reporting and Image Management – Provides reporting and imaging capabilities

Recipient Management – Supports recipient and eligibility management

Provider Management – Supports provider enrollment and information management

Reference File Management – Supports tables’ maintenance for edits and audits



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Provider Network Management – Supports provider network management, credentialing, and enrollment for plans and providers

Case Management/Health Education – Supports case management and health education functions

Member Management – Supports member processing

DSS/DW

DSS/DW Ad Hoc Query Platform through Business Objects – Datamart for information management and analysis of data related to Medicaid claims and associated data

Management and Administrative Reports Subsystem (MARS) – Supports defined MARs and Statistical reporting

Surveillance and Utilization Review Subsystem (SURS) – Supports SUR analysis and reporting

Drug Claim Information – Supports specific reporting and analysis for Pharmacy Claims-related extracts and reports

Encounters Datamart within the DSS/DW – Stores managed care encounter data from contracted Managed Care Organizations

3.3.1 MITA MATURITY CAPABILITIES

In 2012, Florida conducted a full MITA 3.0 SS-A of its Medicaid program, followed by a MITA SS-A Update in November 2014. According to the SS-A, while the FMMIS/DSS/DW impacts most Medicaid business processes, it is most directly associated with those under the Care Management, Financial Management, Operations Management, Performance Management and Provider Management business areas. While these areas encompass certain business processes that were assessed as high as Level 2, the overall areas were all assessed at As-Is MITA Maturity Level 1. To-Be Maturity Level goals for these business areas remain at Level 1, with the exception of Operations Management and Provider Management at Level 2.

Achieving these Level 2 goals will require a variety of improvements to the FMMIS and DSS/DW capabilities, including implementing performance measures, a cloud environment, enhanced methods of sharing encounter information with other state agencies, and a method of tracking data on all current and past providers, including applications that have been received and are in process or have been declined. Streamlining the collection of data, establishing a single Master Provider Index that could be shared across all programs in the Enterprise; and using X12 275 transactions to reduce dependency on paper attachments associated with Medicaid transactions (i.e. claims submissions, prior authorizations and estate recovery) will also be required.

In support of these goals, Florida Medicaid subject matter experts (SMEs) identified re-procuring or enhancing the FMMIS/DSS/DW as the single most important activity required to increase MITA capabilities. The primary drivers for these capability increases include:

Automating the input from outside systems that provide data to FMMIS



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Enhancing the automated collection of data to generate fiscal agent report cards

Automating the reporting of Medicaid expenditures to the U.S. Department of Health and Human Services (HHS)

Modifying FMMIS to include eligibility information for recipients enrolled in waiver programs

Eliminating the manual gross adjustment process where possible, and using an automated online system to eliminate paper processing and improve timeliness and accountability

Centralizing or coordinating care plans and services between agencies

Consolidating all relevant provider information

Interfacing Florida Health Information Exchange (HIE) with the FMMIS

Setting up more communication systems through various agencies to perform tasks more accurately and efficiently

Facilitating data integration with sister agencies to achieve common goals

Identifying and using Commercial Off-the-Shelf (COTS) and open-source solutions collaboratively with other state agencies and entities

Exhibit 3-4: MITA Business Areas Affected by FMMIS/DSS/DW shows the major business areas and supporting processes that will benefit from FMMIS upgrades and enhancements and DSS/DW replacement, resulting in advancement along the MITA maturity continuum.



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Exhibit 3-4: MITA Business Areas Affected by FMMIS/DSS/DW

While the business processes that directly utilize the FMMIS/DSS/DW will experience the greatest impact, many other processes are indirectly affected by the FMMIS/DSS/DW and may also advance in MITA maturity through improved automation, reporting, data sharing, and other efficiencies provided by an enhanced FMMIS/DSS/DW.

3.4 AGENCY GOALS AND OBJECTIVES

Besides the Agency’s specific procurement goals, the Agency has developed comprehensive goals and objectives as part of its MITA SS-A Update, and aligned them with the MITA goals developed by CMS. These goals and objectives are described in more detail in Exhibit 3-5: MITA and Agency Goals :

MITA GOAL FLORIDA’S 2014 GOALS

Develop seamless and integrated systems that communicate effectively to achieve common Medicaid goals through interoperability and common standards

Allow no wrong door Expand flexibility and adaptability Improve accountability – use of common standards Improve fraud and abuse prevention Safeguard public health through collaboration and system

integration

Promote an environment that supports flexibility, adaptability, and rapid response to changes in programs and technology

Expand flexibility and adaptability Improve accountability – use of common standards

Promote an enterprise view that supports enabling technologies that align with Medicaid business processes and technologies

Allow no wrong door Expand flexibility and adaptability Improve accountability – use of common standards Improve fraud and abuse prevention

Provide data that is timely, accurate, usable, and easily accessible in order to support analysis and decision making for health care management and program administration

Optimize health outcomes through the sharing of clinical information Safeguard public health through collaboration and system

integration Expand flexibility and adaptability Improve accountability – use of common standards Improve fraud and abuse prevention Improve data integrity, security, analytics, and reporting

Provide performance measurement for accountability and planning

Improve health outcomes Improve accountability – use of common standards Improve fraud and abuse prevention Improve data integrity, security, analytics, and reporting

Coordinate with public health and other partners, and integrate health outcomes within the Medicaid community

Allow no wrong door Optimize health outcomes through the sharing of clinical information Restructure Medicaid; organizational change; managed Care

Exhibit 3-5: MITA and Agency Goals Alignment

The strategic roadmap included as part of the MITA SS-A described the re-procurement or enhancement of the FMMIS/DSS/DW as the top recommended activity for advancing Florida Medicaid along the MITA maturity continuum over the course of the next five years. This activity was aligned to the Care Management, Financial Management, Operations



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Management, Provider Management, and Performance Management MITA business areas; however, the breadth of capabilities associated with an enhanced FMMIS/DSS/DW is such that the Agency will likely see benefits that contribute to most Medicaid business processes.

3.5 STATEMENT OF OBJECTIVES FOR ENHANCED FMMIS AND REPLACEMENT DSS/DW

The Agency developed a comprehensive Statement of Objectives for the purpose of encouraging innovative FMMIS and DSS/DW solutions from potential vendors and aligning procurement directly with achieving those objectives. The Statement of Objectives, which will be incorporated into the FMMIS and DSS/DW procurement documents, provides the overarching framework for what the enhanced FMMIS and replacement DSS/DW will accomplish.

Exhibit 3-6: Agency Goals and Objectives describes the high level objectives that the FMMIS and DSS/DW must meet, categorized into four key areas: Functionality, Technology, Operations, and Project Delivery.

CATEGORY

COMMON

(BOTH MMIS AND

DSS/DW)

MMIS DSS/DW

Functionality

1) Advance MITA Functionality Maturity

2) Federal Certification 3) Consolidate

Functionality/Data within the Medicaid Enterprise

4) Leverage Assets and Data across the Medicaid Enterprise

5) Expand Automated Processes with a Focus on Communications, Workflow, and Electronic Records

6) Robust Fraud and Abuse Targeting, Detection and Prevention

7) Integration with Consolidated Case Management Functionality

8) Integration with Enhanced Customer Relationship Management (CRM) Functionality

1) Baseline MMIS Functionality

2) Enhanced Provider Enrollment and Management

3) Enhanced Pharmacy Services Functionality

4) Integration with Enhanced Recipient Support Functionality

5) Integration with Replacement DSS/DW

1) End-User Analytics Enablement

2) Timely and Useful Data and Metrics

3) Transparency into Health Plan Information

4) Enhanced Encounter Analytics

5) Enhanced Quality Analytics

6) Enhanced Fiscal Management and Federal Reporting

7) Enhanced Fiscal Modeling and Forecasting



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CATEGORY

COMMON

(BOTH MMIS AND

DSS/DW)

MMIS DSS/DW

Technology

1) Advance MITA Technology Maturity

2) Federal Standards and Guidance Compliance

3) Florida Standards and Mandates Compliance

4) Consistent, Predictable, and Repeatable Data Storage and Use

5) System Agility/Ease of Modification

6) Expand Ability for Integration with Enterprise Initiatives

7) Technology Refresh

1) Baseline MMIS Functionality

2) Enhanced Encounter Processing Rules

3) Enhanced Testing Environment

4) Enhanced System Documentation Tools

1) Access Anywhere 2) Secure Role-Based

Access to Tools and Data 3) On-Demand Access to

Medicaid Enterprise Data 4) Integrated Data 5) Visibility to Sources of

Data 6) Compliance and

Integration with Data Access and Analytics Standards

Operations

1) Advance MITA Operations Maturity

2) Agility in Organization Structures and Processes

3) Support Transition to Managed Care

4) Innovations in Medicaid Program Operations

5) Business Continuity and Disaster Recovery

1) Baseline MMIS Operations with Enhancements

2) Enhanced Operations Support for Manual Processes

3) Enhanced Pharmacy Clinical Support

4) Documentation Cleanup and Maintenance

5) Enhanced Agility in MMIS System Support

1) Medicaid Enterprise Data Governance

2) Data Cleansing, Validation, Normalization Support

3) Analytics Services Support

4) Data Hosting

Project Delivery

1) Ensure Federal Standards (CMS) Compliance for Project Delivery

2) Ensure Florida (AST) Compliance for Project Delivery

3) Realistic Project Schedule

4) Central Readiness/Issue Management During Transition to Operations

5) Integrated Project Management

1) Risk Management in MMIS Takeover Transition Activities

2) Support Migration to and Integration with the Replacement DSS/DW

1) Data Migration from Current Data Warehouse

Exhibit 3-6: Agency Goals and Objectives



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3.6 ADHERENCE TO CMS SEVEN CONDITIONS AND STANDARDS

As the Agency intends to request enhanced FFP to help fund its FMMIS/DSS/DW efforts, the systems are being planned to comply with the Seven Conditions and Standards as outlined by CMS and described in Exhibit 3-7: CMS Seven Conditions and Standards.

