Exhibit 300 (BY2010) for CMS Medicare Integrity Program (MIP)

1. Date of Submission:

2008-09-08

2. Agency:

009

3. Bureau:

38

4. Name of this Capital Asset:

CMS Medicare Integrity Program (MIP)

5. Unique Project Identifier:

009-38-01-06-01-1010-00

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?

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 MIP Systems investment is designed to eliminate improper payments and improve financial performance by taking advantage of e-government and other existing technological capabilities. MIP closes the performance gap in large part between paying Medicare claims efficiency and paying Medicare claims accurately. Without MIP CMS could not insure that critical program integrity safeguards were in place and would not have the capability to partner with other Federal agencies in efforts to identify fraud and abuse in CMS programs and assess the payment accuracy of the Medicare program through e-government and other technologies. MIP is an investment in the control phase of the CPIC life-cycle. MIP is comprised of the following components: Health Care Information Systems (HCIS) HCIS is a next-generation desktop tool for viewing summary information about Medicare claims utilization and enrollment data. It provides a wide variety of pre-defined summary views of CMS data. HCISMod helps users identify data trends and aberrations, perform comparisons and rankings. HCISMod is used primarily by OFM's Program Integrity Group, Program Safeguard Contracts, OIG, and DOJ for payment investigation issues. Provider Statistical & Reimbursement Report (PS&R) The PS&R Report is a key component in the Medicare payment cycle. It is the only tool used by Fiscal Intermediaries (FIs) to accumulate the statistical and reimbursement data applicable to the Medicare claims processed. It summarizes the claims processing activities and payments made to participating Medicare providers by fiscal intermediaries for all Medicate covered services. This PS&R data is subsequently utilized to effectuate final settlement of a provider's Medicare cost report. The PS&R Report summarizes these data on reports that are used by providers and FIs to complete key elements of the Medicare cost report. Limited Online Access System Currently, paid claims history (42 months) for seven Fiscal Intermediaries is consolidated in a DB2 UDB data warehouse deployed on Unix-based servers maintained in the Mutual of Omaha Data Center. The integrated JAVA client Decision Support Application (DSA) provides a user-friendly interface to the warehouse and includes security rules that limit user access to only their FI claims. This DSA application allows users to select required data elements to satisfy their informational requirements, with query results returned to users in a Microsoft Access database.

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

yes

9.a. If "yes," what was the date of this approval?

2008-03-24

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?

2005-06-26

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.

yes

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?)

MIP Systems support the financial performance initiative by improving payment processes and preventing/detecting fraud/abuse. MIP enables CMS to insure critical program integrity safeguards are in place by providing systems to collect /tabulate savings and other measures, assist in reducing the Medicare payment error rate by identifying aberrant billing practices when they occur, and provide increased control over expenditures by consolidating/tabulating cost data.

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?

10000470 - Medicare Integrity Program

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

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	10
Software	10
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?

no

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?

no

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	10.546	14.370	16.670	17.369
Government FTE Cost	1.250	1.300	1.400	1.450
# of FTEs	16	16	16	16

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.

This investment has gone through the CMS CPIC Process for approval of target budget figures. Any changes from the President's Budget reflect changing agency priorities.

