Exhibit 300 (BY2010) - CMS Beneficiary Enrollment and Plan Payment for Part C & D

PART ONE

OVERVIEW

1. Date of Submission:: 2008-09-08

2. Agency:: 009

3. Bureau:: 38

4. Name of this Capital Asset:: CMS Beneficiary Enrollment and Plan Payment for Part C & D

5. Unique Project Identifier:: 009-38-01-02-01-1090-00

6. What kind of investment will this be in FY2010?: Operations and Maintenance

7. What was the first budget year this investment was submitted to OMB?: FY2007

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 investment funds systems that deliver Part C (Medicare Advantage) and Part D (Medicare Prescription Drug) benefits which provide Medicare beneficiaries with prescription drug coverage. The Medicare Advantage Prescription Drug Prescription Drug System (MARx) and Risk Adjustment System (RAS) currently process transactions for over 24 million enrollees from over 704 plans. MARx supports Part D by calculating beneficiary-level payments and risk-adjusted payments; verifying beneficiary eligibility benefits; and by processing notifications of beneficiary enrollment. RAS computes risk factors for all beneficiaries that are used by MARx. The Premium Withholding System (PWS) calculates and makes proper adjustments for each beneficiary, processes premiums, and generates daily enrollment files. This investment directly supports the HHS Strategic Goal to "Broaden health insurance and long-term care coverage" by maintaining the systems that support the optional prescription drug benefit for individuals who are entitled to Medicare Part A and/or enrolled in Part B. This investment also funds systems that support the HHS Strategic goal to "Improve health care quality, safety, cost and value" through Part D sponsors offering plans with either: (1) basic prescription drug coverage; or (2) enhanced alternative coverage, which includes certain supplemental benefits such that the total value of the coverage exceeds the value of basic prescription drug coverage. Prescription drug plans (PDPs) may offer enhanced alternative coverage for a supplemental premium. MA-PD plans may offer enhanced alternative coverage either for a supplemental premium, or they may buy down the supplemental premium with savings from their bids for medical benefits (also known as Medicare Advantage rebate dollars). PDP sponsors must offer at least one plan with basic prescription drug coverage in each service area in which they operate. In order to operate in a service area, MA-PD organizations must offer at least one plan with basic prescription drug coverage or enhanced alternative coverage for no supplemental premium. This investment supports the PMA Initiative "Expand E-Gov" by providing a web-based single point of access to CMS Services. The systems support the PMA initiative "Eliminating Improper Payments" by ensuring that payments are accurate.

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

9.a. If "yes," what was the date of this approval?: 2008-04-04

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?: Waiver Issued

11.b. When was the Program/Project Manager Assigned?: 2007-01-01

11.c. What date did the Program/Project Manager receive the FACP/PM certification? If the certification has not been issued, what is the anticipated date for certification?: 2009-07-31

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?): Expanded electronic government is supported by using web-based communication, data transfer, and various e-business technologies, providing a single point of access for CMS information, services, and products enabling robust collaboration between CMS and its business partners. Eliminating Improper Payments is supported by strengthening the payment validation and authorization toolset used to confirm Plan payments.

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?: 10001060 - Medicare

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)?: yes

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	1
Services	99
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 -2007	PY 2008	CY 2009	BY 2010
Planning Budgetary Resources	0.000	0.000	0.000	0.000
Acquisition Budgetary Resources	69.407	0.000	0.000	0.000
Maintenance Budgetary Resources	105.244	51.420	87.361	60.917
Government FTE Cost	0.420	1.500	1.530	1.560
# of FTEs	2	15	15	15

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

3. If the summary of spending has changed from the FY2008 President's budget request, briefly explain those changes.: A major contract has been re-competed at significant savings. This has affected planned amounts for future years. As the investment went through the CMS CPIC process, funds are re-allocated based on changing agency priorities. This redistribution of limited resources also causes changes form the President's Budget.

