MMIS ReBid Project
PROJECT MANAGEMENT PLAN
Executive Sponsor – Julie Weinberg
Business Owner – HSD Medical Assistance Division
Project Manager – Mario Gonzalez
Original Plan Date: August 24 2011
Revision Date: August 24 2011
Revision: 1.0
This document is submitted as the initial project plan for the MMIS ReBid Project which opens the state Medicaid State Fiscal Agent contract for bid and enables HSD to enhance its Medicaid operations. The procurement is open as of this date. Information related to the current procurement, proposals, available budgets or estimates of project expenditures, future related MMIS projects, or other related information has not been included in this version. It will be updated accordingly after the procurement is concluded.
Revision History 3
1.0 Project Overview 4
1.1 Executive Summary- rationale for the Project 4
1.2 funding and sources 5
1.3 constraints 6
1.4 dependencies 6
1.5 ASSUMPTIONS 6
1.6 Initial Project Risks Identified 7
2.0 Project Authority/ Organizational Structure 7
2.1 Stakeholders 7
2.2 Project Governance Structure 8
2.2.1 Describe the organizational structure – Org Chart 8
2.2.2 Describe the role and members of the project steering committee 8
2.2.3 Organizational Boundaries, interfaces and responsibilities 9
3.0 Scope 9
3.1 Project Objectives 9
3.1.1 Business Objectives 9
3.1.2 Technical Objectives 9
3.2 Project exclusions 10
3.3 Critical Success Factors 11
4.0 Project Deliverables and methodology 12
4.1 Project Management Life Cycle 12
4.1.1 Project Management Deliverables 12
4.1.2 Deliverable Approval Authority Designations 12
4.1.3 Deliverable Acceptance Procedure 12
4.2 PRODUCT LIFE CYCLE 13
4.2.1 Technical Strategy 13
4.2.2 Product and Product Development Deliverables 13
4.2.3 Deliverable Approval Authority Designations 14
4.2.4 Deliverable Acceptance Procedure 14
5.0 Project Work 15
5.1 Work Breakdown Structure (WBS) 15
5.2 Schedule allocation -Project Timeline 15
5.3 Project Budget 16
5.4 Project Team 16
5.4.1 Project Team Organizational Structure 16
5.4.2 Project Team Roles and Responsibilities 17
5.5 STAFF PLANNING AND Resource ACQUISITION 18
5.6 PROJECT LOGISTICS 18
5.6.1 Project Team Training 18
6.0 Project Management and Controls 18
6.1 Risk and issue Management 18
6.1.1 Risk Management Strategy 18
6.2 INDEPENDENT Verification And Validation - Iv&V 19
6.3 Scope Management Plan 20
6.3.1 Change Control 20
6.4 Project Budget Management 21
6.5 Communication Plan 21
6.6 PERFORMANCE MEASUREMENT (PROJECT METRICS) 22
6.7 QUALITY OBJECTIVES AND CONTROL 22
6.8 CONFIGURATION MANAGEMENT 22
6.9 PROCUREMENT MANAGEMENT PLAN 22
7. 0 Project Close 23
7.1 Administrative Close 23
7.2 Contract Close 23
AttachmentS 24
RFP Issued Deliverables List 25
Revision History
Revision / Date / Comment1.0 / 8/19/2011 / Initial version submitted to PCC. It only includes available information available during this procurement. It will be updated as the procurement closes and more definite information will be available.
2.0
2.1
2.2
1.0 Project Overview
In 2010, the Human Services Department (HSD) initiated a project to issue a Request for Proposals (RFP) for the transition, operation, and maintenance of the Medicaid Management Information System (MMIS) and affiliated Medicaid operations. The project includes fifteen required and optional enhancements, including remediation of the MMIS and related systems to accommodate the new federal requirements for ICD-10 diagnosis and procedure codes.
The current MMIS contract, with ACS State Healthcare LLC (ACS), expires on August 31, 2010, with provision for three one-year extensions that could potentially extend the contract to August 31, 2013. New Mexico law prohibits contracts greater than eight years and the federal Centers for Medicare and Medicaid Services (CMS), which funds the majority of MMIS operations and maintenance, requires that states periodically rebid these contracts. As discussed under the next heading, the timing of the re-bid was influenced by upcoming federal mandates that required close attention to the timing of any MMIS transition.
This document is limited to information that is publically available during this procurement, addresses planning related to the procurement and projects related to the Medicaid program over the next seven years. When the procurement is finalized, it will be updated with more accurate and definite information.
1.1 Executive Summary- rationale for the Project
To determine whether to extend the ACS contract, two critical dates had to be considered—the HIPAA 5010 compliance deadline of January 1, 2012 and the ICD-10 compliance deadline of October 1, 2013. In particular, extending the ACS contract to its maximum length, August 31, 2013, would fall a month short of the ICD-10 compliance date.
