HIPAA 2 – Version 5010 and ICD-10
PROJECT MANAGEMENT PLAN
(PMP)
Executive Sponsor – Carolyn Ingram
Business Owner – Medical Assistance Division
Project Manager – Liz Shaw
Original Plan Date: May 18, 2009
Revision Date:
Revision: 1.0
Project Management Plan for HIPAA 2 – Version 5010 and ICD10
Revision History iii
1.0 Project Overview 1
1.1 Executive Summary- rationale for the Project 1
1.2 funding and sources 1
1.3 constraints 1
1.4 dependencies 2
1.5 ASSUMPTIONS 2
1.6 Initial Project Risks Identified 2
2.0 Project Authority and Organizational Structure 3
2.1 Stakeholders 3
2.2 Project Governance Structure 4
2.2.1 Human Services Department Organization Chart 4
2.2.2 Describe the role and members of the project steering committee 4
2.2.3 Organizational Boundaries, interfaces and responsibilities 5
2.3 Executive Reporting 5
3.0 Scope 6
3.1 Project Objectives 6
3.1.1 Business Objectives 6
3.1.2 Technical Objectives 6
3.2 Project exclusions 7
3.3 Critical Success Factors 7
4.0 Project Deliverables and methodology 7
4.1 Project Management Life Cycle 7
4.1.1 Project Management Deliverables 8
4.1.2 Deliverable Approval Authority Designations 9
4.1.3 Deliverable Acceptance Procedure 9
4.2 PRODUCT LIFE CYCLE 9
4.2.1 Technical Strategy 10
4.2.2 Product and Product Development Deliverables 10
4.2.3 Deliverable Approval Authority Designations 10
4.2.4 Deliverable Acceptance Procedure 11
5.0 Project Work 11
5.1 Work Breakdown Structure (WBS) 11
5.2 Schedule allocation -Project Timeline 12
5.3 Project Budget 13
5.4 Project Team 13
5.4.1 Project Team Organizational Structure 13
5.4.2 Project Team Roles and Responsibilities 14
5.5 STAFF PLANNING AND Resource ACQUISITION 16
5.5.1 Project Staff 16
5.5.2 Non-Personnel resources 16
5.6 PROJECT LOGISTICS 16
5.6.1 Project Team Training 16
6.0 Project Management and Controls 16
6.1 Risk and issue Management 16
6.1.1 Risk Management Strategy 17
6.1.2 Project Risk Identification 17
6.1.3 Project Risk Mitigation Approach 17
6.1.4 Risk Reporting and Escalation Strategy 17
6.1.5 Project Risk Tracking Approach 17
6.1.6 ISSUE MANAGEMENT 17
6.2 INDEPENDENT Verification And Validation - Iv&V 17
6.3 Scope Management Plan 17
6.3.1 Change Control 18
6.4 Project Budget Management 18
6.4.1 Budget Tracking 18
6.5 Communication Plan 18
6.5.1 Communication Matrix 18
6.5.2 Status Meetings 18
6.5.3 Project Status Reports 18
6.6 PERFORMANCE MEASUREMENT (PROJECT METRICS) 18
6.6.1 Baselines 18
6.6.2 Metrics Library 19
6.7 QUALITY OBJECTIVES AND CONTROL 19
6.7.1 quality Standards 19
6.7.2 Project and Product Review AND ASSESSMENTS 19
6.7.3 Agency/Customer Satisfaction 19
6.7.4 PRODUCT DELIVERABLE ACCEPTANCE PROCESS 19
6.8 CONFIGURATION MANAGEMENT 19
6.8.1 Version Control 19
6.8.2 Project Repository (Project Library) 19
6.9 PROCUREMENT MANAGEMENT PLAN 19
7. 0 Project Close 20
7.1 Administrative Close 20
7.2 Contract Close 20
Revision History
Revision Number / Date / Comment1.0 / May 18, 2009 / Initial Draft
iii of vi
Project Management Plan for HIPAA 2 – Version 5010 and ICD10
1.0 Project Overview
1.1 Executive Summary- rationale for the Project
In August 2005, the Medical Assistance Division of the Human Services Department contracted with Affiliated Computer Systems (ACS) for maintenance and development of enhancements of the current Medicaid Management Information System (MMIS). In January 2009, the Centers for Medicare and Medicaid Services (CMS) mandated two new rules for the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Electronic Transaction Standards. One rule is to convert to ACS X12 Version 5010 and the other rule is to implement the new International Classification of Diseases, Tenth Revision, ICD-10. The updated X12 standard, Version 5010, affects certain electronic health care transactions; provides an updated version of the National Council for Prescription Drug Programs (NCPDP) standard for electronic pharmacy-related transactions; updated standards for claims, remittance advice, eligibility enquiries, referral authorization, and other administrative transactions; and accommodation of the ICD10 code sets, which are not supported by the current X12 standard.