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	2005	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Efficiency	Percent of identified business functions automated	80%	80%	80%
2	2005	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	New Customers and Market Penetration	Percentage of enrollees (those enrolled compared to those eligible	95%	95%	95%
3	2005	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	External Data Sharing	Percentage of information transfers that are complete and within agreed upon time parameters	85%	90%	90%
4	2005	S.O. 1.1 - Broaden health insurance and long-term care coverage	Mission and Business Results	Health Care Administration	Percentage of legislative requirements met	80%	85%	85%
5	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Efficiency	Accuracy of plan-level payments	80%	85%	85%
6	2006	S.O. 1.1 - Broaden health insurance and long-term care coverage	Mission and Business Results	Health Care Administration	Percentage of legislative requirements met	85%	90%	90%
7	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	External Data Sharing	Percentage of information transfers that are complete and within agreed upon time parameters	90%	90%	90%
8	2006	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	New Customers and Market Penetration	Percentage of eligible beneficiaries successfully enrolled in the program	90%	92%	92%
9	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Efficiency	Accuracy of plan-level payments	85%	86%	86%
10	2007	S.O. 1.1 - Broaden health insurance and long-term care coverage	Mission and Business Results	Health Care Administration	Percentage of legislative requirements met	90%	95%	95%
11	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	External Data Sharing	Percentage of information transfers that are complete and within agreed upon time parameters	85%	90%	89%
12	2007	S.O. 1.1 - Broaden health insurance and long-term care coverage	Customer Results	New Customers and Market Penetration	Percentage of eligible beneficiaries successfully enrolled in the program	92%	95%	95%
13	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Efficiency	Accuracy of plan-level payments	86%	87%	87%
14	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percent of change requests associated with a release that perform the intended function and are delivered within the agreed upon time frame	80%	85%	97%
15	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	External Data Sharing	Percentage of information transfers that are complete and within agreed upon time parameters	89%	92%	92%
16	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Customer Satisfaction	Percentage of complaints received (number of payments calculated versus number of complaints received regarding calculation of payments	10%	8%	8%
17	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Percent of errors in beneficiary-level withholdings, low income cost savings; plan-level payments; beneficiary-level payments	92%	95%	TBD
18	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percent of change requests associated with a release that perform the intended function and are delivered within the agreed upon time frame	80%	85%	TBD
19	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	External Data Sharing	Percentage of information transfers that are complete and within agreed upon time parameters	92%	93%	TBD
20	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Customer Complaints	Percentage of payments calculated incorrectly (determined by dividing # of incorrect payments by total # payments times 100)	8%	7%	TBD
21	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Percent of errors in beneficiary-level withholdings, low income cost savings; plan-level payments; beneficiary-level payments	TBD	TBD	TBD
22	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percent of change requests associated with a release that perform the intended function and are delivered within the agreed upon time frame	TBD	TBD	TBD
23	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	External Data Sharing	Percentage of information transfers that are complete and within agreed upon time parameters	TBD	TBD	TBD
24	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Customer Complaints	Percentage of Complaints (number of payments calculated versus number of complaints received regarding calculation of payment)	TBD	TBD	TBD
25	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Percent of errors in beneficiary-level withholdings, low income cost savings; plan-level payments; beneficiary-level payments	TBD	TBD	TBD
26	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percent of change requests associated with a release that perform the intended function and are delivered within the agreed upon time frame	TBD	TBD	TBD
27	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	External Data Sharing	Percentage of information transfers that are complete and within agreed upon time parameters	TBD	TBD	TBD
28	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Percentage of Complaints (number of payments calculated versus number of complaints received regarding calculation of payment)	TBD	TBD	TBD
29	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Percent of change requests associated with a release that perform the intended function and are delivered within the agreed upon time frame	TBD	TBD	TBD
30	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percent of change requests associated with a release that perform the intended function and are delivered within the agreed upon time frame	TBD	TBD	TBD
31	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	External Data Sharing	Percentage of information transfers that are complete and within agreed upon time parameters	TBD	TBD	TBD
32	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Percentage of Complaints (number of payments calculated versus number of complaints received regarding calculation of payment)	TBD	TBD	TBD
33	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Percent of change requests associated with a release that perform the intended function and are delivered within the agreed upon time frame	TBD	TBD	TBD
34	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percent of change requests associated with a release that perform the intended function and are delivered within the agreed upon time frame	TBD	TBD	TBD
35	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	External Data Sharing	Percentage of information transfers that are complete and within agreed upon time parameters	TBD	TBD	TBD
36	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Percentage of Complaints (number of payments calculated versus number of complaints received regarding calculation of payment)	TBD	TBD	TBD
37	2014	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Percent of change requests associated with a release that perform the intended function and are delivered within the agreed upon time frame	TBD	TBD	TBD
38	2014	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percent of change requests associated with a release that perform the intended function and are delivered within the agreed upon time frame	TBD	TBD	TBD
39	2014	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	External Data Sharing	Percentage of information transfers that are complete and within agreed upon time parameters	TBD	TBD	TBD
40	2014	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Percentage of Complaints (number of payments calculated versus number of complaints received regarding calculation of payment)	TBD	TBD	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 MMA Title 1 and Title II Applications. In order to provide HHS more detail and insight into our investments, last year's major initiative was split out into a separate investment.