These Seven Conditions and Standards played a major role in the alternatives assessment to evaluate viable MMIS solutions, as well as in the development of the Statement of Objectives.

The Seven Conditions and Standards are also currently being incorporated into the evaluation criteria within the solicitation documents for both the FMMIS/FA and DSS/DW procurements. Following a successful award, this section will be updated with specific descriptions as to how the winning solutions align with the conditions and standards below.

Exhibit 3-7: CMS Seven Conditions and Standards

•States must use a modular, flexible approach to systems development

Modularity Standard

•States must advance increasingly in MITA maturity for Business, Information and Technical Architecture

MITA Condition

•States must ensure alignment with standards such as HIPAA

Industry Standards Condition

•States must promote sharing, leveraging and reuse of technology

Leverage Condition

•State systems must support claims, adjudications and effective communications

Business Results Condition

•States must produce transaction data, reports and performance standards

Reporting Condition

•State IT systems must ensure seamless coordination and integration with the other entities

Interoperability Condition



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SECTION 4 REQUIREMENTS AND ALTERNATIVES ANALYSIS

The regulation at 45 CFR §95.605(2) requires that the IAPD include a summary of the results of

the requirements analysis, feasibility study, and alternatives analysis. Note that copies of these

documents are not required; their submission may delay action on the APD due to increased

review time.

4.1 REQUIREMENTS ANALYSIS

The requirements section should describe the functional and technical needs, including system

interface requirements. System interface requirements may relate to IV-A, IV-D, IV-E, Medicaid,

Federal Parent Locator Service (FPLS), Child Care, State Labor and Employment, IRS, and

others as needed.

The requirements gathering and approval process allowed for multiple, iterative reviews of requirements by the Agency personnel at multiple levels, using a Requirements Traceability Matrix (RTM).

To facilitate requirements analysis, the Research and Planning Vendor (R&P Vendor) created a RTM for each Requirement Analysis and Development (RAD) area. The RTM allowed the R&P Vendor to categorize each requirement by MITA business area and relevant sections in the 2005 and 2015 FMMIS/DSS/DW solicitations, to identify a requirement’s status as a system upgrade or major enhancement, and to record meeting notes and comments to explain changes to the requirements or discussions that occurred during RADs or other meetings.

For each RAD area, the RTM was initially populated with requirements from the 2005 Florida Medicaid Fiscal Agent Procurement RFP. For business areas for which no 2005 requirements could be identified, the RTM also included relevant requirements from the MMIS Baseline Requirements spreadsheet that was compiled by the R&P Vendor’s SMEs from their research of common or typical MMIS requirements used in other implementations. In addition, Agency SME’s developed new requirements to address specific areas of concern to the state and requirements from customer service requests (CSR’s) were incorporated in the RTM.

Through a series of meetings and other communication, input from Medicaid Fiscal Agent Operations (MFAO) personnel, SMEs, and the Agency executive leadership was collected through:

Requirement Analysis and Development (RAD) sessions

Technical RAD sessions

Requirement Validation sessions

Enhancement executive direction sessions

Enhancement Requirements Finalization meetings

Upgrade Review sessions

Disposition of ongoing customer service requests (CSRs)



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MFAO requirements development

4.1.1 FMMIS/FA AND DSS/DW REQUIREMENTS

Exhibit 4-1: FMMIS/FA and DSS/DW Requirements categorizes and summarizes the high-level requirements gathered for both systems. Comprehensive and detailed requirements are currently being finalized. Any substantive changes to the summary requirements will be communicated via an IAPD-U.

Exhibit 4-1: FMMIS/FA and DSS/DW Requirements

Upgrades are defined as those requirements that represent minor improvements to features or functionality within the existing FMMIS.



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Enhancements are defined as those requirements that represent major improvements to modules within the existing FMMIS. Enhancements will require separate pricing from potential bidders.

Cross-functional modules are considered “Support Module Alternatives,” indicating that the FMMIS/FA Vendor is permitted to suggest alternative solutions. The FMMIS/FA Vendor may propose either a takeover of the existing system functionality, software, or COTS products with all defined upgrades; or could propose an alternative solution such as employing their own software or a different COTS product. In situations where an existing module cannot be taken over, the FMMIS/FA Vendor must propose an appropriate solution to meet all requirements.

4.2 ALTERNATIVES ANALYSIS

This section should also identify each of the alternatives analyzed for the system project and the

considerations and conclusions reached regarding each one. It should also identify which

alternatives were selected for evaluation of costs and benefits and provide the rationale for

selection of the chosen alternative. If applicable, system transfer is addressed, summarizing

which State systems were assessed for possible transfer and the results of the assessment.

As can sometimes occur with large scale implementation projects, Agency goals for this procurement continued to develop and mature following the conclusion of the formal alternatives analysis, resulting in a procurement decision that does not align directly with the procurement options analyzed. The procurement options ultimately selected by the Agency – takeover of the FMMIS with upgrades and enhancements and replacement of the DSS/DW – align most closely with, respectively, the Two-Phase Systems Integrator Option and Off the Shelf Complete Solution or COTS.

4.2.1 PROCUREMENT OPTIONS

The procurement options established by the FMMIS/FA/DSS/DW Project State Management Team and evaluated as part of the alternatives analysis are:

Existing, which entails a takeover of the current FMMIS with minor enhancements to keep the system up to date with federal regulations.

Enhance Existing System, involving significant modification or replacement of portions of the existing FMMIS.

Off the Shelf Complete Solution or COTS, the replacement of the current FMMIS with one that is installed by a successful bidding vendor. The solution must have been certified as a whole by CMS for at least one state.

Modular Complete Solution in which the current FMMIS is replaced by a combination of components that have not been certified as a whole by CMS. The successful bidder serves as a systems integrator for the DDI effort, and is independent from the vendor supplying the claims engine component.

Custom Development that may include a complete integrated solution or an assembly of multiple components. The Agency or vendor(s) code/integrate a system to the specifications of the state.



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Hybrid with Multiple Prime Vendors, with the Agency acting as a systems integrator overseeing multiple prime vendors who provide a variety of components that may be CMS certified individually, but may not have been certified in combination.

Two-Phase Systems Integrator Option, comprising Phase 1: a takeover of the current MMIS with enhancements and/or replacements of current functions with oversight from a systems integrator and Phase 2: migration of existing functionality to new modules, managed by the systems integrator at the Agency’s direction.

4.2.2 PROCESS OF RANKING PROCUREMENT OPTIONS

In addition to the findings of the MITA SS-A Update, Report on the Research Task and GAP Analysis Report, the ranking of procurement options in this report were based on the Alternatives Assessment Matrix (AAM) and the financial analysis.

The AAM is a tool to facilitate the comparison of possible solutions to be considered for enhancement or replacement of an MMIS. After being adapted to the requirements of Florida Medicaid, the AAM allowed the weighting, scoring and financial analysis of possible solutions in discrete steps:

Step 1 - The AAM procurement options were established by the FMMIS/FA/DSS/DW State Management Team and seven procurement options were considered.

Step 2 - Evaluation criteria were established by the FMMIS/FA/DSS/DW State Management Team and then weighted based on the priorities of the FMMIS/FA/DSS/DW Project governance committee. (Medicaid priorities and goals are detailed in the Updated SS-A and Gap Analysis Report). The evaluation criteria are described in Section 4.2.3: Alternatives Evaluation Criteria.

Step 3 - Based on the business needs identified in the Gap Analysis and the findings in the Research Report, each criterion was scored for each option. A 1 to 5 score was applied to each of the criteria, rating the option’s ability to adhere to or support each of the particular criteria.

Step 4 - The weights determined in Step 2 were combined with the scores in Step 3 to derive a weighted score. Calculations were performed by the AAM without financial considerations to produce qualitative scores.

Step 5 - The three options with highest qualitative weighted scores were selected for financial analysis. The FMMIS/FA/DSS/DW Project Management (PM) Team confirmed the three top-scoring options for financial analysis.

Step 6 - Financial analysis using historical Florida Medicaid data, as well as marketplace data to model anticipated costs, potential savings and financial risk was conducted for the three options confirmed by FMMIS/FA/DSS/DW PM Team.

Step 7 - Final calculations were performed within the AAM to generate final scores for the three selected options.



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4.2.3 ALTERNATIVES EVALUATION CRITERIA

A standard set of evaluation criteria in the AAM allowed the seven procurement options to be evaluated. The evaluation criteria include items related to the CMS Seven Conditions and Standards. First the criteria were grouped into categories, and each of the categories was weighted by State executive leadership to reflect Florida Medicaid’s priorities. The criteria categories are:

Flexibility – including criteria for longevity, interoperability, and maintainability.

Usability – for all audiences, including providers, members, and internal users.

Delivery Time – time projected for building and implementing the option.

Delivery Risk - based on the demonstrated success and complexity of the solution and burden on State staff.