Previously, HSD conducted an assessment of the impact of 5010 and ICD-10 on the MMIS environment; this project resulted in detailed documentation of the system and operational impact of both mandates. Based on the magnitude of the required changes, HSD determined that each remediation project would require 12 to 18 months to complete. In order to give the contractor responsible for each remediation effort enough time to resolve any implementation issues and to avoid the possibility of finger-pointing between an outgoing and incoming contractor, HSD determined that no transition between contractors should occur for at least three months after each compliance date.
Another key issue was whether to require the new contractor to take over the MMIS or replace it. The current MMIS, known at OmniCaid, was implemented in February 2002. It is a modern system that uses a three-tiered client-server architecture with a DB2 relational database management system. It has been tailored to New Mexico’s managed care environment. It was determined that the system is capable of supporting HSD’s needs for at least another full contract term and that the re-bid would require its takeover rather than replacement. HSD also determined that a new contractor would need at least 12 months to take over the MMIS and implement required peripheral systems, establish administrative offices in New Mexico, and be ready to start operations.
As a result, HSD determined that the best approach to this project would be as follows:
· Issue an RFP for the takeover and enhancement of MMIS by July 2010, with an anticipated contract start date of March 1, 2011. RFP issuance was delayed to January 2011 due to changes in the format of the RFP and approach to the procurement. As a result, the contract start date defined by the RFP was changed to October 1, 2011 (but currently estimated to start December 2011).
· Extend the ACS contract for 19 months, through March 31, 2012, giving the current contractor time to complete the HIPAA 5010 remediation and providing a three-month overlap between the January 1, 2012 HIPAA 5010 compliance date and the start of the new MMIS contract. Later, this was changed due to the time required for procurement preparations and a contract amendment was drafted to extend the contract to September 30, 2012.
This approach gives a new contractor 12 months to complete the Transition Phase of the contract and start operations. Should contract execution be delayed, the schedule would be modified to give a non-incumbent contractor 12 months to complete Transition Phase activities.
In addition to the 5010 and ICD-10 assessment documents mentioned previously, a key input to the development of this project was the Medicaid Information Technology Architecture (MITA) State Self-Assessment (SS-A) completed in March 2009. MITA defines maturity levels for more than 70 business processes, and it is the expectation of CMS that states will use any requested federal funding to improve upon their current maturity levels. As part of the MITA SS-A, the “As-Is” (or current) environment was documented. Based on HSD strategic goals and objectives, the “To-Be” (or future) environment was envisioned. The RFP includes several required and optional enhancements that will improve the maturity level of specific business processes based on the “To-Be” roadmap.
1.2 funding and sources
While the procurement is still open, the amount HSD believes may be required for IV&V services is estimated for this section. As the contract is negotiated and completed, the amounts will be updated accordingly.
Source / Amount / Associated restrictions / Approvers /General Appropriation Act of 2011; Laws 2011, Chapter 179, Section 4, HUMAN SERVICES DEPARTMENT, Subsection (1), Paragraph (b). / $1,500,000 for IV&V services / availability of general fund to enable federal matching / HSD Management approves state share.
CMS Management determines and approves federal share.
1.3 constraints
Constraints are factors that restrict the project by scope, resource, or schedule.
Number / Description /1 / Availability of General fund to pay for the State share of the costs
2 / 5010 and ICD-10 mandates, around which the project schedule must be planned
3 / Term of ACS contract as extended (through September 30, 2012) and its maximum term (August 31, 2013)
1.4 dependencies
Types include the following and should be associated with each dependency listed.
· M-Mandatory dependencies are dependencies that are inherent to the work being done.
· D-Discretionary dependencies are dependencies defined by the project management team. This may also encompass particular approaches because a specific sequence of activities is preferred, but not mandatory in the project life cycle.
· E-External dependencies are dependencies that involve a relationship between project activities and non-project activities such as purchasing/procurement
Number / Description / Type M,D,E /1 / cms approval of apd, rfp and budget / E, M
2 / timely release of rfp / e
3 / timely award, negotiation and execution of contract / m
1.5 ASSUMPTIONS
Assumptions are planning factors that, for planning purposes, will be considered true, real, or certain.
Number / Description /1 / cms, spd, and doit will approve the project
2 / state funds will be available to support the project’s minimum requirements
3 / hsd will receive responsive bids from qualified companies to the rfp
1.6 Initial Project Risks Identified
In this section identify and describe how each risk will be managed. Include the steps that will be taken to maximize activity that will result in minimizing probability and impact of each risk.
