Exhibit 300 (BY2009) - Centers for Medicare and Medicaid Services CMS, Medicare Appeals System (MAS)
PART ONE
OVERVIEW
- 1. Date of Submission:
- 2008-02-04
- 2. Agency:
- 009
- 3. Bureau:
- 38
- 4. Name of this Capital Asset:
- CMS Medicare Appeals System (MAS)
- 5. Unique Project Identifier:
- 009-38-01-02-01-1180-00
- 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?
- FY2003
- 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.
- The Medicare Appeals and Hearings function ensures that the due process rights of beneficiaries, physicians and other suppliers who are dissatisfied with initial claims and service determinations and subsequent appeal decisions are protected under the Medicare program. In keeping with CMS' Strategic Plan Objectives to provide High Value Health Care as well as Confident and Informed customers, the appeals and hearings function is focused on improving beneficiary satisfaction with programs and services, increasing the usefulness of communications, and maintaining and improving CMS' position as a prudent program administrator and an accountable steward of public funds. In order to achieve a robust and enduring technical solution to all the appeals processing needs, the Medicare Appeals System (MAS) was awarded to a contractor in September 2003. The MAS design supports a unified case tracking system that will facilitate maintenance and transfer of case specific data with regard to fee-for-service and managed care appeals throughout the four levels of the appeals process, i.e., Level 1 appeals: affiliated contractors, Level 2 appeals: QICs, Level 3 appeals: ALJs, and Level 4 appeals: the DAB. In developing the MAS, HHS and SSA worked together to capitalize on SSA's knowledge and experience in developing the case processing management system (CPMS) and avoid unnecessary duplication. In addition to basic case tracking across all levels of Medicare appeals in a unified system, the MAS provides the capability to report on appeals data, enable more accurate and expedient responses to Congressional questions, and provide more precise data for assessment and policy-setting. MAS fulfills these business needs by focusing on data collection, data analysis, and workflow management. The MAS is capable of docketing/calendaring hearings, scheduling expert witnesses for testimony, and providing information on the Medicare appeals workload as it relates to the number of ALJs and support staff required to process appeals. Moreover, the MAS envisions a future environment in which all of the management of the appeal files will be handled electronically. Specifically, the ALJ would have electronic access to all necessary documents, prior decisions, and other relevant information.
- 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 Expanded E-Government
- 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 introduces e-Government to the Hearing and Appeals process. CMS will ensure appropriate system functionality and availability in a secure, 508-compliant, Web-based interactive fashion. The public will have access to superior services because of the on-line, real-time nature of much of the business. MAS helps medical and legal personnel manage the review process that determines if the provider should be reimbursed for services.
- 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 9 Software 18 Services 72 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, Division of 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
-2006PY
2007CY
2008BY
2009Planning Budgetary Resources 0.000 0.000 0.000 0.000 Acquisition Budgetary Resources 1.345 0.000 0.000 0.000 Maintenance Budgetary Resources 19.889 4.903 5.574 5.615 Government FTE Cost 0.431 0.000 0.329 0.337 # of FTEs 5 0 3 3
- 2. Will this project require the agency to hire additional FTE's?
- yes
- 2.a. If "yes," how many and in what year?