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	Payments	Improve financial performance by monitoring the percent of payment types covered	50%	75%	Percent of payment types covered is 75%
2	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Service Efficiency	Integrate budget and performance by measuring the percent of contractors using system	0%	18%	18%
3	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Efficiency	Improve financial performance by measuring the percent of new contractors covered	50%	70%	70%
4	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Standards Compliance and Deviations	Expand e-government by measuring the percent of systems converted	0%	25%	25%
5	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Payments	Improve financial performance by monitoring the percent of payment types covered	75%	90%	75%
6	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Service Efficiency	Integrate budget and performance by measuring the percent of contractors using system	18%	40%	40%
7	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Efficiency	Improve financial performance by measuring the percent of new contractors covered	70%	90%	90%
8	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Standards Compliance and Deviations	Expand e-government by measuring the percent of systems converted	25%	50%	25%
9	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Payments	Improve financial performance by monitoring the percent of payment types covered	75%	90%	90%
10	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Service Efficiency	Integrate budget and performance by measuring the percent of contractors using system	40%	90%	90%
11	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Efficiency	Improve financial performance by measuring the percent of new contractors covered	90%	95%	95%
12	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Standards Compliance and Deviations	Expand e-government by measuring the percent of systems converted	25%	50%	50%
13	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Payments	Improve financial performance by monitoring the percent of payment types covered	90%	95%	TBD
14	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Service Efficiency	Integrate budget and performance by measuring the percent of contractors using system	90%	95%	TBD
15	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Efficiency	Improve financial performance by measuring the percent of new contractors covered	95%	98%	TBD
16	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Standards Compliance and Deviations	Expand e-government by measuring the percent of systems converted	50%	75%	TBD
17	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Service Efficiency	Integrate budget and performance by measuring the percent of contractors using system	95%	98%	TBD
18	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Standards Compliance and Deviations	Expand e-government by measuring the percent of systems converted	75%	90%	TBD
19	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Efficiency	Improve financial performance by measuring the percent of new contractors covered	98%	98%	TBD
20	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Payments	Improve financial performance by monitoring the percent of payment types covered	95%	98%	TBD
21	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Payments	Improve financial performance by monitoring the percent of payment types covered	98%	98%	TBD
22	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Efficiency	Improve financial performance by measuring the percent of new contractors covered	98%	98%	TBD
23	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Standards Compliance and Deviations	Expand e-government by measuring the percent of systems converted	90%	95%	TBD
24	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Service Efficiency	Integrate budget and performance by measuring the percent of contractors using system	98%	98%	TBD
25	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Payments	Improve financial performance by monitoring the percent of payment types covered	98%	98%	TBD
26	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Standards Compliance and Deviations	Expand e-government by measuring the percent of systems converted	95%	98%	TBD
27	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Efficiency	Improve financial performance by measuring the percent of new contractors covered	98%	99%	TBD
28	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Service Efficiency	Integrate budget and performance by measuring the percent of contractors using system	98%	99%	TBD
29	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Payments	Improve financial performance by monitoring the percent of payment types covered	98%	99%	TBD
30	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Standards Compliance and Deviations	Expand e-government by measuring the percent of systems converted	98%	99%	TBD
31	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Efficiency	Improve financial performance by measuring the percent of new contractors covered	99%	99%	TBD
32	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Service Efficiency	Integrate budget and performance by measuring the percent of contractors using system	99%	99%	TBD
33	2014	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Payments	Improve financial performance by monitoring the percent of payment types covered	99%	99%	TBD
34	2014	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Standards Compliance and Deviations	Expand e-government by measuring the percent of systems converted	99%	99%	TBD
35	2014	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Efficiency	Integrate budget and performance by measuring the percent of contractors using system	99%	99%	TBD
36	2014	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Service Efficiency	Improve financial performance by measuring the percent of new contractors covered	99%	99%	TBD

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 Medicare Integrity Program (MIP) Systems. Renamed for FY08.

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	Medicare Integrity Program 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	10
2	Medicare Program Integrity Standardized / Canned	Ability to review accuracy of payments.	Reporting	Standardized / Canned			No Reuse	10
3	Medicare Program Integrity Graphing / Charting	Ability to review accuracy of payments.	Visualization	Graphing / Charting			No Reuse	1
4	Medicare Program Integrity Forensics	Ability to review accuracy of payments.	Analysis and Statistics	Forensics			No Reuse	30
5	Abillity to produce Ad-Hoc reports to support FWA detection and payment accuracy.	Abillity to produce Ad-Hoc reports to support FWA detection and payment accuracy.	Reporting	Ad Hoc			No Reuse	4
6	This investment provides archiving capabilities for FWA activities.	This investment provides archiving capabilities for FWA activities.	Data Management	Loading and Archiving			No Reuse	20
7	MIP provides data warehouse capabilities for FWA.	MIP provides data warehouse capabilities for FWA.	Data Management	Data Warehouse			No Reuse	10

5. To demonstrate how this major IT investment aligns with the FEA Technical Reference Model (TRM), please list the Service Areas, Categories, Standards, and Service Specifications supporting this IT investment.

FEA SRM Component: Service Components identified in the previous question should be entered in this column. Please enter multiple rows for FEA SRM Components supported by multiple TRM Service Specifications.

