HHS Home > OCIO Home > Capital Planning & Budget > Exhibit 300

Exhibit 300 (BY2009) - Centers for Medicare and Medicaid Services, CMS Interoperability & Standardization - Claims

PART ONE

OVERVIEW

1. Date of Submission:: 2008-02-04

2. Agency:: 009

3. Bureau:: 38

4. Name of this Capital Asset:: CMS Interoperability & Standardization - Claims

5. Unique Project Identifier:: 009-38-01-02-01-1100-00

6. What kind of investment will this be in FY2009?: Operations and Maintenance

7. What was the first budget year this investment was submitted to OMB?: FY2001 or earlier

8. Provide a brief summary and justification for this investment, including a brief description of how this closes in part or in whole an identified agency performance gap.: This portfolio evolved from prior year's HIPAA investment portfolio and includes several CMS systems to process e-health care transactions based upon goals to continue strategic standardization efforts and ensure FFS product interoperability. The versions of HIPAA standards currently implemented in the FFS program are the Accredited Standards Committee X12N version 4010A1 and National Council for Prescription Drug Program (NCPDP) version 5.1. The X12N standards include the MedA claim (827-I), MedB claim (837-P), the remittance notice to providers (835), eligibility inquiry (270) and response (271), claim status inquiry (276) and response (277). The NCPDP standard is used for Durable Medical Equipment (DME) claims. The FFS program currently receives 99.8% of MedAl claims in the 837-I and 95.2% of MedB claims in the 837-P. E-remittances (835) are sent to 57.9% of MedA providers and 44% of the MedB providers while the remainder receives standard paper remittances. GPRA goals for claim status inquiries (276/277) and eligibility inquiries (270/271) are currently on target. The e-exchange of core business transactions is a cornerstone in the Medicare FFS operation.The next version of HIPAA standards (HIPAA-2) will replace the existing formats for the above transactions. This initiative must be carefully planned and executed to maintain the current levels of EDI exchange and avoid the incremental cost of reverting to manual operations.In addition to the transactions mentioned, this portfolio also includes the National Provider Identifier (NPI). The NPI Crosswalk bridges the National Plan & Provider Ennumeration System (NPPES) to the Provider Enrollment System (PECOS). The current HIPAA claims transactions and NPI Crosswalk are steady state activities for FY08.The HIPAA-2 project is being added to this investment for FY09. This project will be initiated in the current FY with a low level of effort to perform a high level business and systems impact analysis only. Subsequently, the effort will increase with the detailed requirements for Shared Systems and Front End systems that continue to be maintained and operated by the MAC/FI/Carrier in their datacenter. Note: ICD-10 PCS and CM cannot be conveyed in the claim and related transactions until the HIPAA-2 is implemented.The Standard Front End project has been removed from this investment.The Durable Medical Equipment Common Front End has also been removed.

9. Did the Agency's Executive/Investment Committee approve this request?: yes

9.a. If "yes," what was the date of this approval?: 2007-06-26

10. Did the Project Manager review this Exhibit?: yes

11.a. What is the current FAC-P/PM certification level of the project/program manager?: TBD

12. Has the agency developed and/or promoted cost effective, energy-efficient and environmentally sustainable techniques or practices for this project.: no

12.a. Will this investment include electronic assets (including computers)?: yes

12.b. Is this investment for new construction or major retrofit of a Federal building or facility? (answer applicable to non-IT assets only): no

13. Does this investment directly support one of the PMA initiatives?: yes

If yes, select the initiatives that apply:

Initiative Name
Eliminating Improper Payments
Expanded E-Government
Financial Performance

13.a. Briefly and specifically describe for each selected how this asset directly supports the identified initiative(s)? (e.g. If E-Gov is selected, is it an approved shared service provider or the managing partner?): This investment supports E-gov by providing Medicare FFS and MMA eligibility via the internet and align the data in the response transaction with current CWF and other legacy methods. It also improves financial management - the NPI cross-walk assigns a unique identifier to all providers & health plans which will reduce improper payments. The next version of HIPAA standards will make use of electronic transactions easier and better aligned with changing business needs.

