Request for Certification and Release of Funds Form s4

Project Initiation/Planning

Request for Certification and Release of Funds Form

All Certified Projects Must Follow NM State Policies and Procurement Code

Project Governance

Project Name

/ ASPEN – State Based Marketplace(SBM)
Date / 2/26/2014
Lead Agency / Human Service Department
Other Agencies / New Mexico Health Insurance Exchange

Executive Sponsor

/ Charissa Saavedra, HSD Deputy Cabinet Secretary
Agency Head / Sidonie Squier, HSD Cabinet Secretary
Agency CIO/IT Lead / Sean Pearson, HSD/ITD Chief Information Officer
Project Manager / Merv Jersak
Project Abstract (Provide a brief description and purpose for this project)
On March 23, 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act, into law. The changes made to the law by subsequent legislation, focuses on provisions to expand coverage, control health care costs, and improve the health care delivery system. The following are the basic components of the Patient Protection and Affordable Care Act:
· Requires most U.S. citizens and legal residents to have health insurance.
· Create state-based American Health Benefit Exchanges through which individuals can purchase coverage, with premium and cost sharing credits available to individuals/families with income between 133-400% of the federal poverty level (the poverty level is $19,530 for a family of three in 2013)
· Create separate Exchanges through which small businesses can purchase coverage. Require employers to pay penalties for employees who receive tax credits for health insurance through an Exchange, with exceptions for small employers.
· Impose new regulations on health plans in the Exchanges and in the individual and small group markets. Expand Medicaid to 133% of the federal poverty level.
Concurrent with the development and implementation of the ASPEN system, the State of New Mexico elected to transfer ownership for the creation and implementation of the American Health Benefit Exchanges for both individuals and small business to the New Mexico Health Insurance Exchange (NMHIX or the “Exchange”).
The New Mexico Health Insurance Exchange (NMHIX) has decided to pursue a full State Based Marketplace (SBM) with an expected production date of October 1, 2014. In accordance with the Center for Medicare and Medicaid Services (CMS) requirements, the Human Services Department (HSD) will have to make changes to ASPEN to accommodate the transition to a SBM. This project is solely focused on those changes required to the ASPEN system.
Planned Start Date / 2/24/2014 / Planned End Date / 12/31/2014
Amount Requested this Certification / $ 5,116,570
Amount Previously Certified / $0
Remaining Appropriation not Certified / $9,985,551
Total Appropriated Amount / $15,102,121

Certification History (Include any previous project or phase certifications and this request)

Date

/ Amount / Funding Source(s) (use specific citations to laws, grants, etc.)
2014 (this request) / $5,116,570 / New Mexico Health Insurance Exchange 3rd Level 1 Establishment Grant(1.3) HBEIE140193-01-00.

Appropriation History (Include all Funding sources, e.g. Federal, State, County, Municipal laws or grants)

Fiscal Year

/ Amount / Funding Source
2014 / $17,967,936 / New Mexico Health Insurance Exchange 3rd Level 1 Establishment Grant(1.3) HBEIE140193-01-00.
· $2,865,815 Maintenance & Operations
Proposed Major Deliverable Schedule and Performance Measure

Major Project Deliverable and Performance Measure

/ Budget /

Due Date

Project Phase

Project Charter / 2/1/2014 / Planning
Certification Form & Documentation / 2/1/2014 / Planning
Project Management Plan / 2/15/2014 / Planning
ASPEN Contract Amendment / 2/23/2014 / Planning
Project Schedule / 1/15/2014 / Planning
Requirements and Design / $4,177,640 / 4/6/2014 / Planning
Development and Quality Assurance Testing / $5,570,186 / 8/24/2014 / Implementation
UAT and Implement ASPEN SBM Eligibility Changes / $4,177,639 / 9/30/2014 / Implementation
Project Closeout Report / 10/01/2014 / Implementation
ASPEN SBM Estimated Budget
FY2014 / FY2015 / Total

Staff - Internal

Consulting Services / $4,177,640 / $9,747,825 / $13,925,465
Hardware / $938,930 / $938,930
Facilities / $237,726 / $237,726
Total / $5,116,570 / $9,985,511 / $15,102,121

IT System Analysis (On this document, or as an attachment, provide a summary description of the technical architecture)

The project is building upon the ASPEN system. The ASPEN architecture is not changing as a result of this project. Architecture information has been previously submitted and presented by the ASPEN project.

Independent Verification & Validation (Include Status of IV V Process)

IV&V services will be procured before the end of the Planning Phase.

Significant Risks and Mitigation Strategy

Risk 1: “External Partners unable to meet ASPEN timeframes” – NMHIX and their vendors must be available to participate in ASPEN requirements and design sessions and develop their corresponding changes simultaneously to coordinate the interface / integration testing within the ASPEN schedule. ASPEN implementation can be delayed if the NMHIX partner and their vendors are unable to meet the aspen timeframes.

Mitigation 1: Coordinate and integrate the ASPEN and NMHIX SBM project schedules. We will conduct joint weekly schedule review meetings and have NMHIX and ASPEN participation on the Executive Steering Committee.

Interoperability (Describe If/how this project interfaces with existing systems/Applications)

There are no changes to the existing interfaces with other systems.
However, a major requirement for this project is to repurpose the existing interface with the Federally Facilitated Marketplace (FFM) to exchange data with the NMHIX SBM. This data exchange will facilitate account transfers between ASPEN and the SBM.
The SBM will send validated accounts to ASPEN for Medicaid eligibility determination. If the applicants are found Medicaid eligible under ACA rules, ASPEN will retain that case. If not eligible, ASPEN will calculate the Advance Premium Tax Credits/Cost Sharing Reductions and return the data to the SBM for its processing.
For applications that originate with ASPEN, cases that are not eligible according to ACA rules will be referred to the SBM for its processing.
Transition to Operations: (Describe agency plan to migrate project solution to production. include agency plans to fund and maintain this project after deployment. )
This will be determined as part of the Planning Phase of the project.

Revision: 6/18/13 Page 1