Service Specification: In the Service Specification field, Agencies should provide information on the specified technical standard or vendor product mapped to the FEA TRM Service Standard, including model or version numbers, as appropriate.

Row	SRM Component	>Service Area	Service Category	Service Standard	Service Specification (i.e., vendor and product name)
1	Data Exchange	Service Access and Delivery	Delivery Channels	Internet	Windows Internet Explorer by: Microsoft Corporation
2	Data Exchange	Service Access and Delivery	Access Channels	Web Browser	Windows Internet Explorer by: Microsoft Corporation
3	Data Exchange	Component Framework	Data Interchange	Data Exchange	Connect:Direct by: Sterling Commerce
4	Data Exchange	Component Framework	Data Management	Database Connectivity	Oracle by: TBD
5	Data Exchange	Component Framework	Data Management	Database Connectivity	IBM DB2 by: International Business Machines Corp.
6	Data Exchange	Service Access and Delivery	Delivery Channels	Intranet	Windows Internet Explorer by: Microsoft Corporation
7	Standardized / Canned	Component Framework	User Presentation / Interface	Content Rendering	IBM DB2 by: International Business Machines Corp.
8	Standardized / Canned	Component Framework	User Presentation / Interface	Content Rendering	Oracle by: TBD
9	Graphing / Charting	Component Framework	User Presentation / Interface	Static Display	Cognos PowerPlay by: Cognos Incorporated
10	Graphing / Charting	Component Framework	User Presentation / Interface	Static Display	Microsoft Office Excel by: Microsoft Corporation
11	Graphing / Charting	Component Framework	User Presentation / Interface	Static Display	SAS Enterprise BI Server by: SAS Institute Inc.
12	Forensics	Component Framework	Business Logic	Platform Independent Technologies	SAS Enterprise BI Server by: SAS Institute Inc.
13	Forensics	Component Framework	Business Logic	Platform Independent Technologies	Cognos PowerPlay by: Cognos Incorporated
14	Forensics	Component Framework	Business Logic	Platform Independent Technologies	Microsoft Office Excel by: Microsoft Corporation
15	Forensics	Component Framework	Data Management	Reporting and Analysis	IBM DB2 by: International Business Machines Corp.
16	Forensics	Component Framework	Data Management	Reporting and Analysis	Oracle by: TBD
17	Ad Hoc	Component Framework	User Presentation / Interface	Dynamic Server-Side Display	Cognos PowerPlay by: Cognos Incorporated
18	Ad Hoc	Component Framework	User Presentation / Interface	Dynamic Server-Side Display	SAS Enterprise BI Server by: SAS Institute Inc.
19	Loading and Archiving	Service Platform and Infrastructure	Database / Storage	Database	Cognos PowerPlay by: Cognos Incorporated
20	Loading and Archiving	Service Platform and Infrastructure	Database / Storage	Database	SAS Enterprise BI Server by: SAS Institute Inc.
21	Data Warehouse	Service Platform and Infrastructure	Database / Storage	Database	SAS Enterprise BI Server by: SAS Institute Inc.
22	Data Warehouse	Service Platform and Infrastructure	Database / Storage	Database	Cognos PowerPlay by: Cognos Incorporated

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

no

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?

2008-04-30

1.b. Has the Risk Management Plan been significantly changed since last year's submission to OMB?

yes

1.c. If yes, describe any significant changes:

Several of the systems are undergoing development as web based applications that will operate on the CMS secure network. CMS has made changes to the risk management plans for those applications to reflect anticipated changes.

1. Was operational analysis conducted?

yes

1.a. If yes, provide the date the analysis was completed.

2008-08-13

What were the results of your operational analysis?

The systems are performing as expected. Data that respondents input is generally (95% of submissions) on time. Reports the systems produce are generally meet program needs, and where reports do not meet user needs because of changing program needs, reports are modified to meet new needs. Costs are justified and do not exceed plans; in fact, costs are sometimes (10% of the time) below expectations because of improvements in contractor efficiency, acquisition of equipment, or quality of system equipment. There is a disconnect between the lifecycle costs in the summary of spending and those reflected in the milestone table. Milestones need to be added for future years. They have been added in a proposed rebaseline request. The request is being processed through appropriate channels according to CPIC policy.