- One, beginning BY08/
PERFORMANCE
- 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 2008 S.O. 1.2 - Increase health care service availability and accessibility Mission and Business Results Health Care Administration Percent of FFS, Medicare Advantage, and Part D appeal types included in system TBD 100% TBD 2 2008 S.O. 1.2 - Increase health care service availability and accessibility Mission and Business Results Health Care Administration Percent of end user locations performing electronic document imaging TBD 60% TBD 3 2008 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part D standard reconsideration appeals adjudicated within 7 calendar days TBD 100% TBD 4 2008 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part D standard expedited appeals adjudicated within 72 hours TBD 100% TBD 5 2008 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of standard FFS appeals adjudicated within 60 calendar days TBD 100% TBD 6 2008 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of FFS expedited appeals adjudicated within 72 hours TBD 100% TBD 7 2008 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part C pre-service appeals adjudicated within 30 calendar days TBD 95% TBD 8 2008 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part C payment appeals adjudicated within 60 calendar days TBD 95% TBD 9 2008 S.O. 1.2 - Increase health care service availability and accessibility Processes and Activities Security Number of high risk security findings TBD 0 TBD 10 2008 S.O. 1.2 - Increase health care service availability and accessibility Technology Availability Percentage of system availability for end users TBD 97.3% TBD 11 2009 S.O. 1.2 - Increase health care service availability and accessibility Mission and Business Results Health Care Administration Percent of FFS, Medicare Advantage, and Part D appeal types included in system TBD 100% TBD 12 2009 S.O. 1.2 - Increase health care service availability and accessibility Mission and Business Results Health Care Administration Percent of end user locations performing electronic document imaging TBD 60% TBD 13 2009 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part D standard reconsideration appeals adjudicated within 7 calendar days TBD 100% TBD 14 2009 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part D standard expedited appeals adjudicated within 72 hours TBD 100% TBD 15 2009 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of standard FFS appeals adjudicated within 60 calendar days TBD 100% TBD 16 2009 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of FFS expedited appeals adjudicated within 72 hours TBD 100% TBD 17 2009 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part C pre-service appeals adjudicated within 30 calendar days TBD 95% TBD 18 2009 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part C payment appeals adjudicated within 60 calendar days TBD 95% TBD 19 2009 S.O. 1.3 - Improve health care quality, safety, cost and value Processes and Activities Security Number of high risk security findings TBD 0 TBD 20 2009 S.O. 1.2 - Increase health care service availability and accessibility Technology Availability Percentage of system availability for end users TBD 97.3% TBD 21 2010 S.O. 1.2 - Increase health care service availability and accessibility Mission and Business Results Health Care Administration Percent of FFS, Medicare Advantage, and Part D appeal types included in system TBD 100% TBD 22 2010 S.O. 1.2 - Increase health care service availability and accessibility Mission and Business Results Health Care Administration Percent of end user locations performing electronic document imaging TBD 80% TBD 23 2010 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part D standard reconsideration appeals adjudicated within 7 calendar days TBD 100% TBD 24 2010 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part D standard expedited appeals adjudicated within 72 hours TBD 100% TBD 25 2010 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of standard FFS appeals adjudicated within 60 calendar days TBD 100% TBD 26 2010 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of FFS expedited appeals adjudicated within 72 hours TBD 100% TBD 27 2010 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part C pre-service appeals adjudicated within 30 calendar days TBD 95% TBD 28 2010 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part C payment appeals adjudicated within 60 calendar days TBD 95% TBD 29 2010 S.O. 1.3 - Improve health care quality, safety, cost and value Processes and Activities Security Number of high risk security findings TBD 0 TBD 30 2010 S.O. 1.2 - Increase health care service availability and accessibility Technology Availability Percentage of system availability for end users TBD 97.3% TBD 31 2011 S.O. 1.2 - Increase health care service availability and accessibility Mission and Business Results Health Care Administration Percent of FFS, Medicare Advantage, and Part D appeal types included in system TBD 100% TBD 32 2011 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part D standard reconsideration appeals adjudicated within 7 calendar days TBD 100% TBD 33 2011 S.O. 1.3 - Improve health care quality, safety, cost and value Processes and Activities Security Number of high risk security findings TBD 0 TBD 34 2011 S.O. 1.2 - Increase health care service availability and accessibility Technology Availability Percentage of system availability for end users TBD 97.3% TBD 35 2012 S.O. 1.2 - Increase