Technology – including usage of COTS, adherence to industry standards, and modularity.

Feasibility – including marketplace availability, CMS compliance, and applicability to Florida.

Financial Analysis – compilation of financial data based on ROI, break-even year and financial risk.

4.2.4 FINAL SCORES

The top three procurement options that resulted from the evaluation are:

The Two-Phase Systems Integrator Option received the highest qualitative score and provides the best financial performance of the three top-scoring options.

The Enhance Existing System Option is the next alternative and provides similar financial performance and meets many of Florida’s needs.

The Off-the-Shelf Complete Solution Option is also a possible option, from a qualitative perspective, but financially may not perform as well as the other two alternatives.

4.3 COST BENEFIT ANALYSIS

The enhancement of the FMMIS and re-procurement of the DSS/DW, with solutions that will not only comply with the MITA standards set forth by CMS but will also be flexible enough to accommodate the changing landscape of Medicaid, will require a significant investment and a dedicated effort. It is necessary to consider the benefits that will ensue from an enhanced/re-procured system and compare them to the expected costs.

The scoring of a simple takeover of the existing system served as a baseline and provided a contextual “measuring stick” that the seven options described in Section 4.2.1: Procurement Options were compared against. After the completion of the analysis, the three highest ranked options are as follows:



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Two-Phase Systems Integrator Option - This option represents a plan to migrate from the existing solution to one that represents an assembly of multiple components. In the first phase, the successful bidder takes over the existing system with a targeted set of enhancements to be defined by the Agency during the requirements gathering phase. In the second phase, existing system functionality is replaced with new components from various vendors. The successful bidder serves as systems integrator for this phase.

Enhance Existing – This option considers making significant changes to modify or replace portions of the FMMIS solution currently in production. Support of the existing solution is assumed or retained by the successful bidding vendor.

Off the Shelf Complete Solution or COTS - A replacement of the current FMMIS/DSS/DW is done with one that is proposed and installed under the management of a successful bidding vendor. The solution may contain multiple components, but the combination of components must have already been installed certified by CMS in at least one state.

Financial analysis is the final step in the assessment of proposed FMMIS solutions. Below is a description of the financial analysis performed on the top three options identified in the AAM and selected by the Agency. These options are evaluated with respect to projected financial performance for a period of years after each option is placed in production.

The cost/benefit technique used in this analysis follows the guidelines and recommendations of the federal Office of Management and Budget (OMB) Circular A-94 “Guidelines and Discount Rates for Benefit-Cost Analysis of Federal Programs”. In line with OMB Circular A-94, simulation analysis was used to derive financial estimates based on constant 2013 dollars. The financial estimates include:

Total Cost: The total cost of DDI of the option

Return on Investment (ROI) at Latest Break-Even Year: The cumulative net present value (cost or benefit) of the option (DDI and Operations) divided by the cumulative investment in the option at furthest break-even year of all the alternatives. If two alternatives break even in 2027 and one in 2029, the ROI for 2029 is used.

Break Even Year: The year when the project ROI goes from negative to positive, indicating project investment has been paid off and expected benefits will start to accrue

Financial Down-side Risk Relative to Return: A measure of uncertainty in the budget due to variability in implementation times and the expected market cost of implementing a system and engaging a fiscal agent, relative to the ROI at the latest break-even year of all alternatives. It represents the risk of over-running the budget for DDI, while taking the potential return on investment into consideration.

Historical trends in Florida’s fiscal agent operations (FA Operations) were used to forecast expenditures through 2030. The team leveraged cost data from both the CMS-published Medicaid Budget and Expenditures System (MBES) and the State’s internal CMS 64.10 quarterly submissions. The Kaiser Family Foundation site, www.KFF.org , was the source for beneficiary and the Affordable Care Act (ACA) population estimates and projections were made with the assumption that no Medicaid expansion under ACA will occur in Florida. MBES

http://www.kff.org/



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information provided gross amount data for DDI and Maintenance and Operations across various levels of federal financial participation for the years 2002-2012. Prior period adjustment and base form detail from CMS 64.10 line items for the years 2009-2013 provided the opportunity to carve out expenditures specific to FMMIS and FA operations.

Kaiser provided actual beneficiary counts up to 2011 with projections for 2014 and 2022 to include ACA expansion population. The number of beneficiaries in between 2011 and 2020 was estimated assuming that no ACA expansion using linear interpolation, which is a method of constructing new data points within the range of a discrete set of known data points.

Detailed invoice and advance planning document (APD) information was used to determine which CMS 64.10 line items (beyond FMMIS maintenance and operations) contribute to FA Operations costs. In addition, this information was used to determine the FA Operations amounts to be carved out of the “All Other FFP” line item in reporting expenditures. With respect to financial performance, the Enhance Existing option is estimated to have the least expense immediately, with a good return on investment (given even a slight increase in payment accuracy) and a competitive break-even year. This is because of the small initial investment

The Off-the-Shelf-Complete Solution option has the highest DDI cost and provides the least return on investment, but has inherently less risk relative to return on investment.

The Two-Phase Systems Integrator option is expected to have the highest return versus the other two alternatives. In terms of risk relative to return, it is significantly better than the other two options because the return will offset a significant portion of the implementation risk should it go over budget.

4.4 COMPARISON OF ALTERNATIVES AND RECOMMENDED SOLUTION

Combining the qualitative alternative assessment and the financial performance analysis in the AAM provides the final combined scores. The qualitative assessment is worth 75% of the final score, and the financial performance is worth 25% of the final score. Exhibit 4-2: Summarized Score – Combined Qualitative and Financial presents a summary qualitative analysis and combines the financial performance for the final composite scores.

CRITERIA ENHANCE

EXISTING

OFF THE SHELF

COMPLETE

SOLUTION

TWO-PHASE

SYSTEMS

INTEGRATOR

Flexibility Score (Weighted)

0.59 0.72 0.72

Usability Score (Weighted)

0.78 0.94 0.94

Delivery Time Score (Weighted)

0.47 0.35 0.35

Delivery Risk Score (Weighted)

0.49 0.54 0.49

Technology Score (Weighted)

0.43 0.44 0.48

Feasibility Score (Weighted)

0.78 0.67 0.74



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CRITERIA ENHANCE

EXISTING

OFF THE SHELF

COMPLETE

SOLUTION

TWO-PHASE

SYSTEMS

INTEGRATOR

TOTAL QUALITATIVE

SCORE (WEIGHTED) 3.54 3.67 3.73

Total Financial Performance

4.25 3.50 4.75

TOTAL COMBINED

SCORE (WEIGHTED) 3.72 3.63 3.98

Exhibit 4-2: Summarized Score – Combined Qualitative and Financial

The final results:

Two-Phase Systems Integrator option scored the highest qualitative score and provides the best financial performance of the three options.

Enhance Existing system is an excellent next alternative and provides similar financial performance and meets many of Florida Medicaid’s needs.

Off-the-Shelf Complete solution is also a reasonable option, from a qualitative perspective, but financially may not perform as well as the other two alternatives.

4.5 SOLUTION CHOICE AND POTENTIAL ADVANTAGES

The Agency will pursue a takeover of the FMMIS with upgrades and enhancements, as well as the full design, development, and implementation of a replacement DSS/DW solution. The Agency is considering the benefit to Florida of pursuing a Systems Integrator for Florida. Once a final decision is reached, an update to this IAPD will be submitted to CMS. This approach will represent two separate procurements for FMMIS/FA and DSS/DW, and aligns most closely with the top ranked Two-Phase Systems Integrator Option.

In the first phase, the FMMIS/FA Vendor will take over the existing system and design, develop, and implement a targeted set of enhancements. In the second phase – a more long term timeframe set to occur over the life of the fiscal agent contract – the Agency will work with the FMMIS/FA Vendor to replace system functionality with new, more modular components.

Potential benefits and advantages of this approach include:

Improved system flexibility

Improved ease of use for all audiences, including providers, members, and internal users

Low risk relative to overall return on investment

Allows the Agency to take advantage of current and future technological innovations in a budget constrained environment

The advantages of the FMMIS/FA and DSS/DW solutions chosen by the Agency will be

expanded upon following contract award.



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SECTION 5 PROJECT MANAGEMENT PLAN

The Project Management Plan summarizes the project activities, deliverables, and products;

project organization; State and contractor resource needs; and anticipated system life. Any

significant differences from the Project Management Plan submitted with the Planning APD

should be explained.

The basis for developing the Agency’s FMMIS/FA and DSS/DW 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.

5.1 PROJECT SCOPE

This section of the Project Management Plan describes in narrative and graphics how and when

the project activities will be conducted and sets forth the resulting project documentation and

contractor deliverables.

The purpose of this project is to successfully procure a vendor for the takeover, upgrade, and enhancement of Florida’s existing MMIS, and assumption of FA operations; and, via a separate solicitation, procure a vendor for the design, development, implementation, and operation of a replacement DSS/DW.

In order to meet the Agency’s goals for this project, there are several high level objectives that must be met:

1. Effectively manage the FMMIS/FA and DSS/DW Vendors for the duration of the project to ensure that all products and deliverables are completely in a timely manner and of acceptable quality.

2. Comply with the applicable federal guidelines in the timeframes required. 3. Complete the project within the agreed budget and timeframe. 4. Deploy a federally certifiable MMIS and DSS/DW designed to operate a managed care

centric system rather than a solely Fee-For-Service centric system.

