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March26, 2012
DEPARTMENT OF HUMAN RESOURCESAND
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Affordable Care Act (ACA) Healthcare Reform Project Overview
Maryland Medicaid Advisory Committee
PMO
- 2 -
Agenda
1. Goals for Health Care Reform Project Implementation
2. Progress at a snapshot
3. Health Care Reform Project Scope Overview
4. IT Vendor (Procurement) Update
5. Project Governance/Supporting Organizations
6. Role of DHR/DHMH
7. High-level Timeline
8. Detailed Timeline (including Milestones)
9. Transition Plan
10. Discussion
- 3 -
Goals for Health Care Reform Project Implementation
1. Assist MD citizens in getting affordable healthcare by providing a “no wrong door” easy-to-use multiple channel gateways to MD health assistance programs.
2. To provide a technology platform, which facilitates the implementation of Affordable Care Act (ACA) requirements as defined by State of MD stakeholders (DHMH, DHR, Exchange) including:
• Eligibility, Shopping Exchange(s), Enrollment, Plan Certification, Reporting
3. To protect the public trust by providing a technology platform that is:
• Cost Effective, Scalable, Security-Enabled and Designed for Future Enhancements
4. To build a scalable platform that easily integrates health and social services programs.
- 4 -
Progress at a snapshotFollowing illustration represents progress of MD Healthcare Reform Project, which has
primarily been led by the Program Management Office (PMO), instituted in May 2011.
PMO Team Starts
OctJun Jul Aug SepMay
Strategy
Delivery
Methodologies
Documentation
Strategy
Methodologies Documentation
Delivery
Progressively Elaborated Structured Approach
5/16
BRD (Business Requirement
Document)
Federal ACA Reqs
MD ACA Reqs
As-is / To-be
Risks / Constraints
Scope In / Out
Regulations / Statutory Compliance
RFI(Request for Information)
19 responses / 7 invitations / 6 demos
Market Research 2-hour sessions
Purpose not to down select
Findings based on functionality versus vendors
FRD(Functional Requirement Document)
Detail requirements from all stakeholders, including but not limited to: DHR, DHMH, DOIT, MIA, and various offices within
Detail process flows illustrating user and system interactions
Decomposition and inclusion requirements based on continuously published federal regulations from CCIIO
RFP(Request for Proposal)
Draft Complete
Stakeholders Review
Leadership / Board Approval
Publish RFP
Receive / Evaluate RFP
Includes: DHR, DHMH, DOIT, Governor’s Office
Nov Dec Jan
- 5 -
Healthcare Reform Project – Scope Overview This is high-level representation of the end-to-end process steps, stakeholders and which
step will be discussed during each JAD session for the Health Care Reform project.
I. P
re-S
cre
en
II.
Inta
ke
& R
eg
istr
ati
on
(C
ust
om
er ID
Val
idat
ion
)
III.
Ve
rifi
ca
tio
n o
f C
us
tom
er
Info
IV.
Eli
gib
ilit
y
De
term
ina
tio
n
VI.
Pla
n P
res
en
tme
nt
& e
Co
mm
erc
e H
UB
VII
. P
lan
En
roll
me
nt
IX.
Pre
miu
m P
ay
me
nt
Tra
ck
ing
X.
Ins
ura
nc
e C
arr
ier
Ma
na
ge
me
nt
XI.
SH
OP
(in
clu
des
Sm
all
Bu
sin
ess
Ow
ner
Man
agem
ent)
XII
. Ag
en
t /
Na
vig
ato
r M
an
ag
em
en
t
XIV
. O
utr
ea
ch
VII
I. A
cc
ou
nt
/ C
as
eM
an
ag
em
en
t
V.
Tax
Cre
dit
/ S
ub
sid
y
Ca
lcu
lati
on
XII
I. R
ep
ort
ing
ExchangeDHMH DHRLegend:
Legend:
Sta
ke
ho
lde
rs*
JA
D
Se
ss
ion
Eligibility Enrollment Change in Circumstances Case Management ACA Functions for Insurance All
*Stakeholder’s include Executive Champion, Policy, End-User as well as Technology experts.
XV
. N
oti
fic
ati
on
s
MIA
- 6 -
IT Vendor (Procurement) Update
• Vendor Select for the MD HIX is the Noridian Team
• Offers the most complete and mature “out of the box” COTS solution:• Social services eligibility, enrollment, and customer relationship management (Curam),
• Plan Management and online Plan Comparison and Enrollment (Connecture).
