Exhibit 300 (BY2010) for CMS Interoperability & Standardization - Claims

PART ONE

OVERVIEW

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

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 FY2010?: Mixed Life Cycle

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 e-exchange of core business transactions is a cornerstone in the Medicare FFS operations. This portfolio includes four CMS investments to process e-health care transactions that continue strategic standardization efforts & ensure FFS product interoperability. HIPAA-2: The current HIPAA standards for administrative transactions & code sets for Medicare FFS include claim, remittance advice, claim status inquiry/response & eligibility inquiry/response. The next version of HIPAA standards (HIPAA-2) will replace the existing formats for the FFS transactions to the ICD-10 diagnosis & procedure codes that are required to be processed by Medicare FFS by October 1, 2011. HIPAA 270/271:This investment supports HIPAA Claims-based Transactions (270/271). CMS is mandated by HIPAA to provide a standard 270/271 health care eligibility inquiry & response to providers & health care institutions. The system provides eligibility information to FFS providers to assist them with the service to Medicare beneficiaries & in the adjudication of Medicare claims. HIPAA EDI: This investment supports ongoing monitoring & mgmt of Medicare FFS contractor compliance with HPAA Electronic Data Interchange requirements. HIPAA compliance includes EDI status, NPI status, ASCA (Administrative Simplification Compliance Act) status, Standard Code Set status with respect to valid values in the EDI transactions. NPI Crosswalk: HIPAA also mandated that the Secretary of HHS adopt a standard unique health identifier for health care providers. CMS, like all health care payers, must be able to cross-refer a provider identified by an NPI to master provider records identified by other identifiers & housed in the Medicare claims processing systems. CMS maintains the Crosswalk File that includes all data elements required to map an incoming NPI to the appropriate legacy provider identifier(s). The NPI Crosswalk bridges the National Plan & Provider Enumeration System (NPPES) to the Provider Enrollment System (PECOS). DME activity has been added for FY2009 to include a single COTS translator that will replace 43 disparate translators with a single translator. This will reduce the number claims acceptance errors and ultimately reduce the cost of maintenance.

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?: 2006-01-15

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
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 the PMA goal Expanding E-gov by providing Medicare FFS & MMA eligibility via the Internet and aligns the data in the response transaction with current CWF and other legacy methods. The next version of HIPAA standards will make the use of electronic transactions easier & better aligned with changing business needs. It also improves financial management as the NPI cross-walk assigns a unique identifier to all providers and health plans, reducing improper 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)?: 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	20
Services	80
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	1.000	0.000	0.000	0.000
Acquisition Budgetary Resources	0.000	0.000	0.000	0.000
Maintenance Budgetary Resources	23.349	35.780	19.359	26.246
Government FTE Cost	1.090	1.600	1.430	1.520
# of FTEs	11	16	14	14