The Scope of Work (SOW) for this project will encompass all project activities related to both initiatives, ensuring along the way that they are MITA compliant and satisfy the design objectives as communicated in the CMS Seven Conditions and Standards. The SOW for both FMMIS/FA and DSS/DW projects will be fully defined within their respective ITNs.

The Agency executed contracts with contractors for research and planning activities, project management services, DDI support, and contract preparation and execution. The Agency plans to contract for IV&V services by August 2015.



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5.1.1 FMMIS/FA PROJECT

Overview

The FMMIS/FA Project will be conducted in the following phases, which may be adjusted based on the successful Vendor’s approved plan for these phases:

Initiation

During this phase, the foundation for the successful takeover of the FMMIS takeover and the design, development, and implementation of enhancements will be established. This phase also includes finalization and Agency approval of project management documents.

The Initiation Phase is anticipated to run from January 1, 2017 through March 31, 2017.

Takeover

This phase will include all of the tasks to transition the FMMIS, operations and Fiscal Agent responsibilities to the new FMMIS/FA Vendor. These activities will occur simultaneously with the Design and Development of Enhancements Phase activities.

During the Planning sub-phase, the FMMIS/FA Vendor will review the Takeover requirements as provided by the contract and conduct the necessary planning activities to make sure the project will be successfully executed. These planning activities will include developing requirements validation documents, technical design documents that define hardware and software specifications, data conversion and migration planning documents, and all necessary test plans. The incumbent Vendor will provide training to acclimate the staff of the new MMIS/FA Vendor to the HPES system installation. Many of the required plans will have been submitted with the contractor’s original proposal and will only require updating to complete. Requirements included in the takeover of the current system that require minor changes or upgrades will have been identified and described in the FMMIS/FA procurement.

The Transfer and Install sub-phase involves transferring the incumbent vendor’s supporting data and procedures to the new FMMIS/FA Vendor and installing it on the FMMIS/FA Vendor’s equipment in their data center. The transferred system must then be tested to ensure it is in an operational state.

During the Data Management sub-phase, the FMMIS/FA Vendor will conduct data conversion and migration activities, testing, reporting, and training on a routine basis through the Implementation phase.

During the Procedure Development and Documentation sub-phase, the FMMIS/FA Vendor will develop and/or update manual procedures and documentation as required by the contract. Required training of Agency staff and other stakeholders will also be developed and delivered during this phase.

During the System Test and Evaluation sub-phase, the FMMIS/FA Vendor will conduct and document the results of testing of the transferred MMIS application. These testing phases will



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include Software Unit and Component Testing, Integration Testing, Functional Testing, System Performance Testing, System Stress Testing, Acceptance and Parallel Testing and End-to-end Testing. The FMMIS/FA Vendor will correct deficiencies identified during testing, updating the system and user documentation

During the Takeover Implementation sub-phase, the FMMIS/FA Vendor will ensure that all necessary tasks are completed to ensure a timely start of Fiscal Agent operations, including training of staff, providers, and users.

The Takeover Phase is anticipated to run from March 1, 2017 through December 31, 2017.

Design and Development of Enhancements

After the contract execution, the FMMIS/FA Vendor provides a project plan for each of the FMMIS enhancements, giving a graphic overview of the timeline relationship of the design and development for each enhancement. The Agency is requesting a number of specific enhancements to the FMMIS to be developed prior to implementation of the DSS/DW. All enhancement projects listed in this phase are mandatory.

Planned major enhancements to the system include:

Pharmacy Benefit Management

Provider Enrollment and Management

Enhanced Encounter Processing Rules

The Design and Development of Enhancements Phase is anticipated to run from March 1, 2017 through December 31, 2017.

Implementation

The FMMIS/FA Vendor will begin Implementation Planning during which, the vendor will plan and prepare to assume all responsibilities of the Florida Medicaid Fiscal Agent contract as well as the planning to implement the takeover of FMMIS and all of the required enhancements and upgrades. This phase includes all of the testing and readiness activities necessary for the vendor to assume the full responsibility of FA activities. The Implementation Phase will end upon successful assumption of all fiscal agent responsibilities and resolution of startup issues.

The Implementation Phase is anticipated to run from October 1, 2017 through August 1, 2018. The scheduled Go-Live date will be on or before July 1, 2018 with Implementation activities continuing for 30 (thirty) calendar days after day one of operations to resolve any remediation activities.

Operations

The Operations Phase constitutes all operations or “production processing” work required of the MMIS/FA Vendor, and begins at the set point in time when the FMMIS/FA Vendor receives the first claim for production processing. Operations includes, but is not limited to, the



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processing of claims and encounters for payment, maintenance and/or upgrading of all components of the claims process system, 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 FMMIS/FA Vendor, for the purpose of obtaining federal certification, must plan to cooperate fully with 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 FMMIS/FA 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 FMMIS solicitation document requirements, and included on the MITA Traceability Matrix for measurement and reporting purposes, will provide the information and tools necessary for the MMIS contractor’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 FMMIS/FA Vendor must prepare for turning over responsibilities and operations at the end of the contract. The FMMIS/FA Vendor must cooperate with the successor fiscal agent, other Vendors, and the Agency in the planning and transfer of operations. The FMMIS/FA 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



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The FMMIS/FA 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 5-1: FMMIS/FA Project – Major Activities below contains a general overview of the major activities to occur during each FMMIS/FA Project phase.

PHASE MAJOR ACTIVITY

Initiation

Contract Execution

Kick-Off Meeting

Operational Primary Project Site (temporary or permanent)

Takeover

Hardware and Equipment Installation Complete

Software Installation Complete

Data Management Conversion and Migration Start

Takeover Testing Start

Agency Approval Takeover Complete


Approved Requirements Validation Document

Approved Enhancement Data Conversion and Migration Plan

Data Conversion Tools in Place

Approved Enhancement Test Management Plan

Testing Environment Ready and Loaded with Data

Reviewed Test Results

Final Enhancement Reports

Implementation

Data Conversion and Migration Completed

Training Completed

User Acceptance Testing Completed

Operational Readiness Testing/Submitted Letter of Readiness to Agency

Go Live/Day One of Operations

Operations Submission of Pre-Operations Deliverables


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



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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 5-1: FMMIS/FA Project – Major Activities

Deliverables

The FMMIS/FA 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 5-2: FMMIS/FA Project – Deliverables below contains a general overview of the deliverables associated with each FMMIS/FA Project phase.

PHASE DELIVERABLE

Initiation

Project Charter

Project Management Plan

Project Work Schedule and Work Breakdown Structure

Staffing Management Plan

Subcontractor Management Plan

Quality Management Plan

Security Management Plan

Facilities and Equipment Management Plan

Hardware and Software Management Plan

Configuration Management Plan

Business Process Management Plan

Primary Project Site

Takeover

Requirements Validation Document

Technical Design Document

Hardware and Equipment Acquisition and Installation Plan

Hardware/Software Inventory

Software Installation Plan Deliverable

Takeover Data Management Plan



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PHASE DELIVERABLE

Takeover Data Management Balancing Reports

Takeover Test Plan

Takeover Test Results

Agency Approval Takeover Complete


Requirements Validation Documents for Pharmacy Benefit Management

Requirements Validation Documents for Provider Enrollment and Management

Requirements Validation Documents for Enhanced Encounter Processing Rules

Business Design Document for Pharmacy Benefit Management

Business Design Document for Provider Enrollment and Management

Business Design Document for Enhanced Encounter Processing Rules

Technical Design Document for Pharmacy Benefit Management

Technical Design Document for Provider Enrollment and Management

Technical Design Document for Enhanced Encounter Processing Rules

Enhancement Data Management Plan

Enhancement Data Management Balancing Reports

Enhancement Test Management Plan

Enhancement Test Results

Final Enhancement Completion Report for Pharmacy Benefit Management

Final Enhancement Completion Report for Provider Enrollment and Management

Final Enhancement Completion Report for Enhanced Encounter Processing Rules

Implementation

Detailed Implementation Plan

Disaster Recovery and Business Continuity Plan

Comprehensive Test Management Plan

Comprehensive Data Management Plan

Comprehensive Training Plan

Special Contingency Plan

Operational Readiness Letter Approved

Post Implementation Evaluation Report

Operations

Quality Assurance Procedures and Standards Manual

Communications Plan

Weekly Status Reporting



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PHASE DELIVERABLE

Training Plan


Documentation Management Plan

Monthly Report Card


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

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 5-2: FMMIS/FA Project – Deliverables

5.1.2 DSS/DW PROJECT

Overview

The DSS/DW Project will be conducted in the following phases:

Initiation

During this phase, the foundation for successful design, development and implementation should be established for the DSS/DW Project. This phase also includes finalization and Agency approval of project management documents.

The Initiation Phase is anticipated to run from January 1, 2017 through March 31, 2017.

Design and Development

The Agency is requesting a number of specific design and development activities prior to implementation of the DSS/DW. All design and development activities listed in this phase are mandatory.

The DSS/DW Vendor will provide a mature and accessible product, including commercial-off-the-shelf (COTS) products where appropriate, that addresses the data conversion requirements with one comprehensive tool suite and that also interfaces with agencies,



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departments, and divisions. The product shall be configurable and interface with complex data navigation and manipulation tools, and support an advanced decision support dashboard and predictive modeling and analytics. The DSS/DW Vendor will also develop and deliver user training to educate the Agency on the new tools and the processes for transitioning their existing work to the new system.