health care service availability and accessibility Mission and Business Results Health Care Administration Percent of FFS, Medicare Advantage, and Part D appeal types included in system TBD 100% TBD 36 2012 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part D standard reconsideration appeals adjudicated within 7 calendar days TBD 100% TBD 37 2012 S.O. 1.3 - Improve health care quality, safety, cost and value Processes and Activities Security Number of high risk security findings TBD 0 TBD 38 2012 S.O. 1.2 - Increase health care service availability and accessibility Technology Availability Percentage of system availability for end users TBD 97.3% TBD 39 2012 S.O. 1.2 - Increase health care service availability and accessibility Mission and Business Results Health Care Administration Percent of FFS, Medicare Advantage, and Part D appeal types included in system TBD 100% TBD 40 2012 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part D standard reconsideration appeals adjudicated within 7 calendar days TBD 100% TBD 41 2012 S.O. 1.3 - Improve health care quality, safety, cost and value Processes and Activities Security Number of high risk security findings TBD 0 TBD 42 2012 S.O. 1.2 - Increase health care service availability and accessibility Technology Availability Percentage of system availability for end users TBD 97.3% TBD 43 2013 S.O. 1.2 - Increase health care service availability and accessibility Mission and Business Results Health Care Administration Percent of FFS, Medicare Advantage, and Part D appeal types included in system TBD 100% TBD 44 2013 S.O. 1.2 - Increase health care service availability and accessibility Customer Results Response Time Percent of Part D standard reconsideration appeals adjudicated within 7 calendar days TBD 100% TBD 45 2013 S.O. 1.3 - Improve health care quality, safety, cost and value Processes and Activities Security Number of high risk security findings TBD 0 TBD 46 2013 S.O. 1.2 - Increase health care service availability and accessibility Technology Availability Percentage of system availability for end users TBD 97.3% TBD
Enterprise Architecture
- 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 Medicare Appeals System (MAS)
- 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 Reused Component Name Reused UPI Internal or External Reuse? Funding % 1 Cryptography Support the use and management of ciphers, including encryption decryption processes, to ensure confidentiality and integrity of data. Security Management Cryptography No Reuse 1 2 Identification and Authentication Defines the set of capabilities that support obtaining information about those parties attempting to log on to a system or application for security purposes and the validation of those users. Security Management Identification and Authentication No Reuse 1 3 Access Control Access Control - Support the management of permissions for logging onto a computer, application, service, or network; includes user management and role/privilege management. Security Management Access Control No Reuse 1 4 Outbound Correspondence Management Defines the set of capabilities that manage internally initiated communication between an organization and its stakeholders. Routing and Scheduling Outbound Correspondence Management No Reuse 11 5 Case Management Defines the set of capabilities that manage the life cycle of a particular claim or investigation within an organization to include creating, routing, tracing, assignment and closing of a case as well as collaboration among case handlers. Tracking and Workflow Case Management No Reuse 11 6 Process Tracking Defines the set of capabilities that allow the monitoring of activities within the business cycle. Tracking and Workflow Process Tracking No Reuse 11 7 Document Referencing Defines the set of capabilities that support the redirection to other documents and information for related content. Document Management Document Referencing No Reuse 6 8 Standardized / Canned Defines the set of capabilities that support the use of pre-conceived or pre-written reports. Reporting Standardized / Canned No Reuse 8 9 OLAP Defines the set of capabilities that support the analysis of information that has been summarized into multidimensional views and hierarchies. Reporting OLAP No Reuse 8 10 Ad Hoc Defines the set of capabilities that support the use of dynamic reports on an as needed basis. Reporting Ad Hoc No Reuse 8 11 Data Warehouse Defines the set of capabilities that support the archiving and storage of large volumes of data. Data Management Data Warehouse No Reuse 5 12 Data Mart Defines the set of capabilities that support a subset of a data warehouse for a single department or function within an organization. Data Management Data Mart No Reuse 5 13 Extraction and Transformation Defines the set of capabilities that support the manipulation and change of data. Data Management Extraction and Transformation No Reuse 3 14 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 3 15 Data Integration Defines the set of capabilities that support the organization of data from separate data sources into a single source using middleware or application integration and the modification of system data models to capture new information within a single system. Development and Integration Data Integration No Reuse 3 16 Software Development Defines the set of capabilities that support the creation of both graphical and process application or system software. Development and Integration Software Development No Reuse 3