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	Bene Enrollment Plan Payment Parts C D Identification and Authentication	Modification and enhancement of existing MMA benefit program applications to support the new processes/data required for Drug Benefit eligibility.	Security Management	Identification and Authentication	No Reuse	25
2	Bene Enrollment Plan Payment Parts C D Standardized / Canned	Access to beneficiary, enrollment, premium, and payment data and eligibility data for MMA and business partners.	Reporting	Standardized / Canned	No Reuse	10
3	Bene Enrollment Plan Payment Parts C D Call Center Management	Ensure that most up-to-date data is available to Customer Service Reps at the desktop	Customer Relationship Management	Call Center Management	No Reuse	5
4	Bene Enrollment Plan Payment Parts C D Data Exchange	Exchanging data needed for coordination of benefits that is in CMS, employer, plan, and state databases.	Data Management	Data Exchange	No Reuse	4
5	Bene Enrollment Plan Payment Parts C D Meta Data Management	For interoperability of the data models from providing/using systems.	Data Management	Meta Data Management	No Reuse	4
6	Bene Enrollment Plan Payment Parts C D Access Control	Ensure that only authorized users have access to systems and data.	Security Management	Access Control	No Reuse	10
7	Bene Enrollment Plan Payment Parts C D Audit Trail Capture and Analysis	Track when updates were done and by whom to ensure integrity of the data and resolve disputes.	Security Management	Audit Trail Capture and Analysis	No Reuse	4
8	Bene Enrollment Plan Payment Parts C D Software Development	Modification and enhancement of existing MMA benefit program applications to support the new processes/data required for Drug Benefit eligibility.	Development and Integration	Software Development	No Reuse	25
9	Bene Enrollment Plan Payment Parts C D Data Integration	Combining data from MMA mainframe and mid-tier applications.	Development and Integration	Data Integration	No Reuse	4
10	Bene Enrollment Plan Payment Parts C D Ad Hoc	Real-time access to beneficiary, enrollment, premium, and payment data and eligibility data for MMA and business partners.	Reporting	Ad Hoc	No Reuse	4
11	Bene Enrollment Plan Payment Parts C D Network Management	Combining data from MMA mainframe and mid-tier applications.	Organizational Management	Network Management	No Reuse	5

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	Identification and Authentication	Service Access and Delivery	Service Requirements	Authentication / Single Sign-on	BMC EUA by: TBD
2	Standardized / Canned	Component Framework	User Presentation / Interface	Static Display	IBM WebSphere by: International Business Machines Corp.
3	Standardized / Canned	Component Framework	User Presentation / Interface	Static Display	Microstrategy by: MicroStrategy, Inc.
4	Call Center Management	Service Access and Delivery	Delivery Channels	Internet	Windows Internet Explorer by: Microsoft Corporation
5	Call Center Management	Service Access and Delivery	Delivery Channels	Intranet	Windows Internet Explorer by: Microsoft Corporation
6	Data Exchange	Component Framework	Data Interchange	Data Exchange	Connect:Direct by: Sterling Commerce
7	Data Exchange	Service Interface and Integration	Integration	Enterprise Application Integration	Connect:Direct by: Sterling Commerce
8	Data Exchange	Service Access and Delivery	Service Transport	Service Transport	File Transfer Protocol (FTP) by: The Internet Engineering Task Force
9	Data Exchange	Service Interface and Integration	Integration	Middleware	IBM WebSphere MQ by: International Business Machines Corp.
10	Meta Data Management	Service Interface and Integration	Interoperability	Data Types / Validation	Microstrategy by: MicroStrategy, Inc.
11	Meta Data Management	Service Interface and Integration	Interoperability	Data Format / Classification	Microstrategy by: MicroStrategy, Inc.
12	Access Control	Service Access and Delivery	Delivery Channels	Virtual Private Network (VPN)	Hypertext Transfer Protocol with SSL by: The Internet Engineering Task Force
13	Audit Trail Capture and Analysis	Component Framework	Security	Certificates / Digital Signatures	BMC EUA by: TBD
14	Software Development	Service Access and Delivery	Service Requirements	Legislative / Compliance	36 CFR Part 1194 by: United States Access Board
15	Software Development	Service Platform and Infrastructure	Software Engineering	Software Configuration Management	MKS Toolkit by: MKS Inc.
16	Data Integration	Component Framework	Data Management	Reporting and Analysis	Microstrategy by: MicroStrategy, Inc.
17	Ad Hoc	Component Framework	Data Management	Reporting and Analysis	Microstrategy by: MicroStrategy, Inc.
18	Network Management	Service Interface and Integration	Integration	Enterprise Application Integration	BMC EUA by: TBD

6. Will the application leverage existing components and/or applications across the Government (i.e., FirstGov, Pay.Gov, etc)?: no

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?: 2008-01-31

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.: 2008-07-30

What were the results of your operational analysis?: The system is meeting its performance objectives and the needs of stakeholders are being met. The investment is continually analyzed to ensure continuous service as the provisions of MMA are implemented.