• Provides the robust operational, technical, and data management capabilities required by the State:
• Large scale social service technical and administrative management (Noridian),
• The EXACT™ Service Oriented Architecture (SOA) platform (Noridian),
• Maryland specific data management and integration (CNSI)
• Detailed project management plan and knowledgeable and experienced staff support achievement of aggressive implementation time lines
• Solution and licenses are extensible to later implementation phases: SHOP (Phase 1B), Non-MAGI determinations (Phase 2), & other social services (Phase 3)
- 7 -
Supporting Organization(s)The following (primary and secondary) organizations are supported by this project:
Exchange
DHR
DHMH
Governor’s Office
DOIT MIA
Legal Counsel
Carriers TPA’s
- 8 -
Role of Maryland DHR/DHMH• DHR, DHMH and HIX will be participating in a Business Process
Reengineering (BPR) effort to answer key operational questions.
• Decisions around the role of the Department of Human Resources and the Exchange as well as their operating models have not been solidified yet.
• BPR will also address the role of the Local departments• how and when the Local department offices will be affected and to what extent;
• will the Locals need to use multiple systems;
• how to handle the influx and exchange information etc.
• We realize no BPR process can succeed without input from the Local stakeholders and we will be requesting their active participation.
• The BPR effort is expected to start in April 2012 and continue through August 2012.
- 9 -
Phase 1A – Selected Exchange Functions and MAGI Medicaid
Eligibility Determinations(Mandatory Task Order)
High-Level Timeline Following adjusted high-level timeline illustrates that based on our current
delays we would be compressing Phase 1A already by two months. Maryland does not have the flexibility to extend the end date as it driven by ACA.
2011 2012 2013 2014 2015
Phase 1A – Selected Exchange Functions and MAGI Medicaid
Eligibility Determinations(Mandatory Task Order)
Phase 2 – Integrating Non-MAGI Medicaid
Determinations
Phase 3 – Integrating Social Services
Programs
Phase 1B – Operations, Hosting & Other Selected
Services (Optional Task Order)
2016 2017 2018 2019
Phase 1B – Maintenance Option
(Optional Task Order)
Phase 1B – Maintenance Option
(Optional Task Order)
Phase 1B – Maintenance
Option(Optional Task
Order)
• Establish a Technology Platform (or “HIX”) that allows for enrollment in Exchange plans and SHOP;
• Conducts eligibility determinations and supports case management services for Advance Premium Tax Credits, cost-sharing reductions, Modified Adjusted Gross Income (MAGI)-related Medicaid categories, and MCHP.
• Incorporate eligibility determinations and case management services for Non-MAGI Medicaid eligibility categories
• Incorporate eligibility determinations and case management services for human services programs such as SNAP and TANF.
- 10 -
Detail Timeline Following detail timeline illustrates that based on current delays, we compress the
Development & Test by almost a full quarter. Additionally, DDR & FDDR milestoneis also extended by the same.
Maryland does not have the flexibility to change the date of Certification that is set by ACA to be January 1, 2013.
- 11 -
Transition Plan The purpose of the Transition-In Plan is to efficiently and effectively insert the Vendor into the
Exchange environment in order to optimize utilization of resources and time. Additionally, the transition plan will ensure the Vendor and Exchange are in sync across the critical on-boarding tasks that are required for a project of this magnitude and aggressive timeline.
The following diagram articulates some of the key incoming transition activities the Vendor will need to accomplish in order to successfully integrate into the State environment. Details for each task follow in subsequent table slides.
31 – 60 Days 61 - 90 DaysFirst 30 Days
Status Reporting
Kick Off & Project Administration
Validation of Work Products
Requirements to COTS Cross-walk
Facilities and Logistics
Review MD EA Repository
Project Management Documentation
Provide Application Licenses
Detailed Design Documentation
Data Management Plan
Technical Architecture
Testing Strategy
Data Use Agreements
Interface Control Documentation
Capacity Planning & Provisioning
Detailed Design Review
Automated Code Review
Physical & Logical Data Models
Data Conversion Plan
System Integration Strategy
On-Boarding & Training
Sprint Execution
- 12 -
Discussion
1. Discuss Role of a Navigator
• Will support MAGI components only (Case Workers will continue with Medicaid and Non-MAGI)
• Other Navigator functions to be determined and contracted out by the Exchange
2. CARES
• Current – CARES is a COBOL-based case management system which keeps track of eligibility for Medical Assistance (MA) and other social services. CARES will remain the system of record for Non-MA services. MA Case Management system will have a bi-directional information exchange with CARES.
• To-Be – CARES will remain the system of record for Non-MAGI and social services. Eligibility information for Non-MAGI and social services will flow back and forth from CARES to Exchange.