- 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 Software Development Component Framework Business Logic Platform Independent ActiveX 2 Software Development Service Interface and Integration Interface Service Description / Interface Application Program Interface (API) / Protocol 3 Extraction and Transformation Component Framework Business Logic Platform Dependent Ascent Capture 4 OLAP Component Framework Presentation / Interface Dynamic Server-Side Display Cognos 5 Ad Hoc Component Framework Presentation / Interface Dynamic Server-Side Display Cognos 6 Data Warehouse Component Framework Presentation / Interface Dynamic Server-Side Display Cognos 7 OLAP Component Framework Data Management Reporting and Analysis Cognos 8 Ad Hoc Component Framework Data Management Reporting and Analysis Cognos 9 Data Warehouse Component Framework Data Management Reporting and Analysis Cognos 10 Software Development Service Platform and Infrastructure Software Engineering Integrated Development Environment Cognos Development Tools 11 OLAP Component Framework Data Management Reporting and Analysis Cognos PowerPlay 12 Data Integration Component Framework Data Management Reporting and Analysis Cognos PowerPlay 13 Ad Hoc Component Framework Data Management Reporting and Analysis Cognos ReportNet 14 Standardized / Canned Component Framework Data Management Reporting and Analysis Cognos ReportNet, OLAP 15 Case Management Component Framework Presentation / Interface Static Display HTML 16 Document Referencing Service Platform and Infrastructure Support Platforms Platform Dependent IBM Content Manager 17 Software Development Service Platform and Infrastructure Delivery Servers Application Servers IBM WebSphere 18 Data Exchange Component Framework Data Interchange Data Exchange IBM Websphere Business Integrator for Medicare Beneficiary Database; Batch text files for Next Generation Desktop and Health Plan Management System 19 Software Development Service Platform and Infrastructure Software Engineering Integrated Development Environment IBM WebSphere Studio 20 Case Management Service Access and Delivery Access Channels Web Browser Internet Explorer 21 Software Development Component Framework Business Logic Platform Independent Java 22 Software Development Component Framework Presentation / Interface Dynamic Server-Side Display Java Server Pages 23 Case Management Component Framework Presentation / Interface Dynamic Server-Side Display Java Server Pages (JSP), Microsoft ActiveX 24 Case Management Component Framework Presentation / Interface Dynamic Server-Side Display Java Server Pages (JSP), Microsoft ActiveX 25 Identification and Authentication Component Framework Security Supporting Security Services Lightweight Directory Access Protocol 26 Access Control Component Framework Security Supporting Security Services Lightweight Directory Access Protocol and Siebel 27 Software Development Service Platform and Infrastructure Software Engineering Test Management LoadRunner 28 Software Development Service Platform and Infrastructure Software Engineering Test Management Mercury Interactive Test Director 29 Software Development Component Framework Data Management Reporting and Analysis Microsoft Visual SourceSafe 30 Software Development Service Platform and Infrastructure Software Engineering Software Configuration Management MKS Toolkit 31 Data Mart Service Platform and Infrastructure Database / Storage Database Oracle 10g RDBMS 32 Cryptography Component Framework Security Certificates / Digital Signatures Secure Sockets Layer 33 Cryptography Component Framework Security Supporting Security Services Secure Sockets Layer 34 Outbound Correspondence Management Component Framework Business Logic Platform Dependent Siebel (Document Manager) 35 Process Tracking Component Framework Business Logic Platform Dependent Siebel (Workflow Manager) 36 Software Development Service Platform and Infrastructure Software Engineering Integrated Development Environment Siebel Development Tools 37 Case Management Component Framework Business Logic Platform Dependent Siebel e-Healthcare (Application Object Manager) 38 Case Management Service Platform and Infrastructure Support Platforms Platform Dependent Sun Solaris 9 39 Case Management Service Access and Delivery Delivery Channels Intranet Via internal CMS network 40 Case Management Service Access and Delivery Delivery Channels Extranet Via Medicare Data Center Network (MDCN) 41 Case Management Service Platform and Infrastructure Support Platforms Platform Dependent Windows 2000
- 6. Will the application leverage existing components and/or applications across the Government (i.e., FirstGov, Pay.Gov, etc)?
- no
PART THREE
RISK
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?
- 2007-01-14
- 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 maintenance contractor submits weekly status reports and monthly EVM reports. Each of these reports provides an opportunity for the project team to analyze contractor performance on cost and schedule. Additionally, the team meets with the business owners twice per month. These meetings allow the business owners to provide feedback on the system performance and whether or not MAS is helping them fulfill their appeals processing capability. These reviews have indicated that contractor performance is acceptable and that MAS is succeeding in helping users execute the appeals process. In addition, this project is being monitored bi-weekly by executive management.