In addition to general enhancements to the DSS/DW, the Agency requires the following features that include:

Encounter Data Use

Federal Financial Reporting

Quality Reporting

The Design and Development Phase is anticipated to run from March 1, 2017 through June 30, 2017.

Conversion

The DSS/DW Vendor will provide the planning, development, testing, and coordination of all data and file conversions required to support the operation of the replacement DSS/DW system. This will include a Conversion Plan that includes: narratives and diagrams of the enterprise data models (including logical and physical), metadata, data dictionaries, and pre-configured business rules for computing environment initialization. The information architecture may include files, databases, repositories, operational data stores, reporting repositories, parameter files, reference files, and reference information.

The DSS/DW Vendor will identify and secure the legacy systems data, data definitions, conversion rules, and migration approaches best suited to initialize and populate the Vendor’s project components architectures. The DSS/DW Vendor will assume responsibility for all legacy system data, data definitions, data cleansing, and data migrations based upon the requirements set forth to the Agency. The Vendor’s planned data conversion and migration activities will be documents, reviewed, and communicated to the Agency for approval as the requirements for a non-disruptive transition.

The Conversion Phase is anticipated to run from August 1, 2017 through January 31, 2018.

Testing

The DSS/DW Vendor’s testing methodology and approach for validating and verifying the DSS/DW in accordance with the test plan approved as part of the Project Plan will include:

A testing system that meets all detailed requirements presented in the ITN

Test cases and scripts

A dedicated test environment that will be developed and maintained

A dedicated User Acceptance Testing (UAT) test environment that will be developed and maintained



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A Testing Summary Report

Their testing approach will include:

System Testing

Interface Testing

Performance/Volume Testing

Parallel Testing

Security and Confidentiality Testing

User Acceptance Testing (UAT)

The DSS/DW Vendor’s approach will describe the methodology to be used for measuring the successful execution of all testing, including the approach to retesting in situations where initial tests fail, and how the system is tested and monitored through the equivalent of at least three (3) consecutive months of successful load, validation and reconciliation cycles. The approach will include how the results are jointly reviewed between the DSS/DW Vendor and the Agency, how the criticality of defects is ranked, and how the DSS/DW Vendor plans to support the Agency during UAT.

The DSS/DW Vendor’s approach will also describe the Test Summary that is provided to the Agency prior to each phase of Testing. Components of the Test Summary will include:

Confirmation that all earlier testing has been performed in accordance with the approved Test Plan.

Documentation that the test environment has been loaded with test data.

Confirmation that all defects discovered in previous testing and ranked as critical are resolved to the best of the Vendor’s knowledge.

The methodology for documenting and ranking defects and deficiencies discovered during Testing.

The process for updating and finalizing the Test Summary prior to moving onto the next phase of Testing.

Documented final testing results

The Testing Phase is anticipated to run from August 1, 2017 through January 31, 2018.

Implementation

Upon receipt of the Contract Execution, the DSS/DW Vendor will begin Implementation planning during which the DSS/DW Vendor will plan and prepare to assume all responsibilities of the Florida DSS/DW required by the procurement. The Implementation Phase will end upon successful assumption of all DSS/DW responsibilities and resolution of startup issues.

The Implementation Phase is anticipated to run from October 1, 2017 through August 1, 2018. The scheduled Go-Live date will be on or before July 1, 2018 with Implementation activities



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continuing for 30 (thirty) calendar days after day one of operations to resolve any remediation activities.

Operations

The DSS/DW Vendor must host, operate, maintain, and enhance the DSS/DW 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 DSS/DW Vendor provide suitably qualified personnel resources and any software necessary to support the production and operation of the DSS/DW 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/DW using the CMS MECT criteria is a mandated requirement. Federal Certification of the DSS/DW will be conducted as a single operation, as a series of computing platforms operating seamlessly within the Agency’s designated computing environments. The DSS/DW 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/DW.

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

Turnover

The DSS/DW 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 DSS/DW 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 5-3: DSS/DW Project – Major Activities below contains a general overview of the major activities to occur during each DSS/DW Project phase.


Initiation Contract Execution



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Kick-Off Meeting

Project Charter

Operational Primary Project Site (temporary or permanent)

Vendor Temporary Office Space


Approval of the Management Plan

Completion of Requirements Validation Document

Completion of Business Design Document

Completion of Detailed System Design Document

Completion of Architectural Design Document

Completion of Enterprise Data Model

Completion of System Documentation Delivery

Conversion

Conversion Plan

Conversion Results

Final Conversion Report at Implementation

Balancing Report

Testing

A test system environment ready to be used for testing prior to commencement of system testing

A UAT environment ready to be used for UAT and fully loaded with current production data prior to the commencement of UAT

Conduct Agency and UAT Vendor training for DSS/DW prior to UAT

Test scripts and cases prior to commencement of each phase of testing

An initial Test Summary at the conclusion of each phase of testing

A final Test Summary prior to commencement of implementation readiness activities

Implementation

Agency approval of the Detailed Cutover Plan and Schedule

Agency approval of Contingency Plan

Agency approval to begin Operations

Monitor & Measure System

Assumption of Operations Phase

Agency approval of Post Implementation Evaluation Report

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



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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/DW

Turnover

Agency approval of Turnover Plan

Agency approval of DSS/DW Resource Requirement Statement

Completion of Turnover training

Completion of Turnover

Exhibit 5-3: DSS/DW Project – Major Activities

Deliverables

The DSS/DW 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 5-4: DSS/DW Project – Deliverables below contains a general overview of the deliverables associated with each DSS/DW Project phase.

PHASE DELIVERABLE

Initiation

Kickoff Meeting

Project Charter

Certification letter that a Project Management Office (PMO) has been established per the DED.

Project Management Plan

Project Work Schedule and Work Breakdown Structure


Subcontractor Management Plan

Quality Management Plan



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PHASE DELIVERABLE

Security Management Plan

Facilities and Equipment Management Plan

Hardware and Software Management Plan

Configuration Management Plan

Business Process Management Plan

Operational Primary Project Site

Vendor Temporary Office Space Setup


Detailed Management Plan to include a Detailed Schedule and Work Breakdown Structure (WBS)

Requirements Validation Document (RVD)

Business Design Document (BDD)

Detailed System Design Document (DSD)

Architectural Design Document (ADD)

Enterprise Data Model (EDM)

System Documentation

Conversion

Data Conversion Plan (DCP)

Balancing Reports

Final Conversion Report

Testing

Comprehensive System Testing Plan and Summary Deliverables

Comprehensive Interfaces Testing Plan and Summary Deliverables

Comprehensive Performance Testing Plan and Summary Deliverables

Comprehensive Parallel Testing Plan and Summary Deliverables

Comprehensive Security and Confidentiality Testing Plan and Summary Deliverables

Comprehensive User Acceptance Testing Plan and Summary Deliverables

Conduct a capacity analysis of the traffic the system can handle and still meet performance requirements

Implementation

Detailed Cutover Plan and Schedule

Contingency Plan

Post Implementation Evaluation Report

Operations

Communication Plan

Training Plan

Data and Document Management Plan

System Modification Plan



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PHASE DELIVERABLE


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/DW Resource Requirement Statement

Financial Reconciliation Report

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

Turnover Results Report

Exhibit 5-4: DSS/DW Project – Deliverables

5.2 PROJECT ORGANIZATION AND RESOURCES

The State's project organization is described in overview in terms of staff, responsibility, and

relationships. The project organization, preferably shown by organization chart:

· Identifies the project manager and other key staff by name and title

· Identifies the relationship of the project team to the project steering committee (if applicable)

· Identifies interrelationships with user groups and contractors.

A common understanding of the project organization, governance, and resources is a key component of effective project management. This purpose of this section is to provide a high level overview of the project structure and framework for providing overall control and direction setting for the Project.

5.2.1 PROJECT ORGANIZATION CHART

Exhibit 5-5: FMMIS/FA/DSS/DW Project Organization Chart represents the Agency staff, Agency external stakeholders and the contractors currently planned for the FMMIS/FA/DSS/DW Project.



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MES Governance Committee

Project Director

Project Sponsor

Executive Sponsor

MES Steering Committee

Deputy Project DirectorContract Management,

Training (LMS), Field Reps.

Project Management Office

Independent Verification & Validation

Agency External Stakeholders

Subject Matter Expert (S.M.E.) Leads

Project Advisors

Research & Planning

Project Admin

MITA MOD ILead

MITA MOD IILead

MITA MOD IIILead

MITA MOD IVLead

MITA MOD VIILead

MITA MOD VLead

MITA MOD VIAnalyst

MITA MOD VIIILead

Design, Development & Implementation (DDI)

Security Coordination

MITA Coordination

Centers for Medicare and Medicaid Services

(CMS)MES Project Governance

MMIS State Management Team

MMIS Project Consulting Teams

External Stakeholders

Exhibit 5-5: FMMIS/FA/DSS/DW Project Organization Chart

Key state staff overseeing the projects are:

Executive Sponsor: David Rogers – AHCA Assistant Deputy Secretary for Medicaid Operations Mr. Rogers has nearly 12 years of experience with State Medicaid Agencies, and 20 years of experience working on Medicaid-related implementation projects. Mr. Rogers served as an Executive Sponsor for the Idaho Medicaid MMIS Replacement Project from 2004-2006.