14. Does this investment support a program assessed using the Program Assessment Rating Tool (PART)?: yes

14.a. If yes, does this investment address a weakness found during the PART review?: yes

14.b. If yes, what is the name of the PARTed program?: 2003: CMS - Medicare Program

14.c. If yes, what rating did the PART receive?: Moderately Effective

15. Is this investment for information technology?: yes

16. What is the level of the IT Project (per CIO Council's PM Guidance)?: Level 3

17. What project management qualifications does the Project Manager have? (per CIO Council's PM Guidance): (1) Project manager has been validated as qualified for this investment

18. Is this investment identified as high risk on the Q4 - FY 2007 agency high risk report (per OMB memorandum M-05-23)?: no

19. Is this a financial management system?: no

20. What is the percentage breakout for the total FY2009 funding request for the following? (This should total 100%)

Area	Percentage
Hardware	0
Software	0
Services	100
Other	0

21. If this project produces information dissemination products for the public, are these products published to the Internet in conformance with OMB Memorandum 05-04 and included in your agency inventory, schedules and priorities?: n/a

22. Contact information of individual responsible for privacy related questions.

Name	Maribel Franey
Phone Number	410-786-0757
Title	Director, Privacy Compliance
Email	maribel.franey@cms.hhs.gov

23. Are the records produced by this investment appropriately scheduled with the National Archives and Records Administration's approval?: yes

24. Does this investment directly support one of the GAO High Risk Areas?: yes

SUMMARY OF SPEND

1. Provide the total estimated life-cycle cost for this investment by completing the following table. All amounts represent budget authority in millions, and are rounded to three decimal places. Federal personnel costs should be included only in the row designated Government FTE Cost, and should be excluded from the amounts shown for Planning, Full Acquisition, and Operation/Maintenance. The total estimated annual cost of the investment is the sum of costs for Planning, Full Acquisition, and Operation/Maintenance. For Federal buildings and facilities, life-cycle costs should include long term energy, environmental, decommissioning, and/or restoration costs. The costs associated with the entire life-cycle of the investment should be included in this report. All amounts represent Budget Authority Note: For the cross-agency investments, this table should include all funding (both managing partner and partner agencies). Government FTE Costs should not be included as part of the TOTAL represented.

Cost Type	Py-1 & Earlier -2006	PY 2007	CY 2008	BY 2009
Planning Budgetary Resources	0.000	1.000	0.000	0.000
Acquisition Budgetary Resources	0.000	0.000	0.000	6.800
Maintenance Budgetary Resources	11.982	23.349	26.107	12.106
Government FTE Cost	0.377	1.090	1.600	1.430
# of FTEs	4	11	16	14

2. Will this project require the agency to hire additional FTE's?: no

PERFORMANCE

In order to successfully address this area of the exhibit 300, performance goals must be provided for the agency and be linked to the annual performance plan. The investment must discuss the agency's mission and strategic goals, and performance measures (indicators) must be provided. These goals need to map to the gap in the agency's strategic goals and objectives this investment is designed to fill. They are the internal and external performance benefits this investment is expected to deliver to the agency (e.g., improve efficiency by 60 percent, increase citizen participation by 300 percent a year to achieve an overall citizen participation rate of 75 percent by FY 2xxx, etc.). The goals must be clearly measurable investment outcomes, and if applicable, investment outputs. They do not include the completion date of the module, milestones, or investment, or general goals, such as, significant, better, improved that do not have a quantitative measure.

Agencies must use the following table to report performance goals and measures for the major investment and use the Federal Enterprise Architecture (FEA) Performance Reference Model (PRM). Map all Measurement Indicators to the corresponding Measurement Area and Measurement Grouping identified in the PRM. There should be at least one Measurement Indicator for each of the four different Measurement Areas (for each fiscal year). The PRM is available at www.egov.gov. The table can be extended to include performance measures for years beyond FY 2009.