1.2 funding and sources
Source / Amount / Associated restrictions / Approvers /Laws of 2009, Chapter 124, Section 4, Human Services Department, (3)(b) Medical Assistance / $6,737,400 (GF)
$600,000 (Other state funds)
$19,082,100 (FF) / CMS approval of each project phase must be obtained. The approval process uses the Advanced Planning Documents / CMS
1.3 constraints
Constraints are factors that restrict the project by scope, resource, or schedule.
Number / Description /1 / Project Phase funding. CMS approval of Advanced Planning Documents, which describe the phase and its associated costs.
2 / The Version 5010 changes must be implemented by January 1, 2012
3 / The ICD-10 code sets have a compliance date of October 1, 2013
1.4 dependencies
Number / Description / Type M,D,E /1 / CMS approval of matching funds / External
1.5 ASSUMPTIONS
Number / Description /1 / There will be adequate resources for the planning phase of this project, including the Project Manager, the business analysts, and the technical resources.
2 / The project team will have the software and reference tools they need in order to plan the changes for this project.
3 / NM DoIT will approve the project.
1.6 Initial Project Risks Identified
Risk 1 - Assessment
Mitigation Strategy – Sufficient peer reviews with ACS and MAD
Contingency Plan - None
Risk 2 – Loss of Key Staff
Description – Loss of key project staff / Probability - Low / Impact - MediumMitigation Strategy – Cross-training so that other staff can fill in as necessary
Contingency Plan – Request additional resources and/or schedule changes to reduce the impact to the project
2.0 Project Authority and Organizational Structure
2.1 Stakeholders
name / Stake in Project / Organization / Title /Carolyn Ingram / Executive Sponsor / HSD Medical Assistance Division (MAD) / Director
Julie Weinberg / Business Owner / HSD MAD / Deputy Director
Mark Pitcock / Business Owner / HSD MAD / Bureau Chief
Terri Gomez / Technical Sponsor / HSD Information Technology Division (ITD) / Chief Information Officer
Liz Shaw / Project Manager / HSD ITD / IT PM
Fasil Metike / Technical Lead / HSD ITD / Senior Software Developer
2.2 Project Governance Structure
2.2.1 Human Services Department Organization Chart
2.2.2 Describe the role and members of the project steering committee
Steering Committee Member / Role /HSD Director, Medical Assistance Division / Once the project has been defined and agreed to by the Steering Committee, this person, in cooperation with the CIO, is responsible for overseeing the progress of the project and responding to any strategic problems as they arise
HSD CIO, Information Technology Division / Once the project has been defined and agreed to by the Steering Committee, this person, in cooperation with the Director, is responsible for overseeing the progress of the project and responding to any strategic problems as they arise
HSD Deputy Director, Medical Assistance Division / Once the project has been defined and agreed to by the Steering Committee, this person actively reviews the project’s progress and escalates any strategic problems to the HSD Director and/or HSD CIO
Project Manager / This person is responsible for developing, in concurrence with the Project Steering Committee, a project definition. The Project Manager then actively reviews the project’s progress and escalates any strategic problems to the HSD Director and/or HSD CIO
Bureau Chief, Medical Assistance Division / This person is responsible for developing, in concurrence with the Project Steering Committee, a project definition. The Medical Assistance Division Bureau Chief then actively reviews the project’s progress and escalates any strategic problems to the HSD Director and/or HSD CIO
2.2.3 Organizational Boundaries, interfaces and responsibilities
HSD will interface with ACS as it currently does for the MMIS maintenance and operations contract.
2.3 Executive Reporting
Communications with the various Executives occur as per the Communications Matrix:
Audience / Frequency / Mode of Communication /HIPAA 2 – Version 5010 and ICD10 Executive Steering Committee / Monthly / Written
Face-to-Face
NM DOIT / As Requested / Written
Face-to-Face
HIPAA 2 – Version 5010 & ICD10 Project Team / Weekly / Conference Call
Face-to-Face
3.0 Scope
3.1 Project Objectives
3.1.1 Business Objectives
Number / Description /Business Objective 1 / Replace the ICD-9-CM code set now used to report health care diagnoses and procedures with the ICD-10 code sets, with a compliance date of October 1, 2013.