Project Sponsor: Gay Munyon – Bureau Chief, Medicaid Fiscal Agent Operations Ms. Munyon has worked for AHCA for two years, and has 16 years of experience working on a variety of Medicaid-related implementation projects. Additionally, Ms. Munyon served as the Economic Self-Sufficiency Director of the Florida Department of Children and Families from 2012-2013. Ms. Munyon served as the vendor’s Executive Program Director for the District of Columbia, leading the DC MMIS replacement project from 2006-2010.

Project Director: Angela Ramsey – Senior Management Analyst Supervisor Ms. Ramsey has been with AHCA for 36 years, and has 18 years of experience working on Medicaid-related implementation projects, including the most recent MMIS/DSS implementation. Ms. Ramsey served as the Project Director for the ICD-10 Transition from 2011-2013.



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Deputy Project Director: Terri Fuller – Procurement Unit, Medicaid Fiscal Agent Operations Ms. Fuller has been with AHCA for nearly 30 years, and has 15 years of experience working on a variety of Medicaid-related implementation projects. Ms. Fuller served as the Project Director for the MMIS/DSS/DW Electronic Health Record Pilot from 2007-2008.

5.2.1.1 PROJECT GOVERNANCE STRUCTURE

Project governance is a framework for how decisions about the project will be made. Well defined governance is critical to project success in that it establishes the roles and responsibilities of all parties involved in the project and determines, in advance, clear decision-making processes and authority.

As events unfold throughout the project lifecycle, there may be impacts to project scope, timeline, budget or quality that require decisions. Decision making authority is aligned with the severity and potential impact of the situation at hand.

There are five tiers of governance. It is important to understand each tier’s level of decision making authority and the resulting escalation path. This enables the team to move issues though the governance framework without jeopardizing scope, schedule, budget or quality of the overall project. The project governance organization structure has five decision-making tiers:

Tier 1 – FMMIS/FA/DSS/DW Project Management Team (PMT), comprised of the Project Director, Deputy Director and State Management and contractors’ team leads, including PMO, Research and Planning, IV&V, and SMEs

Tier 2 – Project Sponsor

Tier 3 – Executive Sponsor

Tier 4 – Medicaid Enterprise Systems (MES) Steering Committee

Tier 5 – MES Governance Committee

These tiers are further illustrated in Exhibit 5-6: FMMIS/FA/DSS/DW Project Governance Structure.



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Project Director

Project Sponsor

Executive Sponsor


Deputy Project DirectorContract Management,

Training (LMS), Field Reps. Lead

Project Management Office, PM

Independent Verification & Validation

Agency External Stakeholders

Subject Matter Expert (S.M.E.) Leads PM

Research & PlanningPM

MITA MOD ILead

MITA MOD IILead

MITA MOD IIILead

MITA MOD IVLead

MITA MOD VIILead

MITA MOD VLead

MITA MOD VILead

MITA MOD VIIILead

Design, Development & Implementation, PM

Security Coordination

MITA Coordination

Tier 4 MES Steering Commitee

Tier 3

Tier 2

Tier 1

Tier 5

Executive Sponsor

Project Sponsor

Project Director


Centers for Medicare and Medicaid Services

(CMS)

Project Management TeamPMT

Other Other Project Teams & Stakeholders

Project Advisors Project Admin

Exhibit 5-6: FMMIS/FA/DSS/DW Project Governance Structure

The roles and responsibilities for the governance structure are as follows:

Tier 1 - FMMIS/FA/DSS/DW Project Management Team (PMT): Comprised of the MMIS Project Director, Deputy Director, and contractor Team Leads. The PMT will work throughout the term of the project to monitor and control project performance and will coordinate, as needed, with other Agency staff, state agencies, the legislature, and federal Medicaid administrators to provide input to decision making, contribute to project work products, and perform departmental planning, management, and coordination with regard to this project.

› Escalation: The Project Director will have authority for Tier 1 decision making. The Project Director will work with the PMT for Low priority/impact items. Low priority refers to items that do not impact critical path items, key deliverables, scope, functionality or budget.

Tier 2 - Project Sponsor: The Project Sponsor has project ownership and provides guidance on the project activities throughout the duration of the project. The Project Sponsor keeps abreast of major project activities, and is a decision-maker for the



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project. The Project Sponsor will also resolve major issues, problems, and policy questions, and review major deliverables.

› Escalation: Project Sponsor with guidance from the PMT for Medium priority/impact items. Medium priority refers to items that do not materially impact major issues, problems, and policy questions.

Tier 3 - Executive Sponsor: The Executive Sponsor will provide leadership and guidance on the overall strategic direction of the project and has overall programmatic responsibility for the successful development and implementation of the project. The Executive Sponsor is ultimately responsible for securing spending authority and resources for the project.

› Escalation: Executive Sponsor for High priority/impact items. High priority items impact critical path, key deliverables, scope, functionality, or budget.

Tier 4 - AHCA MES Steering Committee: The Agency’s MES Steering Committee will provide overall guidance and direction to ensure the project achieves the business objectives for scope, time and budget. The Steering Committee decides when issues and decisions require escalation to the MES Governance Committee with a recommended approach for resolution.

› Escalation: MES Steering Committee for items regarding schedule, scope, or budget that necessitates a contractual change and, contingent upon these, for determining whether to proceed with any major project deliverable.

Tier 5 – AHCA MES Governance Committee: The Agency’s MES Governance Committee will provide visionary and policy guidance to ensure project alignment with Agency-wide strategic policy and program initiatives. It has the authority to reset the direction of the project if deemed appropriate. The Governance Committee may make decisions without the recommendation of the Steering Committee if the circumstances require swift action.

› Escalation: MES Governance Committee for High priority/impact items regarding Federal, State and Agency legislation, policy and procedure that necessitate a change and or impact the critical path, key deliverables, scope, functionality or budget.

In addition to the project governance structure, select teams of project stakeholders meet weekly to review and discuss the status of the project and individual project work streams. The status meeting members consider key issues and actions related to aligning project activities and mutually providing incentives to various stakeholders on the project to achieve the common goal of a quality and timely delivery of the solution.

Timing for decision making is:

Tier 1 escalations should be addressed at the working team level as a course of the normal day-to-day activities.

Tier 2 escalations should be addressed during the weekly project status meetings or as appropriate.

Tier 3 escalations require action at the Executive Sponsor level, either immediately or as appropriate.



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Tier 4 escalations require action at the MES Steering Committee level as needed.

Tier 5 escalations require action at the MES Governance Committee level as needed.

5.2.2 ROLES AND RESPONSIBILITIES OF KEY PROJECT GOVERNANCE ENTITIES

Exhibit 5-7: Project Governance Roles and Responsibilities describes the roles and responsibilities for each Project governance entity. The table below includes the Project governance entities’ role and their associated responsibilities as part of the AHCA Medicaid Enterprise System governance and steering committees and the project management teams.

ROLE RESPONSIBILITY ASSIGNED STAFF


Provides visionary and policy guidance to ensure project alignment with agency-wide strategic policy and program initiatives

Has the authority to reset the direction of the project if deemed appropriate

Secretary, Agency for Health Care Administration

Chief of Staff, Agency for Health Care Administration

Deputy Secretary, Division of Medicaid Deputy Secretary, Division of Health

Quality Assurance Director, Division of Information

Technology General Counsel, General Counsel’s

Office Inspector General, Inspector General’s

Office Chief, Medicaid Fiscal Agent Operations Assistant Deputy Secretary for Medicaid

Policy and Quality Assistant Deputy Secretary for Medicaid

Operations Assistant Deputy Secretary for Medicaid

Finance and Analytics Assistant Deputy Secretary, Division of

Operations AHCA Administrator Project Director, MMIS/DSS/DW/FA

Procurement Project



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Ensures the project meets the business objectives

Provides management direction and support to the Project Management Team (PMT)

Reviews and approves any changes to the project’s scope, schedule and budget

Reviews, approves and determines whether to proceed based on regular reporting

Recommends project suspension or termination if it is determined the project will not meet its objectives

Appoints the Project Management Team, which will work under the direction of the MES Steering Committee

Chief, Medicaid Fiscal Agent Operations Project Director, FMMIS/FA/DSS/DW

Procurement Chief, Bureau of Strategic Information

Technologies Administrator, Medicaid Third Party

Liability Director, Budget Office Assistant Deputy Secretary for Medicaid

Policy and Quality Assistant Deputy Secretary for Medicaid

Operations Assistant Deputy Secretary for Medicaid

Finance and Analytics Chief of Medicaid Plan Management

Operations Chief, Bureau of Medicaid Polilcy Chief, Medicaid Quality Chief, Bureau of Medicaid Data Analytics Chief, Bureau of Medicaid Program

Finance Chief of Medicaid Program Integrity Field Office Manager, Enrollment Broker

Operations Deputy Director, FMMIS/FA/DSS/DW

Procurement Project Senior Management Analyst Supervisor AHC Administrator Senior Management Analyst II

Executive Sponsor

Provides overall project leadership and guidance in support of the overall strategic direction of the project

Has compliance review and programmatic responsibility for successful development and implementation of the system

Oversees budget and resources for the project

Champions the project and legitimizes the project’s goals and objectives

Oversees major project activities, risks, and issues, and is final approver of all scope changes before MES Steering Committee review

Secures spending authority and resources for the project

Assistant Deputy Secretary for Medicaid Operations

Project Sponsor

Oversees all key areas of the project including but not limited to: budget, staffing, work assignments, vendor management, risk identification, and mitigation

Resolves major issues, problems, and policy

Approves scope changes for escalation

Chief, Medicaid Fiscal Agent Operations



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Project Management Team

Project oversight and management Coordinates day-to-day project activities

with the project team Deliverable reviews and approval

recommendation Process and procedure knowledge sharing. Stakeholder coordination Risk and issue management, escalation,

and resolution/mitigation Provides policy expertise Oversees project management processes,

including: › Time/schedule management › Scope and requirements management › Performance management › Deliverable management › Integration management › Communications management › Scope Change management › Configuration management › Document Management › Status management and reporting

Project Director Project Deputy Director IV&V Manager Project Manager, Project Management

Office Project Manager, Research & Planning

Team Lead, Organizational Change

Management Project Manager, SME Leads Team Project Advisors

Exhibit 5-7: Project Governance Roles and Responsibilities

5.2.3 INTERNAL AND EXTERNAL STAKEHOLDERS

Stakeholders are defined as key individuals or groups that will be impacted by or can impact a project. The stakeholders described in the following sections are either directly involved in the performance and/or outcomes of FMMIS/FA and DSS/DW related programs, services, and/or business processes. Stakeholders, on an as needed basis, will be included in project communications of the PMO Vendor as well as the communications plan of the designated Organizational Change Management provider for the duration of the project.