Row	Fiscal Year	Strategic Goal Supported	Measurement Area	Measurement Grouping	Measurement Indicator	Baseline	Planned Improvement to the Baseline	Actual Results
1	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Number of Providers accessing data via internet	0	100	45
2	2006	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Percent of data available to providers	95%	96%	96%
3	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Percent reduction in Error rate per release	--	2%	2%
4	2006	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Accessibility	Percentage of Eligibility System Reliability & Availability	95%	95%	TBD
5	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Number of Providers accessing data via internet	45	100	TBD
6	2007	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Percent of data available to providers	96%	98%	TBD
7	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Percent reduction in Error rate per release	2%	2%	TBD
8	2007	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Accessibility	Percentage of Eligibility System Reliability & Availability	95%	95%	TBD
9	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Number of Providers accessing data via internet	TBD	unlimited	TBD
10	2008	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Populate the Xwalk with matches for active providers to enable proper claims payment	TBD	90	TBD
11	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Populate the Xwalk with matches for active providers to enable proper claims payment	TBD	90	TBD
12	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Accessibility	Percentage of Eligibility System Reliability & Availability	TBD	95%	TBD
13	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Number of Providers accessing data via internet	TBD	unlimited	TBD
14	2009	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Populate the Xwalk with matches for active providers to enable proper claims payment	TBD	95	TBD
15	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Populate the Xwalk with matches for active providers to enable proper claims payment	TBD	95	TBD
16	2009	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Accessibility	Percentage of Eligibility System Reliability & Availability	TBD	95%	TBD
17	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Number of Providers accessing data via internet	TBD	unlimited	TBD
18	2010	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	PercentPopulate the Xwalk with matches for active providers to enable proper claims payment of data available to providers	TBD	95	TBD
19	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Populate the Xwalk with matches for active providers to enable proper claims payment	TBD	95	TBD
20	2010	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Accessibility	Percentage of Eligibility System Reliability & Availability	TBD	95%	TBD
21	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Number of Providers accessing data via internet	TBD	unlimited	TBD
22	2011	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Provider transition to new HIPAA standards is completed	TBD	100	TBD
23	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Percent reduction in Error rate per release	TBD	2%	TBD
24	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Accessibility	Percentage of Eligibility System Reliability & Availability	TBD	95%	TBD
25	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Number of Providers accessing data via internet	TBD	unlimited	TBD
26	2012	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Claims Attachments Business Rules defined	TBD	90	TBD
27	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Percent reduction in Error rate per release	TBD	2%	TBD
28	2012	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Accessibility	Percentage of Eligibility System Reliability & Availability	TBD	95%	TBD
29	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Monthly updates to medicare FFS project plan	TBD	12	TBD
30	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Access	Claims Attachments Business Rules designed	TBD	80	TBD
31	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Change request requirements for claims attachments	TBD	80	TBD
32	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Accessibility	System modifications for claims attachements designed and coding started	TBD	40	TBD

Enterprise Architecture

In order to successfully address this area of the business case and capital asset plan you must ensure the investment is included in the agency's EA and Capital Planning and Investment Control (CPIC) process, and is mapped to and supports the FEA. You must also ensure the business case demonstrates the relationship between the investment and the business, performance, data, services, application, and technology layers of the agency's EA.

1. Is this investment included in your agency's target enterprise architecture?: yes

2. Is this investment included in the agency's EA Transition Strategy?: yes

2.a. If yes, provide the investment name as identified in the Transition Strategy provided in the agency's most recent annual EA Assessment.: CMS Interoperability and Standardization - Claims

3. Is this investment identified in a completed (contains a target architecture) and approved segment architecture?: no

4. Identify the service components funded by this major IT investment (e.g., knowledge management, content management, customer relationship management, etc.). Provide this information in the format of the following table. For detailed guidance regarding components, please refer to http://www.whitehouse.gov/omb/egov/. Component: Use existing SRM Components or identify as NEW. A NEW component is one not already identified as a service component in the FEA SRM. Reused Name and UPI: A reused component is one being funded by another investment, but being used by this investment. Rather than answer yes or no, identify the reused service component funded by the other investment and identify the other investment using the Unique Project Identifier (UPI) code from the OMB Ex 300 or Ex 53 submission. Internal or External Reuse?: Internal reuse is within an agency. For example, one agency within a department is reusing a service component provided by another agency within the same department. External reuse is one agency within a department reusing a service component provided by another agency in another department. A good example of this is an E-Gov initiative service being reused by multiple organizations across the federal government. Funding Percentage: Please provide the percentage of the BY requested funding amount used for each service component listed in the table. If external, provide the funding level transferred to another agency to pay for the service.