Business Objective 2 / Adopt the updated X12 standard, Version 5010 for certain electronic health care transactions, with a compliance date of January 1, 2012
Business Objective 3 / Update the National Council for Prescription Drug Programs (NCPDP) standard, Version D.0, for electronic pharmacy-related transactions, with a compliance date of January 1, 2012
Business Objective 4 / Adopt the updated X12 standard, Version 5010 for Medicaid pharmacy subrogation transactions, with a compliance date of January 1, 2012
Business Objective 5 / Update the standards for claims, remittance advice, eligibility enquiries, referral authorization, and other administrative transactions, with a compliance date of January 1, 2012
3.1.2 Technical Objectives
HSD must convert two systems: Omnicaid (claims adjudication) and the Transaction Interface Exchange (messaging middleware). The transactions that will be assessed include:
Number / Description /Technical Objective 1 / 837 Professional for claims and encounters
Technical Objective 2 / 837 Institutional for claims and encounters
Technical Objective 3 / 837 Dental for claims and encounters
Technical Objective 4 / 270 Eligibility Request
Technical Objective 5 / 271 Eligibility Response
Technical Objective 6 / 276 Claims Status Inquiry
Technical Objective 7 / 277 Claims Status Response
Technical Objective 8 / 820 Billing Remittance Advice
Technical Objective 9 / 835 Remittance Advice
Technical Objective 10 / 834 Benefit Enrollment and Maintenance Transaction
Technical Objective 11 / NCPDP transactions
3.2 Project exclusions
None
3.3 Critical Success Factors
Number / Description /Quality Metric 1 / Thorough analysis of all affected MMIS subsystems
Additional Quality Metrics will be described for the Implementation Phase
4.0 Project Deliverables and methodology
4.1 Project Management Life Cycle
Phase / Summary of Phase / Key DeliverablesPlanning / The MMIS subsystems, including TIE, will be evaluated for the changes that will be necessary for this project / · Requirements Analysis Document
· High Level Project Plan
· Project Management Plan
· Detailed Project Work Plan
· Assessment Report
Implementation / Software changes will be made to the MMIS subsystems, tested, and then put into Production / · Coding, configuration and end-to-end testing
· Fully executed IV&V contracts
· System testing
· Risk Management
· Issues Management
Closeout / All project payments will be made / · Project documentation
· IV&V reports
· Lessons Learned
· Project Closeout Report
4.1.1 Project Management Deliverables
4.1.1.1 High Level Project Plan
Description – An accepted document used to show the overall project scope and schedule / Deliverable Acceptance Criteria – The document should indicate the major project steps and estimated milestonesStandards for Content and Format – The document should be written in Microsoft Word
Quality Review – The document will be reviewed and approved by HSD/MAD and HSD/ITD
4.1.1.2 Project Management Plan
Description – Explanation of scope, overall strategy, project organization, and project management and controls / Deliverable Acceptance Criteria – The document should contain all of the sections in the Description, plus it should describe the project close and include a glossaryStandards for Content and Format – The document should be written using the PMP template provided by NM DOIT
Quality Review – The document will be reviewed and approved by HSD/MAD and HSD/ITD
4.1.1.3 Detailed Project Work Plan
Description – Detailed work plan showing phases, milestones, and deliverables / Deliverable Acceptance Criteria – The document should indicate for each item: duration, percent work complete, and start and finish datesStandards for Content and Format – The document should be written using Microsoft Project
Quality Review – The document will be reviewed and approved by HSD/MAD and HSD/ITD
Quality Review – The document will be reviewed and approved by HSD/MAD and HSD/ITD
4.1.2 Deliverable Approval Authority Designations
Deliverable Number / Deliverable / Approvers (Who can approve) / Date Approved /PRJ-DEL-001 / High Level Project Plan / ITD PM, MAD Bureau Chief
PRJ-DEL-002 / Project Management Plan / ITD PM, MAD Bureau Chief
PRJ-DEL-003 / Detailed Project Work Plan / ITD PM, MAD Bureau Chief
4.1.3 Deliverable Acceptance Procedure
Formal acceptance of the contractor-provided deliverables will consist of a signed cover sheet faxed to ACS. The timeframe for this is approximately 5 business days after the State receives the deliverable. If rework is required, ACS will make changes to the documents and re-submit to the State.
4.2 PRODUCT LIFE CYCLE
“During the project management lifecycle, agencies shall select and implement a phase product development lifecycle methodology approved by the Department.” PROJECT OVERSIGHT PROCESS Memorandum
Phase / Summary of Phase / Key DeliverablesDefine / N/A for this project. CMS requires that the requirements be completed as part of the Planning Phase / N/A
Design / Provide specifications for all the changes needed for the subsystems / Design documents
Test Plans
Build / Develop and implement the software changes / Unit and system tested subsystems
Test Results
Deployment / Software changes loaded into Production / System Incident Reporting
4.2.1 Technical Strategy
The essential technical strategy is based on two approaches: write the code changes to TIE and Omnicaid simultaneously to adhere to the new federal requirements and then test on an end-to-end basis.
4.2.2 Product and Product Development Deliverables
4.2.2.1 Processing Functions in Omnicaid And TIE Systems That Adhere to the Version 5010 and ICD-10 Specifications
Description – Documentation of coding and configuration changes to Omnicaid and TIE to enable both systems to process HIPAA standard transactions according to the Version 5010 and ICD-10 specifications / Deliverable Acceptance Criteria – End-to-end tested claims processingStandards for Content and Format – Data files as transmitted through both systems
Quality Review – Approval to be determined by Medical Assistance Division management
4.2.3 Deliverable Approval Authority Designations
The following deliverables are listed as initial deliverables. These will be modified based upon continued review of coding and configuration efforts by ITD and MAD management.