This section is based upon the information submitted under the Project Charter. A more formal risk assessment will be performed when the final terms and deadlines of the contract are determined.
Risk 1: Interruption of claims processing due to delayed transition or serious start-up issues if there is a period between vendors (the procurement is organized to enable HSD to work with two vendors for a one-year transition period).
Mitigation 1: Project schedule provides for a 12 month Transition phase to assure adequate time to complete all tasks.
Mitigation 2: None of the system enhancements is required to be implemented prior to the start of operations, reducing the scope of work during the Transition Phase.
Risk 2: Failure to meet the October 1, 2013 compliance date for ICD-10 diagnosis and procedure codes if the procurement is delayed and the new contractor does not have enough time to complete its tasks.
Mitigation 1: An ICD-10 assessment was completed through another project in 2009. A number of key business decisions were finalized by HSD and several system changes are being made in conjunction with the HIPAA 2 (5010) project, including all table conversions. This has given HSD a significant head start on the 2013 deadline.
Mitigation 2: Project schedule gives the contractor 12 months after the start of the Operations Phase to remediate the MMIS for ICD-10 compliance.
2.0 Project Authority/ Organizational Structure
The Project Organization describes the roles and responsibilities of the project team. It also identifies the other organizational groups that are part of the project and graphically depicts the hierarchical configuration of those groups. It exists to clarify interaction with the project team.
2.1 Stakeholders
name / Stake in Project / Organization / Title /Julie Weinberg / Executive Sponsor / HSD-Medical Assistance Division (MAD) / Director
Mark Pitcock / Business Owner / HSD-MAD / Bureau Chief
Robert Stevens / Business Owner / HSD-MAD / Bureau Chief
Brian Pietrewicz / Technical Sponsor / HSD-Information Technology Division (ITD) / Acting Chief Information Officer
Mario Gonzalez / Project Manager PM) / HSD-ITD / IT PM Bureau Chief
Roberta Duran / Business Owner / Department of Health (DOH) / Program Manager
2.2 Project Governance Structure
2.2.1 Describe the organizational structure – Org Chart
The following is the org chart as it stands without the solicitation award:
2.2.2 Describe the role and members of the project steering committee
This information is dependent upon which vendor is awarded the contract and will be developed for final review in the next project plan after award of the contract.
2.2.3 Organizational Boundaries, interfaces and responsibilities
Use this section to describe any special considerations regarding contact between the project team, the project manager, and individuals from various organizations involved in the project: Boundary, interface and responsibilities at the interface
This information is dependent on which vendor is awarded the contract and will be addressed after the award is made.
3.0 Scope
3.1 Project Objectives
Project and procurement objectives may change based on procurement scope and selection of final vendor.
3.1.1 Business Objectives
Number / Description /BUSINESS OBJECTIVE 1 / Uninterrupted claims processing
BUSINESS OBJECTIVE 2 / Compliance with ICD-10 by 10/1/2013
BUSINESS OBJECTIVE 3 / Improved MITA maturity levels
BUSINESS OBJECTIVE 4 / Additional Web-based Self-Service capability for providers and clients
BUSINESS OBJECTIVE 5 / increased efficiency
BUSINESS OBJECTIVE 6 / Maximum Federal Funding
3.1.2 Technical Objectives
Number / Description /Technical Objective 1 / Successful takeover of the Omnicaid mmis
Technical Objective 2 / successful implementation of related peripheral systems (hipaa translator, pharmacy claims processing, fraud and abuse detection, document management, web portal)
Technical Objective 3 / remediate all systems for icd-10
Technical Objective 4 / replace legacy management and administrative reporting system (MARS) with a data warehouse-based system
Technical Objective 5 / Implement HIpaa 270/271 eligibility inquiry and response transactions
Technical Objective 6 / implement HIPAA 820 premium payment transactions
Technical Objective 7 / implement HIPAA 834 benefit enrollment and maintenance transactions
Technical Objective 8 / modify web portal to allow client eligibility inquiry on a span of dates
Technical Objective 9 / Implement HIPAA 276/277 claim status inquiry and response transactions (optional enhancement)
Technical Objective 10 / enhance the web portal to support direct data entry of claims (optional enhancement)
Technical Objective 11 / enhance the web portal to support online provider enrollment (optional enhancement)
Technical Objective 12 / implement a new client web portal with self-service features (optional enhancement)
Technical Objective 13 / implement electronic billing of other insurance carriers (optional enhancement)
Technical Objective 14 / automate processing and posting of tpl payments (optional enhancement)
Technical Objective 15 / implement the NCPDP 3.0 SUBROGATION standard (optional enhancement)
3.2 Project exclusions
Areas excluded from the project will be determined after the award is made and CMS makes its final approvals for budget and scope of any sub projects related to this procurement.