Row	Agency Component Name	Agency Component Description	Service Type	Component	Internal or External Reuse?	Funding %
1	Information Sharing	Defines the set of capabilities that support the use of documents and data in a multi-user environment for use by an organization and its stakeholders.	Knowledge Management	Information Sharing	No Reuse	25
2	Information Retrieval	Defines the set of capabilities that allow access to data and information for use by an organization and its stakeholders.	Knowledge Management	Information Retrieval	No Reuse	25
3	Data Exchange	Defines the set of capabilities that support the interchange of information between multiple systems or applications; includes verification that transmitted data was received unaltered.	Data Management	Data Exchange	No Reuse	50

5. To demonstrate how this major IT investment aligns with the FEA Technical Reference Model (TRM), please list the Service Areas, Categories, Standards, and Service Specifications supporting this IT investment. FEA SRM Component: Service Components identified in the previous question should be entered in this column. Please enter multiple rows for FEA SRM Components supported by multiple TRM Service Specifications. Service Specification: In the Service Specification field, Agencies should provide information on the specified technical standard or vendor product mapped to the FEA TRM Service Standard, including model or version numbers, as appropriate.

Row	SRM Component	>Service Area	Service Category	Service Standard	Service Specification (i.e., vendor and product name)
1	Data Exchange	Component Framework	Data Interchange	Data Exchange	Connect:Direct
2	Information Retrieval	Component Framework	Data Interchange	Data Exchange	Connect:Direct
3	Information Sharing	Component Framework	Data Interchange	Data Exchange	Connect:Direct
4	Data Exchange	Component Framework	Data Interchange	Data Exchange	File Transfer Protocol (FTP)
5	Information Retrieval	Component Framework	Data Interchange	Data Exchange	File Transfer Protocol (FTP)
6	Information Sharing	Component Framework	Data Interchange	Data Exchange	File Transfer Protocol (FTP)
7	Data Exchange	Component Framework	Data Management	Database Connectivity	Medicare Data Center Network (MDCN)
8	Information Retrieval	Component Framework	Data Management	Database Connectivity	Medicare Data Center Network (MDCN)
9	Information Sharing	Component Framework	Data Management	Database Connectivity	Medicare Data Center Network (MDCN)

6. Will the application leverage existing components and/or applications across the Government (i.e., FirstGov, Pay.Gov, etc)?: yes

6.a. If yes, please describe.: This investment leverages: Federal Health Architecture (FHA)

PART THREE

RISK

You should perform a risk assessment during the early planning and initial concept phase of the investment's life-cycle, develop a risk-adjusted life-cycle cost estimate and a plan to eliminate, mitigate or manage risk, and be actively managing risk throughout the investment's life-cycle.

Answer the following questions to describe how you are managing investment risks.

1. Does the investment have a Risk Management Plan?: yes

1.a. If yes, what is the date of the plan?: 2007-03-20

1.b. Has the Risk Management Plan been significantly changed since last year's submission to OMB?: no

COST & SCHEDULE

1. Was operational analysis conducted?: yes

1.a. If yes, provide the date the analysis was completed.: 2007-07-31

What were the results of your operational analysis?: The operational analysis was completed to validate that the project's principal goals were done in a timely manner and within budget. The system continues to perform at an acceptable level for CMS users and contractors. The system's performance is meeting program objectives, customer and stakeholder needs, and cost, schedule, and performance goals. GPRA goals for claim status inquiries (276/277) and eligibility inquiries (270/271) are currently on target. The analysis was conducted by reviewing status updates to the FFS Ops Board, cost and schedule reports and annual surveys.