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Exhibit 300 (BY2010) - CMS Common Working File (CWF)

PART ONE

OVERVIEW

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

2. Agency:: 009

3. Bureau:: 38

4. Name of this Capital Asset:: CMS Common Working File (CWF)

5. Unique Project Identifier:: 009-38-01-02-01-1110-00

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?: 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.: The Common Working File (CWF) is a single data source for Fiscal Intermediaries and Carriers to verify beneficiary eligibility and conduct prepayment review and approval of claims from a national perspective. It is the only place in the fee for service (FFS) claims processing system where full individual beneficiary information is housed. CWF meets CMS' core requirements for claims processing: 1) beneficiary entitlement to Part A/B, 2) accurate deductible & coinsurance, 3) appropriate services, 4) benefits on the claim are available, and 5) Medicare Secondary Payer information is correct. CWF also performs limited part A/B crossover editing to insure services are not paid twice on different types of claims. CWF has four quarterly releases that control, implement, and update software changes due to legislative mandates. Software changes for the claims processing operations are managed in quarterly releases developed through a change control process that begins with the Medicare Change Control Board review and prioritization of pending requests. The FFS Operations Board approves the quarterly releases with oversight by the FFS Governance Council and manages/integrates day-to-day operations of the FFS program across CMS. The FFS claims processing environment is distributed across 4 claims processing modules and 1 integrated testing module. This investment also funds the Single Testing Contractor (STC), the only entity responsible for: 1) independently testing the base FFS shared systems and CWF, and 2) validating that Medicare requirements are correctly implemented. Testing is performed in an integrated, production-like environment allowing CMS to monitor and control system testing, costs, standardization, communication, and flexibility across systems. This investment directly supports the PMA Improve Financial Performance, as it is an essential component ensuring that accurate payments are made for medically necessary services and are provided to eligible beneficiaries by qualified providers of care. The impact of not funding CWF & STC would be detrimental to Medicare, introducing system errors, causing harmful delays in claims processing and payment, and reducing the access, availability, and provision of health care services to Medicare beneficiaries. Error-free releases that implement legislative mandates with minimal interruption to processing ensure that beneficiaries receive the correct service and providers receive the correct payment.

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

9.a. If "yes," what was the date of this approval?: 2008-03-26

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?: Waiver Issued

11.b. When was the Program/Project Manager Assigned?: 2004-11-14

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)?: no

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
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?): The CWF directly supports the PMA "Improve Financial Performance" because it is an essential component to ensuring that accurate payments are made for only medically necessary services and are provided only to eligible Medicare beneficiaries by qualified providers. CWF also is vital to minimizing fraud and abuse in the Medicare program and ensuring quality of care is provided to Medicare beneficiaries.

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)?: 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	1
Services	99
Other

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 -2007	PY 2008	CY 2009	BY 2010
Planning Budgetary Resources	0.000	0.000	0.000	0.000
Acquisition Budgetary Resources	0.000	0.000	0.000	0.000
Maintenance Budgetary Resources	40.120	22.214	29.209	30.537
Government FTE Cost	0.400	0.500	0.530	0.561
# of FTEs	4	5	5	5

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.: The current funding levels for this investment were developed through the CMS' annual CPIC process. The funding levels for CWF claims processing do not equal the President's Budget because the CMS portfolio has been adjusted to reflect re-evaluated Agency priorities.