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 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. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Number of Providers accessing data via internet (Pilot of 100 health care providers)	0	100	45
2	2006	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Percent of claims and eligibility data available to providers during operating hours (contractor operating hours vary)	95%	96%	96%
3	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Reduction in Error rate in each quarterly release (baseline fluctuates with every release based on issues identified)	--	2%	2%
4	2006	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Accessibility	Percentage of Eligibility System is available to contractors and providers during operating hour, which vary.	95%	95%	95%
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(Pilot of 100 health care providers)	45	100	100
6	2007	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Percent of claims and eligibility data available to providers during operating hours (contractor operating hours vary)	96%	98%	98%
7	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Reduction in Error rate in each quarterly release (baseline fluctuates with every release based on issues identified)	2%	2%	2%
8	2007	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Accessibility	Percentage of Eligibility System is available to contractors and providers during operating hour, which vary.	95%	95%	95%
9	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percentage of providers having access to Beneficiary eligibility status via the internet (as opposed to through their contractors)	1%	5%	5%
10	2008	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Percent of claims and eligibility data available to providers during operating hours (contractor operating hours vary)	97%	98%	98%
11	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Reduction in Error rate in each quarterly release (baseline fluctuates with every release based on issues identified)	2%	2%	2%
12	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Accessibility	Percentage of Eligibility System is available to contractors and providers during operating hour, which vary.	95%	95%	96%
13	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percentage of providers having access to Beneficiary eligibility status via the internet (as opposed to through their contractors)	5%	10%	TBD
14	2009	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Percent of claims and eligibility data available to providers during operating hours (contractor operating hours vary)	98%	98%	TBD
15	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Reduction in Error rate in each quarterly release (baseline fluctuates with every release based on issues identified)	2%	2%	TBD
16	2009	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Accessibility	Percentage of Eligibility System is available to contractors and providers during operating hour, which vary.	96%	95%	TBD
17	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percentage of providers having access to Beneficiary eligibility status via the internet (as opposed to through their contractors)	TBD	40%	TBD
18	2010	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Percent of claims and eligibility data available to providers during operating hours (contractor operating hours vary)	TBD	98%	TBD
19	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Reduction in Error rate in each quarterly release (baseline fluctuates with every release based on issues identified)	TBD	2%	TBD
20	2010	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Accessibility	Percentage of Eligibility System is available to contractors and providers during operating hour, which vary.	TBD	95%	TBD
21	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percentage of providers having access to Beneficiary eligibility status via the internet (as opposed to through their contractors)	TBD	60%	TBD
22	2011	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Percent of claims and eligibility data available to providers during operating hours (contractor operating hours vary)	TBD	98%	TBD
23	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Reduction in Error rate in each quarterly release (baseline fluctuates with every release based on issues identified)	TBD	2%	TBD
24	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Accessibility	Percentage of Eligibility System is available to contractors and providers during operating hour, which vary.	TBD	95%	TBD
25	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percentage of providers having access to Beneficiary eligibility status via the internet (as opposed to through their contractors)	TBD	80%	TBD
26	2012	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Percent of claims and eligibility data available to providers during operating hours (contractor operating hours vary)	TBD	98%	TBD
27	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Reduction in Error rate in each quarterly release (baseline fluctuates with every release based on issues identified)	TBD	2%	TBD
28	2012	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Accessibility	Percentage of Eligibility System is available to contractors and providers during operating hour, which vary.	TBD	95%	TBD
29	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percentage of providers having access to Beneficiary eligibility status via the internet (as opposed to through their contractors)	TBD	90%	TBD
30	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Access	Percent of claims and eligibility data available to providers during operating hours (contractor operating hours vary)	TBD	98%	TBD
31	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Reduction in Error rate in each quarterly release (baseline fluctuates with every release based on issues identified)	TBD	80	TBD
32	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Accessibility	Percentage of Eligibility System is available to contractors and providers during operating hour, which vary.	TBD	95%	TBD
33	2014	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Percentage of providers having access to Beneficiary eligibility status via the internet (as opposed to through their contractors)	TBD	100%	TBD
34	2014	S.O. 1.2 - Increase health care service availability and accessibility	Customer Results	Access	Percent of claims and eligibility data available to providers during operating hours (contractor operating hours vary)	TBD	98%	TBD
35	2014	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Errors	Reduction in Error rate in each quarterly release (baseline fluctuates with every release based on issues identified)	TBD	2%	TBD
36	2014	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Accessibility	Percentage of Eligibility System is available to contractors and providers during operating hour, which vary.	TBD	95%	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 Retrieval Services for the CMS Interoperability & Standardization - Claims Investment	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	Information Sharing Services for the CMS Interoperability & Standardization - Claims Investment	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
3	Data Exchange for the CMS Interoperability & Standardization - Claims Investment	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	Information Retrieval	Component Framework	Data Interchange	Data Exchange	File Transfer Protocol (FTP) by: The Internet Engineering Task Force
2	Information Retrieval	Component Framework	Data Interchange	Data Exchange	Connect:Direct by: Sterling Commerce
3	Information Sharing	Component Framework	Data Interchange	Data Exchange	File Transfer Protocol (FTP) by: The Internet Engineering Task Force
4	Information Sharing	Component Framework	Data Interchange	Data Exchange	Connect:Direct by: Sterling Commerce
5	Data Exchange	Component Framework	Data Interchange	Data Exchange	File Transfer Protocol (FTP) by: The Internet Engineering Task Force
6	Data Exchange	Component Framework	Data Interchange	Data Exchange	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 TWO

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?: 2008-03-20

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

3. Briefly describe how investment risks are reflected in the life cycle cost estimate and investment schedule:: The identifiable assessment risks associated with these projects were applied using the probability of occurrence, rating of the impact and a mitigation strategy for each phase of the project from cradle to grave. The risk adjustment is a percentage of the cost based on the probability of occurrence and potential impact. This adjustment may vary among years and across life cycle phases. Analysis of alternatives includes the risk adjusted costs. When schedule or cost risks are high, the risk is mitigated by frequent meetings to assess progress. The investment schedule has been adjusted to reflect the impact of risks that have occurred or may occur. Costs have also be adjusted to account for inflation. Upon award of a development contractor, CMS shall ensure that all mitigation strategies associated with Risk Management will be incorporated into contract language between the agency and development contractor.

COST & SCHEDULE

1. Does the earned value management system meet the criteria in ANSI/EIA Standard 748?: no

2. Is the CV% or SV% greater than ± 10%?: no

3. Has the investment re-baselined during the past fiscal year?: yes

3.a. If yes, when was it approved by the agency head?: 2008-08-06

Exhibit 300 (BY2010) for CMS Interoperability &amp; Standardization - Claims