Agency for Health Care Administration

The Agency is responsible for the administration of the Florida Medicaid program, licensure and regulation of Florida’s health facilities, and for providing information to Floridians about the quality of care they receive. The Agency is the project and system owner. As a stakeholder group it is comprised of several stakeholder sub-groups. These include, but are not limited to the AHCA Governance Committee, the AHCA Steering Committee, and the various individuals who serve on these committees. Agency leadership and staff will be ultimately responsible for successful procurement, deployment and operation of the enhanced system and oversight of the fiscal agent and system maintenance and operations contractors.



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Exhibit 5-8: Agency Executive Structure illustrates the high level organizational and executive structure of the Agency:

Elizabeth DudekSecretary

Molly McKinstryDeputy Secretary

Division of Health Quality Assurance

Tonya KiddDeputy Secretary

Division of Operations

Justin SeniorDeputy Secretary

Division of Medicaid

Jenn UngruChief of Staff

Stuart WilliamsGeneral Counsel

General Counsel’s Office

Eric MillerInspector General

Inspector General’s Office

Elizabeth KidderAsst. Deputy SecretaryMedicaid Operations

Stacy LampkinAsst. Deputy Secretary

Medicaid Finance

David RogersAsst. Deputy Secretary

Medicaid Health Systems

Katherine RiviereCommunications Director

Josh SpagnolaDirector

Legislative Affairs Office

Scott WardDirector

Division of Information Technology

Exhibit 5-8: Agency Executive Structure

Major External Stakeholders

Exhibit 5-9: Major External Project Stakeholders lists the major external stakeholders that have been identified to-date, followed by a summarization of how each will be affected by, or will participate in, the FMMIS/FA/DSS/DW Project.

MAJOR STAKEHOLDERS ROLE

Department of Children and Families (DCF)

DCF is the agency responsible for determining eligibility for many of the state’s public assistance programs, including Medicaid. DCF’s Office of Economic Self Sufficiency and Office of Substance Abuse and Mental Health share data and multiple interfaces with AHCA.

Department of Health (DOH)

DOH is a provider of children’s Medicaid related medical services and is responsible for licensing health care practitioners. County Health Departments are also providers of Medicaid related medical services. Among other information, DOH systems house immunization records of interest to the Medicaid program. There are numerous system interfaces and data exchanges between DOH and AHCA.

Agency for Persons with Disabilities (APD)

APD supports individuals with developmental disabilities in living, learning, and working in their communities. They are a provider of Medicaid related medical services and a gateway into the Medicaid program. APD and AHCA share data and several system interfaces.

Department of Education (DOE)

In addition to its statewide education related responsibilities, DOE is a provider of school-based Medicaid related medical services. DOE shares data with AHCA.

Vocational Rehabilitation (VR)

VR is administratively housed in the Department of Education and is a provider of Medicaid related medical services.



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MAJOR STAKEHOLDERS ROLE

Department of Elder Affairs (DOEA)

DOEA plays a part in determining medical eligibility for long-term care clients. DOEA shares data and interfaces with AHCA and is a frequent user of DSS/DW data.

Florida Healthy Kids (FHK)

FHK is Florida’s State Children’s Health Insurance Program (SCHIP) organization and has a role in determining eligibility for non-Medicaid children’s insurance and medical assistance programs. FHK shares data and interfaces with AHCA.

Veterans Affairs (VA) VA is a provider of nursing home Medicaid related medical services. At this time VA does not share any interfaces with AHCA, but does provide data to AHCA.

Exhibit 5-9: Major External Project Stakeholders

5.2.4 PERSONNEL RESOURCE STATEMENT

This section succinctly describes in narrative form the resource needs for which funding support

may be requested by the State. These needs may relate to State and contractor staff costs,

computer time, hardware and commercially available software, depreciation, travel, space,

supplies, telephones, photocopying, office equipment, furniture, and so forth. This information

serves as a narrative explanation of the budget (which is addressed in the next section of the

Implementation APD).

The budget presented in Section 6.1: Proposed Budget is intended to provide for all funding needed by the project. This includes State staff salaries and benefits; project overhead including rent, supplies, communications, travel and training. In addition, it provides for contracted services support, including the DDI, IV&V, Subject Matter Expert Leads, and PMO vendors.

5.3 PROJECT SCHEDULE

As previously mentioned in Section 5.1: Project Scope, the FMMIS/FA Project will be conducted in seven phases:

Initiation

Takeover


Implementation

Operations

Certification

Turnover

The DSS/DW Project will be conducted in eight phases:

Initiation


Conversion



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Testing

Implementation

Operations

Certification

Turnover

While the start and ends dates for each phase will be specified by the FMMIS/FA Vendor and DSS/DW Vendor, Exhibit 5-10: Project Timeline and Milestones below illustrates the general phase sequencing and overlap for each project and their respective project phases. Also included are three major milestones: Contract Execution, which occurs January 1, 2017; System Go Live, which occurs on July 31, 2018; and Contract End, which occurs on June 30, 2023. This timeline is purely notional pending the schedules proposed by the two Vendors. Following the awards, this timeline will be updated and resubmitted in an IAPD-U.

Exhibit 5-10: Project Timeline and Milestones

A detailed preliminary project schedule will be provided in Attachment D following award to the successful FMMIS/FA and DSS/DW Vendors via an IAPD-U. The PMO schedule management process will be used to manage updates and changes to the master project schedule.

5.4 PERIOD OF USE

This section describes the anticipated system life for the required resources, inclusive of

planning, implementation, and operational phases.

All new contracts resulting from this procurement will be in effect from the date of contract award through June 30, 2023. The state will consider the possibility and advantage of longer-term contracts based on optional extensions under good performance by the contractor(s). It



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will be the state’s intent that resulting enhanced systems be durable and flexible enough to be transferred to successive vendors and have a useful life of ten to twenty years.



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SECTION 6 PROPOSED BUDGET AND COST ALLOCATION

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

Detail budget information for the Design, Development, and Implementation Phase of the project, is presented by quarter in Exhibit 6-1: Budget Detail.

Calculations of federal and state shares are provided in Exhibit 6-2: Cost Allocation.

Cost allocation details are provided in the CMS-required format in Exhibit 6-3: Cost Allocation – MMIS Detailed Budget Template (MDBT).



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6.1 PROPOSED BUDGET

This sub-section includes a summary of the proposed project budget by FFY.

The following table contains a summary of the estimated budget for the development and implementation effort. Current estimates indicate the 18 month DDI period to cost $54,592,185 and the Operations period to cost $263,360,780 for a total FMMIS/FA/DSS/DW Project cost of $317,952,965.

The budget also includes a summary column representing costs to operate the enhanced MMIS system as well as the newly developed DSS/DW system.