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. 1.2 - Increase health care service availability and accessibility	Mission and Business Results	Health Care Administration	Cumulative percentage of errors detected by testing contractor prior to release	90%	100%	91%
2	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Average score of CWF Host Survey following a production release	4	5 (scale of 1 to 5, 5 = excellent, 1 = failure)	4.78
3	2006	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within the specified time frame	4 of 4	4 of 4	4 of 4
4	2006	S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery	Technology	Accessibility	Percentage of system availability during processing hours	96%	98%	98%
5	2007	S.O. 1.2 - Increase health care service availability and accessibility	Mission and Business Results	Health Care Administration	Cumulative percentage of errors detected by testing contractor prior to release	91%	95%	95%
6	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	4.78	5 (scale of 1 to 5, 5 = excellent, 1 = failure)	5
7	2007	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within specified time frame	4 of 4	4 of 4	4 of 4
8	2007	S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery	Technology	Accessibility	Percentage of system availability during processing hours	98%	98.5%	98.5%
9	2008	S.O. 1.2 - Increase health care service availability and accessibility	Mission and Business Results	Health Care Administration	Cumulative percentage of errors detected by testing contractor prior to release	95%	96%	95%
10	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	5	5 (scale of 1 to 5, 5 = excellent, 1 = failure)	5
11	2008	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within specified time frame	4 of 4	4 of 4	4 of 4
12	2008	S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery	Technology	Accessibility	Percentage of system availability during processing hours	98.5%	98.5%	99%
13	2009	S.O. 1.2 - Increase health care service availability and accessibility	Mission and Business Results	Health Care Administration	Cumulative percentage of errors detected by testing contractor prior to release	95%	97%	TBD
14	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	5	5 (scale of 1 to 5, 5 = excellent, 1 = failure)	TBD
15	2009	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within specified time frame	4 of 4	4 of 4	TBD
16	2009	S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery	Technology	Accessibility	Percentage of system availability during processing hours	99%	98.5%	TBD
17	2010	S.O. 1.2 - Increase health care service availability and accessibility	Mission and Business Results	Health Care Administration	Cumulative percentage of errors detected by testing contractor prior to release	TBD	98%	TBD
18	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	TBD	5 (scale of 1 to 5, 5 = excellent, 1 = failure)	TBD
19	2010	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within specified time frame	TBD	4 of 4	TBD
20	2010	S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery	Technology	Accessibility	Percentage of system availability during processing hours	TBD	98.5%	TBD
21	2011	S.O. 1.2 - Increase health care service availability and accessibility	Mission and Business Results	Health Care Administration	Cumulative percentage of errors detected by testing contractor prior to release	TBD	99%	TBD
22	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	TBD	5 (scale of 1 to 5, 5 = excellent, 1 = failure)	TBD
23	2011	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within specified time frame	TBD	4 of 4	TBD
24	2011	S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery	Technology	Accessibility	Percentage of system availability during processing hours	TBD	98.5%	TBD
25	2012	S.O. 1.2 - Increase health care service availability and accessibility	Mission and Business Results	Health Care Administration	Cumulative percentage of errors detected by testing contractor prior to release	TBD	100%	TBD
26	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	TBD	5 (scale of 1 to 5, 5 = excellent, 1 = failure)	TBD
27	2012	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within specified time frame	TBD	4 of 4	TBD
28	2012	S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery	Technology	Accessibility	Percentage of system availability during processing hours	TBD	98.5%	TBD
29	2013	S.O. 1.2 - Increase health care service availability and accessibility	Mission and Business Results	Health Care Administration	Cumulative percentage of errors detected by testing contractor prior to release	TBD	100%	TBD
30	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Average score of CWF Host Survey following a production release	TBD	5 (scale of 1 to 5, 5 = excellent, 1 = failure)	TBD
31	2013	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within specified time frame	TBD	4 of 4	TBD
32	2013	S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery	Technology	Availability	Percentage of system availability during processing hours	TBD	98.5%	TBD
33	2014	S.O. 1.2 - Increase health care service availability and accessibility	Mission and Business Results	Health Care Administration	Cumulative percentage of errors detected by testing contractor prior to release	TBD	100%	TBD
34	2014	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Average score of CWF Host Survey following a production release	TBD	5 (scale of 1 to 5, 5 = excellent, 1 = failure)	TBD
35	2014	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within specified time frame	TBD	4 of 4	TBD
36	2014	S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery	Technology	Availability	Percentage of system availability during processing hours	TBD	98.5%	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 Common Working File (CWF)

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	CWF Information Retrieval Services	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
2	CWF Data Exchange Services	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
3	CWF Information Sharing Services	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

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	Information Retrieval	Component Framework	Data Management	Database Connectivity	Connect:Direct by: Sterling Commerce
2	Data Exchange	Component Framework	Data Interchange	Data Exchange	Connect:Direct by: Sterling Commerce
3	Data Exchange	Service Interface and Integration	Integration	Enterprise Application Integration	Connect:Direct by: Sterling Commerce
4	Information Sharing	Component Framework	Data Management	Database Connectivity	Connect:Direct by: Sterling Commerce

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?: 2008-07-30

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.: 2008-08-06

What were the results of your operational analysis?: CMS has established contract performance metrics to monitor CWF's effectiveness in meeting program objectives. It has been determined that the FFS systems need a fundamental technology transformation because of the steady increase in transaction volume and the increasingly complex business processes. Renovation will be needed to meet increasing business demands and improve the accuracy of payment determinations, optimize system quality, availability, and performance, lower operational, management and maintenance costs and position CMS for future reforms.

1.c. If no, please explain why it was not conducted and if there are any plans to conduct operational analysis in the future.: Not Applicable.