Implementation Advance Planning Document Update: Fiscal Agent 2018 Procurement

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Design, Development, and Implementation Period Operations

Total State FY Q3 2016-17 Q4 2016-17 Q1 2017-18 Q2 2017-18 Q3 2017-18 Q4 2017-18 Q1 2018-19 Q2 2018-19 Q3 2018-19 - Q4 2022-23

Federal FY Q2 2016-17 Q3 2016-17 Q4 2016-17 Q1 2017-18 Q2 2017-18 Q3 2017-18 Q4 2017-18 Q1 2018-19 Q2 2018-19 - Q3 2022-23

Staff Costs

Agency Staff* $3,621,510 $420,375 $420,375 $420,375 $420,375 $420,375 $420,375 $366,420 $366,420 $366,420

Training

PBM $395,719 $395,719

Provider Enrollment & Management $253,389 $253,389

DSS/DW $1,467,543 $1,467,543

Subtotal Staff Costs $5,738,161 $420,375 $420,375 $420,375 $420,375 $420,375 $2,537,026 $366,420 $366,420 $366,420

Project overhead

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

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

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

Communication Lines $1,200,000 $150,000 $150,000 $150,000 $150,000 $150,000 $150,000 $150,000 $150,000

Facilities

DSS/DW $136,410 $22,735 $22,735 $22,735 $22,735 $22,735 $22,735

Subtotal Project Overhead $22,336,410 $172,735 $172,735 $172,735 $172,735 $172,735 $172,735 $150,000 $150,000 $21,000,000

Development Contracts

MMIS/FA Contract

Takeover Effort $10,000,002 $1,666,667 $1,666,667 $1,666,667 $1,666,667 $1,666,667 $1,666,667

PBM $5,481,325 $717,225 $952,820 $952,820 $952,820 $952,820 $952,820

Provider Enrollment & Management $3,509,833 $459,258 $610,115 $610,115 $610,115 $610,115 $610,115

Enhanced Encounter Processing Rules $261,000 $43,500 $43,500 $43,500 $43,500 $43,500 $43,500

DSS/DW Contract $20,327,741 $2,659,861 $3,533,576 $3,533,576 $3,533,576 $3,533,576 $3,533,576

PMO Contract $6,063,829 $486,408 $486,408 $656,140 $656,140 $656,140 $656,140 $638,259 $1,828,194

IV&V Contract $1,873,884 $257,659 $257,659 $257,659 $257,659 $257,659 $257,659 $210,812 $117,118

Subtotal Development Contracts $47,517,614 $6,290,578 $7,550,745 $7,720,477 $7,720,477 $7,720,477 $7,720,477 $849,071 $1,945,312 $0

Operations Contracts

MMIS/FA Contract** $165,410,460 $8,270,523 $8,270,523 $148,869,414

DSS/DW Contract** $76,950,320 $3,847,516 $3,847,516 $69,255,288

Subtotal Operations Contracts $242,360,780 $0 $0 $0 $0 $0 $0 $12,118,039 $12,118,039 $218,124,702

$317,952,965 $6,883,688 $8,143,855 $8,313,587 $8,313,587 $8,313,587 $10,430,238 $13,483,530 $14,579,771 $239,491,122

*Agency Staff required for the Design, Development, Implementation, and Certification period of the project. Operations Costs end with Certification after Q3 2018-19. **Operations Phase (Q3 2018-19 to Q4 2022-2013): Total amount assumed to spread equally over the 18 quarters of operations phase.

Exhibit 6-1: Budget Detail



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6.2 PROPOSED COST ALLOCATION

This sub-section describes the cost allocation methodology and presents the distribution of estimated project costs to various funding sources by FFY and quarter.

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 takeover of and design, development, and implementation of enhancements to the FMMIS. 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:

CMS approved some amounts in this IAPD through the PAPD. The Agency expects to close out the planning phase and enter the DDI period on January 1, 2017 (Q3 for State Fiscal Year 2016-2017, Q2 for Federal Fiscal Year 2016-2017).

Shared Costs Shared Amount: $317,952,965

Benefiting Category Share Amount ($) Match Rate

Federal Share ($) FFP

State Share ($)

Design, Development, Implementation Period

AHCA Staff $3,621,510 90% $3,259,359 $362,151

Takeover Effort $10,000,002 90% $9,000,002 $1,000,000

Pharmacy Benefit Manager DDI $5,481,325 90% $4,933,193 $548,133

Provider Enrollment & Management DDI $3,509,833 90% $3,158,850 $350,983

Enhanced Encounter Processing Rules DDI $261,000 90% $234,900 $26,100

Decision Support System and Data Warehouse DDI

$20,327,741 90% $18,294,967 $2,032,774

PMO Support Contract $6,063,829 90% $5,457,446 $606,383

IV&V Vendor Contract $1,873,884 90% $1,686,496 $187,388

Training Costs $2,116,651 50% $1,058,326 $1,058,326

Development Phase Overhead (Communications and Facilities)

$1,336,410 50% $668,205 $668,205

Total Design, Development, Implementation Period

$54,592,185 $47,751,742 $6,840,443

Operations Period

Fiscal Agent Operations (MMIS post Takeover) $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 Operations Period $263,360,780 $194,020,585 $69,340,195

TOTAL SHARED COSTS $317,952,965 $241,772,327 $76,180,638

Exhibit 6-2: Cost Allocation



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6.3 MMIS DETAILED BUDGET TEMPLATE (MDBT)

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.

Approved through DDI

APD

MMIS CMS Share

(90% FFP)

State Share (10%)

MMIS CMS Share

(75% FFP)

State Share (25%)

MMIS CMS Share

(50% FFP)

State Share (50%)

MMIS Funding FFP

Total 2A

State Share Total

2A - 2A - 2A -

FY2017, Q2-Q4 $1,135,013 $126,113 $259,103 $259,103 $1,394,115 $385,215

FY2018 $1,464,791 $162,755 $1,392,428 $1,392,428 $2,857,219 $1,555,183

FY2019, Q1-Q2 $659,556 $73,284 $75,000 $75,000 $734,556 $148,284

TOTAL for FFY 2017-2019

$3,259,359 $362,151 $0 $0 $1,726,531 $1,726,531 $4,985,890 $2,088,682

Approved through DDI

APD

MMIS CMS Share

(90% FFP)

State Share (10%)

MMIS CMS Share

(75% FFP)

State Share (25%)

MMIS CMS Share

(50% FFP)

State Share (50%)

MMIS Funding FFP

Total 2A

State Share Total

2B - 2B - 2B -

FY2017, Q2-Q4 $19,405,620 $2,156,180 $19,405,620 $2,156,180

FY2018 $21,609,452 $2,401,050 $21,609,452 $2,401,050

FY2019, Q1 $1,750,781 $194,531 $1,750,781 $194,531


$42,765,853 $4,751,761 $0 $0 $0 $0 $42,765,853 $4,751,761

M&O MMIS 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 $5,492,255 $1,830,752 $3,596,275 $1,198,758 $9,088,529 $3,029,510

FY2019 $22,844,018 $7,614,673 $14,385,099 $4,795,033 $37,229,117 $12,409,706

FY2020 $23,135,685 $7,711,895 $14,385,099 $4,795,033 $37,520,784 $12,506,928

FY2021 $23,135,685 $7,711,895 $14,385,099 $4,795,033 $37,520,784 $12,506,928

FY2022 $23,135,685 $7,711,895 $14,385,099 $4,795,033 $37,520,784 $12,506,928

FY2023, Q1-Q3 $17,351,764 $5,783,921 $10,788,824 $3,596,275 $28,140,588 $9,380,196


$115,095,090 $38,365,030 $71,925,495 $23,975,165 $187,020,585 $62,340,195



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M&O (Mechanized

Systems)

MMIS CMS Share

(50% FFP)

State Share (50%)

MMIS CMS Share

(50% FFP)

State Share (50%)

MMIS CMS Share

(50% FFP)

State Share (50%)

MMIS Enhanced Funding 50% FFP

Total

State Share Total

5A - 5B - 5C -

FY2018, Q4 $0 $0

FY2019 $1,166,667 $1,166,667 $1,166,667 $1,166,667

FY2020 $1,555,556 $1,555,556 $1,555,556 $1,555,556

FY2021 $1,555,556 $1,555,556 $1,555,556 $1,555,556

FY2022 $1,555,556 $1,555,556 $1,555,556 $1,555,556

FY2023, Q1-Q3 $1,166,667 $1,166,667 $1,166,667 $1,166,667


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

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 $20,799,735 $2,541,395 $20,799,735 $2,541,395 $23,341,130

FY2018 $24,466,670 $3,956,233 $9,088,529 $3,029,510 $33,555,200 $6,985,742 $40,540,942

FY2019 $2,485,337 $342,815 $37,229,117 $12,409,706 $1,166,667 $1,166,667 $40,881,120 $13,919,188 $54,800,308

FY2020 $37,520,784 $12,506,928 $1,555,556 $1,555,556 $39,076,339 $14,062,483 $53,138,823

FY2021 $37,520,784 $12,506,928 $1,555,556 $1,555,556 $39,076,339 $14,062,483 $53,138,823

FY2022 $37,520,784 $12,506,928 $1,555,556 $1,555,556 $39,076,339 $14,062,483 $53,138,823

FY2023, Q1-Q3 $28,140,588 $9,380,196 $1,166,667 $1,166,667 $29,307,254 $10,546,863 $39,854,117


$47,751,742 $6,840,443 $187,020,585 $62,340,195 $7,000,000 $7,000,000 $241,772,327 $76,180,638 $317,952,965

Exhibit 6-3: Cost Allocation – MMIS Detailed Budget Template (MDBT)



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SECTION 7 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/DW, 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 7-1: 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 7-1: 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/DW. The procurement process will be in compliance with all applicable federal regulations and provisions as indicated in Exhibit 7-2: Procurement Assurances.

PROCUREMENT STANDARDS COMPLIANCE

YES NO

45 CFR Part 95.613 Procurement Standards X

45 CFR Part 74 Uniform Requirements for Awards and Subawards to Institutions of Higher Educations, Hospitals, Other Nonprofit Organizations, and Commercial Organizations

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 7-2: Procurement Assurances



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SECTION 8 ATTACHMENTS

This section includes the following attachments:

ATTACHMENT A – Updated MITA SS-A

ATTACHMENT B – Planning Budget Sheets

The following attachments will be provided in an IAPD-U once the FMMIS/FA and DSS/DW awards have been made:

ATTACHMENT C – Medicaid Enterprise Certification Toolkit (MECT) Checklists

ATTACHMENT D – Detailed Preliminary Project Schedule

ATTACHMENT E – Detailed Preliminary Project Budget

ATTACHMENT F – Requirements Definition Document